European School Survey Project On Alcohol And Other Drugs Research Articles

Tranquilisers and sedatives misuse and associated factors among adolescents in Estonia: findings from cross-sectional ESPAD surveys, 2003–2019

ObjectivesThis study aimed to (1) to describe trends of tranquilliser and sedative (TS) misuse in Estonia during 2003–2019 and (2) to analyse the associations between TS misuse and explanatory factors...

Cultural Divergence in Psychedelic Use among Medical Students: An ESPAD-Adapted Survey among Poles and Iraqis.

Psychedelics can profoundly alter cognition and consciousness. Their use in Middle Eastern countries, including Iraq, is ambiguous. We aim to investigate psychedelic awareness and use among Iraqi and Polish medical students. We surveyed 739 university students from Poland (315) and Iraq (424) using 31 adapted questions from the European School Survey Project on Alcohol and Other Drugs (ESPAD). We conducted multivariable analyses based on binary logistic regression to identify the factors associated with psychedelic awareness and use. Most of the respondents were females (65.6%) and senior medical students (69.6%). Notably, the Polish students displayed a higher prevalence of psychedelic use (21.6% compared to 1.2%, p < 0.001), while the Iraqi participants exhibited a lower familiarity with psychedelics (p < 0.001). The multivariable model demonstrated a commendable level of statistical accuracy and satisfactorily conformed to the Hosmer-Lemeshow goodness-of-fit test (statistical accuracy = 91.61%, Nagelkerke R2 = 0.488, p-value = 0.848). Several factors emerged as correlates of increased psychedelic use, including lacking an intact religious belief system or commitment to its practice (OR = 7.26, 95% CI [2.33, 22.60]). Additionally, those who perceived a low risk associated with sporadic psychedelic use (3.03, [1.44, 6.36]) were likelier to engage in such behavior. Other factors included residing in Poland (2.82, [0.83, 9.55]), maintaining positive attitudes toward psychedelics (2.49, [1.20, 5.14]), frequent social nightlife activities (2.41, [1.26, 4.61]), male gender (2.05, [1.10, 3.85]), and cigarette or tobacco smoking (2.03, [1.06, 3.86]). Significant disparities exist between Poles and Iraqis, influenced by religiosity, perceptions of the usage risks, geographical location, gender, attitudes toward psychedelics, parental leniency, and social freedom, especially concerning nightlife activities. Addressing the factors influencing psychedelic usage is paramount to responsible psychedelic engagement and culturally sensitive interventions to prevent misuse.

Implications of the decline in adolescent drinking on the experience of alcohol-related consequences in the Nordic countries: A study based on data from the ESPAD project

Aims: The aim of this study was to investigate: (1) whether self-reported acute alcohol-related consequences among adolescents in the Nordic countries have declined in concert with the decline in alcohol consumption; (2) whether the relationship between alcohol consumption and alcohol-related consequences has strengthened; and (3) whether the decline in alcohol-related consequences can be attributed to the decline in alcohol consumption. Methods: Data are from the European School Survey Project on Alcohol and Other Drugs (ESPAD) cross-sectional surveys in 2007, 2011 and 2015. Participants were students aged 15–16 years in 2007 (n = 16,035), 2011 (n = 14,765) and 2015 (n = 13,517). Alcohol consumption variables included lifetime and 12-month alcohol use, volume ethanol at last drinking occasion and heavy episodic drinking in the past 30 days. Self-reported acute alcohol-related consequences were measured as a sum index of experiencing the following at least once within the last 12 months: (1) an accident or injury; (2) being victimised by robbery or theft; or (3) had trouble with the police. Results: For all alcohol indicators, adolescent alcohol use decreased between 2007 and 2015. The highest prevalence estimates were found in Denmark, and here only the number of current drinkers decreased significantly. In addition, a decreasing trend in self-reported acute alcohol-related consequences was observed. We did not find a strengthening of the alcohol consumption consequences association from 2007 to 2015, except in Iceland. When all surveys were combined, the decrease in alcohol-related consequences could be explained by a decrease in alcohol consumption. Conclusions: Overall, adolescents aged 15–16 years exhibited decreasing trends in both alcohol consumption, less markedly in Denmark, and in our sum index of alcohol-related consequences between 2007 and 2015. Except for Iceland, we found no support for a strengthening of the alcohol-consequences association with declining drinking among adolescents.

