Elsevier

Drug and Alcohol Dependence

Volume 84, Issue 3, 1 October 2006, Pages 273-280
Drug and Alcohol Dependence

Employment experience in relation to alcohol, tobacco, and betel nut use among youth in Taiwan

https://doi.org/10.1016/j.drugalcdep.2006.03.003Get rights and content

Abstract

The aim of this study is to assess the association linking employment experience with alcohol, tobacco, and betel nut involvement among youth in Taiwan. In 2004, an outreach program was conducted during weekdays to recruit youth sample in seven major geographic regions. A total of 5886 youth aged 12–18 years drawn from 26 cities or towns were assessed by a two-page anonymous self-administered questionnaire, including sociodemographic characteristics, employment-, development-, and drug-related experiences. In Taiwan, youthful experience of alcohol, tobacco, and polydrug use varies by employment status, work intensity, and job type. Holding a full-time job and working in certain settings (e.g., grocery, restaurants) were found associated with an excess of drug-using behaviors. With taking age, male gender, family context, disposable allowance, and school attendance into account, working youths were two to four times as likely to have recent drug involvement than their non-working counterparts, especially for tobacco and polydrug (OR = 3.32, 95% CI: 2.58–4.27, p < 0.001; OR = 3.76, 95% CI: 2.76–5.13, p < 0.001). Youths in the labor force emerge as a subgroup experiencing greater use of alcohol, tobacco, betel nut, and polydrug. Future prevention programs may target this high-risk group to reduce possible drug-related negative consequences in developmental and health domains in Taiwan.

Introduction

Adolescents in the labor force have been found to experience disproportionately higher rates of health and behavior-related problems, including alcohol, tobacco, and illegal drug involvement (Johnson, 2004, Kouvonen and Lintonen, 2002, Mortimer et al., 1996, Paschall et al., 2002, Paschall et al., 2004, Valois et al., 1999, Wu et al., 2003). Several hypotheses or mechanisms have been proposed to explain the connection between adolescent employment and psychoactive drug use, such as differential selection, precocious development, and differential association theory (see Finch et al., 1997, McMorris and Uggen, 2000). For instance, Bachman and Schulenberg (1993), among others (Sanford et al., 1994), suggested that the greater risk of psychoactive drug-related problems among working youth might be explained by distant factors which led to both earlier entry into the labor force and subsequent engagement in drug-related activities, such as disadvantaged family background (e.g., low-income or lower parental education), unfavorable family structure (e.g., single-parent family), or school problems (e.g., unsatisfactory grade, school truancy). Nevertheless, longitudinal evidence derived from about 1000 high school attendants found that work alone might still have its independent influences on youngsters’ drinking behaviors, operating via exposing them to opportunities or associates that facilitate alcohol use (McMorris and Uggen, 2000). In addition, youths with longer hours of work seem to spend more time in unstructured social activities, which were associated with increased risks of drug exposure opportunity and initiation (Chen et al., 2004, Osgood et al., 1996, Safron et al., 2001).

In the past decade, tobacco and alcohol use-related problems in youth population have emerged as important public health issue in many developing countries. In Taiwan, after the opening of the tobacco and alcohol markets to foreign imports (Hsu et al., 2005), the National Health Surveys have shown that the median onset age of cigarette smoking has continuously declined in younger cohorts, and smoking rates have been noticeably elevated among young adults, particularly for females (Wen et al., 2005a). Intriguingly, web-based self-administered surveys of high school students suggested that the lifetime prevalence estimates for alcohol, tobacco, and betel nut were 38.3, 21.3, and 6.1%, respectively, nearly 1.2–1.5 times greater than the corresponding estimates derived from self-administered paper-and-pencil questionnaires (Wang et al., 2005). In the meantime, betel nut, one of the widely consumed psychoactive substance in Asian countries, has gradually caught local public health professionals’ attention due to observed compulsive chewing behaviors and increased risks of oral cavity cancer among betel nut users (Chu, 2001). In Taiwan, betel nut is usually chewed with the leaves of betel pepper and lime, and the majority of betel nut chewers were cigarette smokers as well. The prevalence rate of betel nut use has been reported as high as 50% among aboriginal youths (Tsai et al., 2002), and the age of first betel nut appears later than that of cigarette (Wen et al., 2005b).

Compulsory education in Taiwan takes the form of a 6-year primary education and 3-year junior secondary education for youngsters aged 6–15 years. The legal minimum age of employment is 15 years, even though having a part-time or seasonal work is not uncommon among youth under the age of 15 years. Less attention has been paid to work conditions, benefits, and risks of underage workers until recent years, and it was estimated that one out of two to three youths aged 15–19 have ever worked in the preceding year (National Statistics, 2005). Some evolving trend has also been noted in relation to the characteristics of growing working population among students, such as “personal allowance” has replaced “supporting family” as the main reason for youth to seek jobs, and the majority of job type has shifted from labor-oriented to service-oriented. Taken together, in the context of growing availability of psychoactive substance, it is important to probe into whether such changes in the profile of teenage labor force is associated with an increase in substance use among youth population.

The purpose of this study is to examine the extent to which adolescent employment was associated with alcohol, tobacco, and betel nut use in Taiwan. With few exception (Wakai et al., 2005), prior evidence on employment and drug involvement has been mainly derived from the Western societies (Kouvonen and Lintonen, 2002, McMorris and Uggen, 2000, Paschall et al., 2004), and it is not clear whether such youthful employment-related problems will be observed in other societies with different drug availability and education/employment opportunity. Building upon a large sample derived from a street outreach program in Taiwan, which was designed to recruit youth with diverse lifestyle in the cities or towns (not exclusively limited to the homeless or school dropouts), we sought to assess the strength of associations linking employment-related experiences with three most commonly consumed drugs—alcohol, tobacco, and betel nut, with adjustment for possible differential background characteristics.

Section snippets

Study population

The data for this study were derived from a street outreach program designed to investigate health and drug-using behaviors among youth in Taiwan. Between August 2004 and November 2004 (covering the last month of summer recess and the first three months of academic year 2004), the multistage sampling approach was adapted in effort to obtain youth respondents with national representativeness. On the basis of geographic characteristics, urbanicity level, and population composition, Taiwan was

Results

A total of 6014 participants completed the survey questionnaire. The present study focused on the 5886 youth who were 12–18 years old at the time of the interview and who had valid data with respect to variables of major interest; 123 participants whose ages were under 12 or above 18, as well as 5 participants who reported use of a fake drug were excluded.

An estimated 11.4% of the youth in our sample were employed at the time of assessment (n = 671). Differences between working and non-working

Discussion

In this study, we investigated the link between employment with alcohol, tobacco, and betel nut use behaviors in a sample of 5886 youth aged 12–18 recruited by the outreach program in Taiwan, 2004. Our findings revealed that working youth seem more likely to have certain psychosocial characteristics associated with substance use, e.g., being raised by a single-parent, and having less bonds with conventional institutions. The employment-associated risks for psychoactive drug involvement were

Acknowledgements

This work was supported by grants from the Department of Health, Taiwan (DOH92-NNB-1008 and DOH93-NNB-1012). The authors wish to thank Dr. Carla L. Storr at Johns Hopkins University for valuable comments to an earlier version of this paper.

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