Short communicationFurther investigation of psychological and environmental correlates of substance use in adolescence in six European countries☆
Introduction
Patterns of substance use, initiation and progression in adolescence are generally considered to be predictive of later involvement with substance use and its harmful consequences (Tucker et al., 2005). Understanding the factors associated with substance use in adolescence is therefore crucial in the field of prevention. However, a study restricted to one specific sociocultural context has uncertain generalizability; consequently, cross-national studies of the topic are particularly valuable. The European School Survey on Alcohol and Other Drugs (ESPAD; Hibell et al., 2004) provides an excellent context for cross-national investigations, employing standardized methodology and large probability samples. In the present paper, we use data collected among 16-year-olds in 1999 in those ESPAD countries that used a questionnaire module on potential psychosocial correlates of substance use. These were Bulgaria, Croatia, Greece, Romania, Slovenia and the UK, a set of countries differing in sociocultural background, stage of development of the drug use epidemic and current prevalence of substance use.
In the first part of this study (Kokkevi et al., in press), almost all the variables considered as potential correlates of legal and illegal substance use in these countries were significantly associated with substance use when taken one by one. In this second part, we extend the analysis by including all covariates simultaneously in regression models.
Section snippets
Methods
ESPAD draws probability samples of 16-year-old high school students, followed by self-completion of an anonymous questionnaire in the classroom after authorization of the survey by the education authorities. Detailed procedures in each country can be found in the 1999 ESPAD Report (Hibell et al., 2000; www.espad.org/reports.html). In every country, a clustered probability sample was drawn, with school classes forming the sampling units. Sample sizes were: Bulgaria 3229, Croatia 3602, Greece
Results
Table 1 shows the marginal distributions of all of the variables included in the analysis, by gender. The web appendix contains further details, with breakdown by country.
Table 2 shows estimated odds ratios (with 95% confidence intervals) obtained from the models that included all the potential covariates plus country. Odds ratios were particularly high for going out most evenings, especially in relation to smoking, and for substance use by peers and older siblings. In particular, the use of
Discussion
Although our earlier results (Kokkevi et al., in press) showed that almost all the covariates under consideration were associated with each of the four response variables when taken one by one, the present results indicate that going out most evenings, substance use by peers and siblings, and antisocial behavior are generally the strongest correlates of substance use by adolescent students. Family related factors seem to be less important than the peer culture and, apart from antisocial
Acknowledgments
Funding agencies of the ESPAD survey in the participating countries were as follows: National Centre for Public Health, Bulgarian Lions Quest Foundation, Ministry of Education (Bulgaria); Croatian National Institute of Public Health, The Government of the City of Zagreb, The Governmental Commission for Drug Prevention (Croatia); University Mental Health Research Institute (Greece); Institute of Health Services Management, Compartments of Health Education from Public Health Authority from each
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Items used in the questionnaire employed in this study can be viewed by accessing the online version of this paper at http://dx.doi.org by entering doi:10.1016/j.drugalcdep.2006.10.004.