Demographic and Social Correlates of Tobacco, Alcohol and Cannabis Use Among 15-16-Year-Old Students in Albania: Results of the ESPAD Survey

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AIMS – Our aim was to assess the demographic and social factors associated with lifetime use of tobacco, alcohol and cannabis among school students aged 15–16 in Albania in order to make information and knowledge available for health promotion specialists working on substance use prevention. DESIGN – This cross-sectional study was conducted in March–May 2011 in the framework of the European School Survey Project on Alcohol and Other Drugs (ESPAD). In total, 3189 students born in 1995 participated in the survey. The standardised ESPAD questionnaire was used to collect data about substance use. RESULTS – Our multivariable adjustment analysis showed that being a male and having easy access to cigarettes were the only universal factors significantly increasing the likelihood of ever using tobacco, alcohol or cannabis. Own smoking was strongly and significantly associated with alcohol and cannabis use. The associations of own substance use with peer substance consumption were weak to moderate. CONCLUSIONS – Own smoking seems to be the most important single independent risk factor which strongly and significantly predicted alcohol and cannabis use among Albanian school students. Policy makers need to strengthen the rule of law whereas health promotion professionals should firmly address smoking in adolescence through target interventions.

ADHS (2009). Albania Demographic and Health Survey 2008–2009. Report. Institute of Statistics, Institute of Public Health (Albania) and ICF Macro. 2010. Tirana, Albania: Institute of Statistics, Institute of Public Health and ICF Macro.

Andrews, J. A., Tildesley, E., Hops, H., & Li, F. (2002). The infuence of peers on young adult substance use. Health Psychology, 21(4), 349–357.

ARHS (2002). Albania Reproductive Health Survey 2002. Report. Centres for Disease Control and Prevention (CDC), Institute of Public Health (IPH) and Institute of Statistics (INSTAT). Atlanta, Georgia, USA: CDC.

Bandason, T., & Rusakaniko, S. (2010). Prevalence and associated factors of smoking among secondary school students in Harare Zimbabwe. Tobacco Induced Diseases, 8, 12.

Barber, J. G., & Gilbertson, R. (1999). Drinker’s children. Substance Use and Misuse, 34, 383–402.

Bauman, A., & Phongsavan, P. (1999). Epidemiology of substance use in adolescence: Prevalence, trends and policy implications. Drug and Alcohol Dependence, 55(3), 187–207.

Biederman, J., Monuteaux, M. C., Mick, E., Wilens, T. E., Fontanella, J. A., Poetzl, K. M., Kirk, T., Masse, J., & Faraone, S. V. (2006). Is cigarette smoking a gateway to alcohol and illicit drug use disorders? A study of youths with and without attention defcit hyperactivity disorder. Biological Psychiatry, 59(3), 258–264.

Bloomfield, K., Gmel, G., Neve, R., & Mustonen, H. (2001). Investigating gender convergence in alcohol consumption in Finland, Germany, The Netherlands, and Switzerland: A repeated survey analysis. Substance Abuse, 22, 39–54.

Bozicevic, I., Gilmore, A., & Oreskovic, S. (2004). The tobacco epidemic in SouthEast Europe: Consequences and policy responses. WHO Tobacco Control Papers, Center for Tobacco Control Research and Education, UC San Francisco.

Burazeri, G., & Kark, J. D. (2010). Alcohol intake and its correlates in a transitional predominantly Muslim population in southeastern Europe. Addictive Behaviors, 35(7), 706–713.

CDC (2004). The health consequences of smoking: A report of the Surgeon General. US Department of Health and Human Services: Rockville, MD, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Offce on Smoking and Health, chapter 2, p42.

Chatterji, P. (2006). Illicit drug use and educational attainment. Health Economics, 15, 489–511.

Danielsson, A. K., Wennberg, P., Hibell, B., & Romelsjö, A. (2012). Alcohol use, heavy episodic drinking and subsequent problems among adolescents in 23 European countries: Does the prevention paradox apply? Addiction, 107(1), 71–80.

DiFranza, J. R., & Coleman, M. (2001). Sources of tobacco for youths in communities with strong enforcement of youth access laws. Tobacco Control, 10, 323–328.

Engberg, J., & Morral, A. R. (2006). Reducing substance use improves adolescents’ school attendance. Addiction, 101(12), 1741–1751.

Ennett, S. T., Bauman, K. E., Hussong, A., Faris, R., Foshee, V. A., & Cai, L. (2006). The peer context of adolescent substance use: Findings from social network analysis. Journal of Research on Adolescence, 16(2), 159–186.

ESPAD (2011). The European survey on alcohol and other drug use among young people in Albania in 2011. Report. Ministry of Health of Albania, Institute of Public Health of Albania, ESPAD, EMCDDA, CAN: ESPAD Albania (2011), ILAR Printing House, Tirana.

Falk, D. E., Yi, H., & Hiller-Sturmhofel, S. (2006). An epidemiologic analysis of co-occurring alcohol and tobacco use and disorders. Alcohol Research & Health, 29(3), 162–171.

