Alcohol consumption and risk for feeding and eating disorders in adolescence: The mediating role of drinking motives.

BACKGROUND: A complex and bidirectional association has been assumed between feeding and eating disorders (FEDs) and alcohol consumption. Previous research has demonstrated that alcohol use among individuals with different forms of FEDs is more frequently motivated by two subtypes of internal drinking motives: coping and enhancement motives. Namely, these individuals might use alcohol primarily to regulate internal states, such as to mitigate negative emotions or enhance positive emotions. OBJECTIVES: The present study investigated the mediating role of internal drinking motives on the association between risk for FEDs and alcohol consumption over the effects of relevant covariates, such as depressive symptoms or body mass index (BMI). METHODS: Hungarian data of the European School Survey Project on Alcohol and Other Drugs (ESPAD) from 2015 were used. The final sample included responses from 5457 adolescents (50% males; mean age: 16.62 years). Validated self-report psychometric instruments assessed the level of alcohol use, depressive symptoms and risk for FEDs, and drinking motives. RESULTS: Risk for FEDs presented a significant positive relationship with internal drinking motives and alcohol use. In the mediation analysis, a significant indirect effect was identified between risk for FEDs and alcohol use via internal drinking motives among females. CONCLUSIONS: Results demonstrated that risk for FEDs was positively associated with internal drinking motives and alcohol use. An indirect effect of risk for FEDs on alcohol consumption via internal drinking motives was discriminated over the impact of depressive symptoms. However, the latter relationship was only found among females which may highlight the gender differences in the relationship between risk for FEDs and alcohol use.

Prevalence of youth gambling and potential influence of substance use and other risk factors throughout 33 European countries: first results from the 2015 ESPAD study.

BACKGROUND AND AIMS: Although generally prohibited by national regulations, underage gambling has become popular in Europe, with relevant cross-country prevalence variability. This study aimed to estimate the prevalence of underage gambling in Europe stratified by type of game and on-/off-line mode and to examine the association with individual and family characteristics and substance use. DESIGN: Our study used data from the 2015 European School Survey Project on Alcohol and Other Drugs (ESPAD) cross-sectional study, a survey using self-administered anonymous questionnaires. SETTING: Thirty-three European countries. PARTICIPANTS: Sixteen-year-old-year-old students (n = 93 875; F = 50.8%). MEASUREMENTS: The primary outcome measure was prevalence of past-year gambling activity. Key predictors comprised individual behaviours, substance use and parenting (regulation, monitoring and caring). FINDINGS: A total of 22.6% of 16-year-old students in Europe gambled in the past year: 16.2% on-line, 18.5% off-line. High prevalence variability was observed throughout countries both for mode and types of game. With the exception of cannabis, substance use shows a higher association with gambling, particularly binge drinking [odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.39-1.53), life-time use of inhalants (OR = 1.57, 95% CI = 1.47-1.68) and other substances (OR = 1.78, 95% CI = 1.65-1.92)]. Among life habits, the following showed a positive association: truancy at school (OR = 1.26, 95% CI = 1.18-1.35), going out at night (OR = 1.32, 95% CI = 1.26-1.38), participating in sports (OR = 1.30, 95% CI = 1.24-1.37). A negative association was found with reading books for leisure (OR = 0.82%, 95% CI = 0.79-0.86), parents' monitoring of Saturday night activities (OR = 0.81, 95% CI = 0.77-0.86) and restrictions on money provided by parents as a gift (OR = 0.89, 95% CI = 0.84-0.94). CONCLUSIONS: Underage gambling in Europe appears to be associated positively with alcohol, tobacco and other substance use (but not cannabis), as well as with other individual behaviours such as truancy, going out at night and active participation in sports, and is associated negatively with reading for pleasure, parental monitoring of evening activities and parental restriction of money.

Psychoactive Substance Use and Problematic Internet Use as Predictors of Bullying and Cyberbullying Victimization.

