Sex Differences in Soft Tissue Sarcoma: Incidence, Clinicopathological Profile, Survival, and Costs.

Background: There are evident sex differences in the incidence of and mortality rates for several tumors. Soft tissue sarcomas (STSs) account for no more than 1% of all malignancies in adults. This study aimed to provide a comprehensive overview of the sex differences in the epidemiology of STSs and the related costs. Methods: This retrospective population-based study draws on epidemiological data regarding cases of STS collected by the cancer registry of the Italian Veneto region for the years 1990-2018. A joinpoint regression analysis was performed to identify significant changes in the trends of the standardized incidence rates in males and females. Bivariate and survival analyses were conducted to assess differences in clinicopathological characteristics and short-term mortality by sex. Direct health care costs incurred over 2 years after a diagnosis of STS were calculated, stratified by sex. Results: The incidence rates of STS at any age were higher for males; only among males the incidence rates showed a tendency to slightly increase. No significant sex differences came to light in short-term mortality or clinicopathological profile, except for the cancer site. Health care costs in the 2 years after a diagnosis of STS were not sex related. Conclusion: The STS incidence was found to be higher for males and showed a rising trend over the last three decades only for males. These findings could result from the occupational exposure to environmental mutagens mainly involving men. Sex did not affect the survival or the clinicopathological STS profile.

Synchronous and metachronous multiple primary cancers in melanoma survivors: a gender perspective.

Background: Long-term survivors of cutaneous malignant melanoma (CMM) risk subsequent malignancies due to both host-related and environmental risk factors. This retrospective population-based study differentially assesses the risk of synchronous and metachronous cancers in a cohort of CMM survivors stratified by sex. Methods: The cohort study (1999-2018) included 9,726 CMM survivors (M = 4,873, F = 4,853) recorded by the cancer registry of all 5,000,000 residents in the Italian Veneto Region. By excluding subsequent CMM and non-CMM skin cancers, the incidence of synchronous and metachronous malignancies was calculated according to sex and tumor site, standardizing for age and calendar year. The Standardized Incidence Ratio (SIR) was calculated as the ratio between the number of subsequent cancers among CMM survivors and the expected number of malignancies among the regional population. Results: Irrespective of the site, the SIR for synchronous cancers increased in both sexes (SIR = 1.90 in males and 1.73 in females). Both sexes also demonstrated an excess risk for synchronous kidney/urinary tract malignancies (SIR = 6.99 in males and 12.11 in females), and women had an increased risk of synchronous breast cancer (SIR = 1.69). CMM male survivors featured a higher risk of metachronous thyroid (SIR = 3.51, 95% CI [1.87, 6.01]), and prostate (SIR = 1.35, 95% CI [1.12, 1.61]) malignancies. Among females, metachronous cancers featured higher SIR values than expected: kidney/urinary tract (SIR = 2.27, 95% CI [1.29, 3.68]), non-Hodgkin's lymphoma (SIR = 2.06, 95% CI [1.24, 3.21]), and breast (SIR = 1.46, 95% CI [1.22, 1.74]). Females had an overall increased risk of metachronous cancers in the first 5 years after CMM diagnosis (SIR = 1.54 at 6-11 months and 1.37 at 1-5 years). Conclusion: Among CMM survivors, the risk of metachronous non-skin cancers is higher than in the general population and differs significantly by sex. These results encourage sex-tailored interventions for metachronous secondary cancer prevention.

Use of Information and Communication Technology Strategies to Increase Vaccination Coverage in Older Adults: A Systematic Review.

BACKGROUND: Coverage rates of routinely recommended vaccines in older adults still fall below the targets established by international and national advisory committees. As a result, related diseases still have a high incidence, morbidity, and mortality. Information and Communication Technologies (ICT) could provide useful tools to improve immunization rates by bringing information directly to the target user at a relatively low cost. The present research aims to systematically review recent literature on interventions applying ICT to improve the uptake of influenza, pneumococcal, COVID-19 and herpes zoster immunization rates among older adults. METHODS: Studies published in English between 1 January 2000 and 10 November 2022 were identified by searching electronic medical databases (PubMed, Scopus) and were independently reviewed by two different authors. A total of 22 studies were included in this review. FINDINGS: Interventions applied the following ICT tools: phone calls, text messages, messages sent via personal electronic medical records, automated phone calls, remote patient monitoring in a home telehealth program and emails. In terms of the vaccines promoted, 11 studies prompted the influenza vaccine, four prompted the influenza and pneumococcal vaccines, three the pneumococcal vaccine, two the herpes zoster vaccine, one the COVID-19 vaccine and one both the pneumococcal and herpes zoster vaccines. Overall, more than half of the studies (n = 12) found some level of effectiveness of these ICT strategies in increasing vaccination rates among older adults, while five studies were partially effective (for specific vaccines or population subgroups), and five reported no significant effect. CONCLUSIONS: Prevention programs using ICT tools could be effective in promoting immunizations among older adults.

