Youth attitudes reveal gaps in cannabis risk awareness

Substance abuse among adolescents and young people is a growing public health concern, with significant implications for both individuals and society. This study sought to investigate the Perceptions, Perspectives, and Practices (3Ps) related to substance use, as well as explore contextual factors influencing drug and alcohol engagement among youth in the Dehradun district of Uttarakhand, India. A cross-sectional study was conducted in semi-urban and rural areas of Dehradun, screening 14,203 participants aged 10-24 years through multistage stratified random sampling. Data were collected using self-administered questionnaires, which included the standardized and locally-adapted CRAFT and ASSIST screening instruments. Among the 3290 participants with complete socio-demographic data, 77.0% of males and 41.5% of females reported a family history of drug abuse (P < 0.0001). About 85.4% of participants in the 20-24 age group reported such a history. Regarding perceptions, 70.8% identified cannabis as a highly addictive substance (n = 1959). Knowledge of side effects was limited: less than one-third recognized key physical harms (n = 1493). Analysis of attitudes (n = 3236) revealed that 30.1% to 34.8% believed some drugs like cannabis are not addictive, while 60.6% agreed that even first-time use can lead to addiction. Curiosity, peer pressure, and family history emerged as the most common reasons for initiation, especially among males. These findings emphasize the need for targeted educational interventions-particularly about long-term consequences-and for strengthening protective factors in families and peer groups. Systematic, context-aware prevention strategies are essential to reduce substance abuse and its health and social impact among young people in India.