Illicit substance use among university students from seven European countries: A comparison of personal and perceived peer use and attitudes towards illicit substance use
Introduction
Illicit substance use is particularly prevalent among young adults in Europe. Cannabis remains the most frequently consumed illicit substance but substances such as cocaine, ecstasy and amphetamines are also widely used by young adults (EMCDDA, 2010). While cannabis use among young adults has decreased in the last decade, the use of other illicit substances such as amphetamines has remained stable (European Monitoring Centre for Drugs, Drug Addiction (EMCDDA), 2006, European Monitoring Centre for Drugs, Drug Addiction (EMCDDA), 2010). There is virtually no cross-national data on illicit substance use of students but comparable studies indicate that adolescents in England and Spain use illicit substances more frequently compared to young people in other European countries (European Monitoring Centre for Drugs, Drug Addiction (EMCDDA), 2006, European Monitoring Centre for Drugs, Drug Addiction (EMCDDA), 2013).
Research originating in the USA has identified that peers are the most salient social referents for young population groups, such as university students, and that incorrect perceptions of peers' substance use may exert considerable influence on personal substance use behaviours (Perkins and Wechsler, 1996, Perkins, 2002). In this context, peer norms can be differentiated into two types: descriptive and injunctive norms. The former refers to perceptions of the quantity and frequency of peer substance use and the latter to perceptions of peer approval of substance use. Most of the evidence on inaccurate perceptions regarding health behaviour in student populations is related to alcohol; numerous studies have shown that students tend to overestimate the alcohol use of their peers (Berkowitz, 2004, Page et al., 2008, Perkins et al., 2005, Perkins and Wechsler, 1996) and that perceived norms of peer alcohol use predict how often and how heavily an individual drinks alcohol (Lintonen and Konu, 2004, Perkins, 2007, Perkins and Wechsler, 1996). In addition, there is evidence that students overestimate their peers' use of marijuana (Kilmer et al., 2006, Perkins et al., 1999, Wolfson, 2000), and that peer norms are determinants of marijuana use among students and adolescents (Ali et al., 2011, Arbour-Nicitopoulos et al., 2010, Kilmer et al., 2006). Research examining misperceptions of use of other illicit substances is sparse. In a study by Perkins et al. (1999), the majority of participants thought that the average student used cocaine, amphetamines or hallucinogens, yet abstinence was the median response for all illicit substances (Perkins et al., 1999). These findings were confirmed in a subsequent study by Martens et al. (2006).
Research on alcohol consumption has also shown that students tend to misperceive the injunctive norms (Borsari and Carey, 2003, McAlaney et al., 2011). There is meta-analytic evidence of a large discrepancy between students' own alcohol use, the attitudes and the perceived approval from other students, with students perceiving their peers to be more accepting of alcohol use than they actually are (Borsari and Carey, 2003). To date, injunctive norms relating to illicit substances have only been examined for marijuana use, with studies indicating that a perceived approval of substance use among close peers is positively associated with personal substance use (Neighbors et al., 2008a, Neighbors et al., 2008b, Buckner, 2013). These research findings have given rise to a new form of intervention for reducing substance use known as the “social norms approach”, which challenges misperceptions of peer descriptive and injunctive norms via social marketing or personalised web-based feedback to reduce misperceptions and the perceived social pressure on the individual to use these substances (McAlaney, Bewick and Hughes, 2011).
The vast majority of research into normative misperceptions originates in the USA. A limited number of European studies have evaluated misperceptions of illicit substance use but none have investigated injunctive norms (Ali et al., 2011, McAlaney et al., 2011). In the present study, we assessed personal use as well as the approval of illicit substance use, and evaluated perceptions of peers' use and peers' approval of illicit substances among students from seven European countries. The following hypotheses guided the research: (a) European university students perceive that the use and approval of illicit substances by the majority of their peers are higher than the estimates based on actual reported own consumption, and (b) students showing high perceptions of the consumption or approval of illicit substance use of their peers will be more likely to use illicit substances or approve illicit substance use on their own.
Section snippets
Data
The analysis is based on data from the Social Norms Intervention for the prevention of Polydrug usE (SNIPE) project funded by the European Commission (LS/2009–2010/DPIP/AG). An overview of the SNIPE trial is provided elsewhere (Pischke et al., 2012). SNIPE involved the collection of baseline survey data from students to develop a web-based personalised social norms feedback intervention for substance use for students from universities in Belgium, Denmark, Germany, the Slovak Republic, Spain,
Results
The web-based questionnaire was completed by 4482 university students in 2012 (71.4% female). A minority of participants (5.2%) were foreign-born. More than 50% of the participants were from the Slovak Republic (43.2%, n = 1938) and Turkey (19.1%, n = 858) with Spain (4.1%, n = 185) and the UK (2.4%, n = 107) contributing the lowest numbers of participants (Table 1).
Current illicit substance use rates in the participating countries varied from 0.5% of males and 0.7% of females in the Slovak Republic to
Discussion
The findings of our study indicate that high percentages of students thought that their peers have used illicit substances more often than themselves. This is consistent with previous US (Martens et al., 2006, Perkins, 2007) and European studies (Boot et al., 2012). In addition, our findings offer a first insight into discrepancies between personal and perceived peer injunctive norms regarding illicit substance use: 29.2% of the participating students thought that their peers are more approving
Conclusion
Our findings provide an essential contribution to the existing illicit substance use literature across European countries. Our study extends social norms research by examining the influence of injunctive norms on illicit substance use. Perceived descriptive as well as injunctive peer norms were associated with reported individual behaviour. These findings are particularly relevant for health promotion and indicate potential benefits of social normative feedback for substance use in university
Conflict of interest
The authors declare that there are no conflicts of interests.
Final trial registration number
DRKS00004375 on the ‘German Clinical Trials Register’.
Acknowledgment
The Social Norms Intervention for the prevention of Polydrug usE (SNIPE) project was funded by the European Commission (LS/2009–2010/DPIP/AG). We would like to thank Florence Samkange-Zeeb for proof-reading the manuscript.
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