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Smoking, Alcohol & Illicit Drug Use among Young People in a Health Board Region in 1997 and 2002: A Comparative Study   Back Bookmark and Share
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The objectives of this study were to document and compare patterns of licit and illicit drug use among adolescents in a health board region in 1997 and 2002. 1516 students in 1997 and 1426 in 2002, randomly selected from post-primary schools in the region, completed a questionnaire, incorporating items related to smoking, alcohol and illicit drug use. Lifetime smoking prevalence in 2002 (50.8%) showed a statistically significant decrease from 1997 (57.1%). There was also a statistically significant decrease in regular smoking (1997 - 30.7%; 2002 - 18.2%). There was no significant change in regular alcohol consumption (57.3% - 1997; 53.7% - 2002). However, there was an increase in binge drinking at weekends and reports of feeling drunk more than ten times (24% - 1997; 27.2% - 2002). In 2002, 41.2% had ever taken an illicit drug, a statistically significant increase from 1997 (34.9%); 15.1% were regular users, also a statistically significant increase from 1997 (11.9%). These findings highlight that while the misuse of illicit drugs has increased, smoking has significantly declined since 1997. However, alcohol continues to be a major problem within this age-group. This study has implications for the implementation of services and strategies aimed at reducing smoking, alcohol and drug use within this population.
E Flanagan, D Bedford, A OFarrell, C Browne, F Howell

Abstract

The objectives of this study were to document and compare patterns of licit and illicit drug use among adolescents in a health board region in 1997 and 2002. 1516 students in 1997 and 1426 in 2002, randomly selected from post-primary schools in the region, completed a questionnaire, incorporating items related to smoking, alcohol and illicit drug use. Lifetime smoking prevalence in 2002 (50.8%) showed a statistically significant decrease from 1997 (57.1%). There was also a statistically significant decrease in regular smoking (1997 - 30.7%; 2002 - 18.2%). There was no significant change in regular alcohol consumption (57.3% - 1997; 53.7% - 2002). However, there was an increase in binge drinking at weekends and reports of feeling drunk more than ten times (24% - 1997; 27.2% - 2002). In 2002, 41.2% had ever taken an illicit drug, a statistically significant increase from 1997 (34.9%); 15.1% were regular users, also a statistically significant increase from 1997 (11.9%). These findings highlight that while the misuse of illicit drugs has increased, smoking has significantly declined since 1997. However, alcohol continues to be a major problem within this age-group. This study has implications for the implementation of services and strategies aimed at reducing smoking, alcohol and drug use within this population.



Introduction
Among the behaviours frequently initiated during adolescence is experimentation with alcohol, tobacco and illicit drugs and, as observable correlates of adulthood, these behaviours have a powerful appeal for young people. Early initiation of drug use is associated with increased frequency and persistence of use1, 2, 3, 4 and is, therefore, an important marker of lifetime risk for drug use morbidity. Furthermore, smoking and alcohol consumption has been shown to be associated with later experimentation and regular use of illicit drugs.

5, 6, 7 Early adolescent cigarette smoking, for example, has been shown to be directly associated with illicit drug use and problems with drug use. 6 In recent years, there have been several studies examining drug usage among young people in both urban and rural parts of the country 8, 9, 10, 11, 12 and they generally concur that there is widespread lifetime prevalence for both licit and illicit drugs, whereas regular usage is somewhat less extensive.

In 1997, the North Eastern Health Board (NEHB) conducted a study examining the prevalence of smoking, alcohol consumption and illicit drug use as well as patterns of use of these substances within an adolescent population in the north-eastern region.13 As a result of that study, the NEHB implemented a range of strategies and services to tackle the issues of adolescent alcohol, drug and tobacco misuse. In 2002, a follow-up study was undertaken within the same age-group using analogous methodology.

