Multiple Substance Use Among Adolescents in Scotland: Profile and Trends

1 Background and methodology

Policy background

Smoking

Scotland has already come a long way in shifting cultural attitudes to smoking and is now seen as a world leader on tobacco control. Since the Scottish Parliament was established in 1999, it has overseen:

• legislation to ban tobacco advertising in 2002
• historic smoke-free legislation in 2006
• the increase in the age for tobacco sales from 16 to 18 in 2007
• the overhaul of tobacco sale and display law, including legislation to ban the display of cigarettes for sale in shops and self-service sales from automatic vending machines in 2010
• establishment of the first Tobacco Retail Register in the UK
• comprehensive awareness raising campaigns
• record investment in NHS smoking cessation services helping hundreds of thousands of people to attempt to quit smoking.

The Scottish Government published its latest tobacco control strategy, Creating a Tobacco-Free Generation: A Tobacco Control Strategy for Scotland, in March 2013. This set an ambitious target - to reduce smoking prevalence to 5% by 2034. This would mean that a child born in 2013 will turn 21 and become an adult in a Scotland which is largely devoid of tobacco-use with all the health, social and economic benefits that entails. Progress towards the target will be measured on a 5-yearly basis using data on smoking prevalence by SIMD quintile from the Scottish Household Survey.

The 2034 target is challenging and achieving it will require a determined effort to reduce smoking rates and prevent smoking take-up, particularly amongst our young people.

Drinking

In recognition of the harm caused by alcohol in Scotland, the Scottish Government has in place a national alcohol strategy - Changing Scotland's Relationship with Alcohol: A Framework for Action (2009). This Framework adopts a whole population approach and identifies the need for sustained action in four areas: reduced consumption; supporting families and communities; positive attitudes, positive choices; improved treatment and support. The Framework aims to help tackle the damaging impact alcohol misuse has on families and communities, including young people.

The Framework includes legislative measures as set out in the Licensing (Scotland) Act 2005 and the Alcohol etc. (Scotland) Act 2010. Such restrictions cover the sale of alcohol, pricing and promotion of alcohol, and age verification policies such as 'Challenge 25'. Funding has been provided to increase access to specialist alcohol services, while 560,000 alcohol brief interventions (ABIs) have been delivered to date. Additionally, the Alcohol (Minimum Pricing) (Scotland) Act 2012 aims to limit alcohol consumption by reducing affordability; a minimum price of 50 pence per unit of alcohol has been passed but not yet implemented because of a legal challenge led by the Scotch Whisky Association.

There are 30 Alcohol and Drugs Partnerships that are tasked with tackling problem alcohol and drug use and promoting recovery. They are working alongside other partners such as CoSLA and the NHS. The partnerships provide person-centred and recovery-focussed care at a local level. NHS Health Scotland is tasked with Monitoring and Evaluating Scotland's Alcohol Strategy against this Framework.

Drug Use

'The Road to Recovery' outlines the Scottish Government's national performance framework for drug prevention and rehabilitation embedded within an understanding of social exclusion and health inequality. The framework promotes the concept of recovery among service users and providers, and seeks to integrate a range of drug treatment and rehabilitation services. The strategy stresses preventative action in families specifying the need to educate children about drug use through Curriculum for Excellence, the schools based substance use education resource 'Choices for Life', and the drug prevention campaign 'Know the Score'. Additionally, the framework seeks to reduce waiting times for referral to services for drug related problems within 3 weeks under the Scottish Government's Health Improvement, Efficiency, Access to Services and Treatment (HEAT) standard.

The 'Road to Recovery' is delivered by 30 Alcohol and Drug Partnerships (ADPs) alongside a number of initiatives such as the Scottish Recovery Consortium, which is a recovery oriented charity to support recovery from problem drug use. Scottish Government officials are currently finalising arrangements with a range of partners and experts to support The Road to Recovery going forward, and who will work in collaboration with Scottish Government to help deliver the strategy.

Recently the Scottish Government has taken steps to strengthen the evidence base on new psychoactive substances (NPS), supported by an NPS Evidence Group, composed of stakeholders from academia, health, enforcement and the third sector amongst others. The Scottish Government has commissioned research to identify the prevalence and harms of new psychoactive substance use among vulnerable groups in Scotland. This work has been carried out alongside the work of an NPS Expert Review Group, who were tasked with reviewing the current legal framework available to Scottish public authorities to tackle the sale and supply of NPS in Scotland. The final recommendations of the Expert Review Group were published in February 2015 (http://www.gov.scot/Publications/2015/02/3802/0).

Survey background and purpose

1.1 The Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) is a continuation of a long established series of national surveys on smoking, drinking and drug use (Figure 1). These were carried out jointly in Scotland and England between 1982 and 2000, to provide a national picture of young peoples' smoking, drinking, and drug use behaviours within the context of other lifestyle, health and social factors.

1.2 Since 2002, Scotland has developed its own, more tailored, survey known as SALSUS. SALSUS measures progress towards Scottish Government targets for smoking and drug use, and is used to inform the Scottish Government priority of addressing harmful drinking among young people. The survey series also provides local prevalence rates for smoking, drinking and drug use across Alcohol and Drug Partnerships (ADPs), local authorities and NHS Boards. SALSUS data are used in a number of the ADP national core indicators, which allows them to monitor their progress against a common set of outcomes. ADPs and their community planning partners make extensive use of SALSUS data in local needs assessments and in developing their strategic priorities.

Figure 1.1: History of SALSUS and its predecessors

1.3 Full access to the 2013 results can be found here: http://www.isdscotland.org/Health-Topics/Public-Health/SALSUS/Latest-Report/.

Methodology

1.4 SALSUS is a confidential, self-completion questionnaire that is completed by S2 and S4 pupils, average age 13 and 15 years, in school (previous waves surveyed S1-S4). The survey covers items on smoking, drinking and drug use, as well as a number of contextual questions about lifestyle.

1.5 Since 1990, the datasets from SALSUS and its predecessors have been deposited in the UK data archive. The Scottish Government commissioned Ipsos MORI to examine the feasibility of combining these datasets into a single dataset to facilitate greater use of this resource, and, if it was deemed feasible, to create a unified dataset together with accompanying documentation. As part of the feasibility stage, changes in the methodology and questionnaire coverage were examined.

1.6 We concluded that the data was consistent enough that a combined dataset would allow meaningful analysis of trends over time. This combined dataset has now been constructed and this report is one of the first uses of this data source.