Using Failure Mode, Effect and Criticality Analysis to improve safety in the cancer treatment prescription and administration process.

BACKGROUND: Administering cancer drugs is a high-risk process, and mistakes can have fatal consequences. Failure Mode, Effect and Criticality Analysis (FMECA) is a widely recognized method for identifying and preventing potential risks, applied in various settings, including healthcare. The aim of this study was to recognize potential failures in cancer treatment prescription and administration, with a view to enabling the adoption of measures to prevent them. METHODS: This study consists of a FMECA. A team of resident doctors in public health at the University of Padua examined the cancer chemotherapy process with the support of a multidisciplinary team from the Veneto Institute of Oncology (an acknowledged comprehensive cancer center), and two other provincial hospitals. A diagram was drafted to illustrate 9 different phases of chemotherapy, from the adoption of a treatment plan to its administration, and to identify all possible failure modes. Criticality was ascertained by rating severity, frequency and likelihood of a failure being detected, using adapted versions of already published scales. Safety strategies were identified and summarized. RESULTS: Twenty-two failure modes came to light, distributed over the various phases of the cancer treatment process, and seven of them were classified as high risk. All phases of the cancer chemotherapy process were defined as potentially critical and at least one action was identified for a single high-risk failure mode. To reduce the likelihood of the cause, or to improve the chances of a failure mode being detected, a total of 10 recommendations have been identified. CONCLUSIONS: FMECA can be useful for identifying potential failures in a process considered to be at high risk. Safety strategies were devised for each high-risk failure mode identified.

Is adherence to the Mediterranean diet associated with good sleep duration in primary-school children?

Objective: The Mediterranean diet (MD) contributes to preventing numerous chronic diseases and has benefits on cognitive development. Adherence to the MD is associated with sleep quality and duration in adults and adolescents, but this association seems to have been little investigated in primary-school children. The aim of this cross-sectional study was to verify whether good sleep duration was associated with adherence to the MD. Design: The study enrolled a sample of Italian primary school children. Their mothers were asked to answer an anonymous, self-administered questionnaire investigating the children's adherence to the MD (using the KidMed score) and variables related to their lifestyles, behavioral traits and socio-economic factors. Logistic regression models were developed to analyze the association between adherence to the MD, entered as the dependent variable, and adequacy of sleep duration. Setting: Primary schools in Padova, Italy. Subjects: 267 Italian 6-year-olds in their first year of primary school. Results: The multivariate analysis showed an association between adherence to the MD and hours of sleep: for children with a good sleep duration, the odds ratio of a poor-to-moderate adherence to the MD was 0.282 (95% CI, 0.109-0.681, p < 0.05). Conclusion: Ensuring an adequate sleep duration may be an important strategy for enhancing adherence to the MD. Sleep and dietary education should be included in future health promotion programs.

Governance for Patient Safety: A Framework of Strategy Domains for Risk Management.

BACKGROUND: Adverse events in healthcare are primarily due to system failures rather than individuals. Risk reduction strategies should therefore focus on strengthening systems, bringing about improvements in governance, and targeting individual practices or products. The purpose of this study was to conduct a scoping review to develop a global framework of management strategies for sustaining a safety-oriented culture in healthcare organizations, focusing on patient safety and the adoption of good safety-related practices. METHODS: We conducted a search on safety-related strategies in 2 steps. The first involved a search in the PubMed database to identify effective, broadly framed, cross-sector domains relevant to clinical risk management strategies in healthcare systems. In the second step, we then examined the strategies adopted by running a scoping review for each domain. RESULTS: Our search identified 8 strategy domains relevant to patient safety: transformational leadership, patient engagement, human resources management quality, innovation technology, skills certification, education in patient safety, teamwork, and effective communication. CONCLUSIONS: This scoping review explores management strategies key to healthcare systems' efforts to create safety-oriented organizations. Improvement efforts should focus particularly on the domains identified: combined together, they would nurture an overall safety-oriented culture and have an impact on preventable adverse events.

How different combinations of comorbidities affect healthcare use by elderly patients with obstructive lung disease.

