Tobacco and Cannabis Use Among Not in Employment, Education or Training Youth: Systematic Review

Abstract Introduction After the 2008 financial crisis and the rise in youth unemployment, a new term was popularised to describe the population of 15-29 years who are ‘Not in Employment, Education or Training’ (referred to as NEETs). This heterogeneous group includes unemployed youth, those with family responsibilities, and those living with illness or disability. The present study aims to characterise tobacco and cannabis use among NEETs, taking into account the heterogeneity of the population. Methods A systematic review and meta-analysis following PRISMA and MOOSE guidelines was conducted to compare tobacco and cannabis consumption in the NEET population aged 15-29 years with that of other young people. Observational studies examining the association between NEET status and variables ‘current smoker’ and ‘cannabis use’ were included. Sensitivity and subgroup analyses were conducted. Results Twenty-three studies were analysed, comprising a total of 90,853 individuals. NEET status was significantly associated with being a current smoker (OR = 1.81, 95% CI = 1.40-2.34) and cannabis use (OR = 2.15, 95% CI = 1.77-2.61). The sensitivity analysis by comparison group shows that current smoker status is significantly higher among NEETs compared to students (OR = 3.05, 95% CI = 2.31-4.03), but not significantly different compared to workers (OR = 1.10, 95% CI = 0.91-1.34). Regarding cannabis use, NEETs demonstrated a significantly higher risk compared to both students and workers. Conclusions This study revealed an increased risk of tobacco and cannabis use among NEET youth. Tobacco use may reflect social health inequalities related to educational attainment. Knowing that tobacco and particularly cannabis consumption among NEETs may represent specific risks in relation to mental health, social and professional reintegration, and economic vulnerability, targeted prevention is needed to reduce the impact of social health inequities. Key messages • NEETs face a higher risk of tobacco and cannabis use disorders compared to their peers. • NEET youth consumption reflecting social health inequalities and highlighting the need for targeted prevention to reduce the impacts on mental health, social reintegration, and economic vulnerability.