Adolescents’ drug use has become a topical issue due to its onset of behaviors and conditions that not only affect health but also lead to later life disorders associated with individuals’ functioning. This unhealthy behaviour is closely associated with increased morbidity and mortality that pose major public and mental health challenges. Other negative implications may include but not limited to unemployment, theft, vandalism, accidents, suicide, mental illness, and decreased life expectancy 123.

Globally, the burden of disease attributable to substance use seemed to have significantly increased among adolescents and young adults 4. Degenhardt and associates reiterated that “Substance use in young people aged 10–24 years might disrupt key periods of transition that occur as the adolescent brain undergoes cognitive and emotional development, and key psychosocial transitions that are made” (p. 251). The onset of drug use primarily begins during the adolescence period, with the utilization of lawful drugs such as alcohol and tobacco usually preceding the usage of illicit drugs 4.

The major challenges and inherent pressures facing adolescents within the age brackets highlighted above include but not limited to growing academic expectations, changing social relationships with peers and family as well as physical and emotional changes associated with maturation. These age brackets mark a period of increased autonomy in which independent decision-making influence adolescents’ health related behaviors and subsequent health status. Behaviors established during this transition period can continue into adulthood, affecting issues such as mental health, the development of health compromising behaviors such as alcohol, tobacco, marijuana and other substance use. The past 3 decades have witnessed several dramatic shifts in the rates of substance use among young people 5. One substance that has been cited in research literature as the most frequently patronized illicit drug in both developing and developed nations is marijuana 6, with its very addictive properties of nicotine highlighting marijuana as a major global health hazard 7.

Marijuana, popularly known in Ghana as “Wee”, is one of the most commonly cultivated and used illicit drugs among adolescents in the country despite it being considered as an illicit drug. Although research literature on marijuana utilization in Ghana is sparse, different reports have shown variations in the prevalence of its usage in the country. For instance, the latest UN World Drug Report 8 indicates that almost 22% of Ghanaian adolescents and young adults use marijuana. This claim is inferred from the number of recorded drug related patients in psychiatric hospitals in the country. A report from the former Chief Psychiatrist of Ghana’s Ministry of Health asserts that in 2007, out of 594 drug-related cases admitted to the National Psychiatric Hospital, 400 were marijuana related 9. Similarly, it was reported that the same hospital recorded 4,000 marijuana related outpatient cases in 2013 10. Jafaru 10 reiterated that the National Psychiatric hospital receives 400 outpatient cases daily, with 30% of the cases being marijuana related, out of which 10% are usually admitted to the hospital each year Reuben 11.

Recent statistics from the Ghana Narcotic Control Board also reveal that out of a total number of 50,000 drug users, 35000 of these users are adolescents in the Junior and Senior High schools in Ghana 12. According to Degenhardt et al. 4, there seems to be a paucity and distinct gap concerning epidemiological data on the extent of adolescents’ drug usage in Africa. Only few studies have reported the extent of substance use among diverse adolescent populations (e.g., Ghana 131415; South Africa 161718; Zambia19; Zimbabwe 20. A recent transnational study investigating the prevalence of marijuana and amphetamine use, and associated risk factors among adolescents in 9 African countries found overall past month marijuana use among school going adolescents to be 4.1% 21. The highest prevalence of past-month marijuana usage found in Peltzer and Pengpid’s study was Ghana (8.1%), a finding that shows an increase compared to earlier local surveys in Ghana that found lower prevalence rates of 2.6% to 7.2% lifetime marijuana use 1314. Peltzer and Pengpid 21 interestingly noted in their study that the prevalence of past-month marijuana usage in Ghana was significantly higher among girls than boys. Other studies have highlighted different results due to the varied methodological designs and populations used. For example, the Global School Based Health Survey (GSHS) 15 reported cannabis usage of 27.9% in 2007, with a similar study in 2008 reporting an increase in the prevalence of 40.2% where more males were significantly likely to use marijuana than females in the senior high schools in Ghana. A much lower prevalence of 8.2% was recorded among junior high school students by the same group in 2012.

