Application of digital health technologies to substance use reduction among students in higher education institutions: A scoping review

Highlight

Substance use is an escalating issue among young people, particularly in LMICs, where rapid economic, social, and cultural shifts are fostering an environment conducive to increased substance use. College life introduces unique challenges such as separation from family, the formation of new social networks, and academic pressures that can further contribute to substance use. There is a significant gap in research regarding digital health interventions aimed at reducing substance use among college students in low- and middle-income countries. To address this gap, we conducted a scoping review of existing literature, summarizing studies that have evaluated digital health technologies for substance use reduction within this population. Our review focuses on identifying the types of digital health technologies utilized their intended purposes, and their reported outcomes.

Introduction

Young adulthood is a crucial stage of life characterized by significant emotional, educational, vocational, and social transitions. This period marks the adoption of adult roles, responsibilities, and the development of social skills. For many college and university students, this phase is particularly transformative, involving a shift towards greater independence from parental supervision, exposure to new social and academic pressures, and an environment where the use of intoxicating substances particularly alcohol is widespread.^1,2 Psychoactive substances, which include compounds that alter mental processes such as perception, consciousness, cognition, mood, and emotions, encompass a wide range of substances like alcohol, marijuana, nicotine, and khat. While the term “psychoactive” doesn't always indicate dependence, it is frequently used to describe substances that can lead to addiction or misuse, with terms like “substance use” or “substance abuse” often associated with it.³ Unfortunately, substance use among young adults has contributed to an increase in psychosocial issues,⁴ and individuals with substance use disorders are statistically more likely to experience mental health disorders and premature mortality compared to those without such conditions.^5,6

For many young people, college enrollment is a pivotal transition from adolescence to adulthood, often associated with an increased likelihood of substance use. While attending college was once thought to be a protective factor against substance abuse, recent trends have shown a concerning rise in substance use disorders among university students.⁷ These students are considered a high-risk group,⁸ with both alcohol consumption and the use of legal and illegal drugs increasing globally,^8,9 particularly in low- and middle-income countries (LMICs). In countries like Ethiopia, 46.74% individuals aged 18-24 engage in substance use, with alcohol (36.34%) being the most commonly consumed psychoactive substance.¹⁰ The move from high school to college also brings heightened peer interactions and exposure to social norms that can influence behavior.⁹ Peers often directly encourage substance use or subtly shape perceptions of acceptable behavior, increasing the likelihood of risky behaviors such as smoking, drinking, and using drugs.¹¹

The global impact of substance use is vast, contributing significantly to the disease burden worldwide. Alcohol and illicit drugs account for a large portion (5.4%) of the global burden of disease, with cigarette use alone (3.7%) responsible for a substantial percentage.¹² Despite the increasing number of individuals affected by substance use disorders estimated at 64 million people globally only a small fraction (only 1 in 11 people) receives the necessary treatment.¹³ Young people are particularly vulnerable to the negative effects of substance use, which can disrupt their health, academic performance, social relationships, and future career prospects.^14–16 University students face unique challenges, as the combination of newfound independence, the pressures of academic life, and exposure to a range of social influences can heighten the risk of engaging in substance use.^6,15,17–20 The challenges are compounded by the changing cultural norms and rising rates of substance misuse in developing countries, including parts of LMIC,^16–18,21 where alcohol, tobacco, and other substances are increasingly common in schools and universities.²² As a result, the risk of substance abuse is enhanced in academic settings.¹⁴

In many LMIC nations, the increasing prevalence of substance use is linked to significant social and economic transformations.²⁰ Psychoactive substances such as alcohol, cannabis, tobacco, and even harder drugs like heroin and cocaine are often found in educational institutions.²³ Alcohol and cigarettes are especially problematic, as they are commonly seen as “gateway drugs” that lead to the use of more harmful substances.^6,14,16 Regular substance use is associated with several negative outcomes for students, including poor academic performance, increased absenteeism, and higher dropout rates.^24–27 Moreover, substance use can lead to long-term health and psychiatric issues, significantly impacting students’ futures.^28,29

