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Smoking, drinking and drug use among hard to reach children and young people; an evidence synthesis report

This rapid review was produced by the Risk Factors Intelligence’s Evidence Synthesis Team for the Public Health England (PHE) Population Health Survey Board. The report examined the prevalence of smoking, drinking and drug use (and any evidence of trends in these behaviours) among ‘hard to reach’ children and young people. Hard to reach include those children and young people who are young offenders, not in education, employment or training (NEET), truants, care leavers, homeless individuals or those living in socio-economically disadvantaged areas.

The context for this review is that the existing surveys commonly used to monitor and measure the scale of smoking, drinking and drug use prevalence among young people suggest these behaviours are generally declining. However, it is unclear whether hard to reach populations were well represented in these surveys.

Methodological differences make comparison across studies difficult. For example, findings were often based upon only small numbers of individuals from hard to reach populations, studies used a wide variety of different age ranges or measurement scales and often relied upon self-reports. However, taken together, the 46 papers included in this review showed that prevalence of smoking and drug use is much higher among these hard to reach subgroups than the general population.

The evidence for alcohol was more mixed, which may be due to alcohol being less impacted by being hard to reach. There was also very little data (from only 3 papers) on trends in smoking, drinking and drug use behaviours among hard to reach children and young people. Therefore, it is difficult to determine whether the declines in prevalence across the general population of children and young people are also true among particular subgroups.

More consistent monitoring of smoking, drinking and drug use among hard to reach subgroups over time would help to build the evidence base and highlight any disparities across the entire spectrum of children and young people.