Anne Hublet

Cultural and Gender Convergence in Adolescent Drunkenness: Evidence From 23 European and North American Countries

OBJECTIVE To investigate time-trend changes in the frequency of drunkenness among European and North American adolescents. DESIGN Cross-sectional surveys in the 1997/1998 and 2005/2006 Health Behaviour in School-Aged Children Study (HBSC). SETTING High schools in 23 countries. PARTICIPANTS A sample of 77 586 adolescents aged 15 years was analyzed by means of hierarchical linear modeling. MAIN OUTCOME MEASURE The frequency of drunkenness. RESULTS We observed a significant increase of about 40% in the mean frequency of drunkenness in all 7 participating Eastern European countries. This increase was evident among both genders, but most consistently among girls. Meanwhile, it declined in 13 of 16 Western countries, about 25% on average. Declines in Western countries were particularly notable among boys and in North America, Scandinavia, the United Kingdom, and Ireland. Despite this gender convergence, with few exceptions (Greenland, Norway, United Kingdom) boys continued to have a higher frequency of drunkenness in 2005/2006 than girls. CONCLUSIONS The confirmed cultural convergence implies that adoption and implementation of evidence-based measures to mitigate the frequency of adolescent drunkenness such as tax increases and restricting alcohol access and advertisement should get the same priority in Eastern European countries as in Western countries. Policy measures that might facilitate decreases in drunkenness such as server training and the promotion of alcohol-free leisure-time activities should be reinforced in Western countries. The gender convergence implies that prevention policy should be less exclusively focused on male adolescents.

Smoking trends among adolescents from 1990 to 2002 in ten European countries and Canada

BackgroundDaily smoking adolescents are a public health problem as they are more likely to become adult smokers and to develop smoking-related health problems later on in their lives.MethodsThe study is part of the four-yearly, cross-national Health Behaviour in School-aged Children study, a school-based survey on a nationally representative sample using a standardised methodology. Data of 4 survey periods are available (1990–2002). Gender-specific daily smoking trends among 14–15 year olds are examined using logistic regressions. Sex ratios are calculated for each survey period and country. Interaction effects between period and gender are examined.ResultsDaily smoking prevalence in boys in 2002 ranges from 5.5% in Sweden to 20.0% in Latvia. Among girls, the daily smoking prevalence in 2002 ranges from 8.9% in Poland to 24.7% in Austria. Three daily smoking trend groups are identified: countries with a declining or stagnating trend, countries with an increasing trend followed by a decreasing trend, and countries with an increasing trend. These trend groups show a geographical pattern, but are not linked to smoking prevalence. Over the 4 surveys, the sex ratio has changed in Belgium, Switzerland, and Latvia.ConclusionAmong adolescents in Europe, three groups of countries in a different stage of the smoking epidemic curve can be identified, with girls being in an earlier stage than boys. In 2002, large differences in smoking prevalence between the countries have been observed. This predicts a high mortality due to smoking over 20–30 years for some countries, if no policy interventions are taken.

Association between tobacco control policies and smoking behaviour among adolescents in 29 European countries

AIMS To investigate the associations between well-known, cost-effective tobacco control policies at country level and smoking prevalence among 15-year-old adolescents. DESIGN Multi-level modelling based on the 2005-06 Health Behaviour in School-aged Children Study, a cross-national study at individual level, and with country-level variables from the Tobacco Control Scale and published country-level databases. SETTING Twenty-nine European countries. PARTICIPANTS A total of 25 599 boys and 26 509 girls. MAIN OUTCOME MEASURES Self-reported regular smoking defined as at least weekly smoking, including daily smoking (dichotomous). FINDINGS Interaction effects between gender and smoking policies were identified, therefore boys and girls were analysed separately. Large cross-national differences in smoking prevalence were documented. Intraclass correlations (ICC) of 0.038 (boys) and 0.035 (girls) were found. In the final multi-level model for boys, besides the significance of the individual variables such as family affluence, country-level affluence and the legality of vending machines were related significantly to regular smoking [b(country affluence) = -0.010; b(partial restriction vending machines) = -0.366, P < 0.05]. Price policy was of borderline significance [b(price policy) = -0.026, P = 0.050]. All relationships were in the expected direction. The model fit is not as good for girls; only the legality of vending machines had a borderline significance in the final model [b(total ban vending machines) = -0.372, P = 0.06]. CONCLUSIONS For boys, some of the currently recommended tobacco control policies may help to reduce smoking prevalence. However, the model is less suitable for girls, indicating gender differences in the potential efficacy of smoking policies. Future research should address this issue.

