Federica Mathis

Alcohol Consumption in Movies and Adolescent Binge Drinking in 6 European Countries

OBJECTIVE: The goal of this study was to investigate whether the association between exposure to images of alcohol use in movies and binge drinking among adolescents is independent of cultural context. METHODS: A cross-sectional survey study in 6 European countries (Germany, Iceland, Italy, Netherlands, Poland, and Scotland) was conducted. A total of 16 551 pupils from 114 public schools with a mean (± SD) age of 13.4 (± 1.18) years participated. By using previously validated methods, exposure to alcohol use in movies was estimated from the 250 top-grossing movies of each country (years 2004−2009). Lifetime binge drinking was the main outcome measure. RESULTS: Overall, 27% of the sample had consumed >5 drinks on at least 1 occasion in their life. After controlling for age, gender, family affluence, school performance, television screen time, sensation seeking and rebelliousness, and frequency of drinking of peers, parents, and siblings, the adjusted β-coefficient for lifetime binge drinking in the entire sample was 0.12 (95% confidence interval: 0.10−0.14; P < .001). The crude relationship between movie alcohol use exposure and lifetime binge drinking was significant in all countries; after covariate adjustment, the relationship was still significant in 5 of 6 countries. A sensitivity analysis revealed that the association is content specific, as there was no significant association between lifetime binge drinking and exposure to smoking in movies. CONCLUSIONS: The link between alcohol use in movies and adolescent binge drinking was robust and seems relatively unaffected by cultural contexts.

Smoking in movies and adolescent smoking: cross-cultural study in six European countries

Aim To investigate whether the association between exposure to smoking in movies and smoking among youth is independent of cultural context. Method Cross-sectional survey of 16 551 pupils recruited in Germany, Iceland, Italy, the Netherlands, Poland and Scotland with a mean age of 13.4 years (SD=1.18) and an equal gender distribution. School-based surveys were conducted between November 2009 and June 2010. Using previously validated methods, exposure to movie smoking was estimated from the 250 top-grossing movies of each country (years 2004–2009) and related to ever smoking. Results Overall, 29% of the sample had tried smoking. The sample quartile (Q) of movie smoking exposure was significantly associated with the prevalence of ever smoking: 14% of adolescents in Q1 had tried smoking, 21% in Q2, 29% in Q3 and 36% in Q4. After controlling for age, gender, family affluence, school performance, television screen time, number of movies seen, sensation seeking and rebelliousness and smoking within the social environment (peers, parents and siblings), the adjusted ORs for having tried smoking in the entire sample were 1.3 (95% CI 1.1 to 1.5) for adolescents in Q2, 1.6 (95% CI 1.4 to 1.9) for Q3 and 1.7 (95% CI 1.4 to 2.0) for Q4 compared with Q1. The adjusted relationship between ever smoking and higher movie smoking exposure levels was significant in all countries with a non-linear association in Italy and Poland. Conclusions The link between smoking in movies and adolescent smoking is robust and transcends different cultural contexts. Limiting young peoples exposure to movie smoking could have important public health implications.

Smoking in movies and adolescent smoking initiation: longitudinal study in six European countries.

BACKGROUND Longitudinal studies from the U.S. suggest a causal relationship between exposure to images of smoking in movies and adolescent smoking onset. PURPOSE This study investigates whether adolescent smoking onset is predicted by the amount of exposure to smoking in movies across six European countries with various cultural and regulatory approaches to tobacco. METHODS Longitudinal survey of 9987 adolescent never-smokers recruited in the years 2009-2010 (mean age=13.2 years) in 112 state-funded schools from Germany, Iceland, Italy, The Netherlands, Poland, and the United Kingdom (UK), and followed up in 2011. Exposure to movie smoking was estimated from 250 top-grossing movies in each country. Multilevel mixed-effects Poisson regressions were performed in 2012 to assess the relationship between exposure at baseline and smoking status at follow-up. RESULTS During the observation period (M=12 months), 17% of the sample initiated smoking. The estimated mean exposure to on-screen tobacco was 1560 occurrences. Overall, and after controlling for age; gender; family affluence; school performance; TV screen time; personality characteristics; and smoking status of peers, parents, and siblings, exposure to each additional 1000 tobacco occurrences increased the adjusted relative risk for smoking onset by 13% (95% CI=8%, 17%, p<0.001). The crude relationship between movie smoking exposure and smoking initiation was significant in all countries; after covariate adjustment, the relationship remained significant in Germany, Iceland, The Netherlands, Poland, and UK. CONCLUSIONS Seeing smoking in movies is a predictor of smoking onset in various cultural contexts. The results confirm that limiting young peoples exposure to movie smoking might be an effective way to decrease adolescent smoking onset.

