The role of poor mental health in substance use across socioeconomic strata of Armenian adolescents: a counterfactual mediation analysis

A.A. Torchyan*, H. Bosma, I. Houkes

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objective To study the relationship between socioeconomic position (SEP) and adolescent substance use and explore the role of poor mental health in that relationship. Methods Adolescents aged 11-15 years participated in the Health Behavior in School-aged Children survey in Armenia. Robust Poisson regression and counterfactual mediation analysis were used. Results In a pooled analysis with 6512 adolescents, the adjusted prevalences of current smoking (prevalence ratio [PR] = 1.93, 95%CI = 1.29-2.88), weekly beer (PR = 1.46, 95%CI = 1.07-2.01), spirits (PR = 1.54, 95%CI = 1.01-2.37) or lifetime cannabis use (PR = 3.10, 95%CI = 0.91-10.59) were greater in low-SEP adolescents compared to the middle-SEP group. Poor mental health explained 25.6%-54.7% of that relationship. Similarly, high-SEP adolescents had increased risks of current smoking (PR = 1.54, 95%CI = 0.98-2.42), weekly beer (PR = 1.55, 95%CI = 1.11-2.18), spirit (PR = 1.58, 95%CI = 1.02-2.45), wine (PR = 1.33 95%CI = 1.01-1.75) intake, than middle-SEP adolescents. Conclusions Both low- and high-SEP adolescents in Armenia are at greater risk of substance use than the middle-income group. Poor mental health substantially contributes to substance use among low-SEP adolescents. Additional studies are needed to clarify the motives for substance use among high-SEP adolescents.
Original languageEnglish
Number of pages8
JournalJournal of Substance Use
Publication statusE-pub ahead of print - 5 Jun 2022


  • Alcohol
  • cannabis
  • HBSC
  • inequality
  • socioeconomic position
  • tobacco

Cite this