Alcohol drinking and cigarette smoking in a representative sample of English school pupils: Cross-sectional and longitudinal associations

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1 Alcohol drinking and cigarette smoking in a representative sample of English school pupils: Cross-sectional and longitudinal associations Gareth Hagger-Johnson 1, Steven Bell 1, Annie Britton 1, Noriko Cable 1, Mark Conner 3, Daryl B O'Connor 3, Darren Shickle 2, Nicola Shelton 1, Bridgette M Bewick 2 1 Department of Epidemiology and Public Health, University College London 2 Leeds Institute of Health Sciences, University of Leeds 3 Institute of Psychological Sciences, University of Leeds

2 Alcohol drinking, age 11 to 15 Prevalence of having drunk at least once increases 11% at age 11, 74% by age 15 Peaks at age 21 and then declines (normative profile) Downward trend in ever having drunk 45% in 2011, 61% in 2001 Frequency of use also declining 7% weekly in 2011, 20% in 2001 Risk factors for drinking Age, White (vs. Black or Asian) ethnic group, drug use, smoking, truancy, exclusion, higher socio-economic status (SES) Source: NHS Information Centre (2012)

3 Cigarette smoking, age 11 to 15 Reductions in the overall prevalence of smoking by English school pupils since the mid-1990s From age 11 to 15, 25% smoke at least once (lowest since 1982) Prevalence of regular smoking increases 0.5% at age 11, 11% by age 15 Risk factors for regular smoking Age, female, lower SES, not in black ethnic group (vs. any other ethnic group), use, drug use, truancy, school exclusion Source: NHS Information Centre (2012)

4 Cigarette smoking and drinking Both behaviours are major public health issues Smoking is addictive and strongly associated with later disease Early use is a risk factor for later problem drinking Each behaviour is a risk factor for the other Cross-sectionally (Donovan, 2004; Mathers et al., 2006) Longitudinal evidence is mixed Repeated measurement in representative samples is rare Is one behaviour a gateway for the other? Do both behaviours have common causes and move together?

5 Aim Examine cross-sectional and longitudinal associations between cigarette smoking and drinking in a representative sample of English school pupils Covering early to late adolescence Identify bidirectional effects Identify risk factors Having already engaged in either behaviour Moving from non- to Moving from non- to

6 Longitudinal Study of Young People in England (LSYPE) Commissioned by former Department for Education and Skills, now managed by Department for Education Began in 2004 Typical age 13/14, birth year Year 9 of secondary school Repeated visits in 2005, 2006, 2007 Annual interviews with pupil and parent(s) Computer-assisted self-completion element Smoking (2004 to 2006), (2004 to 2007)

7 Statistical analysis Small proportion of pupils (<4%) recanting either behaviour removed before analysis Results are weighted to represent entire population of English school pupils Y9 in 2004 Logistic regression to predict behaviour over follow-up Smoker by 2006, regular by 2007 Path model to examine change over time and reciprocal effects

8 Both behaviours increase over time 25.5% (at least monthly) 42.4% (at least monthly) 53.3% (at least monthly) 71.3% (at least monthly) 11.6% current 21.8% current 27.2% current Year 9 age 13/14 Year 10 age 14/15 Year 11 age 15/16 Year 12 age 16/17

9 Results: Logistic regression Two separate GEE models, N = 10,516: adjusting for age, sex, ethnic minority status, parental occupation, parental education, smoking/ at baseline (at least monthly) OR = 3.15 (2.93, 3.40) OR = 3.60 (3.34, 3.38) (at least monthly) current current Year 9 age 13/14 Year 11 age 15/16 Year 12 age 16/17

10 Results: Path model Adjusting for age, sex, ethnic minority status, parental occupation, parental education N=13,635 Smoking at baseline Correlated at baseline Pupils already smoking move from non- to more slowly (but were more likely to already be s at baseline) Rate of change from non to Rate of increase is correlated Alcohol at baseline Rate of change from to

11 Results: Path model Adjusting for age, sex, ethnic minority status, parental occupation, parental education N=13,635 Smoking at baseline Both behaviours already linked at age 13/14: Correlated at baseline pupils who smoke tend to drink Smokers who don t Pupils already smoking move from non- move to toward more slowly (but were more likely to already be drinking s at at a baseline) slower rate Rate of change from non to Smoking and use move together over time Rate of increase is correlated Alcohol at baseline Rate of change from to

12 Discussion Representative sample of over English school pupils in year 9 in 2004 Smoking and drinking already linked by age 14 Adjusting for age, sex, ethnic group, socio-economic status of parents No dominant causal sequence: common causes? Individual behaviours socially patterned (cf. ALSPAC) High SES with more frequent use Low SES with cigarette smoking

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