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Gateway transitions in rural Irish youth: implications for culturally appropriate and targeted drug prevention.

Dear Editor,

In recent times rural areas in Ireland are indicating comparable drug availability and prevalence of use to urban settings, with the recognition of development of unique rural drug subcultures (NACD, 2008). Additionally, there is a dearth of research on drug-use initiation and transitions among Irish youth, and most particularly outside of the urban context. This letter presents snapshot quantitative findings from a large scale concurrent mixed method study on rural youth substance use in the South East of Ireland. It aims to discuss the observed quantitative findings with reference to potential implications for the design of culturally appropriate and drug specific drug education initiatives in rural Ireland.

BACKGROUND TO THE STUDY

The prevalence and patterns of drug usage in Ireland have become increasingly varied in relation to youth demographic, drug exposure, urban and rural locations, drugs of choice, drug use practices and trajectories (NACD, 2008). The general level of alcohol and drug use is higher among young people in Ireland than in other European countries (Hibell et al., 2009). Alcohol is by far the most commonly used substance in Irish society, with excessive drinking patterns present among younger cohorts (Mongon, Reynolds, Fanagan and Long, 2007). National drug prevalence surveys indicate that lifetime and recreational illicit drug use among all social classes are increasing steadily over the last decade (NACD, 2008). Irish statistics currently show an emerging youth demographic of drug user, with young adults under the age of 24 years reporting greater likelihood of any illegal drugs across all time periods, lifetime, last year and last month, with cannabis most frequently used (NACD, 2008). In 2006, the Health Behaviours for School Children survey signalled very little difference in the proportion of school going youth reporting cannabis use across all socio-economic groups in Ireland (Currie et al., 2008). Treatment data once confined to the urban opiate population, and indeed representing the minority of problematic drug users, now indicate that illicit drug use appears to be gravitating throughout all regions in Ireland and particularly with greater uptake of minors. These national prevalence and treatment statistics offer some insight into Irish youth drug trends, but the research base remains clouded with regard to recreational youth drug use developmental pathways, processes, and trajectories, especially within the contemporary rural context in Ireland.

Research on the developmental pathways of drug use trajectories remains a strongly contested field, most commonly focusing on the gateway theory of drug use transitions (Kandel, 1975). This theoretical framework represents specific drug use within a sequential pattern of onset with causality of the proposed mechanisms still unclear. Kandel's proposed gateway theory presents marijuana (cannabis) as the key gateway substance operating between youth cigarette and alcohol use, and later use of more serious drugs. Specifically, the theory posits that few individuals using drugs at one stage have not used drug(s) at a preceding stage, with the sequence of stages presenting drug pathways as follows: no use of a drug, use of alcohol or cigarettes, use of cannabis, and the use of other drugs (Kandel, 1975). However, one must note that the identification of these stages does not infer the existence of casual stages between different drugs or the inevitable progression along the continuum. Research studies focusing on the gateway theory are limited due to the use of population prevalence samples, generally characterised by low incidence and clustering of hard drug use with scant evidence suggesting that adolescents initiate drug use with hard drugs before becoming regular drug users. Finally, there exists some cloudiness in the interpretation of these research findings with similar results contributing to ambiguous conclusions for the most part.

The gateway framework for understanding drug use is commonly used to steer drug policy and assist in the design of drug educational interventions, with emphasis on delaying the onset of alcohol initiation and cigarette use to deter potential early experimentation of drugs and potential for problematic drug use. However, of most interest for this study and within a greater recognition of broader societal movements mediating drug consumptive behaviours is that; "these stages characterise the behaviors of particular cohorts studies in a particular socio cultural setting and at a particular historical period" (Kandel, Kessler and Margulies, 1978:14). The researcher analyzed the resulting drug using profiles in the target sample of rural youth, amidst rising anecdotal stakeholder reports of increased youth experimentation and drug activity in the research region and self reported drug use among the young people themselves. These publications pertaining to youth, key stakeholders, and parent interviews discussed the emerging rural youth drug trajectories and social contextualisation at length and highlighted the need for greater specific ethnographic understanding and parametric analysis of "localized" rural youth drug activity to guide the development of pragmatic and timely drug prevention efforts.

METHODS

Ethical approval for a regional survey of 14-17 year olds in the South East of Ireland was granted as part of a large scale concurrent mixed method study on rural youth substance use from Waterford Institute of Technology, Ireland. The survey contained questions targeting demographics, alcohol use, cigarette use, drug initiation, and drug use. A random sample of participants (n=345) was taken from 5 participating schools (private, single sex, public, mixed public) in a rural area in the South Eastern Region of Ireland. There was a survey completion rate of 91% with 9% of students not available on the day of the research. The structured nature of the school setting facilitated the administration of the research and the necessary parental consent procedures in order for the pupils to participate in the study. The researcher emphasised the complete anonymity and confidentiality of the survey prior to administering it to the selected classes (approximately 45 minutes) and stayed until completion time in order to supervise and collect the questionnaires. All questionnaires were coded, and the research does not engage in a school type debate as some schools may be identifiable. The research findings shall be discussed thematically in relation to substance trajectories between cigarettes, alcohol and drugs, and will offer recommendations for drug preventative efforts in the rural Irish context.