Research exploring the relationship between addictions and experiences of bullying suggests that problem behaviors may generally be associated with an increased risk of victimization. The aim of the present study was to examine the role of psychoactive substance use, excessive Internet use, and social support in both traditional offline bullying and online "cyberbullying" victimization in a nationally representative sample of adolescents (N = 6237; 51% male; Mage = 16.62 years, SD = 0.95). Results demonstrated that traditional bullying victimization was associated with cyberbullying victimization. Furthermore, psychoactive substance use and problematic Internet use predicted both traditional bullying and cyberbullying victimization. Finally, perceived social support was found to be an important protective factor against both traditional and cyberbullying victimization. However, psychoactive substance use and problematic Internet use accounted for only a small proportion of variance in victimization.

Problematic Social Media Use: Results from a Large-Scale Nationally Representative Adolescent Sample.

Despite social media use being one of the most popular activities among adolescents, prevalence estimates among teenage samples of social media (problematic) use are lacking in the field. The present study surveyed a nationally representative Hungarian sample comprising 5,961 adolescents as part of the European School Survey Project on Alcohol and Other Drugs (ESPAD). Using the Bergen Social Media Addiction Scale (BSMAS) and based on latent profile analysis, 4.5% of the adolescents belonged to the at-risk group, and reported low self-esteem, high level of depression symptoms, and elevated social media use. Results also demonstrated that BSMAS has appropriate psychometric properties. It is concluded that adolescents at-risk of problematic social media use should be targeted by school-based prevention and intervention programs.

Psychometric Properties of the Problematic Internet Use Questionnaire Short-Form (PIUQ-SF-6) in a Nationally Representative Sample of Adolescents.

Despite the large number of measurement tools developed to assess problematic Internet use, numerous studies use measures with only modest investigation into their psychometric properties. The goal of the present study was to validate the short (6-item) version of the Problematic Internet Use Questionnaire (PIUQ) on a nationally representative adolescent sample (n = 5,005; mean age 16.4 years, SD = 0.87) and to determine a statistically established cut-off value. Data were collected within the framework of the European School Survey Project on Alcohol and Other Drugs project. Results showed an acceptable fit of the original three-factor structure to the data. In addition, a MIMIC model was carried out to justify the need for three distinct factors. The sample was divided into users at-risk of problematic Internet use and those with no-risk using a latent profile analysis. Two latent classes were obtained with 14.4% of adolescents belonging to the at-risk group. Concurrent and convergent validity were tested by comparing the two groups across a number of variables (i.e., time spent online, academic achievement, self-esteem, depressive symptoms, and preferred online activities). Using the at-risk latent profile analysis class as the gold standard, a cut-off value of 15 (out of 30) was suggested based on sensitivity and specificity analyses. In conclusion, the brief version of the (6-item) PIUQ also appears to be an appropriate measure to differentiate between Internet users at risk of developing problematic Internet use and those not at risk. Furthermore, due to its brevity, the shortened PIUQ is advantageous to utilize within large-scale surveys assessing many different behaviors and/or constructs by reducing the overall number of survey questions, and as a consequence, likely increasing completion rates.

Alcohol dependence and treatment utilization in Europe - a representative cross-sectional study in primary care.

BACKGROUND: Alcohol dependence (AD) in Europe is prevalent and causes considerable health burden. Recognition by general practitioners (GPs) and provision of or referral to treatment may contribute to reduce this burden. This paper studied AD prevalence in varying European primary care settings and examined who received treatment. METHODS: In a cross-sectional multi-centre study in six European countries, 358 general practitioners assessed 13,003 primary care patients between January 2013 and January 2014, of which 8,476 patients were interviewed, collecting information on socio-demographics, physical and mental problems, and on alcohol use, problems and treatment. AD diagnoses were determined by GPs' clinical judgement and a standardized interview. A wide definition for AD treatment included individual and group interventions provided by different health professionals. Descriptive as well as inferential statistics were employed. RESULTS: AD was prevalent among patients in European primary health care settings (8.7 %, 95 % confidence interval (CI): 8.1-9.3 %). Treatment rates were low (22.3 % of all AD cases, 95 % CI: 19.4-25.2 %). For both prevalence and treatment utilization, considerable country variations were observed. AD was associated with a number of socio-economic disadvantages (e.g. higher unemployment rate) and higher physical (e.g., liver disease, hypertension) and mental comorbidities (e.g., depression, anxiety). Liver problems, mental distress and daily amount of alcohol used were higher among treated versus untreated male patients with AD. CONCLUSION: A minority of people identified as having AD received treatment, showing heavier drinking patterns and a higher level of co-morbidity. Different types of treatment, depending on severity of AD, should be considered.