Method
A random stratified sampling technique was employed in both studies to select post-primary schools in counties Cavan, Monaghan, Louth and Meath. In 1997, 21 of the 57 post-primary schools were selected in 1997 and, in 2002, 24 of the 58 post-primary schools in the region were selected. Each principal was contacted and their permission sought to involve the school in the surveys. Principals were invited to request parental consent, at their own discretion. In both studies, only one school declined to participate. Three classes from each school were then randomly selected to participate. The questionnaire used in 2002 was similar to that used in 1997 and was constructed using previously published questionnaires14 and according to international guidelines.15 In 1997, the questionnaire was piloted in one school and was found to be easily understood and appropriately formatted. In both studies, anonymous questionnaires were distributed to students during a class period by a Research Officer from the Department of Public Health, who explained the purpose of the study. Confidentiality was guaranteed to respondents by the Research Officer. Questionnaires were collected by the Research Officer following their completion.

In both studies, regular smoking was defined as smoking at least one cigarette per day14, while regular drinking was categorised as having one or more drinks per week. Previous studies defined regular drinking as consuming alcohol in the previous month14. For the purpose of these studies, the definition was changed to drinking in the previous week, so as to obtain a clearer picture of the frequency of drinking among young people. Those who reported taking an illicit drug at least once in the last month were classified as regular drug users14. Lifetime prevalence was defined as ever having taken a substance at least once in their lives14.

Statistical analysis was conducted using the SPSS and JMP statistical packages. Univariate analysis was carried out using chi-squared analysis and comparison of proportions.

Results
Questionnaires were completed by 1426 students in 2002 (99.9% response rate) and by 1516 students in 1997 (100% response rate). The mean age of respondents in 2002 was 15.1 years (S.D.=1.6) and 851(59.7%) were male (S.D.=standard deviation). In 1997, the mean age was 15.0 years (S.D.=1.5) and 885(58.4%) were male. The gender difference may be explained by the fact that among the schools that were randomly selected, there was a higher proportion of males than females in attendance.

Smoking Status
In 2002, 18.2% (n=260) regularly smoked. As shown in Table 1, more females than males were regular smokers (21.6% vs. 16.0% and this gender difference was statistically significant (p<0.01). A greater proportion of adolescents in 1997 (30.7%) than in 2002 (18.2%) were regular smokers, resulting in a significant difference of 12.5% (95% CI: 9.4-15.6). Regular smoking in 2002 represented a 41% decrease from that in 1997. Figure 1 illustrates the difference between the two studies at every age category.

Of the regular smokers in 2002, 87.7% (n=228) were smoking three or more cigarettes daily, compared to 67.6% (n=315) in 1997, a difference of 20.1% (95% CI: 14.3-25.9).
The mean age at which regular smokers in 2002 had their first cigarette was 11.6 years (S.D.=1.81). In 1997, the mean age was 12.0 years (S.D.=2.0).

Table 1. Lifetime and regular use of tobacco, alcohol and illicit drugs in 1997and 2002 by gender.
 All AdolescentsMalesFemales
 199720021997200219972002
 No.%No.%No.%No.%No.%No.%
Smoking            
Life time prevalence86557.172550.849656.040247.236759.031656.4
Regular Use466 30.7 260 18.2 263 29.7 136 16.0 200 32.212121.6
Alcohol            
Life time prevalence109672.5101671.365674.060270.743970.640271.8
Regular Use86857.376653.744271.044251.965273.831656.4
Illicit Drugs            
Life time prevalence52934.958841.232536.734740.819932.023441.8
Regular Use18111.921515.111.312.813.816.26510.57513.4

Over 85% (85.4%, n=222) of regular smokers in 2002 reported that they buy their cigarettes themselves. Even among regular smokers aged less than 18 years (n=231), 83.6% (n=193) reported that they buy cigarettes themselves. Similarly, in 1997, 86.3% (n=402) of regular smokers indicated that they buy their cigarettes themselves.

Regular smokers in both studies were more likely than non-smokers to live in a home where at least one other person smokes (p<0.001).