Early Risk Behaviors and Adolescent Injury in 25 European and North American Countries: A Cross-National Consistent Relationship.

Injury is a leading cause of mortality and morbidity among adolescents in developed countries. Jessor and Jessor’s Problem Behavior Theory suggests an association between risk behaviors (e.g., smoking, drunkenness, cannabis use, and sexual intercourse) and adolescent injury. The present study examined whether early engagement in risk behaviors would predict injury at age 15. It also examined whether such associations were consistent in strength across countries. Based on the data from the 2005-2006 Health Behaviour in School-aged Children (HBSC) survey, a multigroup logistic regression analysis was conducted. Our findings demonstrate a cross-national consistent association (with relative odds of injury rising to 1.85; 95% CI: 1.70-2.02). Based on the study findings, early engagement in risk behaviors was considered a marker for a trajectory that places adolescents at higher risk for physical injury, independent of their national context.

Social motives for drinking in students should not be neglected in efforts to decrease problematic drinking

High heavy drinking prevalence persists in students. Recently, drinking motivation received a lot of attention as an important determinant. Enhancement and coping motives are mostly positively related and conformity motives are mostly negatively related with heavy drinking. Relations are less clear for social motives. This study aimed at gaining more insight in the role of drinking motives in heavy drinking students. Overall, 15 897 Belgian university and college students (mean age: 20.7, SD = 2.6) anonymously participated in an online survey. Logistic regressions tested relationships between motives and problematic drinking (>weekly drinking, ≥monthly binge drinking and being at risk for problematic drinking by the Alcohol Use Disorders Identification Test [AUDIT]). Social motives had the highest prevalence, followed by enhancement, coping and conformity motives. Men engaged more in problematic drinking and reported more motives, except for coping. Enhancement, coping and social-motivated students have higher chances for problematic drinking, while the opposite is true for conformity-motivated students. Although this study found a similar ranking of motives as in other studies, a relationship between problematic drinking and all motives, including social motives, was revealed. This might indicate the different functions of social motives in heavy drinking in different cultures/sub-populations and countries. This finding is relevant for the development of interventions.

Traditional and cyberbullying victimization as correlates of psychosocial distress and barriers to a healthy lifestyle among severely obese adolescents - a matched case-control study on prevalence and results from a cross-sectional study

BackgroundObese youth are at increased risk for peer victimization, which may heighten their risk of psychosocial problems and physical activity avoidance, and lower the effectiveness of professional and lifestyle weight-loss initiatives. Little is known about obese adolescents’ risk for victimization from cyber-bullying and how this relates to psychosocial functioning and healthy lifestyle barriers. The purpose of the study was to assess traditional and cyber-victimization among adolescents with severe obesity and its relation to psychosocial distress and barriers to healthy lifestyles.MethodsA sample of 102 obese adolescents (mean age = 15.32 ±1.71) in residential treatment was matched with 102 normal-weight youngsters from the Health Behavior in School-aged Children (HBSC) study (mean age = 15.30 ±1.73).ResultsAdolescents with obesity were significantly more often cyber-victimized than normal-weight peers. Obese youth victimized by traditional bullying experienced lower quality of life, lower motivation for physical activity and higher avoidance and emotional coping towards healthy lifestyles than those non-victimized. Obese cyber-victims experienced significantly higher suicidal ideation.ConclusionsTraditional and cyber-victimization may hinder treatment effectiveness and healthy lifestyle change in adolescents with obesity. Health professionals should pro-actively address peer victimization and psychosocial functioning during multidisciplinary obesity treatment. Schools could contribute to a better physical and psychosocial health of obese youth by implementing multi-behavioral health-promotion programs.