Previous research had shown the number of comorbidities is a major factor influencing the burden of care for elderly patients with obstructive lung disease (OLD). This retrospective cohort study on a large population of elderly patients (age > 65 years) with OLD in northern Italy measures the use of healthcare resources associated with the most frequent combinations of comorbidities and investigates the most common reasons for hospitalization. Total health costs, pharmacy costs, emergency department (ED) visits, outpatient visits, and hospital admissions are assessed for every subject. The most common causes of hospitalization by a number of comorbidities and the most common sets of three comorbidities are identified. For each comorbidity group, we rank a list of the most frequent causes of hospitalization, both overall and avoidable with effective ambulatory care. A small group of patients suffering from major comorbidities accounts for the use of most healthcare resources. The most frequent causes of hospitalization are respiratory failure, heart failure, chronic bronchitis, and bronchopneumonia. The most common conditions manageable with ambulatory care among causes of hospitalizations are heart failure, bacterial pneumonia, and COPD. The set of three comorbidities responsible for the highest average total costs, and the highest average number of hospitalizations and outpatient visits comprised hypertension, cardiac arrhythmias, and heart failure. The main reasons for hospitalization proved to remain linked to heart failure and acute respiratory disease, regardless of specific combinations of comorbidities. Based on these findings, specific public health interventions among patients with OLD cannot be advised on the basis of specific sets of comorbidities only.

Health care service use and costs for a cohort of high-needs elderly diabetic patients.

AIMS: To describe the impact of diabetes comorbidities on the health care services use and costs of a cohort of elderly patients with diabetes and high health care needs (HHCN), based on real-world data. METHODS: We focused on a cohort of diabetic patients with HHCN belonging to Resource Utilization Bands 4 and 5 according to the Adjusted Clinical Group (ACG) system. Their comorbidities were assessed using the clinical diagnoses that the ACG system assigns to single patients by combining different information flows. Regression models were applied to analyze the associations between comorbidities and health care service use or costs, adjusting for age and sex. RESULTS: Our analyses showed that all health care service usage measures (e.g. access to emergency care; number of outpatient visits) and the total annual costs and pharmacy costs are associated significantly with comorbidity class. Instead, no differences in hospitalization rates by comorbidity class were revealed. CONCLUSION: The association between a larger number of comorbidities and higher total health care service usage and costs was seen mainly for primary care services. This underscores the need to strengthen primary care for today's aging and multimorbid population.

Association between health literacy and dietary intake of sugar, fat and salt: a systematic review.

OBJECTIVES: To collect and summarise all current data from observational studies, generating evidence of the association between health literacy (HL) and the dietary intake of sugar, salt and fat, to analyse intervention studies on the promotion of an appropriate dietary intake of the above-mentioned nutrients and to ascertain whether HL moderates the efficacy of such intervention. DESIGN: A systematic literature search of analytical observational studies on the association between HL and dietary intake of sugar, salt and fat was performed in Medline and Scopus databases. Intervention studies on the promotion of healthy nutrition that concerned the intake of sugar, salt and fat were also assessed. RESULTS: Of the eight observational studies included in this review, five investigated dietary intake of sugar, one focused on salt, one assessed sugar and salt and one analysed the fat intake. The results of the five studies assessing sugar were mixed: three found an association between low levels of HL and a high sugar intake, one found this association only for boys and two found no evidence of any association. The two studies assessing salt and the one assessing fat found no evidence of any association with HL. One intervention study on the sugar intake concluded that HL was not a significant moderator of the intervention's effectiveness. CONCLUSION: No evidence of any association between HL and salt and fat intake emerged, while for sugar, the results are mixed. More work is needed to better understand the moderating effects of HL on the outcomes of health promotion interventions.

Healthcare Service Usage and Costs for Elderly Patients with Obstructive Lung Disease.

