Is Trust in Information Sources Associated with Drug Use? A Population-Based Study

According to the World Drug Report by the United Nations Office on Drugs and Crime, there are approximately 269 million people using drugs globally, representing a 30% increase since 2009 (1). A similar prevalence of illicit drug use was also observed in the European Union (EU), where approximately 96 million or 29% of adults (aged 15–64) are estimated to have used illicit drugs at least once in their lifetime (2). In 2018, the most used such substance in both the EU and worldwide was cannabis (54.6 million males and 35.7 million females in the EU, and 192 million people worldwide) (1, 2). Similarly, cannabis was found to be the most commonly used drug in Slovenia as well, with 20,7% of Slovenians reporting using it at least once, while a lower prevalence of using at least once was reported for ecstasy (2.9%), cocaine (2.6%), amphetamines (2.3%) and LSD (2.2%) (3).

In an attempt to design as effective prevention programs as possible, researchers have focused on establishing the risk and protective factors for substance use among young adults, with up to 72% of 27-year-olds reporting having used a drug at least once, and that higher levels of regular illicit drug use are found among males compared to females (21% compared to 12% respectively) (2, 4). Likewise, Slovenian data has also shown a 33.5% lifetime prevalence of illicit drug use among young adults aged 15 to 34 years, and a higher prevalence among men compared to women (3). Moreover, with the global increase in lifetime expectancy an increase in substance use among older adults (50 years and older) has been observed, cannabis being the most commonly used illicit drug in this age group, used by 13.9% of adults aged between 50 and 64 years, and 5.8% of 65-year-olds or older (5, 6).

However, although 75% of substance-use related injuries among young adults result in death, the mortality rates among older adults who use opioids exceeds the mortality rates of younger opioid users in the USA (7, 8). This is due to the associated biological changes occurring with age, which mean that there is an increased risk even with dosages that are considered as moderate for middle aged adults (9). Furthermore, researchers have found that growing up with a low socioeconomic status, using substances during adolescent years, having favourable attitudes towards drugs and being unemployed all represent a higher risk for drug use in young adulthood (7, 10, 11). Among older adults being closer to middle age, having lower than a college education and less financial security were identified as risk factors for drug use in a later stage of life (12,13,14). Furthermore, among older adults, while male gender is associated with a increased risk for cannabis use, women tend to have a greater risk of misusing prescription drugs (e.g. benzodiazepines) (13, 14).

In order to tackle a wide array risk factors for poor health behaviours, various campaigns have utilized the mass-media to disseminate their messages to a broad and diverse audience via television commercials, the radio, internet, newspapers, roadside advertising, and so on (15, 16). An example of successful mass-media campaigns are those that encourage people to stop or never start using tobacco, which have lead to a reduction in the number of young adults starting to smoke and increase in the number of adults that ceased using tobacco products (17, 18). Due to the high success of such mass-media campaigns, similar approaches have been utilized to promote other healthy behaviours, including aimed at deterring illicit drug use (19). However, such campaigns might not always deliver the anticipated behavioural changes, or may even have harmful effects. The results from a systematic review and meta-analysis (20) showed that most of the randomized control trials and observational studies evaluating the effectiveness of such mass-media campaigns found non-significant effects. Moreover, they reported several campaigns had an iatrogenic impact on the public, leading to an increased usage of drugs among the targeted populations (e.g. the first version of My Anti-Drug mass-media campaign by the Office of National Drug Control Policy and the Campuswide Alcohol and Drug Abuse Prevention Program) (15, 20).

A significant shift in information-sharing emerged with the increased access to and usage of new digital media (e.g. social media, web pages, location-based social mobile apps) enabling greater efficiency and coverage of health interventions. Yet wide coverage does not guarantee success, and it is crucial to produce “high-quality evidence-based content that engages with individual participants” (21). In a more recent study, a comparison of the level of trust in information shared online among college students in the USA and Israel showed that the internet was the most popular and trusted source of drug-related information. As such, health campaigns could utilize internet platforms (including social media) to disseminate anti-drug-use content, as there is an increased probability of the target population’s exposure to and acceptance of such messages (22).