Digital health interventions represent a promising avenue for addressing these issues among university students. Digital health, which involves the use of information and communication technologies to promote physical, mental, and social well-being, includes a wide range of tools such as websites, mobile applications, and other technology-based solutions aimed at disease prevention and health promotion.³⁰ Universities worldwide are increasingly embracing these digital solutions to improve student health. Examples of digital health initiatives include mobile apps for reducing substance use,³¹ promoting healthy behaviors like physical activity,^32,33 and improving mental health.^34–36 While much of the research on these digital health tools has been conducted in experimental settings, particularly in Western countries, the landscape is evolving, with many new digital health resources becoming available.³⁷

However, there is a significant gap in research regarding the use of digital health interventions to reduce substance use among university students in LMICs. The existing literature is limited in terms of evaluating the effectiveness of these digital tools in such settings. A scoping review of the available literature on this topic aims to fill this gap by identifying the types of digital health technologies used for substance use reduction, the purposes of these tools, and the outcomes they produce. Unlike systematic reviews, which provide critically appraised and synthesized findings, a scoping review takes a broader approach, exploring the range of digital health technologies currently in use. This review is essential for understanding how digital health interventions can be optimized to address the growing issue of substance use among university students in LMICs, helping to guide future research and intervention strategies in this area.

Methods

We used the procedures recommended by the technique for scoping reviews³⁸ and followed the Joanna Briggs Institute Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist and reporting guideline³⁹ (S1, Supporting Information). The preliminary protocol was with the PI. In summary, we took the following steps: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; and (5) collecting, summarizing, and reporting the results.

The process for developing a research question on digital health technologies for substance use reduction among higher education students in low- and middle-income countries (LMICs) was outlined in several stages. In Stage 1, the research question was designed to explore various digital health technologies, their specific elements, and their effectiveness in reducing substance use. The key questions guiding the study included identifying the technologies used, understanding their key features, and assessing their reported outcomes in the target population.

Stage 2 focused on identifying relevant studies, with a search strategy that included a review of original studies published up to March 2025. The search prioritized literature on digital health technologies for substance use prevention, particularly those influencing policy and practice. Major global databases such as Scopus, PubMed, and PsycINFO were systematically searched using Boolean operators, incorporating keywords related to substance use and digital health technologies. A comprehensive search strategy was used, with a combination of database searches, manual reviews on platforms like Google Scholar, and backward and forward citation searches. The eligibility of studies was based on the Population, Concept, Context (PCC) framework, which ensured that studies focused on students from LMICs, used digital health technologies, and addressed substance use exposure. We used the World Bank Country and Lending Groups list of LMICs for 2019–2020.⁴⁰ Inclusion criteria were clearly defined, while studies like protocols, editorials, and systematic reviews were excluded.

The inclusion criteria for this review focused on studies involving higher education students (university or college) from low- and middle-income countries (LMICs), as classified by the World Bank for 2019–2020. Eligible studies evaluated digital health technologies—such as mobile apps, web-based interventions, and SMS—designed to reduce substance use, including alcohol, tobacco, marijuana, and khat. Studies needed to report outcomes related to substance use prevention, harm reduction, or cessation within LMIC contexts. All study designs were considered, including quantitative, qualitative, mixed methods, randomized controlled trials (RCTs), quasi-experimental, and observational studies. Only original studies published up to March 2025 were included, with no restriction on the earliest year of publication.

Exclusion criteria ruled out studies conducted in high-income countries or those not focused on LMIC students. Studies using solely non-digital interventions, such as face-to-face counseling or paper-based methods, were excluded. Also excluded were studies that did not report substance use-related outcomes—for instance, those focused only on physical activity or diet. Non-peer-reviewed literature, including protocols, editorials, commentaries, conference abstracts (unless full data were provided), and systematic reviews, were not considered, although their references were screened for potential inclusion. Multi-component interventions were included only if the digital health component’s effect could be isolated or was clearly the primary focus of the study.

Stage 3 involved selecting studies through a two-stage screening process. Initially, duplicates were removed, and titles were screened to identify relevant studies for abstract review. In the second stage, abstracts were independently reviewed for inclusion in the full-text analysis. Any disagreements in article selection were resolved through a consensus decision involving a third investigator.

In Stage 4, the data extraction process began with the preparation of a comprehensive form to capture information from the included articles, such as study design, sample size, types of substances used, and the digital health technologies employed. Two authors conducted the data extraction, with third-party involvement if discrepancies occurred. This data was organized into a spreadsheet and will be included as a supplemental file.

