ORIGINAL RESEARCH article
Front. Public Health
Sec. Substance Use Disorders and Behavioral Addictions
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1652601
This article is part of the Research TopicAdolescent Smoking, Alcohol Consumption and Psychoactive Substance Misuse in Low-Middle Income CountriesView all 9 articles
Substance use risk screening and associated factors among Costa Rican secondary students: a nationally representative analysis
Provisionally accepted
- 1Kinesiology and Health Education, The University of Texas at Austin, Austin, United States
- 2School of Public Health, Universidad de Costa Rica, San José, Costa Rica
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Adolescent substance use (SU) is a significant public health concern in Latin America, however, representative data to guide prevention efforts remain limited. This study examined SU risk and potential associated factors among Costa Rican secondary students using the CRAFFT 2.1 screening tool. Methods: Data were drawn from the 2021 VI National Survey on Psychoactive Substance Use in the Secondary School Population, a nationally representative sample of 3,524 students (weighted N ≈ 354,330). Based on CRAFFT scores, students were classified into low-, medium-, and high-risk SU groups. Multinomial logistic regression analyses assessed associations between SU risk levels and sociodemographic characteristics, SU within the family, sexual activity under SU, and exposure to violence. Results: Overall, 64.7% of students were classified as low-risk, 26.6% medium-risk, and 8.7% high-risk. Older age, substance use by family members (i.e., smoking and illicit drug use), sexual activity under SU, and exposure to psychological and sexual violence were all associated with increased odds of classification into the high-risk group. Sexual activity under SU was strongly associated with membership in the high-risk group compared to both low-and medium-risk groups. Conclusion: This study is the first to apply the CRAFFT tool to a nationally representative sample of Costa Rican adolescents, providing critical insights for prevention initiatives in Latin America. Findings emphasize the need for universal multi-level prevention interventions to delay SU initiation and promote prosocial environments that support healthy youth development, ultimately reducing the burden of SU among Costa Rican adolescents.
Keywords: Adolescent substance use, CRAFFT screener, Costa Rica, screening tool, Violence, National survey
Received: 23 Jun 2025; Accepted: 29 Aug 2025.
Copyright: © 2025 Lopez-Soto, Ramirez, Cordoba and Montero-Zamora. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Pablo Montero-Zamora, Kinesiology and Health Education, The University of Texas at Austin, Austin, United States
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.