Concurrent use of tobacco, alcohol and cannabis among Serbian students



Available results among adults show that the most popular psychoactive substance (excluding medicines without doctor’s prescription) in Serbia is alcohol, followed by tobacco and cannabis. Less is known about the concurrent use of these substances, especially among minors. In the period 2011-2017, there was a lack of data on substance use among school children in Serbia. Pilot survey Health Behavior in School-aged Children (HBSC) was conducted in Serbia in 2017, according to HBSC 2013/14 international study protocol. The survey was conducted on a nationally representative survey of 3267 pupils 10-17 years old from V, VII grade of primary school and I grade of secondary school. Among other, the survey included questions on tobacco, alcohol and cannabis use. The aim of this analysis is to explore past month use of alcohol, tobacco and cannabis use as well as dual and poly-use of these substances.


This is a secondary analysis of data obtained from the Serbian 2017 pilot HBSC survey. Data obtained from students in the first grade of secondary school was extracted (N = 1408) for this analysis as only those children were asked about cannabis use.


Current use (at least once in the last 30 days) of tobacco was reported by 23.5 % students of the first grade of primary school (15-16 years old), the prevalence of current use of alcohol was 51.3% and 6.7% of cannabis use. Almost half (44%) of the first-grade students didn’t use any of these substances. Among students that reported current use of either cigarette, alcohol or cannabis use, one quarter (26.9%) reported use of two substances. Among current cigarette smokers, 18% used only cigarettes, while 60.3% apart from smoking, used alcohol. More than half (62.5 %) of current alcohol users, used exclusively this substance. Among current cannabis users, none of the students reported exclusive use of cannabis, and 87% reported poly use of tobacco, alcohol, and cannabis. Among current users of the explored substances, the poly-use (cannabis, alcohol, tobacco) was more frequent (8.5%) than exclusive cigarette smoking (7.7%).


A high percentage of tobacco, alcohol, and cannabis users are dual and poly substance users. Results call for action due to exposure of children to more than one risk factor and stress the importance of integrated view on substance use. Characteristics of poly-substance users should be further explored and results should be taken into account while planning evidence-based interventions in Serbia that will target multiple substances use.


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