Social Inequality and Substance Use and Problematic Gambling Among Adolescents and Young Adults: A Review of Epidemiological Surveys in Germany.

The current review provides an overview of socioepidemiological research in Germany about the prevalence of addictive behaviours (smoking, binge and hazardous drinking, consumption of cannabis and other illegal drugs, the non-medical use of prescription drugs and problematic gambling) among adolescents (11-17 years) and young adults (18-25 years), also differentiating between different socioeconomic status (SES) indicators (attended school type, family affluence, parental occupational status, parental SES, employment status) and migration background. The authors evaluated data from ten national surveys and one regional survey conducted between 2002 and 2012, which included different samples. The trends over this time frame reveal that the proportion of adolescents who smoke tobacco, show problematic patterns of alcohol consumption, use cannabis or other illegal drugs has generally declined over the investigated time span in Germany. The results nevertheless suggest that some strong associations still exist between social inequalities and the prevalence of substance use. The detailed results are summarised in twelve tables. The main results are as follows: 1) Low SES (school type, employment status) was consistently associated with more cigarette smoking, and, where such data was available, this pattern was observed in both males and females. 2) With regard to family affluence, two surveys show that boys with low and middle FAS are significantly less likely to have binge drinking experience compared to boys with high FAS. There were no significant associations between problematic alcohol use and parental SES, and not all results of the surveys show that binge drinking is more prevalent among HS-students. Employment status was associated with gender differences; problematic patterns of alcohol consumption were significantly more prevalent among young unemployed males compared to GY-students (secondary high school/grammar school) of the same age. The opposite was true for females. Another consistent finding was that among adolescents and young adults with a Turkish/Asian migration background, a problematic use of alcohol was significantly less common compared to adolescents and young adults of the same age without a migration background. 3) In terms of the consumption of cannabis, the unemployed and students with low educational level ('Hauptschule´) emerge as high-risk groups. 4) The results concerning problematic gambling significantly overlap with and reflect the findings of international research: being male, of low educational attainment, unemployed, receiving social welfare, and having a migration background significantly increased the risk of problematic gambling habits. 5) The highest lifetime prevalence rates for the consumption of illegal drugs (other than cannabis) were observed among students with low educational level. It should be noted that other SES indicators, in addition to school type, have not been examined to date. The review concludes by outlining gaps and future research areas, as well as presenting several implications for prevention initiatives.