title: Young adults' recreational social environment as a predictor of ecstasy use initiation: findings of a population-based prospective study.
abstract: OBJECTIVE
  To examine prospectively the contribution of the recreational social environment to ecstasy initiation.
  
  
  METHODS
  Population-based retrospective/prospective cohort study.
  
  
  METHODS
  Data from screening an Australian young adult population to obtain samples of users and non-users of ecstasy.
  
  
  METHODS
  A sample of 204 ecstasy-naive participants aged 19-23 years was obtained, and a 6-month follow-up identified those who initiated ecstasy use.
  
  
  METHODS
  We assessed a range of predictors of ecstasy initiation, including elements of participants' social environment, such as ecstasy-using social contacts and involvement in recreational settings.
  
  
  RESULTS
  More than 40% of ecstasy-naive young adults reported ever receiving ecstasy offers. Ecstasy initiation after 6 months was predicted independently by having, at recruitment, many ecstasy-using social contacts [adjusted relative risk (ARR) 3.15, 95% confidence interval (CI): 1.57, 6.34], attending electronic/dance music events (ARR 6.97, 95% CI: 1.99, 24.37), receiving an ecstasy offer (ARR 4.02, 95% CI: 1.23, 13.10), early cannabis use (ARR 4.04, 95% CI: 1.78, 9.17) and psychological distress (ARR 5.34, 95% CI: 2.31, 12.33). Adjusted population-attributable fractions were highest for ecstasy-using social contacts (17.7%) and event attendance (15.1%).
  
  
  CONCLUSIONS
  In Australia, ecstasy initiation in early adulthood is associated predominantly with social environmental factors, including ecstasy-using social contacts and attendance at dance music events, and is associated less commonly with psychological distress and early cannabis use, respectively. A combination of universal and targeted education programmes may be appropriate for reducing rates of ecstasy initiation and associated harms.
authors.affiliation: School of Population Health, Queensland Alcohol and Drug Research and Education Centre, The University of Queensland, Herston, Queensland, Australia; Drug Harm Reduction Branch, Health Protection Directorate, Division of the Chief Health Officer, Queensland Health, Herston, Queensland, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Smirnov
authors.forename: Jake M
authors.initials: JM
authors.lastname: Najman
authors.forename: Reza
authors.initials: R
authors.lastname: Hayatbakhsh
authors.forename: Helene
authors.initials: H
authors.lastname: Wells
authors.forename: Margot
authors.initials: M
authors.lastname: Legosz
authors.forename: Robert
authors.initials: R
authors.lastname: Kemp
mesh_terms: D001315:Australia; D005260:Female; D005500:Follow-Up Studies; D006213:Hallucinogens; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D018817:N-Methyl-3,4-methylenedioxyamphetamine; D011446:Prospective Studies; D011998:Recreation; D012189:Retrospective Studies; D012931:Social Environment; D013315:Stress, Psychological / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology; D055815:Young Adult
chemical_list: D006213:Hallucinogens; D013287:Illicit Drugs; D018817:N-Methyl-3,4-methylenedioxyamphetamine
keywords: Drug offers; drug use initiation; ecstasy (MDMA); epidemiology; social contacts; social environment