Cannabis reduction among adolescents as spillover from successful tobacco control

BackgroundNational programs that reduce adolescent cannabis use warrant renewed attention in light of current discussions to reform cannabis legislation, including the possibility of legalization for recreational use. This study measures the size of a decrease in a country's prevalence of adolescent cannabis use that accompanies a decrease in its prevalence of adolescents who had ever smoked a cigarette. MethodsData are from the European School Survey Project on Alcohol and Other Drugs (ESPAD), which is a collaborative effort of more than 40 European countries to surveil adolescent substance use. This study uses data from the seven survey administrations in 1995, 1999, 2003, 2007, 2011, 2015, and 2019. The main analysis is a fixed-effect regression analysis of country-level, four-year changes in adolescent lifetime cannabis use prevalence on country-level, four-year changes in adolescent lifetime cigarette use prevalence. ResultsDecreases in the national prevalence of adolescents who had ever smoked a cigarette were accompanied by decreases half as large in national prevalence of adolescent lifetime cannabis use. ConclusionFor European countries considering the legalization of adult recreational cannabis use, tobacco control can offer a tool to help counter potential increases in cannabis use among adolescents.

Religijos-viktimizacijos modulio link tarptautinio jaunimo delinkvencijos ir viktimizacijos tyrimo (ISRD) kontekste: mokymasis iš praeities pavyzdžių

The concept of postsecular society highlights the increasing relevance of religion in social, cultural, and political affairs. Given this trend, criminology should pay increasing attention to how religion is linked to victimization and offending. Since the religion–crime studies have traditionally focused on offending, the research lacunae are biggest in the study of victimization. The inclusion of religion is particularly relevant in international surveys in religiously heterogeneous communities. In this article, we aim to develop a survey module suggestion for use in the context of the International Self-Report Delinquency Study (ISRD). We first examine the current content of the ISRD-4 sweep. To locate lacunae in it, we move to review how international surveys have tackled the dimension of religion, including the Health Behaviour in School-aged Children (HBSC) study, the European School Survey Project on Alcohol and Other Drugs (ESPAD), the European Social Survey (ESS), the World Values Survey (WVS), and the International Crime Victim Survey (ICVS). Building on these state-of-the-art examples, we propose a new ISRD module (Appendix) for studying the religion–victimization link in international crime surveys with limited space. In conclusion, we argue that criminology would benefit from increasing attention to religion and other cultural variables alongside traditional socioeconomic, structural, and individual factors.

Odds of gambling among adolescents: a secondary analysis of the cross-sectional European School Survey Project on Alcohol and Other Drugs

BackgroundGambling among adolescents is associated with gambling disorder in adulthood. This study investigated factors associated with gambling and excessive gambling in adolescents. MethodsThis secondary analysis of the cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD) used nationally representative data from the Irish cohort of the 2019 ESPAD wave. Data were collected between March and May 2019. We included 1949 students aged 15–16 years (946 [48·5%] male, 1003 [51·5%] female), with a response rate of 85%. We calculated past year gambling prevalence as the rate of those who had gambled for money on at least one of four games of chance (slot machines, cards or dice, the lottery, betting on sports or animals) in the past 12 months. An adapted version of the three-item Consumption Screen for Problem Gambling was used to identify excessive gambling (score ≥4). We carried out descriptive and logistic regression analyses using binary covariates with Stata v16.1. We included 19 variables in the multivariable analysis. Ethics approval was granted by Dublin Institute of Technology's Ethics Committee. Non-consent forms were issued to all parents to opt out. FindingsOverall, 447 (23%) of 1949 students gambled in the past year, of whom 45 (10%) engaged in excessive gambling. Using a mutually adjusted multivariable logistic regression analysis, past year gambling was associated with alcohol use (adjusted odds ratio [aOR] 1·6, 95% CI 1·1–2·2), experiencing serious arguments (aOR 1·4, 1·1–1·9), and trouble with the police (aOR 1·9, 1·2–2·8). Female gender was a protective factor (aOR 0·6, 0·4–0·9). In the univariable analysis, excessive gambling was associated with gaming (OR 2·3, 1·0–5·1), tobacco use (2·1, 1·1–4·2), e-cigarette use (2·1, 1·1–4·1), heavy episodic drinking (2·7, 1·4–5·1), trouble with the police (2·8, 1·5–5·4, p<0·01), and deliberately hurting themselves (2·8, 1·4–5·6). Female gender (OR 0·3, 0·1–0·6) and social media use (0·4, 0·2–0·8) were protective factors. Excessive gambling was also associated with betting on sports and animals (OR 3·6, 1·6–8·4), slot machines (2·9, 1·5–5·8), card or dice (2·4, 1·2–4·6), and online gambling (4·2, 2·0–8·0). InterpretationA large proportion of 15–16 year olds in Ireland have gambled for money in the past year, with one in ten of those having engaged in excessive gambling. This number is likely to be underestimated due to recall and social desirability bias. Reducing the availability, access, and appeal of gambling products in Ireland should be addressed through ongoing gambling reform. FundingInstitute of Public Health.

