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Risk factors for the behavioural triad of gambling, smoking and alcohol use: an observational study among adolescents in four Southern European countries
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ABSTRACT - Background: Addictive behaviours often co-occur in adolescence. We assessed factors associated with a behavioural triad (BT) – problematic gambling, smoking, and alcohol use – among 16-year-olds in four Southern European countries.
Methods: Cross-sectional analysis of the 2019 European School Survey Project on Alcohol and Other Drugs (ESPAD) for Portugal, Spain, Italy, and Greece. The outcome was the co-occurrence of probable problematic gambling (Lie/Bet positive), past-30-day cigarette smoking, and past-30-day alcohol use. Independent variables covered sociodemographics, substance use, lifestyle, and family/social context.
Associations were estimated using multiple logistic regression with country fixed effects; adjusted odds ratios (aORs) and 95% confidence intervals (CIs) are reported.
Results: The sample included 16,452 adolescents (Portugal n=4,365; Spain n=3,557; Italy n=2,542; Greece n=5,988). BT prevalence was 1.7% overall (Italy 2.0%, Greece 2.0%, Spain 1.5%, Portugal 1.3%). In the pooled model, male sex was strongly associated with BT (aOR 3.31, 95% CI 2.46–4.44). Binge drinking in the past 30 days (1.40, 1.31–1.50) and past-30-day cannabis use (1.28, 1.20–1.38) increased odds. Night-time leisure at least weekly (1.34, 1.23–1.45) and weekly outings with friends (1.15, 1.02–1.31) were also associated. Parental knowledge of Saturdaynight whereabouts was protective (0.54, 0.41–0.71).
Conclusion: Among Southern European adolescents, the clustering of gambling, smoking, and alcohol use is uncommon but patterned by male sex, heavy/early substance involvement, and nightlife exposure, while parental monitoring is protective. Interventions enhancing substance control, parental monitoring and safer leisure environments may reduce clustered risk behaviours.
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Adolescent Gambling Alcohol Drinking Smoking Risk Factors