Background: The worldwide prevalence of obstructive lung disease (OLD) is increasing, especially among people >65 years old, and nearly three in four adults with OLD have two or more comorbid conditions. This study describes the impact of such comorbidities on the healthcare service usage and related costs in a country with universal health coverage, basing on a large cohort of elderly patients with OLD and employing real-world data. Methods: We carried out a retrospective cohort study on a large population of elderly (age >64 years) patients with OLD served by a Local Health Unit in northern Italy. Their comorbidities were assessed using the clinical diagnoses assigned by the Adjusted Clinical Group (ACG) system to individual patients by combining different information flows. Correlations between number of comorbidities and total annual healthcare service usage and costs were examined with Spearman's test. Regression models were applied to analyze the associations between the above-mentioned variables, adjusting for age and sex. Results: All types of healthcare service usage (access to emergency care; number of outpatient visits; number of hospital admissions) and pharmacy costs increased significantly with the number of comorbidities. Average total annual costs increased steadily with the number of comorbidities, ranging from € 1158.84 with no comorbidities up to € 9666.60 with 6 comorbidities or more. Poisson regression analyses showed an independent association between the number of comorbidities and the use of every type of healthcare service. Conclusion: These results based on real-world data provide evidence that the burden of care for OLD patients related to their comorbidities is independent of and in addition to the burden related to OLD alone and is strongly dependent on the number of comorbidities, suggesting a holistic approach to multimorbid patients with OLD is the most sound public health strategy.

Health Literacy and Physical Activity: A Systematic Review.

BACKGROUND: The importance of health literacy (HL) in health promotion is increasingly clear and acknowledged globally, especially when addressing noncommunicable diseases. This paper aimed to collect and summarize all current data from observational studies generating evidence of the association between HL and physical activity (PA) and to analyze intervention studies on the promotion of PA to ascertain whether HL moderates the efficacy of such intervention. METHODS: A comprehensive systematic literature search of observational studies investigating the association between HL and PA was performed. Intervention studies on the promotion of PA that also measured the HL levels of participants and its effect on the outcome of the intervention were also identified. RESULTS: Of the 22 studies included in this review, 18 found a significant positive association between high HL and high levels of PA. The only intervention study among them indicated that HL was not a significant moderator of the intervention's effectiveness. CONCLUSION: HL can enable individuals to make deliberate choices about their PA and thus contribute to preventing many chronic noncommunicable diseases. That said, low levels of HL do not seem to influence the efficacy of health promotion interventions.

Stimulant substance use and gambling behaviour in adolescents. Gambling and stimulant use. / Uso de sustancias estimulantes y comportamiento de juego en adolescentes. Juego y uso de estimulantes.

Gambling is widely recognized as an important public health problem. Despite the rising use of stimulant substances among adolescents, there are still very few studies focusing on whether adolescents' use of stimulants is associated with their gambling behaviour. Therefore, the aim of this study was to investigate the association between gambling habits and consumption of stimulants such as coffee, energy drinks, and new psychoactive substances in a sample of Italian adolescents. A survey was conducted in 2017 with a representative sample of Italians between the ages of 14-17 years, comprising 15,833 students attending 201 secondary schools. Logistic regression analyses were run to assess the association between at-risk/problem gambling (O1) and independent predictors: the model included independent variables (coffee, energy drinks and new psychoactive substance consumption) and covariates (demographic variables, social environment variables and risk-taking behaviour variables). A sensitivity analysis was also conducted to examine a second dependent variable regarding any experience of gambling behaviour (O2). Adolescents who were at-risk gamblers or problem gamblers were significantly more likely to consume energy drinks than non-gamblers or not-at-risk gamblers. A similar pattern was seen for consumption of new psychoactive substances. No significant association emerged with coffee consumption. The sensitivity analysis showed that, compared with non gamblers, the group of gamblers had higher odds for frequent coffee consumption, as well as for consumption of energy drinks and/or new psychoactive substances. Screening for gambling and stimulant use may provide important information, as it may be necessary to take action to reduce stimulant substance use as part of efforts to deal with unhealthy gambling habits.

El juego es un importante problema de salud pública ampliamente reconocido. A pesar del creciente uso de sustancias estimulantes entre los adolescentes, todavía son escasos los estudios centrados en verificar la existencia de una asociación entre el uso de estimulantes y los comportamientos relacionados con el juego en adolescentes. Por tanto, este estudio tuvo como objetivo investigar la asociación entre los hábitos relacionados con el juego y el consumo de sustancias estimulantes como el café, las bebidas energizantes y las nuevas sustancias psicoactivas en una muestra de adolescentes italianos. En 2017 se realizó una encuesta en una muestra representativa de jóvenes italianos de 14 a 17 años, constituida por 15 833 estudiantes provenientes de 201 escuelas de educación secundaria. Se realizó un análisis de regresión logística para evaluar la asociación entre juego de riesgo/juego problemático (R1) y factores predictivos independientes: el modelo incluyó variables independientes (café, bebida energética y consumo de nuevas sustancias psicoactivas) y otras covariables demográficas, del entorno social y de conductas de riesgo. También se realizó un análisis de sensibilidad para examinar una segunda variable dependiente con respecto a cualquier experiencia de conductas relacionadas con el juego (R2). Los adolescentes clasificados como jugadores de riesgo o jugadores con problemas tenían una probabilidad significativamente mayor de consumir bebidas energizantes que los no jugadores o los jugadores sin riesgo. Se observó un patrón similar en el consumo de nuevas sustancias psicoactivas. No se evidenció ninguna asociación significativa con el consumo de café. El análisis de sensibilidad mostró que, en comparación con los no jugadores, el grupo de jugadores tenía mayores probabilidades de consumo frecuente de café, bebidas energéticas y/o nuevas sustancias psicoactivas. La evaluación del juego y el uso de sustancias estimulantes puede proporcionar información importante. Por consiguiente, podría ser necesario tomar medidas para reducir el uso de sustancias estimulantes como parte de los esfuerzos dirigidos a lidiar con los hábitos de juego poco saludables.