Have there been changes in daily smoking and cigarette consumption among adolescents? Investigation between 1999 and 2019 among Finnish adolescents.

It is postulated that due to decreased smoking rates and increased denormalisation of smoking, those who start and maintain smoking have more socially disadvantaged characteristics and are more dependent on nicotine than those who do not (the so-called 'hardening' hypothesis). The aim of this study was to measure changes in daily smoking and cigarette consumption among Finnish adolescents according to background factors. A repeated cross-sectional study using data from European School Survey Project on Alcohol and other Drugs (ESPAD) on six representative cross-sections of 15- to 16-year-old students between 1999 and 2019 in Finland. A total of 11 377 males and 12 247 females. The outcome measures included the proportion of daily smokers among current smokers, daily smoking and the estimated mean number of smoked cigarettes per day (CPD). Substance use, parental monitoring and school performance were used as independent variables. All measures were self-reported. Daily smoking decreased over time and daily smokers constituted a smaller part of current smokers in 2019 compared with 1999 (the ratio among boys 0.68 and 0.43, respectively; among girls 0.59 and 0.43). Boys using cannabis (interaction between cannabis*survey year: P = 0.020; in 2019 odds ratio [OR]: 3.68, 95% confidence interval [CI] 2.23-6.08) and girls with heavy episodic drinking (interaction between heavy episodic drinking*survey year: P = 0.006, in 2019 OR: 9.00, 95% CI 5.61-14.42) had elevated adjusted odds for daily smoking over time. The estimated mean number of CPD decreased among daily smokers from 9.0 in 1999 to 7.2 in 2019 (P = 0.0002) and the differences diminished between groups based on gender, snus/alcohol use and parental monitoring. The between-group differences remained with regard to cannabis use (P = 0.0233 in 2019) and school performance (P = 0.0111 in 2019). Among currently smoking Finnish adolescents, the proportion of daily smokers decreased between 1999 and 2019, as did the number of cigarettes smoked per day (CPD) among daily smokers, suggesting an absence of 'hardening' in this group. However, differences were observed related to the odds of daily smoking and the mean number of CPD, indicating the change has been less favorable among some adolescent groups than others.

Relationship between Gaming and other game related activities: Italian validation of the Screening Test for Problematic Gaming (STPG)

IntroductionGaming is a common leisure activity among adolescents which may have risky implications. The aim of the present study is to validate the Italian version of a short screening instrument, the Screening Test for Problematic Gaming (STPG), which is composed of three items and it is able to distinguish between problematic and non-problematic gamers in a non-clinical population. MethodsData were collected through the ESPAD (European School Survey Project on Alcohol and Other Drugs) questionnaire. It is a cross-sectional school survey that investigates risky behaviours in a representative sample of Italian high-school students (N = 12,237; 50.8% girls) aged between 15 and 19 years (mean = 17.02 years). ResultsAfter the STPG was translated and adapted for Italian use, Principal Component Analysis and Multiple Correspondence Analysis were performed to investigate psychometric properties of STPG and calculate the optimal scaling for each item. Cronbach’s alpha was good (0.769).Finally, confirmatory factor analysis using Structural Equation Modelling was performed, showing a correlation between STPG score and time/money spent gaming (β = 0.467 and β = 0.238, respectively), places where students played (β = 0.142) and gaming apparatus (β = 0.165). ConclusionsThe STPG could be a short and useful instrument for school surveys, to detect problematic gaming among adolescents early on.

School segregation, selective education, and adolescents’ alcohol use – is there a connection?