People with alcohol use disorders in specialized care in eight different European countries.

AIM: To provide a description of patients receiving alcohol treatment in eight different European countries, including the level of comorbidities and functional limitations. METHODS: Drinking behaviours, DSM-IV alcohol use disorder (AUD), mental and somatic comorbidities, disability and health services utilization of 1767 patients from various specialized treatment settings were assessed as representative for regions of eight European countries. Severity of alcohol dependence (AD) in terms of drinking level was compared with a large representative US sample. RESULTS: Patients in specialized care for AUDs showed high levels of consumption [average level of daily ethanol intake: 141.1 g, standard deviation (SD): 116.0 g], comorbidity [e.g. liver problems: 19.6%, 95% confidence interval (CI): 17.5-21.6%; depression: 43.2%, 95% CI: 40.7-45.8%; anxiety: 50.3%, 95% CI: 47.8-52.9%], disability and health services utilization (average number of nights spent in hospital(s) during the last 6 months: 8.8, SD: 19.5 nights). Severity of AD was similar to the US sample, but European men consumed on average more alcohol daily. CONCLUSIONS: High levels of consumption, somatic and mental comorbidities, disability and functional losses were found in this representative treatment sample, indicating that treatment was initiated only at severe stages of AUDs. Earlier initiation of treatment could help avoid some of the health and social burden.

General practitioners recognizing alcohol dependence: a large cross-sectional study in 6 European countries.

PURPOSE: Although alcohol dependence causes marked mortality and disease burden in Europe, the treatment rate is low. Primary care could play a key role in reducing alcohol-attributable harm by screening, brief interventions, and initiating or referral to treatment. This study investigates identification of alcohol dependence in European primary care settings. METHODS: Assessments from 13,003 general practitioners, and 9,098 interviews (8,476 joint number of interviewed patients with a physician's assessment) were collected in 6 European countries. Alcohol dependence, comorbidities, and health service utilization were assessed by the general practitioner and independently using the Composite International Diagnostic Interview (CIDI) and other structured interviews. Weighted regression analyses were used to compare the impact of influencing variables on both types of diagnoses. RESULTS: The rate of patients being identified as alcohol dependent by the CIDI or a general practitioner was about equally high, but there was not a lot of overlap between cases identified. Alcohol-dependent patients identified by a physician were older, had higher rates of physicial comorbidity (liver disease, hypertension), and were socially more marginalized, whereas average consumption of alcohol and mental comorbidity were equally high in both groups. CONCLUSION: General practitioners were able to identify alcohol dependence, but the cases they identified differed from cases identified using the CIDI. The role of the CIDI as the reference standard should be reexamined, as older alcohol-dependent patients with severe comorbidities seemed to be missed in this assessment.

Prevalence of and potential influencing factors for alcohol dependence in Europe.

Alcohol use disorders (AUDs), and alcohol dependence (AD) in particular, are prevalent and associated with a large burden of disability and mortality. The aim of this study was to estimate prevalence of AD in the European Union (EU), Iceland, Norway, and Switzerland for the year 2010, and to investigate potential influencing factors. The 1-year prevalence of AD in the EU was estimated at 3.4% among people 18-64 years of age in Europe (women 1.7%, men 5.2%), resulting in close to 11 million affected people. Taking into account all people of all ages, AD, abuse and harmful use resulted in an estimate of 23 million affected people. Prevalence of AD varied widely between European countries, and was significantly impacted by drinking cultures and social norms. Correlations with level of drinking and other drinking variables and with major known outcomes of heavy drinking, such as liver cirrhosis or injury, were moderate. These results suggest a need to rethink the definition of AUDs.

Problematic internet use and problematic online gaming are not the same: findings from a large nationally representative adolescent sample.

