We found a dramatic increase in a range of health-risk behaviours among older adolescents from the West of Scotland during the 1990s. Prevalence of illicit drug use increased among both males and females. Among females, alcohol use, early sexual initiation and experience of greater numbers of sexual partners also increased significantly, resulting in a gender convergence in patterns of risk behaviour. We are not aware of significant Scottish environmental and/or policy changes between 1990 and 2003. However, in 2006, Scotland introduced a ban on smoking in all public places, and Scottish survey data suggests that since 2003 there has been a reduction in current smoking among 16-24-year old males (rates of 32% in 2003 and 24% in 2009) but not females (29% at both dates) [8
Our findings are consistent with results from previous studies which suggest that the gender gap in substance use has been diminishing among older adolescents or young adults as well as younger adolescents [13
]. The increases in risk behaviours that we observed occurred over a remarkably short period of time but are consistent with the results of previous analyses of changes in substance use among the same cohorts at age 15 years. These also showed gender convergence in risk behaviour rates, largely reflecting changes in female lifestyles during this time [12
]. Of particular concern is the marked increase in female risk behaviour, especially early sexual initiation and multiple sexual partners which are associated with greater risk of sexually transmitted disease and teenage pregnancy before 18 years [16
]. The former, particularly chlamydia, is associated with infertility, the latter with adverse health, economic and social outcomes for mother and child [32
]. A UK-wide survey of sexual attitudes and lifestyles similarly reported an increase in early sexual initiation among females up to the mid-1990s, after which the rate appeared to stabilise [18
]. However, it is also striking that at the same time as the marked increases in these particular sexual risk behaviours, there was no significant change in experience of pregnancy. This suggests more (effective) use of contraception at the later date, consistent with UK studies which have found increases in consistent condom use in adults [33
] and prescription of hormonal contraceptives to adolescent females [34
This study also adds to evidence that the socio-demographic patterning of a particular substance may vary according to the measures used [20
] and highlights the importance of examining whether time-trends are equivalent across all measures. In particular, it showed SES differences in patterns of increase for 'cannabis-only' compared with 'other drugs'. In a previous analysis of the Twenty-07 Study
cohort (1990 dataset), we found that unlike 'other drugs', 'cannabis-only' use in late adolescence, was more likely among those from non-manual backgrounds in full-time education; a 'student effect' [21
]. The increase in cannabis use over time among those from higher SES backgrounds is of concern. However, perhaps more so is that the prevalence of (arguably more risky) past year use of 'other drugs' doubled among those from lower SES backgrounds.
Alcohol use also increased between 1990 and 2003, but there was little difference in the prevalence of these measures between socioeconomic groups, suggesting a lack of socioeconomic gradient with respect to excessive alcohol consumption and binge drinking in young people of this age. This lack of association has been reported for younger adolescents, and, for some measures of alcohol use, older adolescents [16
]. However, other measures of SES appear to have a different relationship with alcohol use, highlighting the complexity of these relationships. For example, higher income is associated with a greater frequency of drinking, and quantity of drinking is associated with education, with the less well-educated consuming more alcohol in a single session [16
]. Interestingly, rates of current smoking were more differentiated by SES at the later date, following differential changes in smoking rates between 1990 and 2003 by SES. Although data on young adults are often not analysed separately from older adults, our findings are supported by English survey data which report a similar social gradient [36
]. Our findings on sexual risk behaviour concur with reports from a UK national survey of sexual attitudes and lifestyles, which also found an association between parental SES and early sexual intercourse [18
]. However, as with alcohol use, SES is not associated with all measures of sexual risk behaviour [17
], and the association between other measures of SES, such as family affluence, and sexual risk behaviour varies by country [17
One of the strengths of this study is its comparison of two cohorts of young people from exactly the same geographic area and life-stage, surveyed using (near) identical questions, 13 years apart. It examines changes over time in behaviour patterns in older adolescents, after school leaving, a life-stage for which few routine data are collected. The size and narrow age range of the cohorts allowed a more accurate determination of health-risk behaviours during later adolescence than is possible with existing surveys which collect data for much wider age bands. However, our analyses also highlight the impact of small increases in age on certain risky behaviours, even in older adolescence. This suggests the possibility of critical periods of susceptibility to the uptake of certain behaviours which may be masked when studies of young people employ wide age-bands. It also underlines the importance of controlling for even small age differences in comparisons such as ours, in order to avoid erroneous conclusions [38
The study does, however, have some limitations. First, the follow-up rate in the 11-16/16+ Study (2003) was quite low, with greater non-response and loss to follow-up among respondents from lower SES backgrounds. Although we accounted for this via weighted analyses, we may not have fully compensated for the differential loss to follow-up of adolescents with more 'risky' patterns of behaviour. However, this would have under- rather than over-estimated time-trends towards increased adoption of risky health behaviours. In a sensitivity analysis we compared the prevalence of risk behaviours in both cohorts using unweighted data, and found that in the 11-16/16+ Study (2003), for some risk behaviours, the prevalence was slightly lower when using the unweighted data. This is unsurprising, given the differential loss to follow-up described above.