ABSTRACT This study examines the connection between studying in selective classes and students’ alcohol use using data from the European School Survey Project on Alcohol and Other Drugs (ESPAD) from Finland. Linear probability models were used to investigate whether (1) studying in selective classes is associated with students’ recent heavy episodic drinking, and (2) whether parental education, students’ school success, and their friends’ alcohol use mediate the association. The results show that Finnish students who are selected for classes with a special emphasis engage less in heavy episodic drinking compared to their peers in non-selective classes. Parental education, school success, and friends’ alcohol use mediate part of the association. The results suggest that having the opportunity to apply for classes with a special emphasis might increase segregation between student groups and schools regarding risky behaviour such as heavy episodic drinking. Implications of urban and school policies on segregation are further discussed.

E-cigarette use and conventional cigarette smoking among European students: findings from the 2019 ESPAD survey.

Representative data on e-cigarette use among European adolescents are scant. This study reports current vaping and tobacco smoking individual and country-specific correlates among European students. Cross-sectional survey: 2019 European School Survey Project on Alcohol and Other Drugs (ESPAD) collecting data on risk behaviours on a representative sample of 16-year-old students. A total of 35 European countries, 25-30 with Tobacco Control Scale (TCS) and TCS components PARTICIPANTS: A total of 99 648 students (49.1% males) turning 16 years in the survey year. Data on current cigarette and e-cigarette use were gathered through a self-administered questionnaire which also collected socio-demographics and individual and family characteristics. ESPAD data were integrated with country-level data on TCS and selected TCS parameters to assess their association with the prevalence of current cigarette and e-cigarette use. Of the 99 648 participating students, 12.4% were current e-cigarette users, from 5.5% in Serbia to 41.4% in Monaco; 19.3% current smokers, from 5.1% in Iceland to 32.4% in Italy. Compared with non-users, current e-cigarette users less frequently came from an average well-off family [odds ratio (OR) =0.85, 95% confidence interval (CI) =0.80-0.90] and lived in countries with higher cigarette prices (OR =0.71, 95% CI =0.50-0.99), restrictive measures on tobacco advertising and promotion (OR =0.79, 95% CI =0.63-0.99) and intermediate implementation of tobacco control measures (OR =0.57, 95% CI =0.38-0.85). Current vapers were more frequently life ever smokers (OR =7.31, 95% CI =6.47-8.25), were early smokers (OR =4.35, 95% CI =3.66-5.17), males (OR =1.61, 95% CI =1.55-1.67), from non-traditional families (OR =1.43, 95% CI =1.34-1.53), with relatively low parental education (OR =1.15, 95% CI =1.10-1.20). Compared with non-smokers, current smokers had similar family characteristics to vapers, and were less likely to live in countries with higher cigarette prices (OR =0.70, 95% CI =0.49-0.99) and higher spending on public anti-tobacco media campaigns (OR =0.23, 95% CI =0.10-0.50). E-cigarette use among European adolescents is associated with weaker tobacco control measures, particularly on tobacco price, advertising and promotion. Besides preventing tobacco smoking, the adoption of governmental tobacco control policies in European countries also seems to contribute to the prevention of vaping among adolescents.

The Declining Trend in Adolescent Drinking: Do Volume and Drinking Pattern Go Hand in Hand?

Traditionally, adolescent drinking cultures differed between Nordic and Mediterranean countries; the former being characterised by low volume and relatively frequent heavy episodic drinking (HED). Across these drinking cultures, we examined the associations between alcohol volume and HED with respect to (i) secular trends at the country level and (ii) individual-level associations over time. The data stem from the European School Survey Project on Alcohol and Other Drugs (ESPAD) conducted among 15–16-year-olds in Finland, Iceland, Norway, Sweden, France and Italy, employing six cross-sectional surveys from 1999 to 2019 (n = 126,126). Both consumption volume and HED frequency decreased in all Nordic countries and displayed a curvilinear trend in France and Italy. In all countries, consumption volume and HED correlated highly over time at the country level. At the individual level, the correlation was positive but with a varying magnitude over time and between countries. In 1999/2003, the alcohol volume–HED correlation was significantly higher in the Nordic compared to the Mediterranean countries but became significantly weaker in Finland, Norway and Sweden and remained stable in France, Iceland and Italy during the period. In conclusion, while trends in consumption volume and drinking patterns went hand in hand at the aggregate level, the association at the individual level weakened over time in several Nordic countries, along with the substantial decline in adolescent drinking since 2000.

