1. Are The Times A-Changin’? Trends in Adolescent Substance Use in Europe
Ludwig Kraus1,2, Nicki-Nils Seitz1, Daniela Piontek1 & The ESPAD Group
1) IFT Institut für Therapieforschung München 2) Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm Universität, Stockholm
Lisbon Addictions 2017
October, , Lisbon, Portugal

2. Background: Changing Behaviours
Wide divergences in substance use practices in Europe, both between and within countries, reflecting particular historical experiences and often cultural traits
A consistent theme in the analysis of trends has been the convergence in European drinking (Room, 2007)
In general, the world has become more interdependent: immigration, open borders, the internet, and the globalization of the economy
A common international culture, characterized by common behaviours, consumption patterns and values might emerge (Clarke, 2004)

3. Background: Changing Behaviours
Health Behaviour in School-aged Children (HBSC) (Kuntsche et al, 2011)
Results
decline in cultural differences due to an increase in the frequency of drunkenness in Eastern European countries and a decrease in Western countries
Explanations
transition to market economies of the formerly planned- economy societies
opening of borders and increasing alcohol advertising targeted to young people

4. Background: Change in Drinking
(Kuntsche et al, 2011)

5. Background: Change in Drinking
(Kraus et al, 2015)

6. Change in Youth Substance Use?
What's known
Decreasing per capita consumption in Europe, North America and Australia with trends in the total population considerably varying by country and World region
Decrease in consumption of tobacco and alcohol use in youth in some countries of the Western World
Mostly abstention and volume; rarely binge or heavy episodic drinking
What's not known
Is there a common pattern of temporal trends in the use of alcohol, tobacco and cannabis in different parts of Europe?
Are there regional differences in these trends?

7. Methods: ESPAD Survey
European Schoool Surevy Project on Alcohol and Other Drugs (ESPAD)
Since 1995
6 waves (every 4th year)
 30 countries
Same instrument and survey methodology
Substance use among 15‐ to 16 year-old students in regular schools
Tobacco, alcohol, illigal drugs: patterns of use, attitudes, risk perception, substance-related problems

8. Methods: Data & Indicators
Data selection
Cross-sectional survey at five time points: 1999, 2003, 2007, , 2015 (Hibell et al, 2000; Hibell et al, 2004; Hibell et al, 2009; Hibell et al, 2012; Kraus et al, 2016)
Trend data on 28 countries with data on at least 4 of the 5 time points and response rate ≥ 45%
Missing data: 1999: n=6; 2015: n=1; all other years complete
Ireland and U.K. had to be dropped !!
n = 223,814 boys and n = 211,712 girls
Missings ranged between 0.4% for cigarette use and 2.6% for heavy episodic drinking among girls

9. Methods: Data & Indicators
Indicators (time frame: last 30 days)
Prevalence of daily cigarette use: any amount
Prevalence of weekly alcohol use: ≥ 1 time
Prevalence of monthly heavy episodic drinking (HED): 5+, ≥ 9 cl ethanol
Prevalence of monthly cannabis use: ≥ 1 time

10. Methods: European Regions
European regions (adopted from United Nations, 2016)
Northern Europe: Denmark, Faroe islands, Finland, Iceland, Norway, Sweden
Southern Europe: Cyprus, Greece, Italy, Malta, Portugal
Western Europe: Belgium (Flanders), France, Germany (Bavaria), Netherlands
Eastern Europe: Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Russian Federation (Moscow), Slovak Republic, Ukraine,
Balkan States: Bulgaria, Croatia, Romania, Slovenia

11. Methods: Analyses Analyses
Trend analysis: multilevel mixed-effects logistic models with time as a linear, or linear and quadratic predictor
Regional trend comparisons: multilevel mixed-effects logistic models with survey year (linear and quadratic), region and the interaction region x survey year (full model) as predictors
Wald-Tests for pairwise regional differences (linear or quadratic)