Fenoglio, P., Parel, V., & Kopp, P. (2003). The social cost of alcohol, tobacco and illicit drugs in France, 1997. European Addiction Research, 9(1), 18–28.

Fergusson, D. M., Boden, J. M., & Horwood, L. J. (2006). Cannabis use and other illicit drug use: Testing the cannabis gateway hypothesis. Addiction, 101(4), 556–69.

Fergusson, D. M., Boden, J. M., & Horwood, L. J. (2008). The developmental antecedents of illicit drug use: Evidence from a 25-year longitudinal study. Drug and Alcohol Dependence, 96(1–2), 165–77.

Gronbaek, M., Becker, U., Johansen, D., Tonnesen, H., Jensen, G., & Sorensen, T. I. A. (1998). Population based cohort study of the association between alcohol intake and cancer of the upper digestive tract. British Medical Journal, 317, 844–848.

GYTS (2004). Global Youth Tobacco Survey, Albania (ages 13–15). Fact sheet.

Hall, W. D., & Lynskey, M. (2005). Is cannabis a gateway drug? Testing hypotheses about the relationship between cannabis use and the use of other illicit drugs. Drug and Alcohol Review, 24, 39–48.

Hanson, M. D., & Chen, E. (2007a).

Socioeconomic status and substance use behaviors in adolescents: The role of family resources versus family social status. Journal of Health Psychology, 12(1), 32–35.

Hanson, M. D., &Chen, E. (2007b). Socioeconomic status and health behaviors in adolescence: A review of the literature. Journal of Behavioral Medicine, 30(3), 263–285.

Hart, C. L., Smith, G. D., Hole, D. J., & Hawthorne, V. M. (1999). Alcohol consumption and mortality from all causes, coronary heart disease, and stroke: Results from a prospective cohort study of Scottish men with 21 years of follow up. British Medical Journal, 318, 1725–1729.

HBSC (2010). Currie C. et al. eds. Social determinants of health and well-being among young people. Health Behaviour in School-aged Children (HBSC) study: International report from the 2009/2010 survey. Copenhagen, WHO Regional Offce for Europe, 2012 (Health Policy for Children and Adolescents, No. 6.

Heath, J. (2004). Liberalization, modernization, westernization. Philosophy & Social Criticism, 30(5–6), 665–90.

Hibell, B., Guttormsson, U., Ahlström, S., Balakireva, O., Bjarnason, T., Kokkevi, A., & Kraus, L. (2012). The 2011 ESPAD report: Substance use among students in 36 European countries. The Swedish Council for Information on Alcohol and Other Drugs (CAN). Stockholm, Sweden.

INSTAT, Institute of Statistics, Albania.

Kenkel, D., Mathios, A. D., & Pacula, R. L. (2001). Economics of youth drug use, addiction and gateway effects. Addiction, 96, 151–164.

King, K. M., Meehan, B. T., Trim, R. S., & Chassin, L. (2006). Marker or mediator? The effects of adolescent substance use on young adult educational attainment. Addiction, 101(12), 1730–1740.

Kirby, T., & Barry, A. E. (2012). Alcohol as a gateway drug: A study of US 12th graders. Journal of School Health, 82(8), 371–379.

Kuntsche, E., Kuntsche, S., Knibbe, R., Simons-Morton, B., Farhat, T., Hublet, A., Bendtsen, P., Godeau, E., & Demetrovics, Z. (2011). Cultural and gender convergence in adolescent drunkenness: Evidence from 23 European and North American countries. Archives of Pediatrics and Adolescent Medicine, 165(2), 152–158.

Laaksonen, M., Prättälä, R., Helasoja, V., Uutela, A., Lahelma, E. (2003). Income and health behaviours: Evidence from monitoring surveys among Finnish adults. Journal of Epidemiology and Community Health, 57, 711–717.

Leatherdale, S. T., Hammond, D., & Ahmed, R. (2008). Alcohol, marijuana, and tobacco use patterns among youth in Canada. Cancer Causes and Control, 19(4), 361–369.

Leonard, K. E., & Rothbard, J. C. (1999). Alcohol and the marriage effect. Journal of Studies on Alcohol, Suppl.13, 139–146S.

Levy, D. T., Ross, H., Zaloshnja, E., Shuperka, R., & Rusta, M. (2008). The role of tobacco control policies in reducing smoking and deaths caused by smoking in an Eastern European nation: Results from the Albania SimSmoke simulation model. Central European Journal of Public Health, 16(4), 189–198.

Lindsay, G. A., & Rainey, J. (1997). Psychosocial and pharmacologic explanations of nicotine’s “gateway drug” function. Journal of School Health, 67(4), 123–126.

Ministry of Education and Sciences (2010). Ministry of Education and Sciences, Albania.

Ministry of Health (2014). Ministry of Health, Albania. Përafrimi i legjislacionit dhe zbatimi i ASQUIS të Bashkimit Evropian mbi shëndetësinë. (In Albanian). Retrieved from userfles/Integrimi/d4.doc. Last accessed: March 2014.