DISCUSSION OF RESULTS

The mean age of the sample was 15.79 years with a gender balance achieved.

In terms of self reported cigarette use, the survey indicated that 45% of the sample reported lifetime prevalence of cigarette use with 34% smoking cigarettes on a daily basis, 31% of them trying it only once, and 26% of young people smoking less often or infrequently. There was no significant difference in relation to gender. Although the sampling size is different, this result was greater than the HBSC youth survey which reported that 15% of 15 year olds were current smokers (Nic Gabhainn, Kelly and Molcho, 2007). The survey yielded a significant result between cigarette and alcohol use with 100% of those reporting lifetime prevalence of cigarette use, also having tried alcohol (Pearsons Chi-Square=13.743, p<0.001). A significant result was found m that a large proportion of those reporting "drunkenness" also reporting lifetime prevalence use of cigarettes (Pearsons Chi-Square=5.032, p<0.05). 100% of those reporting drug use also reported lifetime prevalence of cigarette use (Pearson's Chi-square=8.429, p<0.02). Indeed, research does suggest that adolescents who smoke may be more likely to also try drugs. This underpins the place of cigarette use within alcohol and drug consumptive pathways (see Kandel, 1975). Research has identified that the nonuse of cigarettes at initial pathway stages reduces likelihood of more serious substance consumption at later stages (Kandel, 2003).

In terms of self reported alcohol use, 62% of the sample reported lifetime prevalence of alcohol use with no significant gender differences, and 36% reported drunkenness experiences. Indeed in 2007, Irish research indicated that youth binge drinking rates were considerably higher than European averages (Mongon et al., 2007). Similarly, Nic Gahainn et al., (2007) reported that; "For boys and girls, the majority of those who reported currently drinking and ever being really drunk were in the 15 to 17 years age brackets". However, recent Irish and European surveys indicate a slight decline in Irish youth binge drinking rates (Currie et al., 2008, Hibell et al., 2009). Indeed, the concurrent qualitative element of this regional research highlighted the seriousness of the frequency and normalcy of alcohol consumption within religious and family gatherings in Irish society. Many young people in the qualitative phase observed drinking alcohol at home both in the presence of their parents and with parental permission. In addition, the survey yielded some significant relationships between lifetime alcohol and drug prevalence (Pearsons Chi-Square=19.910, p<0.001), and between drunkenness and lifetime drug prevalence (Pearsons Chi-Square= 41.755, p<0.000). This highlights the potential mediating role that alcohol plays in opportunistic drug initiation and use during the consumption of alcohol or while intoxicated.

The most recent population surveys in Ireland reported that among those aged 15-24 years: 15% reported lifetime prevalence of any illegal drugs and 6% reporting last month use, with cannabis most prevalently used (NACD, 2008); 24% of the sample with no gender difference reported lifetime prevalence drug use, with no significant relationships between frequency of cigarette or alcohol use and the use of specific drugs such as ecstasy, amphetamine, cocaine, solvents, heroin, ketamine, tranquilizers, and magic mushrooms, with great exception of cannabis use. There was a significant relationship between lifetime prevalence cannabis use (23% with no significant gender difference) and alcohol use (Pearsons Chi-Square=45.109, p<0.000), lifetime prevalence cannabis use and drunkenness (Pearsons Chi-Square=8.341, p<0.000) and frequency of cannabis and alcohol use (Pearson's Chi-square=45,109, p<0.000). This was supported in the qualitative phase of the research, where young people described their first introduction to cannabis and subsequent use when drinking and while intoxicated with alcohol. This lends some support to gateway theorists (Kandel, 1975) but may be somewhat simplistic in that cannabis use remains fundamentally grounded in its availability and emerging social accommodation of cannabis use in Ireland. Indeed, one must underscore that children and young adolescent drug consumptive choices are dependent on local availability. Additionally, the qualitative youth research was plotted against the normalization theoretical framework and yielded some support for normalization of cannabis use among the 220 rural youth interviewed. Interestingly, given the mode of use similarities between consuming tobacco and cannabis, the survey did not yield any significant result pertaining to the cannabis and cigarette lifetime prevalence. However, the qualitative research did observe a risk perception similarity where the rural youth perceived the smoking of cannabis as similar to tobacco in relation to safety, fast consumption, and quick avoidance of legal repercussions. Indeed, research indicates that young people are unlikely to experiment with cannabis or more serious forms of drug use without prior use of alcohol or cigarettes, with a limited minority trying hard drugs without prior cannabis experiences (Kandel, 1975; Kandel, 2003). Of note and perhaps fundamentally due to the rural nature of the participating schools, none reported more serious forms of drug use (i.e., cocaine, heroin). This was reportedly due to fear of more serious drug use and grounded in cannabis availability. The increasing spread of cannabis availability and emerging social accommodation of cannabis use in the rural youth peer setting presents a situation of concern, particularly with the increased gravitation to hard drugs across all locations in Ireland.