12. Methode: Samples 1999 2003 2007 2011 2015 Country n %a)
1999
2003
2007
2011
2015
Country n
%a)
Northern Europe
Denmark
1546 56
2504 65
877 46
2181
42b)
1670
26b)
Faroe Islands
413
100
582 97
552
557
511
Finland
3003
99b)
3219
4988 99
3744 81
4049 85
Iceland
3457
3313 98
3510
3333 95
2663 79
Norway
3753 86
3745 77
3482
58b)
2938 28
2584 53
Sweden
3271 89
3212 87
3179
2569 80
2551 83
Southern Europe
Cyprus -
2142
98b)
6340
4243 76
2098
Greece
2195 94
1891
3060 88
5919
3202
Italy
4073
4818
9981
4837
4059
Malta
3635
3443
3668
3377
3326
Portugal
3577
2919
3141
1965 90
3456 96
Western Europe
Belgium (Flanders)
1291
1889d)
54b)
1798e)
1771e)
56b)
France
2266
2277
2916
2572
2714 93
Germany (Bavaria)
810
85c)
814
91c)
724
52c)
862
57c)
Netherlands
2613d)
94f)
2068d)
2091d)
2044d)
50b)
1684d)
43b)

13. Methode: Samples 1999 2003 2007 2011 2015 Country n %a) Eastern Europe
1999
2003
2007
2011
2015
Country n
%a)
Eastern Europe
Czech Republic
3543 99
3149
100
3901
3913 98
2738
96b)
Estonia -
2431 80
2372 90
2460 95
2452
Hungary
2726 92
3109
2817 94
3063 85
2735 93
Poland
3269
84f)
5842
2120
5934
11822
Latvia
2296
2816 97
2275
2622
1119 42
Lithuania
5028
2411
2476
2573
Russian Federation
2918
1883
1973
96 b)
1757 77
Slovak Republic
2437
2122
2468
2009
2208
Ukraine
2958
97b)
4114
2447
2210
2350
The Balkans
Bulgaria
2666
2353
2217
2922
Croatia
3555
2852
3008
3002
2558
Romania
2368
4323
2289
2770
3500
Slovenia
2347
2758
3085
3186
3484

14. Results: Daily Cigarette Use

15. Results: Weekly Alcohol Use

16. Results: Episodic Heavy Drinking

17. Results: Monthly Cannabis Use

18. Results: Regional Differences
Wald-Test
N vs. S
N vs. W
N vs. E
N vs. B
S vs. W
S vs. E
S vs. B
W vs. E
W vs. B
E vs. B
Linear time trend
Chi2 f)
Chi2
Daily cigarette use
Boys
1.37 f)
0.05 f) a)
5.92f)
1.36 f)
1.49 f)
4.83f)
Girls
0.46d)
Weekly alcohol use b) --
Heavy episodic drinking
Monthly cannabis use
2.80 e)
1.00 e)
0.50 e)
1.56 d)
Quadratic time trend c)
0.21e)
2.02e)
3.97 e)
Weekly alcohol use b)
0.44 g)
9.29 g)
27.30 g)
20.76 g)
8.27 g)
33.21 g)
21.32 g)
2.46 g)
2.48 g)
0.13 g)
0.76 f)
32.35 f)
5.47 f)
20.76 f)
6.28 f)
6.38 f)
3.83 g)
9.00 g)
4.00 g)
1.72 g)
2.88 g)
15.84 g)
0.16 g)
17.99 g)
3.59 g)
9.05 g)
36.08 d)
16.77 d)
Notes: N=Northern Europe; S=Southern Europe; W=Western Europe; E=Eastern Europe; B=Balkans; a) one or both trends not linear;
b) logistic regression models did not converge ; c) one or both trends not quadratic;
d)-g) Bonferroni adjusted p-values: d) p=0.05; e) p=0.017; f) p=0.008; g) p=0.005;

19. Discussion: Changes in Substance Use
General decrease in cigarette use in all regions
General decrease in alcohol use + HED in NE; decrease since 2007/11 in all other regions
Decrease in cannabis use in NE, WE and EE, increase in SE and B
Highest levels of use
Cigarette use: Eastern Europe & the Balkans
Alcohol use: Western & Southern Europe
HED: Similar with exception of Northern Europe
Monthly cannabis use: Western Europe
Convergence
No signs of general regional convergence
Cigarette use among girls rather diverging
Narrowing of gender differences in HED: boys de- and girls increase

20. Are the Times A‘Changin ?
Nordic States outstanding
A homogeneous and clear downward trend with the lowest levels of use in Europe across all substances observable in Northern Europe
Reasons for reduced substance use among youth
Not subject of the present analyses, although one might speculate
Many and overlapping factors influencing youth substance use
Cross-cultural as well as longitudinal research needs to be intensified and complemented by qualitative approaches
Viewing the broader spectrum of youth risk behavior as a consequence of structural, social, economic and cultural changes that emerge at particular times, future research also needs to incorporate a historical and generational perspective

21. Vielen Dank