Changes in patterns of adolescent substance use from 1988 to 2011 in Sweden: a latent class analysis

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Abstract Background Prevalence rates of adolescent substance use have shifted over time, although potential changes in nuanced patterns of substance use remain unexplored. We examined patterns of adolescent substance use in Sweden and changes in these patterns between 1988 and 2011. Furthermore, we investigated whether gender and internalizing problems were associated with substance use and whether these associations changed over time. Methods The sample included all 15-16-year-old students in Värmland County, Sweden (N = 20,057). Survey data were collected eight times between 1988 and 2011 and analyzed as four cohorts (1988/1991, 1995/1998, 2002/2005, 2008/2011). We measured alcohol, tobacco and inhalant use and internalizing problems. Results A latent class analysis showed that a three-class model fit the data best (i.e. non/low use, experimental use, and polysubstance use classes). Class- and item-response probabilities changed over time: fewer adolescents exhibited riskier substance use patterns in the later cohorts. Boys were more likely than girls to be in the polysubstance use class compared to the non/low use class across all cohorts (all ps < .001). Gender differences in experimental use differed across the cohorts. Adolescents who reported more internalizing problems were more likely to be included in the experimental and polysubstance use classes compared to the non/low use class (all ps < .001) and this effect did not change over the study period. Conclusions We extended the research on trends in rates of substance use by mapping how patterns of substance use changed over time as well as how the effects of gender and internalizing problems shifted. While fewer adolescents exhibited riskier patterns of substance use in the later cohorts, these patterns were associated with experiencing more internalizing problems across the study period. Prevention efforts could be more effective by targeting patterns of substance use rather than prevalence rates. Key messages We tested whether patterns of adolescent substance use changed from 1988 to 2011 in Sweden. Fewer adolescents showed riskier substance use patterns in the late 2000s than in the earlier study years. Gender differences shifted over time for experimental use but not polysubstance use. Internalizing problems were consistently associated with riskier substance use patterns across the study period.