Young adults' recreational social environment as a predictor of ecstasy use initiation: findings of a population‐based prospective study

Aims To examine prospectively the contribution of the recreational social environment to ecstasy initiation. Design Population‐based retrospective/prospective cohort study. Setting Data from screening an A ustralian young adult population to obtain samples of users and non‐users of ecstasy. Participants 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. Measurements 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. Findings More than 40% of ecs tasy ‐naive young adults reported ever receiving e cstasy offers. Ecstasy initiation after 6 months was predicted independently by having, at recruitment, many e cstasy ‐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 e cstasy 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 e cstasy ‐using social contacts (17.7%) and event attendance (15.1%). Conclusions In A ustralia, e cstasy initiation in early adulthood is associated predominantly with social environmental factors, including e cstasy ‐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 e cstasy initiation and associated harms.