Moore, A. A., Gould, R., Reuben, D. B., Greendale, G. A., Carter, M. K., Zhou, K., & Karlamangla, A. (2005). Longitudinal patterns and predictors of alcohol consumption in the United States. American Journal of Public Health, 95(3), 458–465.

Ogilvie, D., Gruer, L., & Haw, S. (2005). Young people’s access to tobacco, alcohol, and other drugs. British Medical Journal, 331(7513), 393–396.

O’Loughlin, J., Karp, I., Koulis, T., Paradis, G., & Difranza, J. (2009). Determinants of frst puff and daily cigarette smoking in adolescents. American Journal of Epidemiology, 170(5), 585–597.

Pierce, J. P., Naquin, M., & Gilpin, E. (1991). Smoking initiation in the United States. Journal of the National Cancer Institute, 83, 1009–1013.

Pomerleau, J., McKee, M., Rose, R., Haerpfer, C. W., Rotman, D., & Tumanov, S. (2005). Drinking in the Commonwealth of Independent States: Evidence from eight countries. Addiction, 100(11), 1647–1668.

Prescott, E., Hippe, M., Schnohr, P., Hein, H. O., & Vestbo, J. (1998). Smoking and risk of myocardial infarction in women and men: Longitudinal population study. British Medical Journal, 316, 1043–1047.

Ranson, M. K., & Jha, P. (2002). Global and regional estimates of the effectiveness and cost-effectiveness of price increases and other tobacco control policies. Nicotine & Tobacco Research, 4(3), 311–319.

Rehm, J., Gnam, W., Popova, S., Baliunas, D., Brochu, S., Fischer, B., Patra, J.,

Sarnocinska-Hart, A., & Taylor, B. (2007). The costs of alcohol, illegal drugs, and tobacco in Canada, 2002. Journal on Studies on Alcohol and Drugs, 68(6), 886–895.

Room, R., & Rossow, I. (2001). The share of violence attributable to drinking. Journal of Substance Use, 6, 218–228.

Ross, H., Zaloshnja, E., Levy, D. T., & Tole, D. (2008). Results from the Albanian Adult Tobacco Survey. Central European Journal of Public Health, 16(4), 182–188.

Roy, A., Wibberley, C., & Lamb, J. (2005). The usual suspects: Alcohol, tobacco and other drug use in 15- to 16-year-old school pupils – prevalence, feelings and perceived health risks. Drugs: Education, Prevention and Policy, 12(4), 305–315.

SAMHSA (2012). Results from the 2011 National Survey on Drug Use and Health: Summary of national fndings. Report. Substance Abuse and Mental Health Services Administration, NSDUH Series H-44, HHS. Publication No. (SMA) 12-4713. Rockville, MD.

Shapo, L., Gilmore, A. B., Coker, R., McKee, M., & Shapo, E. (2003). Prevalence and determinants of smoking in Tirana city, Albania: A population-based survey. Public Health, 117(4), 228–236.

Single, E., Robson, L., Xie, X., & Rehm, J. (1992). The economic costs of alcohol, tobacco and illicit drugs in Canada, 1992. Addiction, 93(7), 991–1006.

Stinson, F. S., Ruan, W. J., Pickering, R., & Grant, B. F. (2006). Cannabis use disorders in the USA: Prevalence, correlates and co-morbidity. Psychological Medicine, 36(10), 1447–1460.

Swahn, M. H., Hammig, B. J., & Ikeda, R. M. (2002). Prevalence of youth access to alcohol or a gun in the home. Injury Prevention, 8, 227–230.

Torabi, M. R., Bailey, W. J., & Majd-Jabbari, M. (1993). Cigarette smoking as a predictor of alcohol and other drug use by children and adolescents: Evidence of the “gateway drug effect”. Journal of School Health, 63(7), 302–306.

UNODC (2013). World drug report 2013. United Nations Office on Drugs and Crime (UNODC). (United Nations publication, Sales No. E.13.XI.6).

Vakefliu, Y., Argjiri, D., Peposhi, I., Agron, S., & Melani, A. S. (2002). Tobacco smoking habits, beliefs, and attitudes among medical students in Tirana, Albania. Preventive Medicine, 34(3), 370–373.

Valenzuela, E., & Fernandez, M. (2011). The sequence of drug use: Testing the gateway hypothesis in Latin America. The Journal of International Drug, Alcohol and Tobacco Research, 1(1), 1–8.

Weisner, C. (2001). The provision of services for alcohol problems: A community perspective for understanding access. Journal of Behavioral Health Services and Research, 28, 130–142.

Welte, J. W., & Barnes, G. M. (1985). Alcohol: The gateway to other drug use among secondary-school students. Journal of Youth and Adolescence, 14(6), 487–498.

WHO (2011). Global status report on alcohol and health. World Health Organization, Switzerland.

YRBS (2009). Youth Risky Behaviour Survey, second round, 2009. Report. Institute of Public Health. Tirana, September.

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