Problematic gaming risk among European adolescents: a cross-national evaluation of individual and socio-economic factors.

Background and AimsPrevious research has identified numerous risk and protective factors of adolescent problematic gaming (PG) at the individual and social levels; however, the influence of socio‐economic indicators on PG is less known. This study aimed to measure the contribution of individual and socio‐economic factors involved in PG risk among adolescents from 30 European countries.DesignMulti‐level logistic regression analysis of survey data from the 2019 European School Survey Project on Alcohol and Other Drugs (ESPAD) cross‐sectional study using self‐administered anonymous questionnaires.SettingThirty European countries.ParticipantsA representative cohort of 15–16‐year‐old students (n = 88 998 students; males = 49.2%).MeasurementsThe primary outcome measure was adolescents’ (low and high) risk of PG. Individual key predictors included self‐report assessments of socio‐demographic characteristics, time spent gaming and family variables (parental regulation and monitoring, family support). Main country‐level predictors comprised Gini coefficient for economic inequalities and benefits for families and children (% gross domestic product), retrieved from international public data sets and national thematic reports. The data analysis plan involved multi‐level logistic regression.FindingsParticipants who reported stronger parental regulation [odds ratio (OR) = 0.81, 95% confidence interval (CI) = 0.79–0.83] and higher family support (OR = 0.93, 95% CI = 0.91–0.95) reported lower risk of PG. At the country‐level, economic inequalities (OR = 1.05, 95% CI = 1.03–1.07) were positively associated with the risk of PG, while benefits for families and children (OR = 0.78, 95% CI = 0.70–0.89) were negatively correlated with the risk of PG.ConclusionsSupportive family environments, lower country‐level economic inequalities and higher government expenditures on benefits for families and children appear to be associated with a lower risk of problematic gaming among European adolescents.

Single, Dual, and Triple Use of Cigarettes, e-Cigarettes, and Snus among Adolescents in the Nordic Countries.

New tobacco and nicotine products have emerged on the market in recent years. Most research has concerned only one product at a time, usually e-cigarettes, while little is known about the multiple use of tobacco and nicotine products among adolescents. We examined single, dual, and triple use of cigarettes, e-cigarettes, and snus among Nordic adolescents, using data of 15–16-year-olds (n = 16,125) from the European School Survey Project on Alcohol and other Drugs (ESPAD) collected in 2015 and 2019 from Denmark, Finland, Iceland, Norway, Sweden, and the Faroe Islands. Country-specific lifetime use of any of these products ranged between 40% and 50%, and current use between 17% and 31%. Cigarettes were the most common product in all countries except for Iceland, where e-cigarettes were remarkably more common. The proportion of dual and triple users was unexpectedly high among both experimental (24%–49%) and current users (31–42%). Triple use was less common than dual use. The users’ patterns varied somewhat between the countries, and Iceland differed substantially from the other countries, with a high proportion of single e-cigarette users. More knowledge on the patterns of multiple use of tobacco and nicotine products and on the potential risk and protective factors is needed for targeted intervention and prevention efforts.

Friends and family matter Most: a trend analysis of increasing e-cigarette use among Irish teenagers and socio-demographic, personal, peer and familial associations

BackgroundE-cigarette ever-use and current-use among teenagers has increased worldwide, including in Ireland.MethodsWe use data from two Irish waves (2015, 2019) of the European School Survey Project on Alcohol and other Drugs (ESPAD) to investigate gender and teenage e-cigarette use (n = 3421 16-year-olds). Using chi-square analyses, we report changes in e-cigarette ever-use, current-use, and associated variables. Using multivariable logistic regression, we analyse the increase in e-cigarette use and socio-demographic, personal, peer and familial associations, focusing on gender differences.ResultsE-cigarette ever-use increased from 23% in 2015 to 37% in 2019, and current-use from 10 to 18%. Compared with 2015, the odds in 2019, of becoming both an e-cigarette ever-user and current-user, were significantly higher for girls than boys (ever-use: AOR 2.67 vs 2.04; current-use: AOR 3.11 vs 1.96). Smoking and e-cigarette use are linked but never-smokers who try e-cigarettes rose significantly from 33 to 67% and those using e-cigarettes to quit smoking decreased significantly from 17 to 3%. Almost two-thirds of respondents (66%) in 2019 said that their reason for trying e-cigarettes was “out of curiosity”. Peer smoking is significantly associated with likelihood of e-cigarette ever-use (AOR 6.52) and current-use (AOR 5.45). If “Most/All friends smoke”, odds were significantly higher for boys than for girls (ever-use AOR 7.07 vs 6.23; current-use AOR 5.90 vs 5.31). Less parental monitoring is significantly associated with greater e-cigarette ever-use (AOR 3.96) and current-use (4.48), and having parents who usually don’t know where their child is on Saturday nights was also associated with significantly higher odds for boys than for girls (ever-use AOR 5.42 vs 3.33; current-use AOR 5.50 vs 3.50).ConclusionRespondents had significantly higher odds of being e-cigarette ever- and current-users in 2019 compared with 2015. Use is higher among boys but girls are increasingly at risk. Two-thirds had never smoked cigarettes at first e-cigarette use; two-thirds used out of curiosity but few (3%) for smoking cessation. The most prominent risk factors for e-cigarette use were peer- and parent-related, especially so for boys. Interventions that take account of friend and family influences may provide mechanisms for preventing an increasing risk of nicotine addiction.