Research literature has examined a number of risk factors that have the potential of increasing the likelihood or boost drug use across diverse population domains 22. Different factors as varied as gender, age, ethnicity, peer, parental communication and family have all been found to predict substance use 222324. For example, conventionally, marijuana use has been found to be higher among males than females because males have greater opportunity to use marijuana although males and females with same access to marijuana may initiate usage at comparable rates 25. However, longitudinal data suggest that the difference in rates between the sexes is decreasing 26, with the United Nations Office on Drugs and Crime (UNODC, 27) affirming that the prevalence of substance use among girls is becoming closer to that of boys globally.

Research data on whether differences in the prevalence of marijuana use are associated with race, socioeconomic status, and residence in urban, suburban, or rural areas are inconsistent 28293031323334. For instance, adolescents with strong family associations, positive involvement, high parental academic expectations, and a high level of parental communication and supervision have lower rates of marijuana use 353637. Comparatively, those with dysfunctional families 3839 or in which parents use drugs and make them accessible at their homes have higher rates 40. Additionally, religious belief, mainly in a fundamentalist religion (e.g., Christianity, Islamic) is related with lower rates 40, whereas religious affiliations that have values that deviate from cultural norms are linked with higher rates 2342. Further, several studies have also shown that adolescents who are linked with marijuana smokers’ peer groups or family members report higher rates of usage 233743. Many measures such as poor performance in school, disliking school, and truancy are also associated with adolescents’ marijuana usage 434445. A recent study calculated that marijuana users are two to three times more likely to drop out of school than are nonusers 46. However, a study of Swedish adolescents found marijuana use more strongly associated with level of career aspirations than with level of interest or performance in school 31.

While some studies have been conducted on the prevalence of marijuana usage and related risk factors in other societies, little is known about marijuana prevalence, the relationship between patterns of marijuana use, and the risk factors in Ghana. To date very sparse published research studies have explicitly investigated marijuana use and associations between different psychosocial factors promoting its usage among Ghanaian school going adolescents. More research is therefore warranted to increase research understanding on factors associated with substance use of a sample from an African origin since previous research has predominantly focused on white populations 47. The research pursuit for the identification of key determinants of the onset of early marijuana usage among school going adolescents may uncover a wealth of information that may help reduce the potential risk factors that research has described to have negative effects on mental health, especially in young adolescents whose cerebral functioning and enduring personality have not yet fully developed 4849. This triggers a cycle where individuals cease to become functional as effective members of society but instead are subdued by their drug dependence 50.

One possible way of explaining individuals’ possibility of marijuana utilization is to highlight what psychosocial factors such as age, gender, religion, socioeconomic status, academic performance, parental communication and geographical location might be responsible as associated factors for its usage. Based on previous studies, it was hypothesized in the current study that insofar as school going adolescents are concerned, all selected factors would predict marijuana use.

The current study sought to examine marijuana prevalence, the relationship between patterns of marijuana use, and the associated psychosocial risk factors in Ghana. The risk factor approach is useful in understanding vulnerability to substance use across varied population. Conceptually, the current findings support the multiple pathway model of drug use, where different psychosocial factors may lead to substance use. Different psychosocial pathways were associated with adolescents’ marijuana utilization among Ghanaian school going adolescents and findings add to the sparse empirical literature on drug use in the country.

The overall prevalence of marijuana use among school going adolescents in the Central Region was 9%. This prevalence was lower compared to previous findings of 40% and 17% of marijuana usage among JHS students in Bosomtwi, Atwima-Kwanwoma and Dangme East Districts in Ashanti and Greater Regions of Ghana 5253. The possible reason for the difference in the prevalence rates could be attributable to reported high cultivation rates of marijuana plantation in Assabil’s previously studied areas and the high presence of ‘city ghettos’ or slums in the Dangme East District 53. The age at first substance usage was 11 years perhaps due to the relative accessibility of marijuana in the region, a finding that contradicts the view of Quay and Werry 54 that young children ought to have valueless attitudes to substances of abuse. This current finding is similar to what have been reported in other studies 51. We argue that the early onset of marijuana use often occurs during adolescence and further involvement with other psychoactive substances such as alcohol and tobacco with different periods of intermittent experimentation. These trials with marijuana and perhaps other drugs may provide a pathway “gateway effect” into compulsive patterns of future usage, hence promoting both psychological and physical dependence 55. This unwarranted adventure suggests that adolescents who begin smoking marijuana at an early age are more likely to be users of other psychoactive substances during late childhood and adolescence. These negative health compromising behaviours can lead to school problems, social and emotional depressive disorders, and later drug dependence, thus impairing adaptive psychosocial development 5657.