Breast Cancer Primary Prevention and Diet: An Umbrella Review.

Introduction: Many studies have been published, but none have pooled the useful evidence available in the literature to produce guidelines and health policies promoting healthy eating styles to prevent breast cancer (BC). The present study aimed to summarize the evidence produced to date, taking a judicious, critical approach to the quality of the studies analyzed. Methods: An umbrella review method was adopted, which is a systematic review of second-level studies, meta-analyses and literature reviews. Results: In all, 48 studies were considered: 32 meta-analyses, 4 pooled analyses, 5 systematic reviews, and 7 qualitative reviews. A higher intake of total meat, or red or processed meats, or foods with a high glycemic index, or eggs would seem to be associated with a higher risk of BC. Some foods, such as vegetables, would seem instead to have an inverse association with BC risk. One meta-analysis revealed an inverse association between citrus fruit and mushroom consumption and BC. Some nutrients, such as calcium, folate, vitamin D, lignans and carotenoids, also seem to be inversely associated with BC risk. The evidence is still conflicting as concerns exposure to other dietary elements (e.g., polyunsaturated fatty acids, dairy foods). Conclusion: Nutrition is one of the most modifiable aspects of people's lifestyles and dietary choices can affect health and the risk of cancer. Overall, adhering to a healthy eating style may be associated with a significant reduction in the risk of BC.

Primary school children and nutrition: lifestyles and behavioral traits associated with a poor-to-moderate adherence to the Mediterranean diet. A cross-sectional study.

The Mediterranean diet has consistently shown a beneficial influence on health and longevity. The aim of this cross-sectional study was to identify all the various factors-such as socio-demographics, lifestyles, and behavioral traits-associated with the risk of a poor adherence to the Mediterranean diet in a sample of Italian primary school children. The study sample included 267 children in their first year of primary school. Their mothers were asked to answer an anonymous, self-administered questionnaire that investigated their children's adherence to the Mediterranean diet (using the KidMed score) and variables related to their lifestyles, behavioral traits, and socio-economic factors. A multivariate logistic regression was performed to test the association between adherence to the Mediterranean diet and the other variables investigated. Most of the children involved in this study (73.9%) were classifiable as having a poor-to-moderate adherence to the Mediterranean diet. Higher odds of a poor adherence to the Mediterranean diet were associated with videogame playing for more than 1 h a day and lower levels of mothers' health consciousness. On the other hand, the odds were lower in association with more time spent practicing sport, higher levels of prosocial behavior, and with mothers having a high school education as opposed to fewer years of schooling.Conclusions: These results point to the need to consider the role of mothers' health consciousness and formal education in influencing their children's diets. Health promotion interventions should focus on the importance of a healthy overall lifestyle, which includes not only appropriate nutrition but also time spent on physical activity and leisure activities (such as playing videogames).What is Known:• Most of the children were classified as having a poor or moderate adherence to the Mediterranean diet. This result reflects a trend common to numerous countries of the Mediterranean area in recent years.• A mother's level of formal education influences her child's diet.What is New:• Higher levels of prosocial traits coincided with lower odds of a poor adherence to the Mediterranean diet.