Changes in Alcoholic Beverage Choice and Risky Drinking among Adolescents in Europe 1999-2019.

This paper explores trends in beverage preference in adolescents, identifies related regional differences, and examines cluster differences in key drinking measures. Data were obtained from the European School Survey Project on Alcohol and Other Drugs (ESPAD), covering 24 European countries between 1999 and 2019. Trends in the distribution of alcoholic beverages on the participants’ most recent drinking occasion were analysed by sex and country using fractional multinomial logit regression. Clusters of countries based on trends and predicted beverage proportions were compared regarding the prevalence of drinkers, mean alcohol volume and prevalence of heavy drinking. Four distinct clusters each among girls and boys emerged. Among girls, there was not one type of beverage that was preferred across clusters, but the proportion of cider/alcopops strongly increased over time in most clusters. Among boys, the proportion of beer decreased, but was dominant across time in all clusters. Only northern European countries formed a geographically defined region with the highest prevalence of heavy drinking and average alcohol volume in both genders. Adolescent beverage preferences are associated with mean alcohol volume and heavy drinking at a country-level. Future approaches to drinking cultures need to take subpopulations such as adolescents into account.

Association of Cannabis Use and Neurodevelopment Among Adolescents

Source: Albaugh MD, Ottino-Gonzalez J, Sidwell A, et al Association of cannabis use during adolescence with neurodevelopment [published online ahead of print June 16, 2021]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2021.1258Investigators from multiple institutions reviewed data from a longitudinal study to assess the association between cannabis use during adolescence and cerebral cortical thickness development as measured using MRI. Participants were enrolled in the IMAGEN study, conducted across 8 European sites, when they were approximately 14 years old. Using a standard protocol, MRI scans were obtained of the adolescents’ brains at enrollment and a 5-year follow-up visit. In addition, at baseline and at follow-up, study participants completed the European School Survey Project on Alcohol and Other Drugs (ESPAD), in which lifetime use of alcohol, nicotine, and cannabis is self-reported using a 7-point scale with usage ranging from “never” to “>40 times.” Only youths who reported never using cannabis at baseline and had baseline and 5-year data were included in the present study. At the 5-year follow-up, participants also completed the Barratt Impulsiveness Scale, a 30-item self-report that assesses 3 domains of impulsiveness (attentional, non-planning, and motor). Alcohol consumption was estimated at baseline and 5-year follow-up with the Alcohol Use Disorders Identification Test Consumption scale.Cross-sectional regression models were used to assess the association between lifetime cannabis use and local cortical thickness. Longitudinal models were used to identify areas of accelerated age-related cortical thinning associated with cannabis use and to evaluate the association between the 3 domains of impulsiveness as measured by the Barratt Impulsiveness Scale.A total of 799 youths who were cannabis-naïve at baseline were included in the analyses. Mean age of these participants at baseline was 14.0 ±0.4 years, and 56.3% were female. At the 5-year follow-up, 208 participants (26.0%) reported 1-9 lifetime uses of cannabis, and 161 (20.2%) reported 10 to >40 uses. On cross-sectional analysis, there was a dose-dependent, statistically significant negative association between cortical thickness in the left prefrontal and right prefrontal cortices and lifetime cannabis use assessed at the 5-year follow-up. No statistically significant relationships were found between lifetime cannabis use and cortical thickness on baseline MRI results, suggesting that differences observed at follow-up did not precede cannabis use. On longitudinal analysis, statistically significant associations between accelerated age-related thinning in both the left and right prefrontal cortices were found. There was no significant difference in the effects of cannabis on cortical thickness between females and