The key reasons for the use of marijuana among school adolescents in the region were peer group membership and enhancement of learning, supporting previous research findings 525358 that found perceived benefits as enabling factors of marijuana use. Importantly, adolescents’ marijuana utilization in the current study might have been greatly influenced by normative peer group culture, often associated group membership characteristics regardless of geographical location. Social competence development among adolescents in many countries can be traced to peer group popularity and exploration of new experiences; in others, this may symbolize low family connectedness, low school commitment and affiliation with likewise disengaged peer group. Equally, refraining from this group engagement may mean social reservedness 596061. Alternatively, adolescents in this study may have enjoyed the marijuana effect because of the possibility of aiding the process of group socialization and the prominent role in recreational activities 62. Marijuana use then becomes valuable to these adolescents. According to Glassner and Loughlin 62, its usage promotes notable pathways such as an available activity; something one does with peers; as a facilitator for group interaction; as central to a gathering; and as a commodity of exchange for group membership.

Gender prediction of marijuana usage among school adolescents in the region was also realized. Boys were at a higher risk of using marijuana than girls. Gender has been one of the most studied demographic characteristics related to youth substance use 63. Epidemiological research to date suggest that males are more likely to use marijuana than females 526465666768, findings that are mirrored in the current study. However, the current finding shows inconsistency in gender differences reported in other studies in Ghana but corroborate with other results in other African countries and elsewhere in the use of marijuana 21. One possible reason for the male dominant findings currently prevailing in research literature could be argued from a masculinity-feminism paradigm that previous research has ignored. Societies that are ranked to be more masculine dominant on the continuum may show more societal approval, tolerance, male preference for marijuana usage and deviance as well as the selection of deviant peers compared to societies that may be considered feministic, hence may restrict females in the use of this drug and deviant behaviours due to societal disapproval and intolerance for females perceived to engaging in male dominant roles (e.g., smoking) according to the masculinity-feminism classification. For Ghanaian females, cultural related influences restrict the expression of deviant attitudes and behaviours. Other possible reasons for this outcome could be that boys are more sociable and more exposed to experiment cannabis than girls 58. Even though the current trend in male dominant marijuana usage is reversing 11212627, it is possible that males and females with same access to marijuana may initiate usage at comparable rates 25. Some local researchers, Doku et al. 69 have posited that in Ghana, smoking has been declining in the past few decades and the decline was faster among boys than girls. Therefore, issues surrounding marijuana should be considered equally important for both genders (males and females). There is a compelling need to explore more research on gender differences in marijuana utilization using perhaps a longitudinal approach and varied research protocols (e.g., multi-trait and multi-method approaches) in order to clarify current inconsistent findings.

Socioeconomic status also predicted marijuana use among students in the region. Adolescents from low socioeconomic backgrounds were at a higher risk of using marijuana than those from high socioeconomic backgrounds. This finding affirmed previous research findings that familial socioeconomic status of school going adolescents is highly associated with marijuana use among adolescents, with low socioeconomic group having higher probability of using marijuana, compared to those from higher socioeconomic group 14697071. Although Humensky’s 72 finding is similar to the current study, the attributed reason was that late adolescents with higher familial socioeconomic status had the propensity to use marijuana than adolescents from a lower familial socioeconomic background. The possible reason for this difference in the findings could be assigned to the characteristics of the sample used for the study. Humensky used a sample from European background where marijuana usage is common among the youth regardless of their socioeconomic status. Additionally, measuring socioeconomic status as a dichotomous variable (i.e., low versus high) currently prevailing in research literature without considering its multidimensional nature may also account for the somewhat inconsistent findings. Future research should consider the importance of separating socioeconomic status into income, education, occupation, and perceived social status. This separation may help provide consistent results.

