Psychosocial Determinants of Marijuana Utilization among Selected Junior High School Students in the Central Region of Ghana Abstract Marijuana utilization among school aged adolescents is major public and mental health concern in Ghana and other developing countries, with the rate of usage soaring 

Marijuana utilization among school aged adolescents is major public and mental health concern in Ghana and other developing countries, with the rate of usage soaring high among school going adolescents. The objective of this study was to investigate the prevalence of marijuana utilization among selected Junior High School (JHS) students in the Central Region of Ghana and explore the relative impact of psychosocial factors accounting for its usage. Using a descriptive cross-sectional survey design with the Global School Based Survey [GSHS] questionnaire, a sample of 1400 school going adolescents students were drawn using multistage sampling procedure. Frequencies, percentages and binary logistic regression results indicated marijuana utilization prevalence of 9% (n = 122). Statistically, gender (OR = 0.52, 95% CI= 0.35 .765, p = 0.001), religious affiliation (OR = 1.76, 95% CI = 1.0 2.95, p = 0.034), socioeconomic background (OR = 0.52, 95% CI = 0.33 1.23, p = 0.004) and geographical location (OR = 0.53, 95% CI = 0.31 .886, p = 0.016) significantly predicted marijuana utilization among school aged adolescents. No statistically significant variations were found in the odds of students’ marijuana usage for age (OR = 1.15, 95% CI = 0.69 1.88, p = 0.590), parental communication (OR = 0.83, 95% CI = 0.56 1.23, p = 0.348) and academic performance (OR = 1.09, 95% CI = 0.66 -1.80, p = 0.744). Findings suggest that school based research should reflect and perhaps replicate existing prevalence, patterns of marijuana and other drug use through multiple school surveys nationwide. This pathway may provide useful information towards the design, evaluation and implementation of drug prevention cognitive-behavioural interventions and the development of stringent drug regulative standards. DOI : COMING SOON Thomas Hormenu , Hagan Jnr. John Elvis , Schack Thomas , Pollmann Dietmar 2 Department of Health, Physical Education and Recreation, University of Cape Coast, Ghana 2 Neurocognition and Action Biomechanics"Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, 33501 Bielefeld, Germany 3 Center of Excellence "Cognitive Interaction Technology" CITEC, Bielefeld University, Germany Corresponding Author: Hagan Jnr. John Elvis, “Neurocognition and Action Biomechanics"Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, 33501 Bielefeld, Germany, Center of Excellence "Cognitive Interaction Technology" CITEC, Bielefeld University, Germany , Email: elvis.hagan@ucc.edu.gh


Introduction
Adolescents' drug use has become a topical issue due to its onset of behaviors and conditions that not only affect health but also lead to later life disorders associated with individuals' functioning. This unhealthy behaviour is closely associated with increased morbidity and mortality that pose major public and mental health challenges. Other negative implications may include but not limited to unemployment, theft, vandalism, accidents, suicide, mental illness, and decreased life expectancy [1,2,3].
Globally, the burden of disease attributable to substance use seemed to have significantly increased among adolescents and young adults [4]. Degenhardt and associates reiterated that "Substance use in young people aged 10-24 years might disrupt key periods of transition that occur as the adolescent brain undergoes cognitive and emotional development, and key psychosocial transitions that are made" (p. 251). The onset of drug use primarily begins during the adolescence period, with the utilization of lawful drugs such as alcohol and tobacco usually preceding the usage of illicit drugs [4].
The major challenges and inherent pressures facing adolescents within the age brackets highlighted above include but not limited to growing academic expectations, changing social relationships with peers and family as well as physical and emotional changes associated with maturation. These age brackets mark a period of increased autonomy in which independent decision-making influence adolescents' health related behaviors and subsequent health status. Behaviors established during this transition period can continue into adulthood, affecting issues such as mental health, the development of health compromising behaviors such as alcohol, tobacco, marijuana and other substance use.
The past 3 decades have witnessed several dramatic shifts in the rates of substance use among young people [5]. One substance that has been cited in research literature as the most frequently patronized illicit drug in both developing and developed nations is marijuana [6], with its very addictive properties of nicotine highlighting marijuana as a major global health hazard [7].
Marijuana, popularly known in Ghana as "Wee", is one of the most commonly cultivated and used illicit drugs among adolescents in the country despite it being considered as an illicit drug. Although research literature on marijuana utilization in Ghana is sparse, different reports have shown variations in the prevalence of its usage in the country. For instance, the latest UN World Drug Report [8] indicates that almost 22% of Ghanaian adolescents and young adults use marijuana. This claim is inferred from the number of recorded drug related patients in psychiatric hospitals in the country. A report from the former Chief Psychiatrist of Ghana's Ministry of Health asserts that in 2007, out of 594 drug-related cases admitted to the National Psychiatric Hospital, 400 were marijuana related [9]. Similarly, it was reported that the same hospital recorded 4,000 marijuana related outpatient cases in 2013 [10]. Jafaru [10] reiterated that the National Psychiatric hospital receives 400 outpatient cases daily, with 30% of the cases being marijuana related, out of which 10% are usually admitted to the hospital each year Reuben [11].