Portrayal of Alcohol Consumption in Movies and Drinking Initiation in Low-Risk Adolescents

OBJECTIVES: To investigate the hypothesis that exposure to alcohol consumption in movies affects the likelihood that low-risk adolescents will start to drink alcohol. METHODS: Longitudinal study of 2346 adolescent never drinkers who also reported at baseline intent to not to do so in the next 12 months (mean age 12.9 years, SD = 1.08). Recruitment was carried out in 2009 and 2010 in 112 state-funded schools in Germany, Iceland, Italy, Netherlands, Poland, and Scotland. Exposure to movie alcohol consumption was estimated from 250 top-grossing movies in each country in the years 2004 to 2009. Multilevel mixed-effects Poisson regressions assessed the relationship between baseline exposure to movie alcohol consumption and initiation of trying alcohol, and binge drinking (≥ 5 consecutive drinks) at follow-up. RESULTS: Overall, 40% of the sample initiated alcohol use and 6% initiated binge drinking by follow-up. Estimated mean exposure to movie alcohol consumption was 3653 (SD = 2448) occurrences. After age, gender, family affluence, school performance, TV screen time, personality characteristics, and drinking behavior of peers, parents, and siblings were controlled for, exposure to each additional 1000 movie alcohol occurrences was significantly associated with increased relative risk for trying alcohol, incidence rate ratio = 1.05 (95% confidence interval, 1.02–1.08; P = .003), and for binge drinking, incidence rate ratio = 1.13 (95% confidence interval, 1.06–1.20; P < .001). CONCLUSIONS: Seeing alcohol depictions in movies is an independent predictor of drinking initiation, particularly for more risky patterns of drinking. This result was shown in a heterogeneous sample of European youths who had a low affinity for drinking alcohol at the time of exposure.

VEdeTTE, a longitudinal study on effectiveness of treatments for heroin addiction in Italy: study protocol and characteristics of study population.

The aim of this study was to provide a methodological overview of the study design of the national evaluation large-scale study VEdeTTE and a description of the VEdeTTE study population and to compare enrollments with refusals and the study population with the overall clients at the National Health System (NHS) treatment centers. VEdeTTE is a longitudinal study of heroin addicts recruited in 115 NHS treatment centers in Italy, 1998–2001; 11,903 people were enrolled, 3876 refused to participate; data were analysed on 10,454. Information from refusals was compared to enrollments. The characteristics of the cohort were compared to those of all patients treated in 1999 in Italy. Refusals had a lower educational level and less regular occupational status than those enrolled. Fourteen percent of enrolled patients were women; heroin users in the VEdeTTE study were older than patients attending all NHS treatment centers in Italy; incident cases were less represented. The majority of participants had more than 8 years of education, 33.5% were regularly employed, and only 2% did not have a fixed address. Injectors were 72.3%; 40.6% had a previous overdose, and 14.3% had been imprisoned for life; 15.7% shared injection equipment during the previous 6 months. The proportion of participants reporting heroin use approximately halved from the beginning of the current treatment to the time of the interview. The VEdeTTE study is the biggest cohort of heroin addicts attending treatment centers in Europe. The Italian heroin-addicted population under treatment seems to have low level of education but good social integration. Compared with men, women show a higher severity. Participants show a beneficial effect of treatment.

