In the vibrant educational landscape of Northeast Ethiopia, a groundbreaking study has emerged, illuminating the pressing issue of problematic khat use among high school students in Legambo woreda. This research delves into the complexities of khat consumption—a culturally entrenched psychoactive substance—and distinguishes habitual use from the far more concerning phenomenon of problematic khat use (PKU), which carries profound mental health implications. As adolescent consumption rises, understanding the true prevalence and its associated factors becomes imperative, warranting urgent attention from public health authorities and educational stakeholders alike.
Khat, derived from the leaves of the Catha edulis plant, is renowned throughout East Africa and the Middle East for its stimulating effects, attributed mainly to cathinone and cathine, alkaloids which produce amphetamine-like sensations. While many users chew khat socially or recreationally, the line between casual use and problematic patterns is often blurred, complicating efforts to measure and address potential harms. The latest study utilizes the rigorous Problematic Khat Use Screening Test (PKUST-17), providing a standardized and clinically relevant tool to quantify and classify PKU with unprecedented precision among Ethiopian youth.
Conducted over the course of six weeks in 2023, this cross-sectional investigation sampled nearly a thousand high school students through systematic random selection, ensuring a robust representation of the student population from Legambo High School. This methodological rigor enhances the validity of the findings and presents vital epidemiological data on a demographic frequently underrepresented in substance-use research. The adoption of sophisticated data management and statistical analysis protocols, including SPSS-based logistic regression models, further underscores the scientific rigor driving this inquiry.
Findings from the study paint a complex portrait of khat use within this youth cohort. Approximately 42.3% of surveyed students reported khat use—a figure that starkly highlights the substance’s pervasiveness. Significantly, nearly one in five participants (19.7%) met the criteria for problematic khat use, which corresponds to nearly half of the khat-using subset. This high prevalence rate of PKU among adolescents signals an emerging public health risk that extends beyond mere cultural practice, with implications that ripple through mental health, academic performance, and future socio-economic outcomes.
Statistical analyses shed light on various social, psychological, and demographic factors associated with increased vulnerability to PKU. Notably, exposure to traumatic events raised the odds of developing PKU by over three-fold, illustrating the intricate interplay between trauma and substance misuse. This association aligns with wider literature indicating that traumatic experiences often precipitate maladaptive coping mechanisms in youth, including substance use disorders, thus underscoring the need for targeted psychosocial interventions in school settings.
Furthermore, age emerged as a critical determinant in the propensity for PKU. Students younger than twenty years exhibited nearly five times the risk, while those aged 20 to 24 years were similarly at higher risk compared to older counterparts. This age-related susceptibility likely reflects developmental, social, and environmental factors that potentiate substance misuse during transitionary life phases, especially in educational environments fraught with academic and peer pressures.
Social support networks—or the lack thereof—were also pivotal in influencing PKU risk. Students reporting poor social support were twice as likely to experience problematic use. This finding is particularly salient in the Ethiopian context, where communal bonds and family structures traditionally offer protective buffers against psychosocial stressors. A rupture in these support mechanisms may render adolescents more vulnerable to maladaptive behaviors, including substance misuse, emphasizing the importance of nurturing resilient social ecosystems within schools and communities.
Intriguingly, the study found inverse associations between certain expected risk factors and PKU. For instance, both depression and paternal substance use correlated with lower odds of PKU, each halving the risk. These counterintuitive findings warrant further exploration, as they challenge prevailing assumptions and may reflect complex socio-cultural dynamics, reporting biases, or differential patterns of substance use within families. Such nuances highlight the necessity for multifaceted research approaches to unravel underlying mechanisms.
Academic performance surfaced as a protective factor with compelling implications. Students with satisfactory academic achievements were over three times less likely to engage in problematic khat use. This association reinforces the hypothesis that academic engagement and success may serve as vital deterrents against risky behaviors, fostering better mental health and decision-making capacities. As such, educational attainment may function not only as an outcome variable but also as a mediating factor for substance use interventions.
Ultimately, this study’s revelations underscore an urgent need for comprehensive school-based mental health initiatives tailored to the complex realities of Ethiopian adolescents. The absence of standardized diagnostic criteria for problematic khat use impedes consistent identification and intervention, a gap this research endeavors to fill with its application of the PKUST-17 instrument. Recognizing PKU as a distinct clinical entity will enhance targeted prevention programs, enabling policymakers to allocate resources more effectively and implement evidence-based strategies.
Moreover, targeted prevention must prioritize students bearing the brunt of compounded vulnerabilities—those traumatically exposed, socially isolated, or hailing from households with limited educational attainment. By focusing on these high-risk groups, interventions can more effectively curb the trajectory toward chronic substance misuse and its downstream consequences. Such prioritization aligns with global frameworks advocating for equity-focused public health approaches, tailored to address the intersecting determinants of adolescent health.
This research contributes significantly to a growing evidence base that challenges traditional perceptions of khat use as a benign cultural practice, spotlighting its potential for harm in vulnerable populations. It invites a recalibration of public discourse and health policy surrounding khat consumption, emphasizing a balanced perspective that respects cultural contexts while actively mitigating health risks. By injecting much-needed data into the debate, the study paves the way for nuanced, culturally sensitive, yet scientifically grounded interventions.
In summary, the study conducted in Legambo woreda is a clarion call illuminating the intersection of culture, youth behavior, and health in Ethiopia. It provides critical insights into the magnitude and correlates of problematic khat use among adolescents, delineating pathways for intervention and policy development. As khat’s role continues to evolve within regional cultures, the findings urge an evidence-based response that champions adolescent well-being while navigating complex sociocultural terrains.
As policymakers and mental health professionals digest this evidence, the imperative is clear: to transform secondary schools into arenas of resilience, support, and awareness. Embedding mental health services and substance use education within these institutions will not only mitigate current challenges posed by PKU but also nurture healthier, more informed generations poised to contribute positively to Ethiopia’s future.
This landmark study not only advances scientific understanding but also holds transformative potential for public health strategies, establishing a foundation for research, policy, and practice to coalesce around the urgent issue of adolescent khat misuse. The journey from cultural custom to clinical concern continues, marked now by data-driven clarity and a mandate for progressive action.
Subject of Research: Problematic khat use prevalence and associated factors among high school students in Northeast Ethiopia
Article Title: Prevalence of problematic khat use and its associated factors among high school students in Legambo woreda, Ethiopia
Article References: ligaba, B., Tareke, M., Mamaru, A. et al. Prevalence of problematic khat use and its associated factors among high school students in Legambo woreda, Ethiopia. BMC Psychiatry 25, 738 (2025). https://doi.org/10.1186/s12888-025-07167-7
Image Credits: AI Generated