Although in Slovenia mass-media communication is regulated by the Mass Media Act (Zmed) (23) of the Republic of Slovenia, no article in the legislation directly regulates the area of illicit drug reporting or implementation of mass-media campaigns for deterring illicit drug use. However, in 2014 Slovenia introduced a national strategy that aims to regulate the field of illicit drugs and that briefly addresses the importance of paying attention to the media and marketing agencies in order to ensure more responsible reporting in this context, with a focus on the promotion of health and a healthy lifestyle (24). What is more, the results of an analysis of Slovenian mass-media reports (Drev, Sever in Kamin 2006) on illicit drugs conducted in 2006 indicate that, if taken together, most related media coverage is focused on illicit drug related crime and mortality (a total of 18%, at 14% and 4%, respectively), whereas 16.4% of such coverage addressed the topic of prevention (e.g. conducting preventive programmes in schools, collecting used needles, and so on). Moreover, the results also showed that the majority of the mass-media coverage was prompted by outside organisations, and most often was presented with a short and sensational form of writing, with in-depth analysis of the issue being very limited. Moreover, to the best of our knowledge there have been few national mass-media campaigns aiming to reduce illicit drug use in Slovenia, and their effects are generally unknown. For example, the national anti-drug-use media campaign Choose health because you appreciate yourself! (Slovenian: Izberite zdravje, ker se cenite!) was not evaluated in any manner (26).

Moreover, there has also not been any research conducted assessing the association of trust in media information with drug use. In addition, due to the shift in the public’s perception of trust with regard to online information, additional research is needed in order to get a better insight in the effects of the internet on drug use. Therefore, the aim of the present study is to assess the different levels of trust with regard to information about drug use within different population groups. More specifically, we are interested in the level of trust in different information sources within the observed sample, and how it differs when controlling for age, gender, and drug use groups and types.

The results show that 26.3% of the study participants personally know someone who uses illicit drugs. The participants were also asked about their own use of illicit drugs – 20.7% stated that they had used cannabis or hashish (in any form) at least once in their lives, and 5.9% in the last year. Additionally, 2.5% had tried cocaine or crack cocaine at least once, 0.8% in the last 12 months, and 0.4% had tried heroin at least once, 0.1% in the last 12 months. The mean age of the first cannabis or hashish use was 19.59 years, cocaine or crack cocaine 22.73 years, and heroin 20.63 years.

When asked about trust in various information sources regarding tobacco, alcohol and illicit drugs, the participants gave the following responses: newspapers (M=3.72; SD=1.32), television (M=3.44; SD=1.06), radio (M=3.55; SD=1.17), brochures or booklets (M=3.67; SD=1.32), internet and web pages (M=3.41; SD=1.27), social media (M=3.53; SD=1.55), friends (M=3.72; SD=0.91), immediate family and relatives (M=3.99; SD=0.88), and healthcare workers (M=4.10; SD=0.90). According to these responses, the participants most value and trust such information if it comes from healthcare workers (4.10) and immediate family and relatives (3.99), and put the least trust in information from the internet and television.

As shown in Figure 1, there is a difference between the whole sample and the group of study participants that had used the above-mentioned illicit drugs, especially the group of participants reporting drug use in the past 12 months. As this group reported the least trust in the information sources, we have compared this group with the whole sample of participants with regard to trust in information sources about tobacco, alcohol and illicit drugs (shown in Table 1). The data show that those participants who had used drugs had less trust in the information sources compared to the whole sample, especially social media and the internet, with heroin users having the highest means.

Figure 1.

Furthermore, and as shown in Table 2, we compared the level of trust in information sources between the study participants who had used heroin or cocaine at least once time and the participants who had never tried these substances.

The Mann-Whitney U-test was used to compare trust in information sources for users and non-users of cocaine (shown in Table 2). Statistically significant differences were found were found relating to the trust in information obtained via television (U=741466.000. z=−2.618, p=0.009), and trust in information provided by healthcare workers (U=853345.000. z=−2.014, p=0.044), which indicates that survey participants who had never tried cocaine have more trust in these information sources, as they have listed higher levels of trust in the majority of information sources. Furthermore, we compared trust in information sources for users and non-users of illicit drugs in general, but there were no statistically significant differences between the two groups.

There are differences regarding drug use between the genders, and the same is true regarding trust in the various information sources, as the level of trust is higher among women, and this is the case for all information sources (shown in Table 3).

Furthermore, we were interested in the level of trust in information sources and the age of the participants. Since the share of drug users is higher among the younger respondents, namely those aged 15 to 34 years, it makes sense to check which information sources they trust more and if there are any differences here with those aged 35 or older. The results show that the younger respondents trust newspapers, brochures, booklets and friends the most (Table 4), and compared to those aged 35 to 65 years they trust the majority of information sources (except newspapers and healthcare workers) less than the older group (shown in Table 5).