Trends in educational differences in adolescent daily smoking across Europe, 2002–10

BACKGROUND Across Europe, tobacco use is more prevalent among secondary school students attending vocational tracks compared with students attending academic tracks. The purpose of the present study is to describe trends in social inequality in daily smoking among adolescents between 2002 and 2010 by addressing both absolute social inequality (prevalence difference between vocational and academic tracks) and relative social inequality (prevalence ratio) in seven European countries. METHODS Analyses were based on data from 15-year-olds who participated in the Health Behaviour in School-aged Children study in 2002, 2006 and 2010 in Belgium, Croatia, France, Germany, Hungary, Italy and The Netherlands (total N = 32 867). RESULTS Overall, daily smoking decreased between 2002 and 2010 in Belgium, France, Germany and The Netherlands, increased in Croatia and remained stable in Hungary and Italy. Considerable differences in daily smoking according to educational track existed in all countries. Absolute educational inequalities increased dramatically in Croatia and Italy, while relative inequalities showed a tendency to increase in all countries (significant in Belgium and The Netherlands). CONCLUSIONS Conclusions on social inequality in adolescent smoking may appear differently when described by absolute and relative measures. Especially the large increase in absolute educational inequalities in daily smoking in Croatia and Italy are worrisome and warrant attention from the public health domain. The findings underline the need for appropriate smoking policies and interventions in vocational schools across Europe.

Social capital and adolescent smoking in schools and communities: a cross-classified multilevel analysis.

We sought to determine whether social capital at the individual-, school- and community-level can explain variance in adolescent smoking and accounts for social inequalities in smoking. We collected data as part of the 2005/6 Health Behavior in School-aged Children survey, a nationally representative survey of the health and well-being of high school pupils in Belgium (Flanders). Social capital was assessed by structural and cognitive components of family social capital, a four-factor school social capital scale and a cognitive community social capital scale. We fitted non-hierarchical multilevel models to the data, with 8453 adolescents nested within a cross-classification of 167 schools and 570 communities. Significant variation in adolescent regular smoking was found between schools, but not between communities. Only structural family social capital and cognitive school social capital variables negatively related to regular smoking. No interactions between socio-economic status and social capital variables were found. Our findings suggest that previously observed community-level associations with adolescent smoking may be a consequence of unmeasured confounding. Distinguishing nested contexts of social capital is important because their associations with smoking differ.

Dance Is the New Metal: Adolescent Music Preferences and Substance Use Across Europe

This study examined relationships between music preferences and substance use (tobacco, alcohol, cannabis) among 18,103 fifteen-year-olds from 10 European countries. In 2005–2006, across Europe, preferences for mainstream Pop (pop chart music) and Highbrow (classical music and jazz) were negatively associated with substance use, while preferences for Dance (house/trance and techno/hardhouse) were associated positively with substance use. In three countries, links were identified between liking Rock (rock, heavy metal punk/hardcore, and gothic) and substance use; associations between Urban (hip-hop and R&B) and substance use were mixed. No substantial gender differences emerged in these patterns, and controlling for relevant covariates did not attenuate the predictive value of substance use. The findings are consistent with the conclusion that music is a robust marker of adolescent substance use.

The association between family affluence and smoking among 15‐year‐old adolescents in 33 European countries, Israel and Canada: the role of national wealth

AIMS To examine the role of national wealth in the association between family affluence and adolescent weekly smoking, early smoking behaviour and weekly smoking among former experimenters. DESIGN AND PARTICIPANTS Data were used from the Health Behaviour in School-aged Children (HBSC) study conducted in 2005/2006 in 35 countries from Europe and North America that comprises 60 490 students aged 15 years. Multi-level logistic regression was conducted using Markov chain Monte Carlo methods (MCMC) to explore whether associations between family affluence and smoking outcomes were dependent upon national wealth. MEASUREMENT Family Affluence Scale (FAS) as an indicator for the socio-economic position of students. Current weekly smoking behaviour is defined as at least weekly smoking (dichotomous). Early smoking behaviour is measured by smoking more than a first puff before age 13 years (dichotomous). Weekly smoking among former experimenters is restricted to those who had tried a first puff in the past. FINDINGS The logistic multi-level models indicated an association of family affluence with current weekly smoking [odds ratio (OR) = 1.088; 95% credible interval (CrI) = 1.055-1.121, P < 0.001], early smoking behaviour (OR = 1.066; CrI = 1.028-1.104, P < 0.001) and smoking among former experimenters (OR = 1.100; CrI = 1.071-1.130; P < 0.001). Gross domestic product (GDP) per capita was associated positively and significantly with the relationship between family affluence and current weekly smoking (OR = 1.005; CrI = 1.003-1.007; P < 0.001), early smoking behaviour (OR = 1.003; CrI = 1.000-1.005; P = 0.012) and smoking among former experimenters (OR = 1.004; CrI = 1.002-1.006; P < 0.001). The association of family affluence and smoking outcomes was significantly stronger for girls. CONCLUSIONS The difference in smoking prevalence between rich and poor is greater in more affluent countries.