Personality disorders among patients accessing alcohol detoxification treatment: prevalence and gender differences

BACKGROUND Alcohol abuse and dependence are frequently associated with psychiatric disorders and personality disorders (PDs) with differences among gender. However, only few studies investigated gender differences in PDs among alcoholics. The aim of this study was to investigate PDs in a sample of patients accessing inpatient alcohol detoxification treatment and to describe gender differences in prevalence and comorbidity of PDs. METHODS The study population consisted of 206 patients entering alcohol detoxification treatment in a specialized clinic in Italy. At enrollment, patients filled in the Millon Clinical Multiaxial Inventory-III for the assessment of PDs. RESULTS The sample consisted of 150 males and 56 females. Twenty-five percent of males vs 12.5% of females had 1 PD; 16% vs 23%, 2 PDs; and 46% vs 48%, more than 3 PDs. A statistically significant higher proportion of females got high scores on avoidant (21.4% vs 9.3%), self-defeating (50.0% vs 24.0%), and borderline scales (42.9% vs 25.3%). Depressive, self-defeating, and borderline PDs were frequently associated both to other PDs and among each other, particularly among females. CONCLUSIONS Borderline PD is confirmed to be more frequent among females than among males accessing alcohol detoxification treatment. More studies are needed to clarify prevalence and associations of PDs, prognosis, and gender differences in alcoholics patients.

Psychopathological symptoms of patients with heroin addiction entering opioid agonist or therapeutic community treatment

BackgroundThe relationship between substance use disorders and psychiatric pathology is still an open question. The main aim of the present study was to verify whether the five psychopathological dimensions identified through the SCL-90 tool in a previous study carried out on patients with heroin addiction entering an outpatient opioid agonist treatment (OAT) were also observable in those entering a residential treatment community (TC). Further aims were to look at differences in the psychopathological profiles of patients entering a TC versus an OAT treatment and at the correlation between gender and the observed psychopathology.MethodsA confirmatory factor analysis was performed on the results of SCL-90 filled by 1,195 patients with heroin dependence entering TC treatment. It replicates the extraction method previously used on 1,055 OAT patients with heroin addiction by using a principal component factor analysis (PCA). The association between the kind of treatment received (TC or OAT), gender, and the psychopathological dimensions was assessed through logistic regression and general linear model (GLM) analysis.ResultsThe PCA carried out on the SCL-90 results of patients entering a TC yielded a five-factor solution, confirming the same dimensions observed in patients entering an OAT: `worthlessness and being trapped’, `somatization’, `sensitivity-psychoticism’, `panic anxiety’, and `violence-suicide’. The logistic regression analysis showed a statistically significant association between `somatization’ and `violence-suicide’ severity score and OAT. GLM analysis showed that psychopathological factorial scores for `worthlessness-being trapped’, `somatic symptoms’, and `panic anxiety’ dimensions were more severe in OAT vs TC male patients and in TC vs OAT female ones. `Violence suicide’ followed the same severity pattern for males, but did not differ in TC vs OAT females, while `sensitivity-psychoticism’ did not differ in OAT vs TC patients. The five dimensions did not differ in OAT males vs females.ConclusionsOur research appears to confirm the existence of a specific aggregation of psychological/psychiatric features within the category of individuals with heroin addiction. It also shows a correlation between the dominant psychopathological subgroup and the assignment to TC versus OAT. Further research is needed to clarify the differences between the five psychopathological subgroups and their determinants.

High youth access to movies that contain smoking in Europe compared with the USA

Background Based on evidence that exposure to smoking in movies is associated with adolescent smoking, the WHO has called on countries to assign a rating that restricts youth access to such movies. Objective To evaluate youth access to movies that portray smoking in European countries and compare with that in the USA. Methods The authors identified the most commercially successful movies screened in six European countries (Germany, Iceland, Italy, the Netherlands, Poland and UK) and the USA between 2004 and 2009. The authors coded the 464 movies that were screened in both Europe and the USA according to whether or not they portrayed smoking. Results 87% of the movies were ‘youth’ rated in Europe (ratings board classification as suitable for those younger than 16 years) compared to only 67% in the USA (suitable for those younger than 17 years). Smoking was portrayed in 319 (69%) movies. 85% of the movies that portrayed smoking were ‘youth’ rated in Europe compared with only 59% in the USA (p<0.001). Conclusions Tobacco imagery is still common in popular films shown in European countries and the USA. None of the seven countries examined followed the WHO recommendations on restricting youth access to movies that portray smoking. Compared to the USA, European youths have access to substantially more movies in general, and this gives them access to more movies that portray smoking in particular.

