Abstract
BackgroundSubstance use and sexual risk behaviour affect young people's current and future health and wellbeing in many high-income countries. Our understanding of time-trends in adolescent health-risk behaviour is largely based on routinely collected survey data in school-aged adolescents (aged 15 years or less). Less is known about changes in these behaviours among older adolescents.MethodsWe compared two cohorts from the same geographical area (West of Scotland), surveyed in 1990 and 2003, to: describe time-trends in measures of smoking, drinking, illicit drug use, early sexual initiation, number of opposite sex sexual partners and experience of pregnancy at age 18-19 years, both overall and stratified by gender and socioeconomic status (SES); and examine the effect of time-trends on the patterning of behaviours by gender and SES. Our analyses adjust for slight between-cohort age differences since age was positively associated with illicit drug use and pregnancy.ResultsRates of drinking, illicit drug use, early sexual initiation and experience of greater numbers of sexual partners all increased significantly between 1990 and 2003, especially among females, leading to attenuation and, for early sexual initiation, elimination, of gender differences. Most rates increased to a similar extent regardless of SES. However, rates of current smoking decreased only among those from higher SES groups. In addition, increases in 'cannabis-only' were greater among higher SES groups while use of illicit drugs other than cannabis increased more in lower SES groups.ConclusionMarked increases in female substance use and sexual risk behaviours have implications for the long-term health and wellbeing of young women. More effective preventive measures are needed to reduce risk behaviour uptake throughout adolescence and into early adulthood. Public health strategies should reflect both the widespread prevalence of risk behaviour in young people as well as the particular vulnerability to certain risk behaviours among those from lower SES groups.
Highlights
Substance use and sexual risk behaviour affect young people’s current and future health and wellbeing in many high-income countries
We describe changes between 1990 and 2003 in smoking, drinking and illicit drug use and sexual risk behaviour, both overall and stratified according to gender and socioeconomic status (SES) and examine the effect of changes over time on the patterning of these behaviours according to gender and SES
We examined associations between each risk behaviour and age at each date. (Since early sexual initiation was based on retrospective data, we would not expect it to be associated with age at interview.) We used logistic regression to obtain odds ratios (ORs) for each risk behavior according to a one month increase in age, with further logistic regression including interaction parameters to examine whether the association with age differed for 1990 vs 2003, males vs females; or respondents from non-manual vs manual backgrounds
Summary
Substance use and sexual risk behaviour affect young people’s current and future health and wellbeing in many high-income countries. Our understanding of time-trends in adolescent health-risk behaviour is largely based on routinely collected survey data in school-aged adolescents (aged 15 years or less). Less is known about time-trends among older adolescents or young adults, among whom fewer data are routinely collected and where analyses may be limited by small numbers and the use of broad age categories such as 16-24 years [7,8,9], potentially masking differential trends in behaviours between those at either end of the age spectrum. Males are more likely to drink alcohol and use cannabis, the gender gap in these behaviours appears to have diminished in many countries [4,10]. Fewer data are available, results from a number of studies suggest that some of the changing gender patterns of health-risk behaviour observed among younger adolescents may have occurred among older adolescents or young adults [13,14,15]
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