Alcohol Consumption
As shown in Table 1, lifetime prevalence for alcohol consumption in 1997 was 72.5% (n=1096) and in 2002 it was 71.3% (n=1016), representing a non-significant change. Regular drinking in 2002 (53.7%, n=766) also showed a non-significant decrease from 1997 (57.3%, n=869). In both studies, no gender differences emerged with regards to lifetime prevalence or regular drinking. However, as shown in Figure 2, there was a significant increase with age for regular alcohol consumption in both 1997 (p<0.0001) and 2002 (p<0.0001).

Table 2. Regular use of illicit drugs in 1997 and 2002
Type of Drug19972002
 No%No%
Cannabis1439.418312.8
Glue / Solvents302.0362.5
Ecstasy241.6191.3
Speed211.440.3
Psilocybin120.850.4
Cough Syrup110.780.6
Cocaine60.410.1
LSD 120.83
Heroin (smoked)40.330.2
Heroin (needle)10.110.1
Barbiturates40.310.1
Other drugs80.5101.0

Overall, 20.6% (n=294) of respondents in 2002 were drinking more than ten drinks per week. In 1997, this was reported by 18.3% (n=278) and, in both studies, there were no significant gender differences. Most adolescents who drank, did so at weekends in both studies. Having more than 10 drinks on a Saturday night showed a significant increase of 3.4% in 2002 (6.9%, n=70) from 1997 (3.5%, n=38) (95% CI: 1.5-5.3).

In 2002, 56.7% (n=809) had felt drunk at least once and 27.2% (n=388) had felt drunk more than ten times. Feeling drunk more than ten times showed a significant increase of 3.2% from 1997 (24.0%, n=364) to 2002 (95% CI: 0.4-6.4).

Results from 2002 show that alcohol was typically bought in a pub (55.5%, n=564) and bought by themselves (50.2%, n=510) or by someone they knew aged 18 years or older (25.6%, n=260). Among drinkers aged less than 16 years (n=470), 27.7% (n=130) indicated that they buy alcohol in a pub; this was reported by 80.0% (n=425) of drinkers aged 16 years and older (n=531). Comparable results from 1997 were not available.

Illicit Drug Use
Overall, lifetime prevalence for illicit drug use in 2002 was 41.2% (n=588), a figure significantly greater than that of 1997 (34.9%, n=529) (overall difference = 6.3%; 95% CI: 2.8-9.8). Lifetime prevalence was highest for cannabis and glue/solvents in both studies.

As presented in Table 1, regular drug use was reported by 15.1% (n=215) in 2002 and 11.9% (n=180) in 1997, thereby resulting in a statistically significant increase of 3.1% (95% CI: 0.5-6.6). No significant gender differences in regular drug use were observed. Table 2 shows that cannabis was the most regularly used drug in 2002 (12.8%, n=183) as well as in 1997 (9.4%, n=143). Regular use of cannabis and glue/solvents was more frequently reported in 2002 than in 1997. For most other illicit drugs, regular usage was lower in 2002 than in 1997.

A statistically greater proportion of respondents in 2002 (56.7%, n=809) than in 1997 (46.4%, n=703) reported having been offered an illicit drug (overall difference =10.4%, 95% CI: 6.7-14.0). Almost 30% (29.3%, n=237) of those offered in 2002 indicated that they were first offered at 13 years or younger. Just over half of all respondents in 2002 (51.9%, n=740) indicated they had been offered cannabis, while almost one-quarter (24.3%, n=347) were offered ecstasy. In 1997, 38.4% (n=582) reported that they were offered cannabis and 20.6% (n=312) were offered ecstasy.

Regular smokers and drinkers in both studies were more likely to have been offered drugs, to have taken an illicit drug and to report that they regularly use an illicit drug than were non-smokers and non-drinkers (p<0.001).

There were no significant social class or county of residence differences with regard to smoking, drinking or illicit drug use.

