Associations between tobacco and alcohol use and aggressive behavior among adolescents in 55 Low- and Middle-Income countries.

Background: Aggressive behavior has become a serious public health problem among adolescents worldwide. We aimed to assess the associations between tobacco and alcohol use and aggressive behavior among adolescents in 55 Low- and Middle-Income countries (LMICs).

Methods: Data from 55 LMICs that had done a Global School-based Student Health Survey (GSHS) between 2009 and 2017, comprising 187,787 adolescents aged 12-17 years, were used to examine the associations between tobacco and alcohol use and aggressive behavior.

Results: Among adolescents in the 55 LMICs, the proportion of aggressive behavior was 5.7 %. Compared with none tobacco users, those who used tobacco on 1-5 days (odds ratio [OR] = 2.00, 95 % confidence interval [CI] = 1.89-2.11), 6-9 days (2.76, 2.48-3.08), 10-19 days (3.20, 2.88-3.55), and ≥20 days (3.88, 3.62-4.17) during the past 30 days were positively associated with aggressive behavior. Compared with none alcohol users, those who used alcohol on 1-5 days (1.44, 1.37-1.51), 6-9 days (2.38, 2.18-2.60), 10-19 days (3.04, 2.75-3.36), and ≥20 days (3.25, 2.93-3.60) during the past 30 days were positively associated with aggressive behavior.

Limitations: Aggressive behavior, tobacco use and alcohol use were assessed by self-reported questionnaires, which might be prone to recall bias.

Conclusions: Higher amounts of tobacco and alcohol use are associated with aggressive behavior among adolescents. These findings emphasize the need to strengthen tobacco and alcohol control efforts to reduce tobacco and alcohol use targeting adolescents in LMICs.