The study was conducted in Yaoundé, the capital city of Cameroon. It is the second most populous city in the country with a population of approximately 2.8 million spread over 7 subdivisions. It is an administrative area with a high level of urbanization, industrialization and education. Owing to this high-profile structure, Yaoundé has a higher cost of living than majority of other cities in Cameroon. This creates a favorable environment for drug distribution and consumption. The school system consists of 2 broad categories based on the type of funding: public schools (government funding) and private schools (fee-paying).

A cross-sectional study was conducted in 12 secondary schools (6 public and 6 private schools) in Yaoundé between October 2022 and May 2023 (8 months). This study builds on previous studies on adolescent psychoactive drug use in Cameroon in terms of its methodological approach. A probabilistic sampling method was used as opposed to a non-probabilistic sampling methods employed in other studies.

Selection of participants was done using a three-stage sampling approach. Firstly, six out of seven subdivisions were randomly selected. Secondly, secondary schools in the selected subdivisions were stratified into public and private categories, after which we randomly chose one school from each category. Finally, a simple random approach was used to select one classroom from form 4, form 5, lower sixth and upper sixth. The survey form was shared to all adolescents who assented to participate in the study and had received parental consent. Considering the fact that drug use among children is still a taboo in Cameroon, the study was limited to adolescents from form 4, form 5, lower sixth and upper sixth because of administrative restrictions.

Research authorizations was obtained from the regional delegation of secondary education and administrative authorization from principals of the selected secondary schools. Eligible participants were then handed a pretested, structured questionnaire adapted from the Global Assessment Programme (GAP) on Drug Abuse Toolkit Module 3 [2] . The questionnaire was piloted on upper sixth students in a secondary school not included in the study in order to ensure reliability and internal validity of questions.

The questionnaire contained two major items. The first item sought to identify the users in terms of age, sex, school, pocket money, toxicological information and relevant family history. The second item assessed initiators features (types and sites).

Of the 1593 students enrolled in this study, 1478 students filled the questionnaire completely and were used for the final analysis. A total of 338 participants had taken a psychoactive drug other than alcohol at least once in their lifetime.

Ethical clearance was obtained from the Institutional Review Board of the Faculty Medicine Biomedical Sciences (reference: 0104/UY1/FMSB/VDRC/DAASR/CSD), University of Yaoundé I. Students were approached and the nature and purpose of the study explained to them collectively. Voluntary participation was ensured by obtaining informed consent from all participants. Anonymity and confidentiality, by identifying each technical sheet with numbers instead of names. All information obtained during the course of this study was used for the sole purpose of the study. The results obtained were used to provide baseline data for early diagnosis and prevention of drug abuse.

Each technical sheet was visually checked for obvious errors and inconsistencies. All the validated questionnaires were coded. Data was entered into an automated data entry form in CSPro. We exported this data into the statistical software IBM SPSS (Statistical Package for Social Sciences) for analysis. Data cleaning was done using consistency and range checks. The categorical variables were expressed in frequency and percentage, and the quantitative variables were expressed using measures of central tendency and dispersion. In cases where variables had missing data, we calculated the rates and frequencies with the available data only.

The sociodemographic characteristics of drug users were registered in Table 1 and included sex, age, class, school type and weekly allowance of adolescents. The majority of psychoactive drug users in this study were male (55.3%) giving a

sex ratio of 1.2. The median age of drug users was 17 years with a range of 11 to 19 years. Most of them identified as Christian (90.2%), followed the Anglo- Saxon education system (52.1%) and attended public schools (48.5%). Their median weekly pocket money was 2550 FCFA [1000; 5000], with some receiving up to 30,000 FCFA per week.

Family history was registered in Table 2. Most of the drug users (69.2%) came from nuclear families with siblings (91.4%). The majority of the families in the sample had between 2 and 7 members, accounting for 83.2% of the total. Their parents were mostly educated, with more than half of them having a tertiary degree (56.8% of fathers vs 54.3% of mothers). However, three quarters (76%) of the drug users reported witnessing parental conflicts.

Majority of drug users (34.9%) had no one in their immediate environment who used psychoactive drugs. Amongst those who had models of psychoactive drug use, 32.2% of models were friends.

Most drug users (84.9%) lived or schooled close to a bar or market. Drug users knew an area in their neighborhood where psychoactive drugs were sold in 42.3% of cases (Table 3).

As shown in Table 4, nearly half of the drug users (49.7%) were first exposed to

psychoactive drugs by non-family members, such as friends outside school (47.6%) and schoolmates (42.9%). However, more than a quarter of respondents (25.7%) did not identify any person who initiated them into drug use.

Data in Table 5 revealed that the majority of respondents (68.4%) first tried drugs away from their homes (20.4%) or schools (11.2%), with snack bars being the most frequent place of initiation (33.1%). The majority of the respondents (84.9%) lived or studied near a bar or market, and almost half of them (42.3%) were aware of a location where psychoactive drugs were sold.