Background: Substance abuse is a major but neglected public health problem across the globe. Most of the time it starts during adolescence, which is also considered a critical risk period for the initiation of substance use. Materials and Methods: We conducted a cross-sectional analytical study to estimate the prevalence and determine the association of socio-demographic and other risk factors with substance abuse among adolescents in an urban area of Himachal Pradesh. A multi-stage cluster with probability proportional to size sampling technique was followed and a semi-structured, pretested questionnaire was used as the study tool. Results: We studied a total of 728 participants and 39.6% were females. The mean age was 15.6 ± 1.3 years. Out of these, 12.1% reported any substance abuse earlier in their lifetime. Among ever users, most commonly abused substance was alcohol (8.9%), followed by smoked tobacco (7.1%), bhang (3.7%), hard liquor (2.8%), charas/ganja (1.4%), chewing tobacco (1.4%), inhalants (fluid/eraser) 0.82%, prescription drugs (cough syrup/tablets 0.69% and injecting drugs 0.27%), Chitta (0.27%), opium and heroin with 0.14% each. On multiple logistic regression analysis, male gender (AOR=1.82), among friend’s tobacco smoking (AOR=2.33), alcohol abuse (AOR=4.52), and cannabis abuse (AOR=2.99) were found to be associated with an increased likelihood of substance abuse. High socio-economic status (AOR=0.59) and tobacco chewing among friends (AOR=0.49) had a protective effect on indulgence in substance abuse. Conclusion: The influence of peers played the most significant predictor while the presence of substance abuse in the family was also associated with an increased likelihood of abuse by adolescents.

Background: Delays in diagnosis of tuberculosis (TB) is still a problem at all levels of health care. Understanding the etiology of these delays is essential for all stakeholders involved in TB control. This study was done to find the delays related to health-care seeking behavior, diagnosis, and major contributors to such delays among newly diagnosed patients of TB. Methods: This cross-sectional study was conducted from August 1, 2018, to July 2019 among the patients of TB diagnosed at Indira Gandhi Medical College, Shimla. A consecutive sample of 105 patients was enrolled for the study. Newly diagnosed cases aged 18 years and above were included in the study. Prevalence ratio with 95% confidence interval was calculated for risk factors associated with the identified delays. Results: At the patient level around 55% reported a delay of more than 14 days in seeking care with a median delay of 45 days (interquartile range [IQR] of 30–60 days). Nearly 67% patients were found to have a diagnostic delay of more than 7 days at the health-care provider level (Median 30 days; IQR 12.5–54.7 days). Delayed initiation of treatment after 7 days of diagnosis was found in 6.6% cases (Median 10 days; IQR 8–15 days) and all of these were patients of extra pulmonary TB. Delay was significantly associated (P = 0.01) with patients who travelled <5 km to reach the health facility. Conclusion: Inter-sectoral coordination, refresher trainings of health-care providers, patient education and capacity building for diagnostics at peripheral institutions can reduce delay in diagnosis and treatment of TB.

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