Studies indicate that substance use among Ethiopian adolescents is considerably rising; in particular college and university students are the most at risk of substance use. The aim of the study was to assess substance use and associated factors among university students. A cross-sectional survey was carried out among 1040 Haramaya University students using self-administered structured questionnaire. Multistage sampling technique was used to select students. Descriptive statistics, bivariate, and multivariate analysis were done. About two-thirds (62.4%) of the participants used at least one substance. The most commonly used substance was alcohol (50.2%). Being male had strong association with substance use (AOR (95% CI), 3.11 (2.20, 4.40)). The odds of substance use behaviour is higher among third year students (AOR (95% CI), 1.48 (1.01, 2.16)). Being a follower of Muslim (AOR (95% CI), 0.62 (0.44, 0.87)) and Protestant (AOR (95% CI), 0.25 (0.17, 0.36)) religions was shown to be protective of substance use. Married (AOR (95% CI), 1.92 (1.12, 3.30)) and depressed (AOR (95% CI), 3.30 (2.31, 4.72)) students were more likely to use substances than others. The magnitude of substance use was high. This demands special attention, emergency preventive measures, and targeted information, education and communication activity. 1. Introduction The use of substances such as alcohol, khat, and tobacco has become one of the rising major public health and socioeconomic problems worldwide [1]. The global burden of disease attributable to alcohol and illicit drug accounts 5.4% of the total burden of disease. Another 3.7% of the global burden of disease is attributable to tobacco use. And disorders due to psychoactive substance use including alcohol, drug, and tobacco dependence are the main underlying conditions ultimately responsible for the largest proportion of the global burden of disease attributable to substance use [2]. The rapid economic, social, and cultural transitions that most countries in sub-Saharan Africa are now experiencing have created a favorable condition for increased and socially disruptive use of drugs and alcohol [3]. Substance misuse is a growing problem in Ethiopia, as in many developing countries. Alcohol and khat are the most frequent substances of abuse [4]. According to the Ethiopian Demographic and Health Survey (DHS) 2011, the prevalence of alcohol use among men and women is 53% and 45%, respectively, and 11% of women and 28% of men ever chewed khat [5]. Studies indicate that substance use among Ethiopian adolescents is considerably rising
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