There is an ongoing debate in the literature whether problematic Internet use (PIU) and problematic online gaming (POG) are two distinct conceptual and nosological entities or whether they are the same. The present study contributes to this question by examining the interrelationship and the overlap between PIU and POG in terms of sex, school achievement, time spent using the Internet and/or online gaming, psychological well-being, and preferred online activities. Questionnaires assessing these variables were administered to a nationally representative sample of adolescent gamers (N=2,073; Mage=16.4 years, SD=0.87; 68.4% male). Data showed that Internet use was a common activity among adolescents, while online gaming was engaged in by a considerably smaller group. Similarly, more adolescents met the criteria for PIU than for POG, and a small group of adolescents showed symptoms of both problem behaviors. The most notable difference between the two problem behaviors was in terms of sex. POG was much more strongly associated with being male. Self-esteem had low effect sizes on both behaviors, while depressive symptoms were associated with both PIU and POG, affecting PIU slightly more. In terms of preferred online activities, PIU was positively associated with online gaming, online chatting, and social networking, while POG was only associated with online gaming. Based on our findings, POG appears to be a conceptually different behavior from PIU, and therefore the data support the notion that Internet Addiction Disorder and Internet Gaming Disorder are separate nosological entities.

Hungary's neglected "alcohol problem": alcohol drinking in a heavy consumer country.

Hungary has always belonged to the group of nations characterized by high alcoholic beverage consumption and it is still one of the leading liver cirrhosis mortality countries in Europe and in the world. This research studies changes in selected contextual factors and control policy measures that are most strongly correlated with changes in alcohol consumption and selected related harms in Hungary between 1960 and 2008. The method to analyze the association between different variables was similar to that of the European AMPHORA project. The analysis, which has been done, highlights the central role of urbanization and population ageing in Hungary in affecting the increase of consumption of alcoholic beverages, especially beer. Alcohol control policy measures show little explanatory power to interpret consumption changes; having had no effect in curbing alcohol consumption and no, or little impact on alcohol consumption-related deaths. Study's limitations are noted.

[Methodological background and descriptive features of the ESPAD 2011 Study (European School Survey Project on Alcohol and other Drugs) in Hungary]. / A 2011-es ESPAD kutatás (European School Survey Project on Alcohol and other Drugs) magyarországi adatfelvételének módszertana és a minta leiró jellemzoi.

BACKGROUND AND AIMS: The aim of the ESPAD (European School Survey Project on Alcohol and other Drugs) study - launched in 1995 and repeated in every four years - is to collect representative data on alcohol and drug consumption patterns of the 16 year old population, in as many European countries as possible. METHOD: The survey followed standardized methodology to gain comparable data in every participating country. Students fill in the self-report questionnaire during a school lesson. Beside the compulsory core-question blocks, the Hungarian survey in 2011 contained questions on behavioral addictions (online gaming, internet, eating disorders and gambling) as well. All classes were included into the sample pool, where at least 10% of the students were born in 1995. Data collection took place between 1-20 March 2011. The sample was representative in terms of type of school; class and geographic location. RESULTS: Data was gathered from 370 classes and resulted in 8570 questionnaires. Only 0,96 percent of the total collected data was unreliable. Obtained data is valid and reliable; and can be compared to data from previous years, as well as to data from other ESPAD countries. Representative data on behavioral addictions is highly valuable, because our current knowledge is limited on this domain.

Psychometric properties of the problematic online gaming questionnaire short-form and prevalence of problematic online gaming in a national sample of adolescents.

The rise and growing popularity of online games has led to the appearance of excessive gaming that in some cases can lead to physical and psychological problems. Several measures have been developed to explore the nature and the scale of the phenomenon. However, few measures have been validated psychometrically. The aim of the present study was to test the psychometric properties of the 12-item Problematic Online Gaming Questionnaire Short-Form (POGQ-SF) and to assess the prevalence of problematic online gaming. Data collection was carried out to assess the prevalence of problematic online gaming in a national representative adolescent sample by using an offline (pen and pencil) method. A total of 5,045 secondary school students were assessed (51% male, mean age 16.4 years, SD=0.9 years) of which 2,804 were gamers (65.4% male, mean age 16.4 years, SD=0.9 years). Confirmatory factor analysis was applied to test the measurement model of problematic online gaming, and latent profile analysis was used to identify the proportion of gamers whose online game use can be considered problematic. Results showed that the original six-factor model yielded appropriate fit to the data, and thus the POGQ-SF has appropriate psychometric properties. Latent profile analysis revealed that 4.6% of the adolescents belong to a high risk group and an additional 13.3% to a low risk group. Due to its satisfactory psychometric characteristics, the 12-item POGQ-SF appears to be an adequate tool for the assessment of problematic online gaming.

