What Affects What? Perceived Cannabis Availability and Its Use Among Czech Urban Youth—A Multilevel Sociogeographic Analysis

Abstract

Although there is already considerable research on the connection between the availability of substance and the prevalence of its use, the relative effect that one factor has on the other is rather unclear. The present study aims to scrutinize the mutual relationship between subjectively perceived cannabis availability and the prevalence of cannabis use among 15-to 16-year-old students, applying an integrative multilevel analytic framework. The Czech 2011 European School Survey Project on Alcohol and Other Drugs (ESPAD) dataset (N = 8,069 respondents) entered multilevel regression analyses to examine the sociogeographical inequalities in both perceived availability and adolescent frequent cannabis use (individuals [Level 1] nested within schools [Level 2] and localities [Level 3]). At the same time, the mutual relationship of the two cannabis indicators was demonstrated. At the level of individuals (Level 1), the simultaneous equations modeling (SEM) approach was applied to estimate the relative effect of perceived cannabis availability on the frequency of cannabis use and compare it vice versa. Adolescents coming from highly urbanized areas perceived cannabis to be more readily available, and they had a higher prevalence of frequent cannabis use. The higher availability mediated the sociogeographic inequalities in cannabis use. The locality unemployment rate was unrelated to either of the two cannabis indicators. At the individual level of the adolescent respondent, the effect of perceived availability on cannabis use appears to be much stronger than that of the effect of cannabis use on perceived availability when reversed. Perceived availability was found to mediate sociogeographic inequalities in cannabis use among Czechs adolescents. If a higher availability increases opportunities for adolescent substance misuse, then alongside other preventive measures, a spatially integrated approach should be applied in the national drug policy.