Second, although the questions included at each date were very similar, not all were identical. The 'heavier smoking' variable was based on a question about daily cigarette consumption in 1990, but weekly consumption in 2003, which might have reduced reporting accuracy, while the more detailed drinking grid in 2003 might have encouraged increased reporting. Parental occupational data, used to derive social class, were collected via parental interview in the earlier dataset, and via parental self-completion questionnaire supplemented, if necessary, by interview-based information provided by the respondents. However, we have shown this latter data to be reliable [30
] and there is little reason to think that the different data-collection methods would impact in such a way as to produce bias.
Third, although data on risk behaviours were collected in a similar manner (one-to-one interviews) in both studies, thereby limiting the introduction of information bias through differential misclassification of behaviours between the two cohorts, interviewer-administered questionnaires such as ours have been shown to lead to under-reporting of behaviours compared with self-administered instruments [39
]. Under-reporting through social desirability responses may have occurred. However, recall error (in terms of accurate recall of past behaviours) may have been less likely, especially regarding illicit drug use, since questions on this referred to both more recent ('past year') and 'ever' use [39
]. Age at first sexual intercourse may be particularly prone to inconsistent reporting, although this has only been demonstrated in younger adolescents [40
]. It is hard to find Scotland-wide data with which to compare health risk behaviour rates among the 1990 cohort. The first Scottish Health Survey of individuals aged 16-64, including questions on smoking and drinking, collected data in 1995 [41
], while the first independent Scottish Crime Survey, including questions on drug use for 12-59 year olds (but only 232 respondents in the 16-19 year age group) was launched in 1993 [42
]. The first British National Survey of Sexual Attitudes and Lifestyles of 16-59 year olds was conducted in 1990-91. This included 3377 16-24 year olds [43
], but Scotland is not reported on separately, presumably since it comprised fewer than 10% of the overall sample. However, some comparisons can
be made between health risk behaviour rates among the 2003 cohort and those found in other studies. When compared with self-completion data obtained from a Scottish sample of 15-year olds in 1998, rates of (recalled) early sexual initiation were lower in the 11-16/16+
cohort among females (27% compared with 37%) but not males (31% compared with 33%) [3
]. However, rates of alcohol and tobacco use were broadly in keeping with those of young adults reported in the 2003 Scottish Health Survey [44
]. For example, 'excessive' alcohol consumption (≥ 22 units in the past week for males, ≥ 15 for females) was reported by 38% males and 26% females from our 2003 cohort and, by 31% males and 23% females aged 16-24 in the 2003 Scottish Health Survey; rates of current smoking were 35% (males) and 33% (females) among our cohort compared with 32% (males) and 29% (females) in the Scottish Health Survey. However, past-year illicit drug use rates (reported by 50% males and 30% females from our 2003 cohort) were considerably higher than those reported in the 2003 Scottish Crime Survey (27% males and 20% females aged 16-19) [45
], perhaps reflecting higher rates of drug use in and around Glasgow than Scotland as a whole.
Finally, it is possible that there may have been greater under-reporting of some risk behaviours in the 1990 than the 2003 cohort, particularly those that were perhaps less "normative" in the late 1980s and early 1990s (such as early sexual initiation). The 1990 cohort were all interviewed at home, while the majority of interviews with the 2003 cohort were conducted in survey centres at Glasgow University or schools previously involved in the study. Since several of the health risk behaviours reported here might be regarded as sensitive, it is possible that a perceived lack of confidentiality or privacy in the home situation [39
] might have resulted in under-reporting at the earlier date. However, this is unlikely to entirely explain the general increase in risk behaviour, particularly among females, observed in this study.
The data we report here reflect risk behaviours towards the beginning of the first decade of the 21st
century. However, a more recent (2008-2009) Scottish survey of 16-24 year-olds, albeit a wider age range, revealed no increase in levels of alcohol [8
] or illicit drug [9
] use, and, as noted earlier, decreases in smoking prevalence among males since the beginning of the 2000s [8
]. A survey of Scottish 15 year-olds conducted in 2006 also reported no change in early sexual initiation rates since data were first collected in 1998 [3
]. This suggests that the rapid increase in risky adolescent behaviour during the 1990s did not continue into the new century. Nevertheless, the rates we report are amongst the highest in Europe. Given the potential for adolescent risk behaviours to continue into adulthood and affect future health, our results are of significance for the current adult population.