Tobacco, alcohol, cannabis and other illegal drug use among young adults: The socioeconomic context

Abstract

Background

Low socioeconomic position predicts risk of substance abuse, yet few studies tested the role of preexisting familial and individual characteristics.

Methods

Data come from the TEMPO (Trajectoires Epidémiologiques en Population) study (community sample in France, 1991–2009, n = 1103, 22–35 years in 2009) set up among offspring of participants of an epidemiological study (GAZEL). Past 12-month substance use was assessed in 2009 by self-completed mail survey: regular tobacco smoking, alcohol abuse (AUDIT), cannabis use, problematic cannabis use (CAST), other illegal drug use. Socioeconomic position was defined by educational attainment, occupational grade, employment stability and unemployment. Covariates included demographics (age, sex, relationship status, parenthood), family background (parental income, parental tobacco smoking, parental alcohol use), and juvenile characteristics (psychological problems, academic difficulties) measured longitudinally.

Results

35.8% of study participants were regular smokers, 14.3% abused alcohol, 22.6% used cannabis (6.3% had problematic cannabis use) and 4.1% used other illegal drugs. Except for alcohol abuse, substance use rates were systematically higher in individuals with low, rather than intermediate/high, socioeconomic position (age and sex-adjusted ORs from 1.75 for cannabis use to 2.11 for tobacco smoking and 2.44 for problematic cannabis use). In multivariate analyses these socioeconomic disparities were decreased, but remained statistically significant (except for illegal drugs other than cannabis).

Conclusions

Tobacco smoking, alcohol, cannabis and polysubstance use are common behaviors among young adults, particularly those experiencing socioeconomic disadvantage. Interventions aiming to decrease substance abuse and reduce socioeconomic inequalities in this area should be implemented early in life.

Introduction

Adolescents and young adults are at high risk of tobacco, alcohol, cannabis or other illegal drugs use (Choquet et al., 2004, Merline et al., 2004). Prevalence of substance use tends to decrease during the 20s and 30s (except for tobacco), but a significant fraction of young adults continue using and abusing alcohol and illegal drugs (Melchior et al., 2008, Schulenberg et al., 2005). In particular, a growing number of young adults use cannabis even after embracing social roles such as work and parenthood, possibly jeopardizing their long-term health, social, and economic outcomes (Perkonigg et al., 1998).

In industrialized countries, risk of substance abuse appears especially high in youths from socioeconomically disadvantaged backgrounds (Fothergill and Ensminger, 2006, Hanson and Chen, 2007). To date research in this area was limited to the United States (Merline et al., 2004, Windle et al., 2005, Windle and Wiesner, 2004), Australia/New Zealand (Swift et al., 2008), and Northern Europe (Netherlands, Germany) (Karam et al., 2007, Perkonigg et al., 2008), and few studies were able to account for pre-existing individual and family characteristics which may determine both socioeconomic position and substance abuse in young adulthood.

Studying the socioeconomic context of substance use in France is particularly interesting. First, in French youths and adults, levels of substance use are high: a nationally representative study conducted in 17-year olds reported 12-month prevalences of 29% for regular tobacco smoking, 49% for binge drink and 25% for cannabis use; in the adult population, an estimated 6% meet criteria for an alcohol-related disorder (Beck et al., 2006a, Hibell et al., 2000, Lépine et al., 2005). While adolescents’ levels of tobacco use have decreased in recent years, rates of alcohol abuse have increased, and the use of cannabis has stabilized at approximately 25% (any use over 12 months) (Legleye et al., 2009). In parallel, experimentation and regular use of other illegal drugs, particularly cocaine, has increased (Beck et al., 2006b). Second, despite high educational achievement (83% of 25–35 year olds in France hold a high school degree, as compared with an average of 79% in the OECD) (OECD, 2010), French youths have low labour force participation (10% are unemployed compared to 9% in the OECD) and disproportionately face job instability (51% are in temporary employment compared to 25% in the OECD) (OECD, 2010). Given how difficult it is to transition to the labour market, socioeconomic disparities with regard to substance use may be more pronounced than in other countries. To date, research on socioeconomic position and tobacco, alcohol and cannabis use in French youths was based on cross-sectional samples, and the contribution of early life characteristics has not been fully investigated (Baumann et al., 2007, Legleye et al., 2008, Peretti-Watel et al., 2009a).

More broadly, although recent changes in substance use in adolescence are documented, few studies have monitored trends in young adults (Merline et al., 2004, Patton et al., 2007, Perkonigg et al., 2008) and there is need to update knowledge on this risk prone segment of the population. With notable exceptions (Merline et al., 2004, Patton et al., 2007), past studies which report on the relationship between socioeconomic position and substance use studied one substance at a time (Fagan et al., 2005, Perkonigg et al., 2008, Schulenberg et al., 1996, Schulenberg et al., 2005, Swift et al., 2008) or overall symptoms of abuse (Barrett and Turner, 2006), making it difficult to make cross-substance comparisons.

In this investigation, we use data from the TEMPO study, a cohort of young adults age 22–35 in 2009, to examine the regular use or abuse of psychoactive substances (tobacco, alcohol, cannabis, polysubstance) in relation to socioeconomic position, measured through individuals’ educational and employment situation. Our hypothesis is that young adults with low socioeconomic position have disproportionately high levels of psychoactive substance use. Based on evidence that any illegal drug use bears health and social risks (Huas et al., 2008), we also study past 12-month consumption of cannabis and other illegal drugs. Analyses account for participants’ familial and own juvenile characteristics which can predict socioeconomic position and substance abuse later in life (family socioeconomic background, parental history of tobacco and alcohol use, participants’ psychological problems and academic difficulties while growing up) (Buu et al., 2009, Fothergill and Ensminger, 2006), as well as participants’ relationship and parenthood status in young adulthood (Merline et al., 2004, Staff et al., 2010). Data from this study add to current knowledge on factors associated with substance-related difficulties in young adults, especially with regard to workforce and family life characteristics.