Use of addictive substances and distress among 15-year-olds in Estonia, Latvia, Lithuania, and Poland

This presentation is about the use of addictive substances (cigarette smoking, use of alcohol, and use of e-ciga­rettes), their interrelations, and their associations with psychological distress among adolescents. We used data from 4 countries: Estonia, Latvia, Lithuania, and Poland. Data are from the 2021/22 data collection of the HBSC study. We used data pertaining to 15-year-olds only (n = 7595).
For tobacco smoking, we distinguished between 3 groups: having smoked cigarettes at least 6 days during the last 30 days (regular use), having smoked 1-5 days during the last 30 days (occasional use), or not having smoked any day during the last 30 days (non-use). Use of alcohol and e-cigarettes were categorised the same way.
Use of alcohol is more common in Poland with 11% of regular users, versus 4-7% in the other 3 countries. The proportion of regular and experimental drinkers in Poland is as high as 36%. Estonia has lower proportions of tobacco smokers (regular or experimental) than the other 3 countries, at 12% versus 19-23%. Again, Poland is the country with the highest prevalence, but only marginally higher than Latvia and Lithuania. Regu­lar use of e-cigarettes is more widespread than tobacco smoking and use of alcohol in all 4 countries, with numbers varying from 14% (Estonia) to 22% (Lithuania).
It turns out that all 3 behaviours are highly intercorrelated. Among non-users of alcohol, 3% were regular smokers, versus 47% among regular drinkers. Among non-users of alcohol, 7% were regular users of e-cigarettes, versus 68% among regular drinkers.
Use of e-cigarettes has been recommended as a less harmful alternative to smoking tobacco (harm reduction). If e-cigarettes really were an alternative behaviour, there could hypothetically be a negative association between them. This is not the case in our data. Forty-two per cent of the regular e-cigarette users were regular smokers, as opposed to only 1% among the never users of e-cigarettes. The total association between use of e-ciga­rettes and tobacco smoking corresponds to a gamma value as high as 0.89.
In the HBSC data collection there is a scale for the measurement of psychological and somatic distress (the HBSC Health Complaints Scale) with items covering aspects such as depression, anxiety, and headache. All 3 potentially addictive behaviours examined in this study (use of alcohol, tobacco smoking, and use of e-cigarettes) are associated with health complaints. When all 3 behaviours are combined by comparing non-users of all substances with regular users of all 3, the regular users of all 3 obtain much higher mean scores than the non-users. The difference corresponds to effect sizes of 0.63 (medium strong) for boys and 0.98 (strong) for girls (estimated with standard deviations for each gender separately). For many young people the use of addictive substances might serve a “self-medication” purpose.

DISCLOSURE

The authors report no conflict of interest.