males in either the cross-sectional or longitudinal analyses. Cannabis-related cortical thinning in the right dorsomedial prefrontal cortex was significantly associated with more attentional impulsiveness as measured by the Barratt Impulsiveness Scale.The authors conclude that cannabis use during adolescence was associated with altered neurodevelopment.Dr Doolittle has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Cannabis use has become more popular and socially accepted in recent years. Many states have decriminalized marijuana use and expanded licensing for dispensaries.1 Nearly 50% of adolescents consider marijuana to be easily accessible, and 28% believe it to have no or low health risks.1 Nearly 1 in 10 persons older than 12 years of age has used marijuana within the past month.2 Large studies of marijuana derivatives, such as tetrahydrocannabinol and cannabidiol, have demonstrated improvement in a range of medical conditions, such as chemotherapy-related nausea, spasticity in multiple sclerosis, and chronic pain.3,4 As marijuana becomes more widely accepted, however, its deleterious effects are often overlooked. This is especially important among adolescents, whose cerebral cortex has not yet fully matured.5 In fact, the current authors describe thinning of the cerebral cortex of adolescent brains based on the cumulative dose of marijuana ingested. In addition, these anatomic effects are associated with a measurable behavioral change: attentional impulsiveness.While the decriminalization of marijuana has resulted in important legal reform, marijuana is best regarded as a drug, akin to alcohol. Use by adolescents ought to be discouraged, except when its medical benefit exceeds its potential harmful effect. While the investigators in the current study do not address the impact of marijuana beyond the 5-year follow-up, other large population studies highlight the association of marijuana use and harmful outcomes, such as respiratory problems, increased depression and anxiety, impaired executive function, poor school performance, and poverty.6,7The current study is the largest longitudinal study of its kind, making an important contribution to ongoing debate of marijuana’s harm and efficacy. Despite marijuana’s increasing popularity, pediatric caregivers should continue to advise caution.Marijuana use among adolescents is associated with cortical thinning and increased impulsiveness.

Trends in alcohol consumption among adolescents in Europe: Do changes occur in concert?

ObjectiveThe present paper extends the scope of testing Skog’s theory on the ‘collectivity of drinking culture’ to adolescent alcohol use in 26 European countries. The aim was to 1) examine whether changes in adolescent alcohol use are consistent across different consumption levels, and 2) explore whether trends in heavy and light drinkers diverged or converged. MethodData came from six waves of the cross-sectional European School Survey Project on Alcohol and other Drugs (ESPAD) between 1999 and 2019. The sample consisted of n = 452,935 students aged 15–16 years. Trends in alcohol volume across consumption levels including abstainers were estimated by quantile regression models (50th, 80th, 90th and 95th percentile). Countries were classified according to trends showing (soft/hard) collectivity or (soft/hard) polarisation. Trends in heavy drinkers were compared with the population trend. ResultsTrends in alcohol consumption at different levels across 26 European countries in the period 1999–2019 were not homogeneous. Collective changes were found in 15 (14 soft/1 hard), and polarised trends in 11 countries (5 soft/6 hard). Collectivity was generally associated with a declining trend. In 18 countries, trends in heavy and light drinkers diverged. ConclusionAccepting some variation in the strength of changes across consumption levels, changes in many European countries occurred in the same direction. Yet, diverging trends at different consumption levels in most countries indicate a less beneficial change in heavy compared with light drinkers, implying that in addition to universal population-level strategies, intervention strategies targeting specific risk groups are needed to prevent alcohol-related harm.

Stronger alcohol-violence association when adolescents drink less? Evidence from three Nordic countries.

