Tobacco, alcohol, cannabis and other illegal drug use among young adults: The socioeconomic context
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.
Section snippets
Methods
Data for this study come from two sources: young adults participating in the TEMPO study (assessment in 2009) and their parents who participate in the GAZEL cohort study (yearly assessments of parents’ health, health behaviors and living circumstances between 1989 and 2009) and who reported on their child back in 1991.
TEMPO participants’ characteristics
Table 1 presents study participants’ characteristics according to sex. Past 12-month prevalence of substance use was as follows: regular tobacco smoking: 35.8%, alcohol abuse: 14.3%, cannabis use: 22.6%, problematic cannabis use: 6.3%, use of other illegal drugs: 4.1%, polysubstance use: 12.4%. Men were systematically more likely to use psychoactive substances, except illegal drugs other than cannabis. Among participants with polysubstance abuse, 23.8% regularly used tobacco and abused alcohol,
Main findings
In a community sample of French young adults, 35.8% regularly smoked tobacco, 14.3% showed signs of alcohol abuse, 22.6% used cannabis, 6.3% showed signs of problematic cannabis use, and 12.4% used at least two psychoactive substances. Tobacco smoking, cannabis or other illegal drugs use, as well as polysubstance use, disproportionately occurred among individuals with low socioeconomic position, even after accounting for demographic characteristics, familial substance use, and past
Conclusion
Tobacco smoking, alcohol, cannabis and polysubstance use are common behaviors among young adults, particularly those experiencing socioeconomic disadvantage. Compared to other groups of the population, individuals in their 20s and 30s are disproportionately likely to experience unfavourable employment characteristics and these may contribute to high levels of substance use. Socioeconomic disparities with regard to addictive behaviors which can be observed in young adulthood are likely to deepen
Role of funding sources
This research was supported by the French Ministry of Health-IReSP (TGIR Cohortes), the French Inter-departmental Mission for the fight against drugs and drug addiction (MILDT), The French Institute of Cancer (INCa), the French Foundation for Research on Psychiatry and Mental Health (FRPSM). Maria Melchior is the recipient of a Young Researcher Award from the French National Research Agency (ANR). The founders had no further role in study design; in the collection, analysis and interpretation
Contributors
BR and MM had the initial idea and designed the study and conducted background literature searches. AC conducted statistical analyses. BR and MM wrote the first draft of the manuscript. EF and LB contributed to interpreting the findings. EF and MM were responsible for study protocol and data collection. All authors reviewed and have approved the final manuscript.
Conflict of interest
No conflict declared.
Acknowledgements
The authors wish to thank the Gazel study team for help in implementing the Tempo cohort and Professor France Lert for helpful comments on this manuscript.
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