Substance Use Among Middle School Adolescents: Association with Family Members’ and Peers’ Substance Use and the Mediating Role of School and Mental Difficulties

Abstract

Objective

We assessed the associations of substance (alcohol, tobacco, cannabis, and other illicit drugs) use of adolescents with that of their family members (father, mother, step-parent, brothers/sisters, and grandparents) and peers, and the mediating role of school and mental difficulties (SMDs) which remained insufficiently addressed.

Methods

This cross-sectional population-based study included 1,559 middle-school adolescents in France (mean age = 13.5 ± 1.3, 778 boys, 781 girls). They completed a questionnaire including socioeconomic features (nationality, family structure and parents’ education, occupation, and income), substance use, cumulative number of substance use of family members (father, mother, step-parent, brothers/sisters, and grandparents) and peers (noted familySUcn and peerSUcn), SMDs (grade repetition, suffered physical/verbal violence, sexual abuse, lack of family/peer support, depressive symptoms, suicide attempt, and age at onset). Data were analyzed using logistic regression models and Kaplan–Meier estimates.

Results

Most adolescents had familySUcn 1–2, 3–5, and ≥ 6 (39.1%, 23.0%, and 4.5%, respectively) and peerSUcn 1–2 and ≥ 3 (36.1% and 13.0%, respectively). Strong dose–effect associations were found between all substance use and familySUcn and peerSUcn (odds ratio adjusted for sex, age, and socioeconomic features reaching 13.44 and 9.90, respectively, most with p < .001). SMDs explained more the associations of all substance use with familySUcn than with peerSUcn (contributions reaching 69% and 34%, respectively). The proportion of subjects without each substance use decreased with age more quickly among the adolescents with higher familySUcn or peerSUcn.

Conclusions

Early prevention reducing familySUcn, peerSUcn and SMDs among adolescents and their families may reduce efficiently initiation and regular use of substances during adolescents’ life course.

Highlights

• Many adolescents had a high cumulative number of family members’ and peers’ substance (alcohol, tobacco, cannabis, or other illicit drugs) use (familySUcn and peerSUcn)

• Strong dose–effect links of substance use with familySUcn and peerSUcn (odds ratio up to 13)

• School and mental difficulties explained up to 69% of the link of substance use with familySUcn and up to 34% of that of substance use with peerSUcn

• The proportion of subjects without each substance use decreased with age more quickly among the adolescents with higher familySUcn/peerSUcn than among the others

• Our results may help implementing prevention to reduce substance use

Acknowledgments

The authors would like to thank the staff of the schools for their valuable help in the study. This research involved a French national institute with public funds and did not receive specific funds.

Disclosure statement

No potential conflict of interest was reported by the author(s).

AUTHORS’ CONTRIBUTION

KC conceived and conducted the survey, performed the statistical analysis, and wrote the article. NC participated in conceiving the survey, statistical analysis, and writing of the paper. All authors read and approved the manuscript and its submission to the journal. The authors agree to the ICMJE statements.

ETHICAL APPROVALS

This study was approved by the National Commission for Data Processing and Freedoms (national review board, declaration number 1,408,688) and the regional education authority.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/00332747.2024.2303897.

Additional information

Funding

This research involved our French national institute with public funds.

Notes on contributors

Kénora Chau

Kénora Chau, MD, Ph.D., is Assistant Professor of General Medicine at the Lorraine University and INSERM Unit 1433, Nancy, France. Her research interests include health determinants, needs and barriers to primary-care access. Her achievements include 37 articles, 33 congress presentations; reviewer for 9 journals.

Nearkasen Chau

Nearkasen Chau, Ph.D., is Research Director at the French National Institute for Health and Medical Research since 1978, unit 1178, Center of Epidemiology and Population Health, South-Paris and Paris Descartes Universities. His research concern mathematics, informatics, epidemiology, clinical research, public health, occupational health, and adolescent health.