Tobacco, alcohol and cannabis among adolescents

Alcohol, tobacco, and cannabis use and abuse by adolescents is a major public health problem in France. Myriam Khlat, Océane Van Cleemput, Damien Bricard and Stéphane Legleye[1] analyzed disparities in teenage consumption of these substances using data from the 2017 ESCAPAD survey conducted by the Observatoire Français des Drogues et des Toxicomanies (OFTD) with 40,000 17-year-olds. The study found consumption to be more closely linked to family living arrangement than socioeconomic milieu. Teenagers living in single-parent or blended families more often consume risky substances than those living in different family situations. However, parental separation cannot be said to cause teenage alcohol and drug use.

High levels of tobacco, alcohol, and cannabis use

France figures among the European countries most affected by teenage alcohol and drug abuse (www.espad.org). In 2017, 25% of young people aged 17 reported smoking every day; 16% had experienced at least 3 episodes of occasional heavy drinking (defined as having at least 5 glasses on a single occasion) in the previous 30 days; and 7% reported smoking cannabis regularly (at least 10 times in the previous 30 days). 

A strong association between family living arrangement and use of these substances

The transition from adolescence to adulthood is a key stage in the establishment of individuals’ health-related behaviors and lifestyles. The findings of this study show a strong association between tobacco, alcohol, and cannabis use in adolescence and family living arrangement. Having experienced family reconfiguration—the case for young people living in single-parent or blended families—is associated with more frequent use. However, this correlation does not mean there is a causal link between parental breakup and substance use. Adolescents may have started using substances before the change in family living arrangement, perhaps as a means to cope with the conflicts and stress that often precede breakup; it could also be that parental surveillance in the new family arrangement is simply not as strict, making substance use easier for teenage children. 

Sharper variations in cannabis and tobacco consumption than alcohol consumption

Overall, use variations by family situation are much greater for cannabis and tobacco than for alcohol (Figure 1 below). Taking teenagers living with both parents as the reference category, more young people living in other family configurations report regularly using cannabis. In those non-reference situations, young people living in a shared parental custody arrangement seem to consume the least cannabis, whereas those living solely with their father or in complex situations seem to consume the most. Daily smoking is more widespread in non-reference-type families, but the disparities between the different types are smaller than for smoking than regular cannabis consumption. Regarding cannabis, the increase in substance use risk (compared to the reference) is lower for young people in shared custody or living solely with their mother, and slightly higher for young people living solely with their father, a stepparent, or in other situations. Last, for occasional heavy drinking, the increase is slighter and overall differences with living-with-both-parents arrangements smaller than for the other substances, particularly for children living solely with their mother. 

Variation in risk of teenage substance use by family living situation (adjusted prevalence ratio)

More smoking in poorer socioeconomic groups, greater alcohol abuse in wealthier ones, cannabis use not sensitive to socioeconomic group

Teenage tobacco, alcohol, and cannabis use is also associated with socioeconomic group or milieu. However, that association is not as strong as the one found for family living arrangement. And it varies by substance. In less privileged family contexts, everyday smoking is more common—a finding comparable to what is generally observed for adults. Conversely, occasional heavy drinking is more frequently found in well-off families. It should be noted that family arrangement and socioeconomic milieu can be interdependent in several ways: risk of divorce differs in by socioeconomic group, and family breakup impacts a household’s economic situation. The study’s analyses take these interdependencies into account. 

Adapting prevention policies by family situations

Adolescence is a developmental period characterized by an increase in risky behaviors, and the study’s results clarify the importance of adapting substance use prevention policies to the specificities of this age group. Such an approach would benefit in particular by taking into account family living situation and functioning.

Data used

The study is based on data from the last edition of the Enquête Transversale Française sur la Santé et l’Usage de Substances [Transversal French survey on health and substance use], that was conducted annually from 2000 by the Observatoire Français des Drogues et des Toxicomanies (OFTD) on the country’s National defense and citizenship day (Journée de la Défense Nationale et de la Citoyenneté) (Enquête sur la Santé et les Consommateurs lors de l’Appel de Préparation à la Défense, or ESCAPAD) to track teenager psychoactive substance use. The findings are based on the responses of the 39,115 17-year-olds living in metropolitan France who answered the 2017 survey.

For more information, see 

Myriam Khlat, Océane Van Cleemput, Damien Bricard and Stéphane Legleye, 2020, "Use of tobacco, alcohol and cannabis in late adolescence: roles of family living arrangement and socioeconomic group," BMC Public Health 20: 1-9.