Dennermalm Nicklas, Karlsson Patrik, Ekendahl Mats
Stockholm University, Stockholm, Sweden.
Nordisk Alkohol Nark. 2022 Oct;39(5):535-552. doi: 10.1177/14550725221108792. Epub 2022 Sep 6.
The public health model for prevention of disease and disorder has been influential in informing interventions regarding substance use. While a number of risk factors within this model have been found to predict substance use, few studies have explored the associations across substances, at different time points and in the same individuals. The aim of this study was to test this model across legal and illegal substance use among adolescents, and to identify potential changes in associations over time. Data from two waves of a nationally representative cohort study among Swedish adolescents were used. Baseline data were collected in 2017 (9th grade) with a follow-up in 2019 (11th grade). Using modified Poisson regression analyses, we explored cross-sectional associations between factors from different domains and prevalence of cigarette use, binge-drinking and illegal drug use at both baseline and follow-up. The results in part supported the public health model. Substance use was predicted by factors within the family, school and the individual/peer domain, but several associations were not statistically significant. The only consistent risk factors across substances and time points were lack of parental monitoring, truancy and minor criminal activities. Despite widely different prevalence rates across substances, some risk factors were consistently associated with adolescent substance use. Nonetheless, the findings challenge the assumption that risk factors are stable over adolescence. They suggest a need for flexible prevention interventions spanning across substances and legal boundaries of substances, but also over domains to reflect the heterogenous needs of adolescents.
疾病和失调预防的公共卫生模式在为物质使用相关干预提供信息方面具有影响力。虽然已发现该模式中的一些风险因素可预测物质使用，但很少有研究探讨不同物质之间、在不同时间点以及在同一人群中的关联。本研究的目的是在青少年合法和非法物质使用方面检验该模式，并确定关联随时间的潜在变化。使用了来自瑞典青少年全国代表性队列研究两波的数据。2017年（九年级）收集基线数据，并于2019年（十一年级）进行随访。通过修正泊松回归分析，我们探讨了不同领域因素与基线和随访时吸烟、暴饮和非法药物使用患病率之间的横断面关联。结果部分支持了公共卫生模式。物质使用可由家庭、学校和个人/同伴领域内的因素预测，但一些关联在统计学上并不显著。跨物质和时间点唯一一致的风险因素是缺乏父母监督、逃学和轻微犯罪活动。尽管不同物质的患病率差异很大，但一些风险因素始终与青少年物质使用相关。尽管如此，研究结果挑战了风险因素在青少年时期稳定不变的假设。它们表明需要灵活的预防干预措施，这些措施不仅要跨越物质以及物质的合法界限，还要跨越不同领域，以反映青少年的多样化需求。