Finally, in Stage 5, the results were collated, summarized, and reported. The findings were categorized into emergent themes such as publication trends, research design, substance types, technology used, outcomes assessed, and gaps in the research. The scope of digital health technologies for substance use reduction among LMIC university students was mapped, providing insight into existing methodologies and areas for future investigation.

Results

Search results using PRISMA-ScR

Our search encompassed four electronic databases: PubMed,⁴¹ PsycINFO via APA,⁴² Scopus,⁴³ and Google Scholar,³² which resulted in an initial pool of 190 articles. After removing 45 duplicates, we screened the remaining 145 articles based on their titles and abstracts. This process led to the exclusion of 74 publications that did not meet our inclusion criteria. Additionally, we included one study from the reference lists of reviewed articles⁴³ and another from Google scholar.⁴⁴ Following a full-text review of the remaining 31 articles, 11 studies were selected for data extraction and analysis. The review process ensured that only those studies meeting the rigorous inclusion criteria were included in the final analysis ( Figure 1). This method of review was conducted on the basis of a predetermined protocol in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) standards for scoping reviews³⁹ (S1- PRISMA Checklist). Lastly, we searched for grey literatures, but none met the inclusion criteria.

Figure 1. PRISMA Flowchart describing the selection of studies mapping existing literature on digital health technology for substance use reduction in young adult college or university students in the LMIC.

Characteristics of the studies

The review identified 11 original, peer-reviewed studies (published between 2015 and 2025) examining digital health interventions for substance use reduction in LMICs. Publication trends revealed a gradual increase in research interest, with five studies (45.5%) published in the last five years (2020–2025). The year 2019 had the highest number of publications (n = 3, 27.3%), followed by 2018, 2023, and 2024 (two studies each, 18% per year), while 2015 and 2020 contributed one study each. Despite this growth, the limited total number of studies highlights a significant research gap in LMICs. The earliest eligible study dated back to 2015,⁴³ the earliest eligible study dated back to 2015,^44,45 2019,^41,46,47 2020,⁴⁸ 2023^42,49 and 2024^50,51 ( Figure 2).

Of the 11 included primary studies, seven employed quantitative methodologies using randomized controlled trial (RCT) designs,^44–50 while one study utilized a quasi-experimental approach,⁵¹ one used an interventional study with a single group,⁴³ another employed a cross-sectional methodology,⁵² and one article adopted a qualitative approach.⁵³ The studies spanned five countries: Brazil had the highest representation,^45–48 contributing four studies, followed by Hong Kong with two,^49,53 and Iran,⁵¹ Korea,⁵⁰ and Vietnam,⁵² each contributing one study. The participants in the studies were college or university students aged 18 years or older. For instance, in Brazil,^45,46 the studies focused on college drinkers aged 18–30 who reported alcohol use in the past three months. In Hong Kong,⁴⁷ one study involved participants aged 18 or older who had consumed alcohol in the last 12 months, while another study focused on students at risk for alcohol use disorder.⁴⁹ In Tehran,⁵¹ a study included 130 students living in dormitories to assess smoking prevention behaviors. Additional studies included participants from Turkey, India, Iran and other countries ( Figure 3) (Tables 1 and 2).⁷⁴

The studies employed a range of research designs to evaluate interventions targeting substance use, showcasing diverse methodological approaches. One study⁴⁴ conducted a mixed-methods cluster randomized controlled trial, integrating both quantitative and qualitative elements. Several studies used pragmatic RCTs,⁴⁷ including a dismantling design⁴⁶ and standard approaches.⁴⁵ Other studies utilized quasi-experimental designs,⁴³ cross-sectional surveys, and semi-structured interviews to assess intervention effectiveness. The sample sizes in these studies varied widely, from a small group of 20 university students to larger cohorts, such as one study analyzing data from 5,476 participants. Other studies included 931, 4,460, and 772 participants, with one focusing on 458 participants, and another examining a cohort of 191 individuals. The studies also demonstrated a mix of large-scale and smaller, targeted research efforts, illustrating the diverse strategies employed to explore substance use in different contexts (Table 1).⁷⁴

Figure 2. Lome graph showing articles published per year (publication trends as of time of data collection).

Figure 3. Bar chart showing the distribution of articles per countries.

