Medium Socioeconomic School and Area Environments Had Higher Cannabis Use Than Low-SES Settings in Croatia | Research

The takeaway

Among Croatian 15-year-olds, medium school-level and area-level socioeconomic status was associated with higher cannabis use compared to low SES, while low individual and school SES were protective against most risk behaviors.

Read this if you are interested in how socioeconomic factors influence adolescent cannabis use.

Medium SES environments had higher cannabis use than low SES environments

What the researchers found

Multilevel analysis of 1,601 Croatian secondary school students (age 15) from the WHO Health Behavior in School-aged Children study examined how individual, school, and area socioeconomic status related to risk behaviors. Individual SES explained the majority of differences across all risk behaviors.

For cannabis use specifically, school heterogeneity (vs. homogeneity) and medium school-level SES (vs. low) were associated with higher probability. Medium area-level SES was also associated with higher cannabis use compared to low area-level SES. Counter-intuitively, lower individual, school, and area SES played a protective role against most risk behaviors.

Why it matters

This study challenges the assumption that drug use is primarily a problem of disadvantaged communities. For cannabis specifically, medium-SES environments had higher use, suggesting that prevention programs need to target middle-class schools and neighborhoods as well.

The numbers in context

1,601 pupils aged 15. Low individual SES: protective for tobacco, drunkenness. Medium school SES and school heterogeneity: higher cannabis use. Medium area SES: higher cannabis use and fighting. Gymnasium (advanced school) attendance: protective against fighting.

How the study worked

Multilevel logistic regression analysis of WHO HBSC data from Croatia (2006). 1,601 pupils aged 15 in secondary schools. Three levels: individual, school, area. Risk behaviors: tobacco, drunkenness, cannabis, early sexual initiation, fighting. Census data for area-level SES.

What this study cannot tell us

Croatian-specific findings may not generalize to other countries. Cross-sectional design cannot establish causation. Self-reported risk behaviors subject to social desirability bias. Only one age group (15-year-olds) studied. The WHO HBSC data are from 2006, and patterns may have changed.

How to read the evidence

Large multilevel analysis with appropriate methodology; preliminary evidence for SES-cannabis patterns in one country.

When this study was published

Published in 2013 (data from 2006). Socioeconomic patterns of adolescent drug use continue to be studied.

The bigger picture

The counterintuitive finding that medium SES is associated with higher cannabis use may reflect greater disposable income, more exposure to social environments where cannabis is available, or cultural factors specific to transitional economies. This challenges one-dimensional prevention approaches focused solely on disadvantaged communities.

Questions still open

Why is medium SES associated with higher cannabis use? Does school heterogeneity increase exposure to substance-using peers? Would these patterns hold in other European countries? Are prevention programs adequately targeting middle-SES environments?

Common questions

Does poverty cause teen drug use?

This study found the opposite for cannabis: medium socioeconomic environments (both at school and area level) had higher cannabis use than low-SES environments. Low individual SES was protective against tobacco use and drunkenness. This suggests the relationship between socioeconomic status and drug use is more complex than "poor communities = more drugs."

Why might middle-class teens use more cannabis?

The study did not explain the mechanism, but possibilities include greater disposable income to purchase cannabis, more exposure to social environments where cannabis is normalized, less parental supervision, and cultural factors where some risk-taking is seen as normal in middle-class adolescent peer groups.

Read the original research

Inequalities in Croatian pupils' risk behaviors associated to socioeconomic environment at school and area level: a multilevel approach.

Social science & medicine (1982), 98, 154-61

View on PubMed ↗Publisher’s paper ↗

Citation

Pavic Simetin, Ivana; Kern, Josipa; Kuzman, Marina; Pförtner, Timo-Kolja. (2013). Inequalities in Croatian pupils' risk behaviors associated to socioeconomic environment at school and area level: a multilevel approach.. Social science & medicine (1982), 98, 154-61. https://doi.org/10.1016/j.socscimed.2013.09.021