Recent statistics from the Ghana Narcotic
Control Board also reveal that out of a total number of 50,000 drug users, 35000 of these users are adolescents in the Junior and Senior High schools in Ghana [12].
According to Degenhardt et al. [4], there seems to be a paucity and distinct gap concerning epidemiological data on the extent of adolescents' drug usage in Africa. Only few studies have reported the extent of substance use among diverse adolescent populations (e.g., Ghana [13,14,15]; South Africa [16,17,18]; Zambia [19]; Zimbabwe [20]. A recent transnational study investigating the prevalence of marijuana and amphetamine use, and associated risk factors among adolescents in 9 African countries found overall past month marijuana use among school going adolescents to be 4.1% [21]. The highest prevalence of past-month marijuana usage found in Peltzer and Pengpid's study was Ghana (8.1%), a finding that shows an increase compared to earlier local surveys in Ghana that found lower prevalence rates of 2.6% to 7.2% lifetime marijuana use [13,14]. Peltzer and Pengpid [21] interestingly noted in their study that the prevalence of past-month marijuana usage in Ghana was significantly  [25]. However, longitudinal data suggest that the difference in rates between the sexes is decreasing [26], with the United Nations Office on Drugs and Crime (UNODC, [27]) affirming that the prevalence of substance use among girls is becoming closer to that of boys globally.
Research data on whether differences in the prevalence of marijuana use are associated with race, socioeconomic status, and residence in urban, suburban, or rural areas are inconsistent [28,29,30,31,32,33,34].
For instance, adolescents with strong family associations, positive involvement, high parental academic expectations, and a high level of parental communication and supervision have lower rates of marijuana use [35,36,37]. Comparatively, those with dysfunctional families [38,39] or in which parents use drugs and make them accessible at their homes have higher rates [40]. Additionally, religious belief, mainly in a fundamentalist religion (e.g., Christianity, Islamic) is related with lower rates [40], whereas religious affiliations that have values that deviate from cultural norms are linked with higher rates [23,42]. Further, several studies have also shown that adolescents who are linked with marijuana smokers' peer groups or family members report higher rates of usage [23,37,43]. Many measures such as poor performance in school, disliking school, and truancy are also associated with adolescents' marijuana usage [43,44,45]. A recent study calculated that marijuana users are two to three times more likely to drop out of school than are nonusers [46]. However, a study of Swedish adolescents found marijuana use more strongly associated with level of career aspirations than with level of interest or performance in school [31].

Discussion
The current study sought to examine marijuana  Gender prediction of marijuana usage among school adolescents in the region was also realized. Boys were at a higher risk of using marijuana than girls.
Gender has been one of the most studied demographic characteristics related to youth substance use [63].  [11,21,26,27], it is possible that males and females with same access to marijuana may initiate usage at comparable rates [25]. Some local researchers, Doku et al. [69] have posited that in Ghana, smoking has been declining in the past few decades and the decline was faster among boys than girls. Therefore, issues surrounding marijuana should be considered equally important for both genders (males and females).
There is a compelling need to explore more research on gender differences in marijuana utilization using perhaps a longitudinal approach and varied research protocols (e.g., multi-trait and multi-method approaches) in order to clarify current inconsistent findings.
Socioeconomic status also predicted marijuana use among students in the region. Adolescents from low socioeconomic backgrounds were at a higher risk of using marijuana than those from high socioeconomic backgrounds. This finding affirmed previous research findings that familial socioeconomic status of school going adolescents is highly associated with marijuana use among adolescents, with low socioeconomic group having higher probability of using marijuana, compared to those from higher socioeconomic group [14,69,70,71]. Although Humensky's [72] finding is similar to the current study, the attributed reason was that late adolescents with higher familial socioeconomic status had the propensity to use marijuana than adolescents from a lower familial socioeconomic   in deviant behaviours [14,27].

Conflict of Interest
Authors have no financial or personal connection with people or educational institutions involved in the current study that may have inappropriately influenced this research.