Geographical location significantly influenced marijuana usage among the current study sample. School going adolescents living in the southern and northern parts of the Central region were at more risk of using marijuana than their counterparts from the central part of the region. This finding supports Currie’s et al. 73 study that the engagement in health behaviours reflects geographical differences in that certain health behaviours depict certain patterns across geographical locations. Arguably, health outcomes may be elicited by certain pattern of life, culture, traditions and weather conditions of the geographical zones of people. The southern part of the region is predominantly endowed with a lot of educational institutions and other social exposures that mostly coax these adolescents through peer initiation compared to other parts of the region. The premise is that social exclusion and relative deprivation of certain societal conditions may contribute to drug use (e.g., living in poor communities or deprived areas (slumps, 74). The ‘‘duality of structure’’ perspective is a process whereby ‘structural conditions’ (i.e., insecure and disengaging family and school environment) may constrain or trigger certain social actions (i.e., the construction of a favoured negative social identity) and enable others (i.e., strong group bond or membership). This structural consequence of these actions may trigger adolescents to develop entrenched disengagement from their teachers at school and parents at home, leading to the reproduction of health compromising behaviours such as different pattern of drug use. In addition, media reports commonly suggest that the northern part of the region is an area where cultivation of the marijuana plant is high, the reason accounting for a higher risk of marijuana utilization. Hence, putting school going adolescents in the northern and southern parts at risks of devastating health consequences of marijuana use.

Religious affiliation significantly predicted marijuana usage among adolescents in the region. Adolescents practicing Muslims were at higher risk of using marijuana than their Christians counterparts. Although previous research confirms the current finding 757677, other available supportive evidence provide contradictory information. For example, Muslims have been found to strongly condemn the use of psychoactive substances and are less likely to even drink alcohol than their other religious counterparts in other societies 7879. However, regular church attendance, personal religious devotion (importance of religion, religious seeking/prayer), religious conservatism (belief of the Bible and belief that God rewards and punishes), and institutional conservatism (religious denomination) have been found to hinder marijuana use among adolescents 757677. The possible reason for the current outcome is that many practicing Muslims of African descent explore the usage of leaves, shrubs and herbs for curative purposes and as part of African traditional medicine. Another plausible reason could be that most studies previously have measured religiosity and drug use from a unidimensional perspective (e.g., mosque or church attendance as a crude indicator), leading to flawed or inconsistent results 80. Therefore, future research should consider exploring religiosity and drug use from a multidimensional perspective (i.e., religious affiliation, religious service attendance, and religious importance (i.e., the ‘‘tripartite’’ construct, 81).

Unlike in previous studies 222324, this study did not find any connection between age, parental communication and academic performance for marijuana utilization. For instance, research findings 82838485 to date on academic performance have been inconclusive on its association with risky behaviours. Surprisingly, age which has strongly been associated with prevalence of drug use among young people across a wide range of factors was not related to marijuana use in this study. This perhaps might be due to the early age of onset of marijuana use among school going adolescents in the region thereby causing a narrowing gap between younger adolescents and their older ones. Parental communication also did not predict marijuana use, meaning school going adolescents with easy or difficult parental communication were at same or similar risk of using marijuana in the region, contradicting previous research findings 8687, perhaps due to used samples from European backgrounds with heterogeneous characteristics.

Despite the current observations, marijuana utilization in the region could be described as low, compared to empirical findings in other regions of the country. However, the number of school going adolescents using marijuana in the region could pose public health problems. Marijuana is considered to be one of the most commonly used illegal drug in Ghana among the adolescent and youth populations while the highly addictive properties of nicotine make it a major worldwide health hazard 7. Even when used separately, these substances appear to create numerous public health problems. For example, marijuana use had the potential of causing structural brain abnormalities and altered neural activity among adolescents, subsequently leading to higher impulsivity and other neurocognitive effects 5895. Since school-based delivery avenues may provide congenial evaluative platforms for targeting school going adolescents for marijuana use, compelling attempts should be made by stakeholders in delivering substance use interventions that target adolescents for drug use, especially marijuana. Such intervention programmes should vigorously aim at educating school going adolescents with varied group member characteristics from deprived communities where their socioeconomic conditions, especially in the northern and southern parts of the region are below average in order to help prevent and minimize drug use among adolescents.More awareness and continued research on protective factors such as enhancing family bonding, i.e. the attachment between parents and children and taking a more active role in children’s lives, e.g., monitoring their activities and friendships, and being involved in their learning and education may mitigate against the major peer influence in deviant behaviours 1427.