Psychic Structure of Opioid Addiction: Impact of Lifetime Psychiatric Problems on SCL-90-based Psychopathologic Dimensions in Heroin-dependent Patients

Background:By applying a Principal Component Analysis (PCA) to the items of the SCL-90 checklist, we previously investigated the psychopathologic structure of individuals with heroin addiction, finding a 5-factor aggregation of psychological/psychiatric symptoms: “Worthlessness and Being trapped,” “Somatic Symptoms,” “Sensitivity-Psychoticism,” “Panic-Anxiety,” and “Violence-Suicide.” Our studies on this subject did not, however, explore the possible impact of comorbid psychiatric conditions on 5 psychopathologic dimensions listed above. The aim of the present study is to verify whether there is any difference in these 5 dimensions between heroin-addicted patients with (PC-HA) or without (NPC-HA) known lifetime psychiatric problems. Methods:A total of 1195 patients with heroin dependence entering a residential therapeutic community treatment were assigned to one of the 5-factor solutions yielded by Principal Component Analysis on the basis of the highest z score obtained. Differences between NPC-HA and PC-HA patients in the frequency of the 5 psychopathologic dimensions and in their severity were then analyzed by means of univariate and multivariate analyses. Results:All the SCL-90 factor scores were, from a statistical viewpoint, significantly higher in PC-HA than in NPC-HA patients, but the only statistically significant differences in the frequency of the 5 psychopathological dimensions were those observed in the case of “Panic-Anxiety,” which turned out to be higher in the PC-HA group. Stepwise discriminant analysis showed that the severity of “Somatic Symptoms” and “Panic-Anxiety” made these 2 factors the only ones that successfully discriminated between NPC-HA and PC-HA patients. The other SCL-90-based psychopathologic dimensions were unable to improve the value of the discrimination. Conclusions:On the basis of our results, the SCL-90-defined structure of opioid addiction may be considered to be only partly dependent on the presence of a “psychiatric” condition. This observation adds to the previous ones that go to show the stability of the above aggregations of symptoms, irrespectively of other demographic and clinical characteristics, as well as active involvement with heroin abuse or the kind of treatment chosen. When the available evidence is considered as a whole, it seems to support the trait-dependent, rather than state-dependent, nature of the proposed factorial dimensions of the psychopathology of opioid addiction.

Gender differences in heroin addiction and treatment: results from the VEdeTTE cohort

ABSTRACT Background: Gender differences strongly affect heroin addiction, from risk factors to patterns of consumption, access to treatments, and outcomes. Objectives: To investigate gender differences in the VEdeTTE cohort of heroin addicts. Methods: VEdeTTE is a cohort of 10,454 heroin users enrolled between 1998 and 2001 in 115 public drug treatment centres in Italy. Clinical and personal information were collected at intake through a structured interview. Treatments were recorded using a standardized form. Gender differences were explored with regard to characteristics at intake, treatments, and retention in methadone maintenance and therapeutic community. Cox Proportional models were carried out to identify risk factors for treatment abandon. Results: Compared with men, at their first access to treatment women with drug addiction were younger, more frequently married, legally separated, divorced or widow, unemployed though better educated, HIV+; more frequently they lived with their partner and sons. They reported a higher use of sedatives, but a lower use of alcohol; more frequently they had psychiatric comorbidity, including depression, self-injuries, and suicide attempts. Psychotherapy was more frequently prescribed to women, pharmacological treatments to men. Methadone maintenance was less frequently abandoned by women. Drug abuse severity factors predicted abandon of methadone among women. High methadone doses and the combination with psychotherapy improved treatment retention in both genders. Low education level and severity factors among women and young age among men predicted abandon of therapeutic community. Conclusions: Gender differences in the VEdeTTE cohort suggest the need of a gender sensitive approach to improve treatment outcomes among heroin addicts.