Discussion
A number of notable findings in terms of smoking, drinking and illicit drug behaviour were elicited from these two studies of post-primary pupils in the north-eastern region.
Firstly, it was shown that fewer young people were regularly smoking in 2002 than five years previously. Furthermore, the rate of regular smoking was lower in 2002 than that observed in other Irish studies8, 9,10 and corresponded to one of the lower rates observed in the ESPAD report.16 It was similar to the latest HBSC survey17, which included, nonetheless, a younger sample than the present study. The findings also highlight that regular smoking was more prevalent among teenage girls and that while, overall, smoking has shown a decrease since 1997, this decrease was less pronounced among females. Other studies have also shown higher smoking rates among adolescent females10, 18 including the HBSC survey.17 Overall, it is clear that the trends with regard to smoking in this area are in keeping with the national figures.17 The findings also show that regular smokers in 2002 were smoking more cigarettes daily than were regular smokers in 1997, which, as a result, heightens their risk of adverse health outcomes.

Regular smokers were shown to initiate smoking at an early age and this is significant in light of research indicating that earlier smoking onset predicts nicotine dependence and substance problems in young adulthood.19 Smokers were also more likely to live in households where others smoke and studies have shown that parental smoking significantly predicts smoking onset among adolescents.20 The finding in these studies that smokers typically buy their cigarettes themselves despite being under the minimum legal age has ramifications for retailers and those with responsibility for enforcing the law in the area.

The majority of the young people in both studies indicated that they had taken an alcoholic drink and over half were regular drinkers. This is comparable to the 15-17 year-old group in the HBSC survey.17 One important difference between these studies and the HBSC survey in this regard was that these studies defined regular drinking as having consumed alcohol in the last week whereas the HBSC17 refer to drinking in the last month. The high levels of regular drinking on a weekly basis by adolescents in these studies clearly highlight how serious the problem of alcohol consumption is in the region. Drinking more than ten drinks per week showed an increase, while binge drinking was also more prevalent in 2002 than in 1997. Well over half of respondents in both studies reported that they had drank enough to feel drunk, a finding similar to other studies8,10, while more than one-quarter of respondents in 2002 had felt drunk more than ten times and this was significantly greater than in 1997. ESPAD16 observed a higher rate of having been drunk at least once (72%) and having been drunk more than ten times (37%). Problems arise in making comparisons with international16 as well as with other national17 and regional studies, largely due to variations in terminology and the age-groups surveyed. These variations in methodology could account for some of the differences observed between these studies.

Despite being under the legal age requirement, it appears that young people have little difficulty sourcing alcohol themselves, with over half of those who have had a drink indicating that they buy alcohol in a pub. Even among those younger than 16 years who had taken alcohol, over one-quarter reported buying alcohol in a pub.

More young people in 2002 than in 1997 reported that they had taken an illicit drug at least once in their lives. ESPAD16 found a lower overall lifetime prevalence among Irish respondents than that found in the 2002 study. Indeed, the rate found was higher than any rate found in the countries surveyed by ESPAD, where the UK had the highest lifetime prevalence (37%).

Regular use of illicit drugs was also more frequently reported in 2002 than in 1997. Cannabis and, to a lesser extent, glue/solvents were the drugs most regularly used in both studies, while regular use of other illicit drugs was infrequently reported. This has also been shown in other studies conducted in Ireland.10, 11 Similar reports of regular use of specific illicit substances were observed by ESPAD16 as well as by other regional studies. 8,10,11

In summary, this study highlights that while fewer young people in the region are regularly smoking, regular alcohol consumption continues to remain high and is the main drug of misuse within the adolescent population in the region. In particular, binge drinking at weekends is a problem that has intensified since 1997. Lifetime prevalence and regular use of illicit substances have also shown an increase and it appears that cannabis is the drug of preference, with infrequent usage of other illicit drugs. These findings have implications for the development and implementation of strategies and services aimed at tackling the issues of tobacco, alcohol and drugs among young people in the north-eastern region.

Correspondence:
Declan Bedford, Department of Public Health,
North Eastern Health Board,
Railway St., Navan,Co. Meath.
Tel: +353 (046) 9076410

References
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