Individual and Contextual Determinants of Substance Use among Refugees in Shared Accommodations: A Cross-Sectional Multilevel Analysis

Introduction: The increasing number of refugees in the European Union has led to challenges in terms of allocation and housing. Shared accommodation, which often presents vulnerable living conditions, may exacerbate health risks including substance use. This study aims to identify individual and contextual determinants of substance use behaviours among refugees in shared accommodations. Methods: Data from a cross-sectional study and baseline data from an evaluation study resulted in a sample size of 391 refugees residing in 22 shared accommodations in Stuttgart, Germany. Data were collected using self-reported measures of substance use as well as physical and mental health indicators at the individual level, and conditions of shared accommodations on a contextual level. Multilevel logistic regression analysis was performed to examine individual-level and contextual factors. Results: Substance use behaviours were influenced primarily by individual factors. Male refugees were more likely to engage in substance use than females, whereas being Muslim was associated with a lower likelihood of substance use. Prolonged residence in shared accommodations and possession of a work permit increase the risk of substance use. Poor physical health was also correlated with higher substance use behaviours. Contextual factors, such as deteriorating conditions or isolation due to limited access to support systems, played a smaller role. However, deteriorated accommodation conditions were unexpectedly linked to a reduced likelihood of hazardous substance use. Conclusion: The findings highlight the predominance of individual-level determinants over contextual factors in shaping substance use behaviours among refugees in shared accommodations. Interventions should prioritize addressing individual vulnerabilities, such as health and social integration challenges, while improving living conditions to mitigate risks. These insights can inform targeted European policies and support programmes for refugee populations.