Substance Use among Undergraduate Students at a Malaysian Public University: Prevalence, Patterns, and Associated Factors in a Cross-Sectional Study from Sarawak

Abstract

Background: Substance use in university populations is a persistent public health and educational concern because it intersects with risk-taking behavior during emerging adulthood, mental wellbeing, campus culture, and academic functioning. Malaysian evidence remains limited, particularly from East Malaysia. This study estimated the prevalence and pattern of substance use among undergraduate students in a public university in Sarawak and examined factors associated with current use. Methods: This is a cross-sectional study among undergraduate students at Universiti Malaysia Sarawak between October 2023 and August 2024. A bilingual self-administered questionnaire captured sociodemographic, academic, financial, and psychosocial characteristics, together with substance use using the Alcohol, Smoking and Substance Involvement Screening Test–Lite (ASSIST-Lite). Depression, anxiety, and stress were assessed with the DASS-21, and perceived social support with the Multidimensional Scale of Perceived Social Support. Pearson’s chi-square test was used for bivariate analysis, followed by binary logistic regression for factors associated with current substance use (past 3 months). Results: A total of 246 students participated (mean age 22.18 years, SD 1.51; 56.1% women). The prevalence of lifetime substance use was 38.2%, while current substance use was 27.2%. Alcohol was the predominant substance for both lifetime use (31.3%) and current use (24.0%), followed by tobacco smoking (7.7% lifetime; 6.1% current). Current use of other psychoactive substances was rare (0.4–0.8% for individual substances). In adjusted analysis, women had lower odds of current substance use than men (adjusted odds ratio [aOR] 0.44, 95% confidence interval [CI] 0.24–0.80). Compared with Malay students, Chinese (aOR 3.44, 95% CI 1.35–8.77), Bumiputera Sarawak (aOR 6.88, 95% CI 2.80–16.86), and other ethnic groups (aOR 3.69, 95% CI 1.39–9.79) had higher odds of current substance use. No statistically significant associations were observed for age group, living arrangement, academic characteristics, financial variables, psychological distress, or perceived social support. Conclusions: Substance use among these undergraduates was driven largely by alcohol and, to a lesser extent, tobacco rather than frequent use of illicit drugs. Sex and ethnicity were the most consistent correlates of current use, suggesting that campus prevention strategies should be culturally responsive, gender-sensitive, and focused on alcohol and nicotine as well as illicit substances. Universities should integrate confidential screening, first-year transition support, and targeted health education into student wellbeing programmes.