Family and contextual factors associated with licit drug use in adolescence

Gomes, Monalisa Cesarino; Granville-Garcia, Ana Flávia; Neves, Erick Tássio Barbosa; Dutra, Laio da Costa; Ferreira, Fernanda Morais; Paiva, Saul Martins

doi:10.11606/s1518-8787.2021055003531

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Original Article • Rev. Saúde Pública 55 • 2021 • https://doi.org/10.11606/s1518-8787.2021055003531 copy

Family and contextual factors associated with licit drug use in adolescence

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

TO evaluate the family and contextual factors associated with licit drug use among 15 to 19-year-old adolescents in the school context.

METHODS:

This is a representative, school-based, cross-sectional study conducted with 746 adolescents from 15 to 19 years old enrolled in public and private schools. Parents/guardians reported on the sociodemographic variables, while adolescents answered questionnaires on drug use, family cohesion and adaptability, oral health literacy and visits to the dentist. Information on school context was obtained at the institution and via municipal publications. Associations between variables were analyzed using unadjusted and adjusted multilevel Poisson regression models.

RESULTS:

Prevalence of licit drug use at least once and a pattern indicative of harmful drug use were 39.8% and 15.1%, respectively. After the adjusted analysis of licit drug use at least once, the variables gender (PR = 1.26; 95%CI: 1.01–1.59), family cohesion (PR = 9.81; 95%CI: 1.23–72.54), and average income of the school district (PR = 0.72; 95%CI: 0.57–0.91) remained in the final model. As for drug abuse, only the detached type (PR = 23.01; 95%CI: 2.46–214.87) and separated type (PR = 13.54; 95%CI: 1.40–130.97) of family cohesion remained in the final model.

CONCLUSION:

Experience with licit drug use was associated with family and contextual factors among the adolescents, while family cohesion was the main factor related to harmful drug use.

DESCRIPTORS:
Adolescent; Drug Users; Underage Drinking; Tobacco Smoking; Risk Factors; Socioeconomic Factors; Family Relations

Variable			Licit drug use sometime in life			Harmful substance use
Variable			n%	p	PR (95%CI)	n%	p	PR (95%CI)
Individual level
	Gender
		Female	38.5		1.00	14.0		1.00
		Male	41.7	0.194	1.17 (0.92–1.50)	16.9	0.609	1.13 (0.69–1.85)
	Parent/Guardian’s schooling level
		≤ 8 years of study	41.3	0.015	1.35 (1.06–1.73)	17.1	0.198	1.39 (0.84–2.31)
		> 8 years of study	38.0		1.00	12.7		1.00
	Monthly family income
		≤ R$937	41.9	0.203	1.20 (0.90–1.59)	17.3	0.015	1.94 (1.13–3.32)
		> R$937	35.2		1.00	11.5		1.00
	Parent/Guardian’s marital status
		Married	38.2		1.00	12.4		1.00
		Single/Divorced/Widowed	41.5	0.362	1.12 (0.87–1.43)	18.4	0.015	1.81 (1.12–2.93)
	Race
		White	32.7		1.00	13.3		1.00
		Non-White	42.6	0.163	1.23 (0.91–1.65)	15.9	0.844	1.05 (0.60–1.83)
	Number of residents in home
		< 6	39.7		1.00	15.0		1.00
		≥ 6	39.2	0.990	1.01 (0.72–1.38)	14.4	0.409	0.76 (0.40–1.44)
	Family cohesion
		Detached	48.0	0.017	8.85 (1.48–52.67)	20.1	0.002	27.10 (3.35–218.80)
		Separated	35.0	0.060	5.59 (0.93–33.55)	11.7	0.020	12.31 (1.48–102.02)
		Connected	30.6	0.091	4.75 (0.77–29.09)	9.9	0.066	7.67 (0.87–67.25)
		Enmeshed	13.3		1.00	6.7		1.00
	Family adaptability
		Chaotic/Very flexible	36.8		1.00	20.2		1.00
		Flexible	40.0	0.891	1.02 (0.73–1.42)	14.7	0.162	0.66 (0.37–1.18)
		Structured	42.6	0.935	0.98 (0.69–1.39)	14.4	0.343	0.72 (0.37–1.40)
		Rigid	38.5	0.891	1.02 (0.68–1.54)	10.7	0.609	0.81 (0.36–1.81)
Contextual level: School
	Type of school
		Public	42.5	0.093	1.24 (0.96–1.60)	18.7	0.003	2.42 (1.35–4.37)
		Private	34.5		1.00	8.0		1.00
	Number of adolescents in classroom		-	0.190	0.99 (0.97–1.01)	-	0.276	0.98 (0.96–1.01)
	School district average monthly income
		< monthly minimum wage	33.4	0.017	0.74 (0.58–0.94)	13.7	0.528	0.86 (0.54–1.36)
		≥ monthly minimum wage	44.4		1.00	16.2		1.00
	Number of healthcare teams		-	0.242	0.98 (0.94–1.01)	-	0.927	1.01 (0.94–1.06)
	Sale of alcoholic beverages near school
		No	40.3	0.234	1.15 (0.91–1.45)	14.9	0.276	1.28 (0.82–1.99)
		Yes	39.1		1.00	15.5		1.00

