Socioeconomic inequalities in cannabis use among European adolescents: the role of access and risk perception

Introduction There is evidence that regular and high-risk-consumption is more prevalent among adolescents with a lower socioeconomic family status (SES). Yet, the causes for the SES gap remain unclear. We postulate that SES inequalities in regular and high-risk cannabis use among adolescents are mediated by differences in risk perception and access. Methods This cross-sectional study used data from a survey to students aged 15-17 years from 35 European countries in 2019 (European School Survey Project on Alcohol and Drugs). We modelled current regular use ([≥]10 times in the past month) and past-year high-risk/problematic use as a function of maternal and paternal education, adjusting for age, sex, and country, then further adjusting for moderating variables: perceived cannabis availability and perceived risk of harm. Results Lower paternal education was related to both higher regular and high-risk use (OR: 1.55 (1.20-2.0) and OR: 1.77 (1.49-2.11), respectively. A similar pattern was observed with maternal educational level. Including mediating factors, perceived availability increased the likelihood of higher use among adolescents with lower SES, related to their lower perceived availability. In contrast, adjusting for risk perception, SES factors lost significance for regular use and reduced OR by 40 to 50% for high-risk use. Conclusion Results indicate that SES inequalities in perceived risk explain the SES gap in regular and high-risk cannabis use among the worse-off. Attention should be paid to policies that may foster the perception that cannabis is risky, which may aggravate dangerous consumption among the worse-off, contributing to larger SES inequalities.