CONCLUSION

These identified substance using profiles and pathways underpin that alcohol use and excessive alcohol consumption among rural Ireland youth remain central concerns in the prediction of the consumptive pathways of cigarette and drug use and is fundamentally situated in a culture of socially accepted alcohol use. In this context, one must bear in mind the rural and indeed Irishness of the research context, which points the need for localized and substance specific drug prevention initiatives amidst a recognition of the contextualisation of youth recreational substance use in rural communities. Pathways of recreational drug use are largely determined by the chosen drugs, their availability, drug taking profiles, social settings, and cultural values. One cannot underestimate the rural school and community influence in the prediction of substance initiation, mediation, and progression of use. Therefore, the examination of rural peer relationships within a greater appreciation of the more distal school setting, as dictated by pupil and community profile, may offer much in the design of school based and community drug prevention initiatives. Well designed school based drug prevention programs reportedly have the potential to increase substance related knowledge, reduce self-reported substance use, delay onset and amount of use, however short lived these outcomes are (Faggiano, Vigna-Taglianti, Versino and Alession 2008). However, the research base is inconclusive regarding optimum objective design criteria, with the majority of studies taking place in the United States. Indeed, gateway drug prevention tactics have been criticized for failing to recognise changing drug scenes, the influences of local drug scenes and markets amid clustering of drug use based on availability (Reid, Elifson and Sterk, 2007). This research offers initial pragmatic points of interest for Irish drug policy makers and practitioners involved in the design of rural drug prevention interventions and underscores the need for continued research efforts within associational rural life.

Corresponding Author:

Marie Claire Van Hout

Department of Health, Sport and Exercise Science

School of Health Sciences

Waterford Institute of Technology

Water ford

Ireland

Co Author:

Rebecca Ryan

Waterford Institute of Technology

Waterford

Ireland

REFERENCES

Currie, C., Nic Gabhainn, S., Godeau, E., Roberts, C., Smith, R and Currie, D. (Eds.). (2008). Inequalities in Young People's Health: HBSC International Report from the 2005/2006 Survey. Copenhagen: WHO Regional Office for Europe.

Faggiano, F; Vigna-Taglianti, V; Versino, E and Alession, Z (2008). School-based prevention for illicit drugs use: A systematic review. Preventive Medicine, 46, 385-396.

Hibell, B., Guttormsson, U., Ahlstrom, S., Balakireva, O., Bjarnason, T., Kokkevi, A. and Kraus, L. (Eds.). (2009). The 2007 ESPAD Report. Substance use among students in 35 European countries. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs (CAN).

Kandel, DB. (2003) Does marijuana use cause the use of other drugs? Journal of the American Medical Association, 289, 482-483.

Kandel, DB (1975). Stages in adolescent involvement in drug use. Science, 190, 912-914.

Kandel DB, Kessler RC and Margulies RZ (1978). Antecedents of adolescent initiation into stages of drug use: A developmental analysis. Journal of Youth and Adolescence, 7, 13-39.

Mongon, D., Reynolds, S., Fanagan, S and Long, J. (2007). Overview-health related consequences of problem alcohol use. Dublin: Health Research Board.

National Advisory Committee on Drugs [NACD]. (2008). Drug Use in Ireland and Northern Ireland-2007/2008 Drug Prevalence Survey. Dublin, NACD, Governmental Publication.

Nic Gabhainn, S., Kelly, C., & Molcho, M. (2007). The Irish Health Behaviour in School-aged Children (HBSC) Study 2006. Dublin, Department of Health and Children, Governmental Publication.

Reid, LW; Elifson, K and Sterk, C (2007). Ecstasy and Gateway Drugs: Initiating the Use of Ecstasy and Other Drugs. Annals Epidemiology; 17, 74-80.
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Author:Van Hout, Marie Claire; Ryan, Rebecca
Publication:Journal of Alcohol & Drug Education
Article Type:Letter to the editor
Geographic Code:4EUUK
Date:Apr 1, 2011
Words:2480
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