Community-Level Risk Factors Associated with Alcohol and Other Substance Use Among Youth in Informal Settlements of Eldoret, Kenya

Substance use among youth in informal settlements poses a significant public health challenge in rapidly urbanising Kenyan cities such as Eldoret. This cross-sectional study examined community-level risk factors associated with alcohol and other substance use among 400 youth aged 15-24 residing in four informal settlements (Huruma, Langas, Kamukunji, and Kaptembwa) in Eldoret, Kenya. Data were collected using a structured questionnaire incorporating the AUDIT, ASSIST, and adapted scales for neighbourhood disadvantage, substance availability, collective efficacy, peer norms, recreational space access, and residential instability. Current substance use prevalence was 56.3%, with alcohol (48.0%) and khat (28.0%) most prevalent; 37.0% met criteria for hazardous or high-risk use. Multivariable logistic regression identified six independent community-level predictors of current substance use, each statistically significant at p < .05: high neighbourhood disadvantage (AOR = 2.34, 95% CI 1.52-3.61), easy perceived availability of alcohol and khat (AOR = 2.68, 95% CI 1.78-4.03), low collective efficacy (AOR = 1.95, 95% CI 1.28-2.97), high perceived peer substance-use norms (AOR = 2.81, 95% CI 1.85-4.27), lack of safe recreational spaces (AOR = 1.76, 95% CI 1.15-2.69), and high residential instability (AOR = 1.68, 95% CI 1.09-2.58). Perceived peer norms and substance availability showed the strongest associations, while recreational space access and residential instability, though still significant, showed the smallest effect sizes. These findings point to the influence of settlement-level structural vulnerabilities on youth substance use. Interventions that regulate informal outlets, strengthen community cohesion, expand safe recreational opportunities, and address neighbourhood disadvantage are urgently needed to reduce risk and promote youth well-being in Eldoret's informal settlements.