BackgroundSince 2000, adolescents’ alcohol use and heavy episodic drinking (HED) have declined in the Nordic countries. However, little is known about corresponding trends in alcohol-related harm and possible changes in the alcohol-harm association. The aims are to examine (i) whether the decline in HED was accompanied by a decline in alcohol-related violence (AV) and (ii) whether the strength of the HED-AV association changed concomitant with the decline.MethodsAnalysis of data from the European School Survey Project on Alcohol and Other Drugs (ESPAD), conducted among 15–16-year-olds in Iceland, Norway and Sweden in 2007 and 2015 (n = 17 027). Changes in proportions of AV and alcohol use past 12 months, and mean frequency of HED past 30 days were examined using Pearsons χ2-test and F-test, respectively. The HED-AV associations were estimated using logistic regression analysis.ResultsHED and AV proportions decreased from 2007 to 2015 in all countries. Among current drinkers (n = 8927), both HED frequency and AV proportion decreased in Norway (P < 0.001) and remained stable in Iceland. In Sweden, AV decreased (P < 0.001) whereas HED remained stable. The magnitude of the HED-AV association increased in Norway (Beta2015–2007 = 0.145, 95% CI 0.054–0.236), remained the same in Iceland and decreased in Sweden (Beta2015–2007 = −0.082, 95% CI −0.158 to −0.005).ConclusionsAmong youth in Iceland, Norway and Sweden, heavy episodic drinking and alcohol-related violence declined from 2007 to 2015. Among drinkers, the strength of the alcohol-violence association was moderated by the extent of heavy episodic drinking.

E-cigarettes and smoking in Irish teens: a logistic regression analysis of current (past 30-day) use of e-cigarettes

AimElectronic cigarette (e-cigarette) use among Irish teenagers has risen significantly. In 2019, prevalence of current use (last 30 days) among 15–17-year-olds was 17.3%. We examine social determinants of adolescent e-cigarette current use.Subject and methodsA stratified random sample of 50 schools in Ireland was surveyed in 2019, part of the European School Survey Project on Alcohol and other Drugs (ESPAD), with 3495 students aged 15, 16, and 17. Bivariate and multivariable logistic regression [providing adjusted odds ratios (AORs)] analyses were performed using Stata version 16.ResultsCurrent e-cigarette users were more likely to be male (AOR = 0.55, 95% CI:0.32–0.96, p < .01), younger (AOR = 0.34, 95% CI: 0.17–0.67, p = < .05), to participate in sport (AOR = 2.21, 95% CI: 1.05–4.65, p < .05), to have higher-educated parents (maternal higher education: AOR = 27.54, 95% CI: 1.50–505.77, p = < .05, paternal higher education: AOR = 2.44, 95% CI: 1.00–5.91, p < .05), and less likely to consider their families better off (AOR = 0.29, 95% CI: 0.13–0.65, p < .01), or to report familial support (AOR = 0.78, 95% CI: 0.64–0.95, p < .05). They were more likely to be cigarette smokers (AOR = 7.22, 95% CI: 3.97–13.12, p < .001), to report problem cannabis use (AOR = 3.12, 95% CI: 1.40–6.93, p < .01), to be ‘binge’ drinkers (AOR = 1.81, 95% CI : 1.00–3.32, p = .054), and to have friends who get drunk (AOR = 5.30, 95% CI: 1.34–20.86, p < .05).ConclusionBoys, smokers, binge drinkers, problem cannabis users, and sport-playing teenagers from higher-educated families, are at particular risk. As the number of young people using e-cigarettes continues to rise, including teenagers who have never smoked, improved regulation of e-cigarettes, similar to other tobacco-related products, is needed urgently to prevent this worrying new trend of initiation into nicotine addiction.

Cannabis Policy Changes and Adolescent Cannabis Use: Evidence from Europe.

Cannabis accounts for the largest share of the illicit drug market, with a high prevalence of use even among adolescents. To tackle this longstanding problem, many kinds of reforms to national cannabis control policies have been implemented in Europe, but their effectiveness is still unclear. This paper analyses the association between selected categories of cannabis policy reforms and changes in perceived cannabis availability and patterns of use among adolescents. Data from 20 European countries across 15 years were drawn from a novel database of the European school Survey Project on Alcohol and other Drugs (ESPAD). Our analysis is based on a Difference-in-Differences design, which application is allowed by the fact that only thirteen out of the twenty countries included implemented policy changes. The results suggest that selected categories of reforms influence the availability and prevalence of cannabis use. In particular, some forms of restrictive intervention reduce the general prevalence of use and more liberal reforms seem linked to an increase in the share of students initiating use of cannabis. We find no evidence of an effect of policy changes on the share of frequent users, which are presumably those more likely to develop use-related health consequences.