Communication and information sources can play an important role when addressing drug use among the population. Therefore, assessing the association of different levels of trust with regard to information sources on drug use within different population groups is an important issue. When observing the levels of trust in different information sources among various age, gender and drug use groups we observed that participants value and trust most the information they receive about tobacco, alcohol and illicit drugs received from healthcare workers and immediate family and relatives, while they put the least trust in the internet and television. Participants reporting drug use in the past 12 months reported the least trust in the listed information sources about tobacco, alcohol and illicit drugs (newspapers, television, radio, brochures or booklets, internet, social media, friends, immediate family and relatives, healthcare workers), and have less trust in these sources compared to the whole sample, especially with regard to social media and the internet. This could indicate that more recent drug users tend to value information sources differently than other groups.

Furthermore, we can conclude that the survey participants that had never tried cocaine have more trust in healthcare workers as well and in television (which seems to be a specific for this group), and this group also reported higher levels of trust in the majority of information sources. While the results show more trust in the information sources by participants who had never used cocaine, the same could not be confirmed for the heroin users. This was due to the lack of statistically significant differences within the two groups, which might be due to a small sample size as only six participants reported having used heroin in the past 12 months. Although we live in a digital era and some results indicate the importance and potential of digital information sources related to drug use (22, 27), the levels of trust of digital information sources were, surprisingly, lower than for traditional media information sources or personal channels. Furthermore, a decline in trust in traditional mass media channels, such as radio and television, has been identified for health information, with high trust reported for interpersonal sources, like physicians (28). However, in order to balance the pros and cons before structuring multicomponent community health interventions, the intended audience’s trust in all sources, both media (traditional and digital) and interpersonal, must be assessed (29).

The data show significant differences in drug use between gender and age groups, and the same is true for the level of trust in the given information sources, which might play an important role within the promotion of a healthy lifestyle and drug prevention activities. Specifically, while more men use drugs than women, the latter trust the information sources more than men. Furthermore, the results also showed that the younger participants had the most trust in printed media, such as newspapers, brochures and booklets, as well as their friends, since peer support systems are a significant information source among this age group. Since there has been a global fall in the usage of print media, especially among younger generations (30,31,32), this could lead to further decline in the reported levels of trust in information pertaining illicit drugs. What is more, not trusting certain information solely due to the form of delivery (i.e. print vs digital) could potentially contribute to an increase in illicit drug use among younger populations. Therefore, these results should prompt decision-makers, researchers and other professionals working with younger people to consider disseminating information related to illicit drug use in printed format.

Several communication activities are used to address the “most major public health issues, including a broad array of behavioural outcomes ranging from the initiation and maintenance of preventive health behaviours to the cessation of behaviours that increase the risk of negative health outcomes”, such as reducing drug use (33). The results obtained in this study can therefore serve to help design and implement communication activities to support public health intervention measures. More specifically, the results can serve as the basis to identify and define target audience segments (i.e. segments of people that will respond in a similar way) in order to maximize the effects of the delivered health messages, as well to identify the best communication channels and tools to be used. Often multiple communication channels are used, and these can complement media (television, radio) channels with personal ones (health professionals, outreach workers) (33). Thus, when designing public health responses aiming to promote health and prevent drug use, a special focus should be put on developing programmes and interventions targeting healthcare workers, as well as the immediate family and relatives of the target groups (34,35,36,37,38) when addressing the general public, and avoiding internet and television as well social media when addressing more recent drug users. On the other hand, more research is needed in order to better identify the best communication channels when addressing cocaine users. Furthermore, when designing programmes and interventions targeting health promotion and drug use prevention a special focus should be put on men as opposed to women. Moreover, as drug use is higher among younger people, a special focus should be put on this group by focusing on printed communication media and designing programmes and interventions aiming at empowering peer support systems (39,40,41).

Although the present study used a rigorous methodological procedure there are some weaknesses which might influence the results. While a mixed methods approach was used to maximize the response rate there can be potential drawbacks to this. Namely, the data obtained from individual interviews can be biased due to the effects external collaborators can have on the individuals being interviewed. Furthermore, some validity constraints of self-reported information and social desirability biases (i.e. the participants choosing more socially acceptable answers) can also occur, which can influence the reliability of the results thus gained.

The evidence regarding information sources and communication channels and tools regarding the field of drugs is scarce. Thus, the present research provided an insight into how different groups could potentially be differently impacted by using different information sources, and the results can therefore serve as evidence for the development and implementation of targeted interventions, including communication activities and tools. Future research should extend the present study by also exploring how the level of trust in information related to illicit drugs is influenced if delivered by different types of professionals – e.g. government officials, school workers, police officers, social workers, and experts with personal experience of the focal issues, as interpersonal relations were among the most trusted sources of health information.