Fixed effects			Model 1 (“null”)	Model 2	Model 3
Fixed effects			PR (95%CI)
Intercept			0.40 (0.35–0.45)	0.04 (0.01–0.26)	0.04 (0.01–0.35)
Individual level
	Gender
		Female		1.00	1.00
		Male		1.29 (1.02–1.62)	1.26 (1.01–1.59)
	Parent/Guardian’s schooling level
		≤ 8 years of study		1.21 (0.95–1.54)	1.23 (0.94–1.62)
		> 8 years of study		1.00	1.00
	Race
		White		1.00	1.00
		Non-White		1.23 (0.93–1.62)	1.25 (0.95–1.66)
	Family cohesion
		Detached		8.37 (1.38–50.80)	9.81 (1.23–72.54)
		Separated		5.63 (0.92–34.34)	6.73 (0.90–50.24)
		Connected		5.16 (0.83–32.14)	5.80 (0.76–44.20)
		Enmeshed		1.00	1.00
Contextual level: school
	Type of school
		Public			0.92 (0.67–1.27)
		Private			1.00
	School district average monthly income
		< monthly minimum wage			0.72 (0.57–0.91)
		≥ monthly minimum wage			1.00
	Number of adolescents in classroom				0.99 (0.98–1.01)
		Random effects
		Deviance (-2 log likelihood)	57,679,175	52,727,713	50,603,679

Fixed effects			Model 1 (“null”)	Model 2	Model 3
Fixed effects			PR (95%CI)
Intercept			0.16 (0.12–0.21)	0.01 (0.01–0.09)	0.01 (0.01–0.07)
Individual level
	Monthly family income
		≤ R$937		1.48 (0.82–2.69)	1.15 (0.66–1.99)
		> R$937		1.00	1.00
	Parent/Guardian’s schooling level
		≤ 8 years of study		0.98 (0.56–1.73)	0.84 (0.47–1.50)
		> 8 years of study		1.00	1.00
	Parent/Guardian’s marital status
		Married		1.00	1.00
		Single/Divorced/Widowed		1.49 (0.86–2.57)	1.39 (0.82–2.35)
	Family cohesion
		Detached		23.73 (2.59–216.86)	23.01 (2.46–214.87)
		Separated		13.18 (1.40–123.76)	13.54 (1.40–130.97)
		Connected		7.13 (0.67–75.61)	7.65 (0.70–82.95)
		Enmeshed		1.00	1.00
	Family adaptability
		Chaotic/Very flexible		1.00	1.00
		Flexible		0.66 (0.35–1.25)	0.67 (0.36–1.26)
		Structured		0.66 (0.33–1.31)	0.64 (0.32–1.29)
		Rigid		0.77 (0.37–1.58)	0.76 (0.37–1.54)
Contextual level: School
	Type of school
		Public			2.10 (0.95–4.64)
		Private			1.00
		Random effects
		Deviance (-2 log likelihood)	34,557,746	23,598,829	23,345,729

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[1] Correspondence: Ana Flávia Granville-Garcia, Rua Baraúnas, 351- Bairro Universitário 58429-500 Campina Grande, PB, Brasil E-mail: anaflaviagg@hotmail.com