Family relationships and adolescent drug use in Cameroon: a school- based cross-sectional study of prevalence, perceptions, and associated factors

Background Psychoactive substance use among adolescents remains a growing public health concern in sub-Saharan Africa, yet local data are scarce. This study aimed to determine the prevalence, perceived consequences, and associated factors of alcohol and illegal psychoactive substance use among secondary school students in Cameroon, with a focus on family relationships. Methods A school-based cross-sectional study was conducted from April to June 2021 among 352 adolescents (aged 13–18) in three secondary schools in Yaoundé. Data were collected using a self-administered questionnaire partly based on the DEP-ADO screening tool. Descriptive analyses assessed prevalence and perception patterns. Co-occurrence analyses (Jaccard C and T coefficients) explored thematic associations between known substances and perceived effects. Multivariable analyses (Robust Poisson and Complementary Log-Log Regression, with 1,000 samples bootstrap) identified associated factors. Results The 12-month prevalence of alcohol abuse was 32.7%, while 3.7% reported using at least one illegal psychoactive substance (e.g. marijuana, cocaine, tramadol). Marijuana and cocaine were most frequently cited. Strong co-occurrence was found between cocaine and marijuana (Jaccard C = 0.24; T = 0.389). Most perceived consequences were negative (neuropsychological, somatic, behavioural, social), though some adolescents reported positive effects such as courage or power. Alcohol abuse was associated with older age, male gender, Form 3 level, poor paternal relationship, drug availability around home, and illegal psychoactive substance use (aPR = 2.51, 95% CI: 1.77–3.56). Illegal psychoactive substance use was more likely among students in lower school levels and those not abusing alcohol. The bootstrap model also identified “living with father only” as a risk factor. Conclusion Adolescent substance use is shaped by age, school level, gender, and family dynamics. These findings call for multi-level prevention strategies, including school-based psychoeducation on drug risks and coping, enhanced father–child engagement, and community-level interventions to limit home-based access to substances