The studies in the review involved a wide range of sample sizes, further highlighting the diversity of research approaches. One study⁴⁶ analyzed data from a large cohort of 5,476 participants, while another⁴⁷ included 931 individuals, and a third study⁴⁵ involved 4,460 participants. One study⁴⁹ had 772 participants, whereas another⁵³ focused on a smaller group of 20 university students. Additionally, one study⁴⁸ involved 458 participants, while another⁴⁴ examined a sample of 191 individuals (Table 2).⁷⁴

One study⁴³ initially recruited 433 participants, completing their study with 314 individuals. Another study⁵¹ focused on a smaller group of 130 participants, while a separate study⁵⁰ included a larger cohort of 1,496 individuals. Finally, one study⁵² worked with a moderately sized cohort of 1,082 participants. Together, these studies reflect a balanced mix of large-scale and smaller, targeted research efforts, illustrating the multifaceted strategies employed to explore and address substance use across diverse populations and contexts (Table 2).⁷⁴

Discussion

This scoping review aimed to explore various digital health technologies to reduce substance use, focusing on their applications, specific elements, and effectiveness among college and university students in low- and middle-income countries (LMICs). The findings reveal a notable lack of peer-reviewed articles on this topic, especially from 2020 to 2025, with only five studies identified and none from Africa, underscoring a critical research gap. The earliest study included was from 2015,⁴⁸ emphasizing the need for more primary research, despite the increasing availability of information technology in recent years.^54,55 This review collectively highlights the promise of tailored digital and educational interventions, albeit with varying levels of success influenced by participant motivation, cultural contexts, and methodological limitations.

Brazil had the most studies included in the review, likely due to its significant internet growth and widespread smartphone penetration, especially among individuals aged 18–55.⁵⁶ However, other LMICs face challenges like limited internet access, illiteracy, worsening poverty, and a lack of research from Africa.^57,58 Notably, no studies from Nigeria—a country with the highest number of internet users in Africa were included, suggesting potential issues with resource allocation and prioritization of research on substance use disorder (SUD) interventions,⁴² lacked representation. Despite these challenges, our findings suggest that digital health interventions have the potential to decrease substance use in LMICs. However, the effectiveness of these interventions may not be widely reported or published, highlighting the need for more research and dissemination of findings.

The review suggests that digital health interventions, including web-based programs, instant messaging platforms, web-based personalized normative feedback (PNF), web-based motivational interviewing (MI), and e-health applications, hold promise for reducing substance use among college students.^59,60 However, their effectiveness varies based on factors such as participant motivation, cultural context, and methodological design. Among the targeted population of young adults aged 18 and older, alcohol and tobacco use were the primary focus, reflecting evidence that substance use often peaks between ages 18–25.⁴¹ Digital interventions, such as instant messaging and web-based feedback, showed potential in motivating students to abstain from psychoactive substances, though success depended on specific contexts and approaches. Furthermore, substance use disorder represents a major public health challenge with profound impacts on individuals, families, and society.⁶¹ Consequently, it is essential to implement substance use reduction programs tailored to this demographic. Due to their cost-effectiveness, accessibility, and ability to reach underserved populations, digital health technologies should be a priority in LMICs to enhance healthcare delivery and expand access to necessary interventions.

While the majority of studies in the review employed quantitative methods, randomized controlled trials (RCTs) were the most common design. Interventions were typically evaluated at both individual and group levels, lending robustness to the findings. However, methodological limitations, such as high attrition rates, reliance on self-reported data, short follow-up periods, and underrepresentation of non-smartphone users, were common. Additionally, few studies explored educational interventions incorporating health literacy and the Health Belief Model, highlighting another research gap. The diverse mechanisms contributing to these significant findings suggest that studies employing eclectic approaches may require replication across different settings to confirm the positive outcomes of digital health interventions in reducing substance use.^62,63

The review identified that digital health interventions for alcohol use were more prevalent than those for other substances, such as tobacco, marijuana, or opioids. This focus is justified by alcohol’s significant contribution to global disease burden and injury outcomes.⁶⁴ However, studies on interventions for other psychoactive substances should be interpreted cautiously due to the limited data and varying levels of effectiveness.⁶⁵

