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The use of cigarettes, alcohol, khat, and other substances is a worldwide threat which especially affects young people and which is also common among the youth of Ethiopia. However, its prevalence and associated factors have not been addressed well yet. Thus, this study aimed to assess the prevalence and associated factors of substance use among preparatory school students in Bale Zone, Oromia Regional State, Southeast Ethiopia.    Methods  An institutional-based cross-sectional study was conducted among 603 randomly selected students from five of eight preparatory schools of Bale Zone, Oromia Regional State, Southeast Ethiopia, in March 2013. The sample size was calculated by a single population proportion formula and allocated proportionally for the schools based on the number of students. A pretested structured questionnaire was used to collect the data. The data were analyzed using SPSS version 16.0. Descriptive, bivariate, and multivariate logistic regressions were employed to identify the predictors of substance use.    Result  The overall current prevalence of substance use among the respondents was 34.8% (210). Specifically, 23.6% (102) and 4.6% (28) of the respondents chewed khat and smoked cigarette, respectively. Sex, age, and substance use status of the respondents’ father, mother, siblings, and best friend had an association with substance use. Male respondents were about ten times more at risk of practicing substance use compared to female respondents [adjusted odds ratio (AOR) 11.37, 95% confidence interval (CI) 4.42–29.23]. Respondents whose sibling(s) smokes cigarette were four times more likely to use substance (AOR 4.44, 95% CI 1.11–17.79). Respondents whose best friend chews khat were 11 times more likely to use substance when compared with those whose best friend does not practice the given factor (AOR 11.15, 95% CI 4.43–28.07).    Conclusion  Respondents whose family uses one or more substances were more likely use substance(s). Respondents whose best friend uses substance(s) were more prone to practice substance use. Fifteen years of age of the respondents was the critical age when they began to practice substance use. Sex and family of the respondents were the predicting factors for them to practice substance use or not. Hence, health extension workers and district health workers should tackle substance use of the respondents through focusing the identified factors.

Substance use and associated factors among preparatory school students in Bale Zone, Oromia Regional State, Southeast Ethiopia