Use of tobacco, alcohol and cannabis in late adolescence: roles of family living arrangement and socioeconomic group

Adolescence is a developmental period of heightened risk-taking behaviours, with substance use and misuse at the forefront of the health concerns. In epidemiological surveys, consumption of tobacco, alcohol and cannabis are appreciable from early adolescence, accelerate in late adolescence and culminate in the early twenties [1]. Analysing the contexts related to the engagement in those behaviours during the course of the transition between adolescence and adulthood is essential for prevention purposes.

Family factors hold a good place as predictors of adolescent substance use [2], with a prominence of two dimensions: family living arrangements and family socioeconomic level. Regarding the former, prior research has provided evidence for a strong association between substance use and not living with both parents, i.e. living in “non-intact families”, be they single parent families or stepparent families. However, the increasing diversity of “non-intact families” is not yet fully explored, and particularly the situation of single father families and that of single-parents sharing custody deserve further attention [3]. On the other hand, findings may be context-specific, as it has been suggested that the rarer a family configuration, the stronger its association with youth consumption [4], and at the opposite the greater the availability of a substance, the stronger its association with the different types of “non-intact families” [5].

Socioeconomic background also exerts an influence on adolescents’ substance use. Among adults, there is a social gradient in health-related behaviours, but the relation between socioeconomic status (SES) and health does change across the lifespan [6, 7]. For adolescents and young adults, variable patterns have been found, depending on substance and study context. Lower family SES has generally been associated with greater prevalence of cigarette smoking, with differences across countries [8‐10]. For the other substances, findings are not consistent, with some studies reporting a negative association of cannabis and alcohol consumption with family SES among adolescents [11], and others no clear relation [6]. There is also evidence that adolescents with higher SES may be at risk for developing substance use disorders [1, 12]. Overall, no coherent vision of the social gradient of substance use among adolescents emerges from the literature.

Another important aspect is that family structure and socioeconomic conditions are inter-related in several ways. First, there may be differences in the risk of divorce by occupational class, and in the United States adolescents in lower SES families were found to be less likely to live with both their parents than those from middle and upper-class families [13, 14]. Second, family disruption affects material circumstances of the household. Notably, single-parent families, and particularly single mother families, are more likely to experience economic hardship than intact families and than other types of non-intact families such as stepparent families [4, 15]. Socioeconomic factors may therefore at the same time confound and mediate the relationship of family structure to adolescent substance use. In the literature, the focus was put on one of the two factors, with a mere adjustment on the other, but there is a lack of research fully considering and discussing those inter-related dimensions as independent variables in their own right to explain disparities in adolescent smoking and drinking. Testing for gender-specific effects may also be relevant, as it has been hypothesized that children who live with their same-sex parent are in a better situation than their peers who live with an opposite-sex parent [16], or alternatively that girls may be more affected than boys by disruptions in their childrearing environment [17].

Our aims in this study are to explore disparities in adolescent substance use in France, considering at the same time the full diversity of family living arrangements and the socioeconomic group of the parents. France is currently one of the countries with the highest prevalence levels in Europe for early use of both legal and illegal psychoactive substances, despite improvements in prevention since the early 2000s, in young adults [18, 19] as well as in adolescents aged 15–16 years [20]. While daily tobacco smoking is on the decline, problematic alcohol-related behaviours are a source of concern, and the proportion of problem cannabis users increased in 2017 [21]. On the other hand, the number of divorces has considerably increased in France during the past two decades [15], and diversification of family configurations is well under way [15, 22]. The French context is therefore very well suited to a study of disparities in adolescent substance and the role of family factors.

We use a large-scale nationally representative survey conducted in 2017 in France, providing both family background information and substance use reports from late adolescents. The three most commonly used substances at adolescence are investigated, with a focus on daily smoking, binge drinking and regular cannabis use. Our research questions are:

For living arrangement, we compare the different configurations, and particularly the different non-intact types regarding their relation with substance use. We also test for gender-specific effects. Lastly, we assess whether the social pattern of use for the different substances is a classical one, with greater use in the most disadvantaged groups as is found in the literature on adults, or whether it is reversed or non-existent.