Digital health interventions offer significant potential for delivering information and healthcare services aimed at reducing substance use and implementing effective treatment strategies across diverse populations.^65,66 Promising approaches include mobile applications, instant messaging platforms, and web-based programs, which have been shown to reduce stigma, enhance treatment accessibility, and address resource limitations in LMICs.^67–69 Text messaging interventions, in particular, demonstrated affordability and feasibility, making them a practical option for resource-limited settings.^70,71 Despite these advantages, high attrition rates and challenges such as infrastructure limitations, resistance from healthcare staff and associated costs can hinder the acceptability and effectiveness of these interventions. Nevertheless, their overall benefits remain substantial.⁵⁹

Overall, this review underscores the potential of digital health technologies to reduce substance use among university students in LMICs. Despite challenges such as high attrition rates and methodological constraints,^65,72 these interventions provide innovative, cost-effective, and accessible solutions to address public health concerns.⁷³ Future research should focus on expanding the scope of studies, particularly in underrepresented regions like Africa, and evaluating long-term outcomes to ensure sustainable benefits.

Strengths and limitations

This scoping review provides a valuable synthesis of digital health interventions for substance use reduction among university students in LMICs, employing a rigorous methodology guided by PRISMA-ScR standards. Its key strengths include a comprehensive search strategy across multiple databases, clearly defined inclusion criteria, and a focus on an under-researched population in global health. However, several important limitations must be acknowledged. The review was restricted to English-language publications, potentially excluding relevant studies in other languages and introducing geographic bias, as evidenced by the predominance of studies from Brazil and absence of research from Africa. The included studies exhibited significant heterogeneity in design, interventions, and outcome measures, which, while providing breadth of understanding, limited direct comparisons of effectiveness. Most concerning is the paucity of studies (only 11 over a decade) meeting inclusion criteria, suggesting either limited primary research in LMICs or publication bias favoring high-income country research.

Methodological challenges were apparent across studies, including short follow-up periods (typically ≤6 months), high attrition rates, and reliance on self-reported data, all of which constrain conclusions about long-term effectiveness. The predominance of alcohol-focused interventions (7 of 11 studies) leaves other substance use behaviors underexplored. Technological barriers were rarely addressed, despite varying internet access across LMICs potentially limiting intervention reach. While maintaining broad inclusion criteria aligned with scoping review methodology, the incorporation of studies with varying quality levels may affect overall findings’ robustness.

These limitations highlight critical gaps for future research, including the need for culturally adapted interventions in underrepresented regions, longer-term evaluations incorporating objective measures, and studies examining implementation barriers in low-resource settings. Addressing these challenges will be essential for developing effective, scalable digital solutions to reduce substance use in LMIC university populations.

Conclusions

This scoping review offers a thorough overview of the use of digital health technologies to reduce substance use among college and university students in LMICs. It highlights the effectiveness of various digital health interventions and identifies key areas for future research. The findings underscore the significant potential of digital health technologies to address substance use, particularly in underserved communities. When effectively implemented, mobile health interventions could play a pivotal role in reducing substance use. However, despite a growing body of evidence, a notable knowledge gap remains regarding the specific impact of these interventions on LMIC college and university students, making it challenging to definitively establish their effectiveness. To address this gap, larger-scale randomized studies are urgently needed to evaluate these interventions’ efficacy in this population.

Overall, the review highlight the potential of digital, web-based, and mobile interventions to reduce alcohol and smoking behaviors, with their effectiveness varying depending on factors such as participant motivation, cultural context, and intervention design. They emphasize the wide range of strategies, tools, and designs employed in digital interventions for substance use. While many of the interventions in the review showed effectiveness or feasibility, the outcomes differed based on the type of substance, delivery methods, and target populations.

To reduce substance use in low- and middle-income countries (LMICs), a strategic, multi-faceted approach is essential. This involves creating supportive environments for digital health technologies, even in resource-limited settings. Research on substance use reduction should be prioritized, with a focus on disseminating findings widely. Future studies should target college and university students, using larger, more diverse samples, appropriate follow-up periods, and replication across different populations to validate the effectiveness of digital health interventions. Additionally, conducting systematic reviews or meta-analyses will help synthesize existing evidence and improve understanding of mobile health (mHealth) interventions for substance use reduction in these regions. This comprehensive approach will contribute to developing sustainable and effective solutions for the unique challenges in LMICs.

Ethics and consent

Ethics and consent were not required.