Uso de sustancias estimulantes y comportamiento de juego en adolescentes. Juego y uso de estimulantes / Stimulant substance use and gambling behaviour in adolescents. Gambling and stimulant use

El juego es un importante problema de salud pública ampliamente reconocido. A pesar del creciente uso de sustancias estimulantes entre los adolescentes, todavía son escasos los estudios centrados en verificar la existencia de una asociación entre el uso de estimulantes y los comportamientos relacionados con el juego en adolescentes. Por tanto, este estudio tuvo como objetivo investigar la asociación entre los hábitos relacionados con el juego y el consumo de sustancias estimulantes como el café, las bebidas energizantes y las nuevas sustancias psicoactivas en una muestra de adolescentes italianos. En 2017 se realizó una encuesta en una muestra representativa de jóvenes italianos de 14 a 17 años, constituida por 15 833 estudiantes provenientes de 201 escuelas de educación secundaria. Se realizó un análisis de regresión logística para evaluar la asociación entre juego de riesgo/juego problemático (R1) y factores predictivos independientes: el modelo incluyó variables independientes (café, bebida energética y consumo de nuevas sustancias psicoactivas) y otras covariables demográficas, del entorno social y de conductas de riesgo. También se realizó un análisis de sensibilidad para examinar una segunda variable dependiente con respecto a cualquier experiencia de conductas relacionadas con el juego (R2). Los adolescentes clasificados como jugadores de riesgo o jugadores con problemas tenían una probabilidad significativamente mayor de consumir bebidas energizantes que los no jugadores o los jugadores sin riesgo. Se observó un patrón similar en el consumo de nuevas sustancias psicoactivas. No se evidenció ninguna asociación significativa con el consumo de café. El análisis de sensibilidad mostró que, en comparación con los no jugadores, el grupo de jugadores tenía mayores probabilidades de consumo frecuente de café, bebidas energéticas y/o nuevas sustancias psicoactivas. La evaluación del juego y el uso de sustancias estimulantes puede proporcionar información importante. Por consiguiente, podría ser necesario tomar medidas para reducir el uso de sustancias estimulantes como parte de los esfuerzos dirigidos a lidiar con los hábitos de juego poco saludables

Gambling is widely recognized as an important public health problem. Despite the rising use of stimulant substances among adolescents, there are still very few studies focusing on whether adolescents' use of stimulants is associated with their gambling behaviour. Therefore, the aim of this study was to investigate the association between gambling habits and consumption of stimulants such as coffee, energy drinks, and new psychoactive substances in a sample of Italian adolescents. A survey was conducted in 2017 with a representative sample of Italians between the ages of 14-17 years, comprising 15,833 students attending 201 secondary schools. Logistic regression analyses were run to assess the association between at-risk/problem gambling (O1) and independent predictors: the model included independent variables (coffee, energy drinks and new psychoactive substance consumption) and covariates (demographic variables, social environment variables and risk-taking behaviour variables). A sensitivity analysis was also conducted to examine a second dependent variable regarding any experience of gambling behaviour (O2). Adolescents who were at-risk gamblers or problem gamblers were significantly more likely to consume energy drinks than non-gamblers or not-at-risk gamblers. A similar pattern was seen for consumption of new psychoactive substances. No significant association emerged with coffee consumption. The sensitivity analysis showed that, compared with non gamblers, the group of gamblers had higher odds for frequent coffee consumption, as well as for consumption of energy drinks and/or new psychoactive substances. Screening for gambling and stimulant use may provide important information, as it may be necessary to take action to reduce stimulant substance use as part of efforts to deal with unhealthy gam-bling habits

Pathways connecting socioeconomic variables, substance abuse and gambling behaviour: a cross-sectional study on a sample of Italian high-school students.

OBJECTIVES: The aim of this study was to elucidate the pathway of associations linking gambling, alcohol intake, smoking habit, cannabis consumption between each other and with demographic and socioeconomic variables. SETTING AND PARTICIPANTS: A survey was conducted in 2017 on a representative sample of 15 602 Italian 14-year-olds to 17-year-olds attending 201 secondary schools. OUTCOME MEASURES: Structural Equation Models analysis was used to assess the pathway between gambling, alcohol intake, smoking, cannabis consumption, demographics and socioeconomic factors. RESULTS: Irrespective of socioeconomic or demographic variables, gambling is positively associated with alcohol and cannabis consumption, while cannabis consumption is predicted by smoking and by alcohol intake, smoking is predicted by alcohol intake. Adolescents with a higher weekly income are more at risk of gambling, drinking alcohol and smoking, while the degree of economic dissatisfaction was positively associated with alcohol intake, cannabis consumption and smoking. Maternal employment appeared to be positively associated with adolescents' smoking, alcohol intake and cannabis consumption. CONCLUSIONS: This is one of the first studies to shed light on the pathways of associations connecting various health-risk behaviours among adolescents with demographic and socioeconomic factors.