Descriptive statistics for the independent variables and substance use outcomes are presented in Table 1. Of all substances, tobacco was the most frequently used, with one adolescent out of four smoking on a daily basis. Binge drinking came next, with about 16% of the adolescents reporting at least three risky single-occasions drinking in the month preceding the survey. Regular cannabis use was rarer, as it concerned 7% of the adolescents. Males had higher prevalence than females, much more so for alcohol and cannabis (two-fold difference).

A small majority of respondents (57%) reported living in an intact family. Among non-intact family living arrangements, mother single parents were the most represented, concerning about 15% of all adolescents, followed by parent-stepparent families (9% of all adolescents), shared custody (6%) and father single parent families (about 4%). The distributions were quite similar for boys and girls, with slightly more girls living in mother single parent families and slightly more boys living in father single parent families.

Table 2 shows the prevalence ratios estimates (PR) associated with the two independent variables in the initial model (separate analyses) and in the full model (combined analyses). For all three substances, boys had higher prevalence than girls, with about a two-fold difference for binge drinking and cannabis. Age also mattered, and 18-year olds were consistently more frequent users than 17-year olds. The results confirm the relevance of family structure, as adolescents living in the different types of non-intact family arrangements had a significantly higher consumption compared to those living in an intact family.

For socioeconomic group, distinctive gradients were found. Daily smoking followed a classical but moderate gradient, increasing with decreasing socioeconomic group, similar to the pattern in adult populations. At the opposite, the frequency of binge drinking declined with decreasing social status (inverse gradient). For cannabis consumption, no salient differences were found. After adjustment for family structure, the social gradient flattened for smoking, whereas the reversed gradient for binge drinking appeared to be slightly accentuated and a lower cannabis use (with borderline significance) emerged for the most disadvantaged category.

Comparing the three substances, several features emerge. Cannabis stands out as having the strongest associations with non-intact family living arrangement. It is also the least frequently consumed substance, and the only one which use is not socially stratified. The specificity of binge drinking is that it has a non-classical inverse pattern, and has the weakest association with family living arrangement. Smoking is the only substance which follows the classical social gradient, and it is strongly associated with family living arrangement.

In order to contrast more finely the different non-intact family types, we conducted pairwise post-estimation significance testing based on the full model estimates (Table 2). Those tests led us to conclude that adolescents in father single parent families significantly more frequently reported daily smoking than those in mother single parent families or in shared custody, as did those in parent-stepparent families compared to those in shared custody. Adolescents living with their mothers less often reported binge drinking than those living with their fathers or in shared custody. Lastly, adolescents living with only one of their parents were more frequent cannabis consumers than those in shared custody.

Our analyses clearly demonstrate the existence of an intrinsic role of each of the two factors considered: the association of reported use of substances with socioeconomic factors is not explained by the specific distribution of family types within the different levels, and reciprocally, the association with family types is not explained by socioeconomic differences across the different types. Further to that, the association with family types seems stronger than that with socioeconomic level for smoking and cannabis, and at the opposite, the association with socioeconomic level seems stronger than that with family type for binge drinking.

Overall, we confirm that adolescents living in non-intact families are more subject to problematic substance use, compared to adolescents living with both their parents, with little difference between the various non-intact configurations. The observed pattern is very coherent, with strong and consistent associations for tobacco, alcohol and cannabis use.

These results are consistent with a large body of literature that already highlighted that adolescents from non-intact families were more prone to experiment and to regularly use psychoactive substances [3, 25‐34]. Several mechanisms have been suggested to explain the association of family structure and adolescent behaviours [35]. First, due to limited parental resources, a lack of supervision or the presence of more permissive rules, adolescents from non-intact families may have lower perception of risk and therefore be more likely to engage in consumption behaviours perceived as problematic. This is a key aspect in sociology of deviance [36]. Second, higher levels of stress are likely within disrupted families, with substance use being resorted to as a coping mechanism for youth when facing this type of adversity. Lastly, socialization models posit the protective role of the interpersonal parent-child ties, which would be closer and stronger in families with two parents.

