1. Swedish Council for Information on Alcohol and Other Drugs
“Prevalence study, ESPAD 2015”
Tentative title:
The role of national policies and perceived availability for the use of alcohol, cigarettes and cannabis among European students
CAN
Håkan Leifman,
Director CAN
Swedish Council for Information on Alcohol and Other Drugs

2. The study
A study in collaboration with most ESPAD Principal Investigators
New finalised, but a work in progress
Different from ”previous draft”
Based on data from latest data collection in year 2015
Focus on use of alcohol cigarettes and cannabis use – the impact of availability and prices

3. Rationale
Despite declining trends in alcohol and smoking (and stable cannabis levels): still common among young people
Adolescent substance use causes harm
Thus, important to achieve further decreases
From a public health perspective: availability and prices among the most effective instruments for reducing consumption at the population level (most evidence from alc and cig)
Little research on the association between availability/price and use of alcohol, cigarettes and cannabis among adolescents
The aim of the present study is thus to address this topic

4. Multilevel approach Individual level:
each student’s answers on using alcohol, cigarettes and cannabis (frequency of using)
each student’s answers on perceived availability for each substance
for all three substances (perceived availability and use): using all response categories, thus not dichotomous measures

5. Multilevel approach Country level:
Not aggregating ESPAD-individual level data.
Instead: external country scales on comprehensiveness and strictness of alc -, tob- and cann policy
Alcohol: Scaling alcohol control policies in Europe (latest version refers to 2012 (sum of seven sub-scales) (Karlsson & Österberg)
Cigarettes: The Tobacco Control Scale latest update 2013 (sum of six sub-scales) (Joossens, L. and M. Raw)
Cannabis: Not available. We ‘created’ a simple new scale that measured the degree of decriminalization: the growth of cannabis, the sales of cannabis, and the possession of cannabis. (from 1 (all activities decriminalized) to 4

6. Multilevel approach Country level:
Prices
Purchasing power parity adjusted) on alcohol, tobacco obtained from Eurostat
Cannabis prices, from EMCDDA and then purchasing power parity adjusted (lowest price of the two series: cannabis resin, herbal cannabis)
Scales not available for all 35 ESPAD 2015-countries. In this study 24 countries included

7. Multilevel approach Individual level: Country level:
Perceived availability for alc, cig cann
Fq of use of alc, cig, cann past 30 days
Strictness of alc, cig cann policy
Prices on alc, cig cann

8. Results, country level: the relationship between tobacco policy scale, cig prices and frequency of smoking

9. Results, country level: the relationship between alcohol policy scale, alc prices and frequency of alcohol use

10. Results, country level: the relationship between degree of decriminalisation (crude scale), prices and frequency of cannabis use

11. Results, estimates from multilevel models (Poisson regression)
Smoking
Drinking
Cannabis use
EST SE p
Individual level:
Perceived availability
2.680
0.026
<0.001
2.232
0.014
4.092
0.029
Male
0.100
0.008
0.276
0.005
0.575
0.011
Country level:
Policy
-0.413
0.022
-0.315
0.072
-0.029
0.036
0.430
Price
-0.338
0.016
-0.773
0.052
-0.216
0.027
All covariates (except Male) were logged which implies that the estimates (except for Male) can be interpreted as elasticities: 1% increase in X leads to X% increase in Y.

12. Thus
Individual level: Perceived availability is strongly statistically significant for all substances; strongest for cannabis use
Country level:
The strictness of tobacco and alcohol policy is inversely related to freq. of smoking/alcohol use.
Legal regulation of cannabis is not related to the freq of cannabis use.
All price elasticities are statistically significant and of the expected sign; the strongest observed for drinking.
Thus, not only individual level association, also on the country level – countries’ policies: individual’s risk reduces with increased degree of strictness in national policies (cannabis?)
More or less – expected results. In line with previous result. Policies and prices matters?!

13. Strengths and limitations
A multilevel approach: using external country level data on “availability” and price (not aggregating ESPAD-individual level data) Using external policy scales that differentiate countries in degree of strictness (for alcohol and tobacco) Cannabis scale – very crude, be developed? Cross-sectional data: causality could work in both directions. Time dimension - use also earlier ESPAD-years? Could look different in different group of countries – not necessarily the same relationship in all countries. Maybe be developed?