INTRODUCTION: During adolescence, an individual can develop behaviours, which will affect his/her health, wellbeing and prosperity in adulthood. These behaviours include the use of psychoactive substances, which generally starts in adolescence. Foreign data show that tobacco, alcohol and cannabis use is common among adolescents; a substantial share of them is using more than one psychoactive substance. Many of them continue with the use of psychoactive substances in adult age, depending on the type of the substance. The use and co-use of psychoactive substances in adolescence are related to numerous short- and long-term unfavourable health, socioeconomic, psychosocial, cognitive and educational outcomes, as well as to higher probability of other risk behaviours, harmful use of psychoactive substances, and addiction. Several different factors influence the initiation, continuation and frequency of the psychoactive substances use among adolescents. These factors are related to individual’s characteristics, as well as their family, social and physical environment.
Studies in Slovenia showed that tobacco, alcohol and cannabis use among adolescents represents a public health issue and wider social problem; many indicators place us above the international averages. There are few available data on tobacco, alcohol and cannabis co-use, and on the factors related to their use and co-use. Thorough knowledge on the prevalence of the problem and on risk and protective factors related to use and co-use of psychoactive substances is key for effective prevention and reduction of psychoactive substances use. The objective of this publication is to improve knowledge in this area in Slovenia. The aim of the publication is to present the current state and factors related to tobacco, alcohol and cannabis use and co-use among 15-year-olds in Slovenia. In the beginning, there is a review of findings from foreign literature on factors related to tobacco, alcohol and cannabis use and co-use among adolescents. This is followed by data from analyses among Slovenian 15-year-olds.
METHODS: The publication presents data analyses for Slovenian 15-year-olds, which were obtained from international cross-sectional study Health-related Behaviour in School-aged Children from 2014. The questionnaire includes a set of questions on demographic, behavioural and psychosocial aspects of health including tobacco, alcohol and cannabis use. Based on the questions on tobacco, alcohol and cannabis use at any time in life, we have first calculated the shares of those, who have used tobacco, alcohol and/or cannabis at any time in life and presented the age at first use. After that, we are presenting the data on 15-year-olds who have reported on the more frequent/more risky use of at least one psychoactive substance (tobacco, alcohol, cannabis), and on those, who have reported on the frequent/more risky use of all three psychoactive substances. Frequent/more risky tobacco, alcohol and cannabis use was defined as smoking tobacco at least weekly or more frequent, drinking alcohol weakly or more frequent and/or being drunk at least twice in life; and the use of cannabis at least three days in the last 12 months. We have included numerous factors from different groups (individual, family, school, peer factors, mental health, (un)healthy lifestyle and early sexual intercourse, socioeconomic position) into the analyses on the relation between tobacco, alcohol and cannabis use and co-use. Using the logistic regression, we have then prepared seven individual models, one for each individual group of factors (individual, family, school, peer factors, mental health, (un)healthy lifestyle and early sexual intercourse, socioeconomic status), to identify those that are importantly related to tobacco, alcohol and/or cannabis use and co-use. Afterwards, we have included only factors that were statistically significantly related to tobacco, alcohol and/or cannabis use and co-use into the joint model of logistic regression.
Most 15-year-olds (84%) have used tobacco, alcohol and/or cannabis at least once in life (44% one, 22% two and 18% all three analysed psychoactive substances).
Most frequently, they have used alcohol and least frequently cannabis.
Tobacco, alcohol and/or cannabis use started at age 11 or less, while the shares rapidly increased with age.
Most frequently, they first drank alcohol, most often at age 12.
40% of 15-year-olds have reported on frequent/more risky use of at least one psychoactive substance – 25% of one (most frequently alcohol), 10% of two (most frequently tobacco and alcohol) and 5% of all three psychoactive substances.
Frequent/more risky use of at least one or all three psychoactive substances (tobacco, alcohol and cannabis) was related mainly to peer factors (peer tobacco and cannabis use, less with peer alcohol consumption and with frequent socializing with friends after 8 PM), and with (un)healthy lifestyle factors (irregular breakfast, every-day energy drinks consumption) and with early sexual intercourse, as well as with bullying, frequent fighting, feelings of depression and perceived lower support from teachers.
Our research showed the importance of family and school factors in tobacco, alcohol and cannabis use/co-use to a lesser degree than foreign sources, which could be due to the availability of variables in the study and to the combination of variables in the models.
Limitations of our research are related to the type of research (it is a cross-sectional study, which does not enable conclusions regarding causality and chronological order), self-reporting of data and the fact that only school-attending 15-year-olds are included in the study and not also school dropouts.
CONCLUSIONS: As the first of the kind published in Slovenia, our study showed the selected data on the initiation of tobacco, alcohol and cannabis co-use and on the factors related to frequent/more risky tobacco, alcohol and/or cannabis use and co-use on a representative sample of school-attending adolescents. A substantial share (15%) of 15-year-olds in Slovenia are frequent/more risky tobacco, alcohol and cannabis co-users; in these adolescents, we are detecting also other health-harming behaviours. Every tenth 15-year-old is frequently/more risky using at least two out of three analysed psychoactive substances (tobacco, alcohol, cannabis), whereas every twentieth uses all three. According to the scope of the problem, it is key to immediately plan and implement adequate measures. We propose the preparation of a joint national strategy for the prevention and reduction of addictions and risky behaviours. It is important that the strategy ensures the systemic implementation of measures, with this sustainable implementation and financing are established, as well as the activities in all key population groups, which will prevent health inequalities. It is essential to enable and encourage healthy choices in each individual since the early beginnings. Habits, obtained in childhood and adolescence, will be maintained in adulthood, and thus healthy individuals will be able to actively contribute to the development and welfare of the society. It is important to strengthen healthy lifestyles of adolescents and implement effective programmes for preventing use and further use of psychoactive substances. Programmes should be focused on several different psychoactive substances or risky behaviours; however, if they are focused on one individual psychoactive substance or risky behaviour, they should be harmonized with other programmes. Programmes need to be implemented early and adjusted to the age of children or adolescents. It is important to ensure their systemic implementation and activities in different environments (school, family, local community, etc.). With the implementation of legislative, economic and physical measures, it is necessary to change different environments in a way to reduce the exposure of children and adolescents to unhealthy, risky choices and to offer variety of healthy choices. One of the most important/effective ways is legislative action in this field, namely the introduction of comprehensive programmes and measures for the prevention and reduction of tobacco, alcohol and cannabis use. Next to the reduction of risk factors, we also need to strengthen protective factors, which reduce the risk of psychoactive substance use and co-use among adolescents. Regular monitoring of the state and further research are also among key activities in this field in Slovenia.