Socioeconomic trends in anxiolytic, hypnotic, and sedative use among secondary school students in Spain from 2010 to 2021: a repeated cross-sectional design

Abstract

Background: The increasing use of anxiolytics, hypnotics, and sedatives (AHS) among adolescents is a growing public health concern. Social determinants such as gender or socioeconomic status have a significant influence on consumption levels. However, whether trends in adolescent AHS use show socioeconomic and gender disparities is unknown. The aim of this study is to examine the trends in gender and socioeconomic inequalities in secondary school students’ AHS use in Spain from 2010 to 2021. Methods: A repeated cross-sectional analysis was conducted using data from the Survey on Drug Use in Secondary Education in Spain (n = 192,656), targeting students aged 14–18 years during 2010–2021. Gender-specific prevalences of AHS use were calculated according to the educational and occupational status of the mother, the father, and both parents. Chi-squared tests assessed statistical significance of the observed social gradients. The Relative Index of Inequality (RII) and Slope Index of Inequality (SII) with 95% confidence intervals were used to measure inequality magnitudes. Consumption trends were examined through prevalence ratios (PR) derived from age-adjusted robust variance Poisson models. Results: Statistically significant social inequalities in AHS use were identified among girls, which increased over time. These inequalities were particularly pronounced when considering maternal educational level (e.g. 2021: 21.5% vs. 16.3%; RII2021 = 1.37 [1.16–1.62]) and paternal occupational status (e.g. 2021: 23.2% vs. 16.5%). Trends showed a significant increase among all groups in both male and female students (e.g. both parents with primary education: PR2021 = 1.74 [1.23–2.47] and PR2021 = 1.83 [1.49–2.25], respectively). Conclusions: The findings highlight the necessity for developing equity-focused public health policies addressing adolescent AHS use, especially among disadvantaged female students. Further research is needed to explore the social determinants of adolescent AHS use, considering inequalities from an intersectional perspective.