Adolescents’ Risk Perception on Health of Drug Use: A European Comparative Analysis

Andrea Bonanomi, Università Cattolica del Sacro Cuore
Francesca Luppi, Bocconi University
Nicoletta Balbo, Bocconi University

Sociological literature provides few cross-country evidence of existing normalization processes in drugs use among adolescents in Western countries. They found that – on average - adolescents living in countries with high prevalence in substances use report a lower associated risk perception than adolescents living in low prevalence countries do. Moreover, results from recent studies show that polydrugs users are becoming a prevalent group among adolescent substance users. Our research aims to integrate the normalization approach with the new evidences about polydrugs consumption among adolescents. More specifically, using ESPAD data (waves: 2003, 2007 and 2011), the paper provides with a synthetic measure of risk perception related to substance use, which takes into account both the frequency of use and the type of substance. In addition, it tests whether, using comprehensive indexes for risk perception in drug use, the normalization thesis is confirmed in a European cross-country perspective.

Introduction

In Western societies, tobacco, alcohol and cannabis are the most widespread drugs among adolescents (Hibell et al. 2000; Johnston et al. 2003). Psychological studies have shown that the consumption of legal and illegal drugs among adolescents is related to low perception of health-related risks from their use (Hampson et al. 2001) and to social and individual risk factors.

Besides, there is the idea that a “normalization process” might also drive the diffusion of drugs use among adolescents (Parker et al. 1998). The normalization thesis claims that the normalized use of a substance is due to the diffusion of the drugs use from adolescents with tendencies to violate norms and already performing deviant behaviours to those attached to the conventional social norms (Parker et al. 2002). According to normalization framework, high substances use prevalent rate is associated with a widespread recreational drugs consumption, and consequently with a lower perception of the connected risk.

Sociological literature provides few evidence of existing normalization processes in drugs use among adolescents in Western countries, especially in cross-country comparative perspective (see Sznitman et al. 2013, 2015). Other studies have shown that polydrugs users – those who make use of more than one substance – are becoming a prevalent group among adolescent substance users in Europe and US (e.g. Choquet et al. 2003; Sneed et al. 2015).

Our research aims to integrate the normalization approach with the new evidences about polydrugs consumption among adolescents. More specifically, using ESPAD - European School Survey Project on Alcohol and Other Drugs data (2003, 2007 and 2011), the paper provides with a synthetic measure of risk perception related to substance use, which takes into account both the frequency of use and the type of substance. Additionally, it tests whether, using comprehensive indexes for risk perception in drug use, the normalization thesis is confirmed in a European cross-country perspective.

Sample and method

ESPAD survey collects data on adolescent aged 15-16, from 48 European countries. The perception of health risk related to substance use and use frequency is measured through 12 substance specific indicators. Next to them, the use of each substance is measured through two sets of variables, collecting information on the average consumption over the lifetime and during the last 30 days.

We explore the possibility of having a synthetic measure for the overall risk perception of drugs use, by performing a factor analysis using the Principal Axis Factoring extraction method and Promax rotation. The 12 items collapse in three factors, from which we derived three indexes of perceived risk related to: [1] sporadic use of illegal substances; [2] frequent use of illegal substances; [3] use of legal substances.

Results

Supporting the main findings in the literature on polydrug users, we found that correlations between the use of different drugs is always high.

About the trends of the perceived risk and the actual use of substances at the country level, we found quite diverging results. The perception of the risk associated with the use of legal and illegal drugs remains stable over time. However, the use of substances – both in the lifetime and in the last 30 days – significantly declines over time in most of the countries, especially for tobacco and cigarettes.

Looking at the macro correlations between the indexes of perceived risk and the actual use of substances, we found strong negative significant correlations (|ρ| > 0.5) between the three indexes of perceived risk and the use of illegal drugs. We also found moderate significant negative correlations between the perceived risk of sporadic use of illegal drugs and the use of alcohol and tobacco (|ρ| > 0.3).

In order to test whether the normalization thesis is supported by our data, we distinguished between countries where the substance use is normalized from those in which the substance use is not normalized. Comparing the means of the indexes, we found that in countries with high prevalence of substance use the perceived risk related to occasional use of illegal drugs is significantly lower if compared with countries with low prevalence.

Conclusion

By providing new synthetic measures of the perceived risk of drugs use, our paper substantially contributes to the literature on normalization and polydrugs consumption among young people.

Taking into account the behaviour of polydrugs use, our indexes are able to account for both the type of substance and the frequency of use. We also showed the stability and robustness of our indexes over time and across countries.

Finally, supporting the normalization thesis, we found a strong significant association between adolescent low-risk perception and high prevalence of substance use. However, the consumption of legal and illegal substances among adolescents is declining almost all countries, while the perception of the associated risks is quite stable and in general not increasing. This finding seems to go against the normalization thesis.

Presented in Session 1179: Health, Wellbeing, and Morbidity