Bhutan has the highest number of (24.6 percent) smokers in the region, a report on mental health status of adolescents in South-East Asia states.

Despite complete ban on tobacco sales, tobacco use remains high among 13 to 17 year-old which constitutes 9.4 percent of the total population

Bhutan also has the highest number of adolescents using other tobacco products at 29.3 percent followed by Timor-Leste (27.1 percent) and Thailand (14 percent).

The data used in the report are from the latest round of the global school-based student health surveys implemented by the member states of the WHO SEA region.

According to the report, while almost all countries in the region with a few exceptions legally restrict supply including sale of tobacco and alcohol to people under a certain age ranging from 18 to 21 years and completely ban the supply and sale of drugs, the results show their use remains high among 13-17 year olds.

Almost one in 10 and almost one in 12 adolescents in the age-group 13–17 years in the region smoked cigarettes and used alcohol respectively.

About 24.2 percent of the adolescents in Bhutan currently use alcohol. About 10 percent got into trouble with family or friends, missed school, or got into fights as a result of drinking alcohol.

According to the report, mental health conditions such as depression, anxiety or other conditions may lead to behavioral problems such as tobacco, alcohol and drug use.

The age of initiation of use of alcohol and tobacco is decreasing in SEA.

“This is of great concern from the public health point of view, as the lower the age of initiation, more the risk of developing addiction and dependence on these substances,” the report states.

Bhutan also has the highest number of adolescents currently using marijuana at 12 percent, followed by Thailand at 5.3 percent. Timor-Leste and Maldives have a little over 4 percent of adolescents using marijuana.

Sri Lanka tops the list in terms of multiple substance use by students aged between 13 and 17 (26.5percent), followed by Bhutan (20.3) and Timor-Leste (9.5).

“The actual prevalence may even be higher, as the current estimate is based only on school-going adolescents, and the non-school-going adolescents may smoke or drink alcohol more often,” the report states.

Regional director for WHO SEA region, Dr Poonam Khetrapal Singh, said that mental health and substance use disorders are one of the largest contributors to the regional and global burden of disease.

“Recognizing and addressing mental health needs of young people help them function better socially, academically and vocationally, and develop into well-adjusted and productive adults,” Dr Poonam Khetrapal Singh said.

She said that an urgent task in addressing adolescent mental health is improving and expanding the evidence base, particularly in resource-constrained countries. “The evidence is required not only to inform policies and programmes but also to generate public awareness of mental health issues and mobilise social support for adolescents.”

The report states that adolescents constitute an important social and demographic group in the WHO South-East Asia Region, accounting for almost one fifth of the total population of the Region. “The failure to recognise and address mental health problems in children and adolescents is a serious public health problem in the context of Sustainable Development Goals 3.4 and 3.5.”

“The multi-directional linkages between mental health conditions and other health, educational, social and development problems call for evidence for action in this area,” the report states.

The publication is a step towards building an evidence base to facilitate informed policy and programmatic actions by the WHO Regional Office for SEA.

Dechen Tshomo