Over and above this general pattern, there are differences related to the specific family arrangements. Regarding smoking, a study based on data from eleven European countries reported that adolescents living with both parents smoked less than those living with single mothers, and that the latter smoked less than those living with their single fathers, mother-stepfather, or with neither parent [4]. Our findings somewhat accord with this cross-national study, as we find that adolescents living with their mother have the lowest levels of consumption of all non-intact families, but we find additionally that this relative advantage extends to adolescents in shared custody. Further to that, we show that adolescents in parent-stepparent families more frequently report daily smoking than those in shared custody. Overall, those patterns seem to suggest a relative protection from smoking in mother only and shared custody arrangements.

Regarding cannabis and alcohol, in a large cross-national study of data from 37 countries, youth living with both their parents reported less alcohol and cannabis use than those from other types of families [3]. The observed differences were not very large, and the excess consumption was mostly found in father-stepmother families, single father families and grand-parent only families, leading the author to conclude that the absence of the mother may be the common denominator exposing the adolescents to excess substance consumption. Keeping in mind that many of the confidence intervals overlap, our findings tend to corroborate this conclusion for binge drinking, whereas cannabis consumption appears to be more nuanced. Indeed, we found that adolescents in every single type of non-intact families seemed to be at-risk for binge drinking and, to an even greater extent, for cannabis. For binge drinking, the most protective configuration among non-intact families seemed to be the single mother family. For cannabis, adolescents in father single parent as well as those in mother single parent were more frequently cannabis users than those in shared custody, which could be indicative of the importance of the maintenance of the tie with both parents [30].

Another important contribution is that, in the face of prior inconsistent evidence, our analyses reveal distinctive socioeconomic gradients for the three substance uses. We find that daily smoking is the only behaviour which displays the classical type of gradient (higher consumption in adolescents from lower SES families), with however a flatter pattern in the full model. A study based on the 2008 ESCAPAD survey found similar results: higher tobacco use among youth of modest background but higher alcohol and cannabis use in youth from the most affluent families [37]. In a multilevel study spanning 35 countries, adolescents from low affluent families had an increased risk of weekly smoking compared to adolescents from high affluent families [38]. The authors suggested the role of psychosocial risks faced by low affluent adolescents, in terms of their relationships with their parents, living conditions and school achievements, with smoking constituting a coping behaviour in inadequate family environments. Another important aspect is that adolescents with low SES parents are more likely to grow up in contexts where smoking is common and particularly to have role models such as parents or siblings who smoke [39]. Under the influence of stress, negative events and the role modelling to which they are exposed, they may experiment smoking, and, once they do, the addictiveness of nicotine may lead them to shift from occasional to regular use through adolescence and into adulthood [6].

The same rationale cannot however be applied to the other two substances. In a literature review on socioeconomic status and health behaviours in adolescence, low SES was associated with greater cigarette smoking, but had no clear pattern of association with alcohol consumption or cannabis use [6]. In the United States, young adults with the highest family background SES were found to be more prone to alcohol and cannabis use [1]. In a database covering 24 European countries, adolescents in lower socioeconomic positions were found to be more likely to report regular smoking and heavy episodic drinking, but there was no association with recent cannabis use [40]. In France, experimenting with tobacco or cannabis occurred more frequently among youngsters from affluent than from modest or underprivileged families, whereas at the opposite, the latter were more prone to engage in daily or regular use after experimenting [41], and the same applied to binge drinking [42]. We find binge drinking to be more common in the upper SES families, a pattern which may be related to the hypothesis that high SES adolescents engage in negative health behaviours due to the combination of high achievement pressures, increased access to spending money, less adult supervision and permissive parental attitudes [12], or to the isolation from parents very involved in their demanding careers [1]. Lastly, no visible socioeconomic gradient emerges in our study for cannabis use, and for some authors this lack of association may be interpreted as a reflection of the influence of peers and school environments, outweighing the impact of family SES [43].