Contextual determinants of alcohol consumption changes and preventive alcohol policies: a 12-country European study in progress.

Beginning with France in the 1950s, alcohol consumption has decreased in Southern European countries with few or no preventive alcohol policy measures being implemented, while alcohol consumption has been increasing in Northern European countries where historically more restrictive alcohol control policies were in place, even though more recently they were loosened. At the same time, Central and Eastern Europe have shown an intermediate behavior. We propose that country-specific changes in alcohol consumption between 1960 and 2008 are explained by a combination of a number of factors: (1) preventive alcohol policies and (2) social, cultural, economic, and demographic determinants. This article describes the methodology of a research study designed to understand the complex interactions that have occurred throughout Europe over the past five decades. These include changes in alcohol consumption, drinking patterns and alcohol-related harm, and the actual determinants of such changes.

Beyond drinking: differential effects of demographic and socioeconomic factors on alcohol-related adverse consequences across European countries.

BACKGROUND/AIMS: Evidence underlines the importance of drinking patterns and individual characteristics in experiencing adverse alcohol-related consequences; however, little research has been conducted to explore who does and who does not experience consequences with similar drinking patterns. Using data from seven European countries, this study assesses the association between demographic and socioeconomic characteristics and six adverse consequences. METHODS: Conditional logistic regression models were estimated, cases (experiencing a consequence) being matched to controls (not experiencing the consequence) by drinking patterns. RESULTS: In general, protective effects with increasing age and being in a partnership were consistent. Gender effects were mixed, but mainly protective for women. Educational achievement and economic status showed consistent effects across countries, but different directions of effect across consequences. Consequences mostly associated with individual drinking pattern (injury, blackout, and loss of control over drinking) exhibited similar patterns of associations, but varying ones arose for consequences additionally influenced by societal reaction to drinking (guilt, role failure, and pressure to cut down drinking). CONCLUSION: Differences in strengths and directions of effects across consequences pointed to the possibility that the reporting of adverse consequences is not only influenced by alcohol consumption, but also by attributional processes related to demographic and socioeconomic statuses.

Alcohol culture, family structure and adolescent alcohol use: multilevel modeling of frequency of heavy drinking among 15-16 year old students in 11 European countries.

OBJECTIVE: Frequency of heavy alcohol use among adolescents is examined by family structure and propensity toward heavy alcohol use on the individual level, and by alcohol availability and drinking patterns among adolescents on the societal level. The analysis includes direct effects and moderating effects of societal-level indicators on individual-level associations between family structure and frequency of heavy alcohol use. METHOD: The study drew upon self-reports from 34,001 students in Cyprus, France, Hungary, Iceland, Ireland, Lithuania, Malta, the Slovak Republic, Slovenia, Sweden and the United Kingdom participating in the 1999 European School Survey Project on Alcohol and Other Drugs study. Distinctions were drawn between adolescents living with both parents, a single mother, a single father, a mother and stepfather, a father and stepmother, and neither biological parent. The multilevel analysis estimated the effects of societal-level factors on the intercepts and slopes of individual-level regression models. RESULTS: Adolescents living with both biological parents engaged less frequently in heavy alcohol use than those living in any other arrangements. Living with a single mother was associated with less heavy drinking than living with a single father or with neither biological parent. National beer sales figures and societal patterns of heavy adolescent alcohol use predicted more frequent heavy drinking and greater effects of living in nonintact families. CONCLUSIONS: Adolescent heavy drinking is more common in all types of nonintact families. The adverse effect of living in nonintact families is greater in societies where alcohol availability is greater and where adolescents drink more heavily.

Old and new drug consumption habits in Hungary, Romania and Moldova.

The authors present patterns of drug use during the political and social transition periods in Hungary, Romania and Moldova. During the 1990s, each country witnessed major changes in the proliferation of various deviant behaviour patterns. These changes remain rather difficult to interpret and often reveal conflicting tendencies. Available statistical data and research results vary from country to country. On the basis of the information available, we can conclude that the era following the political transitions is characterised by an increase in drug-related problems. Although the extent of illicit drug use is probably much smaller than the extent of many other social problems, the novel nature of the drug problem and its extreme growth in the 1990s make it more of a social issue in all three countries.