European School Survey Project Research Articles

The cards they're dealt: types of gambling activity, online gambling, and risk of problem gambling in European adolescents

ObjectiveThis study aims to identify risk factors associated with gambling engagement and the likelihood of problem behavior, distinguishing by type of gambling activity and examining the impact of online gambling. MethodsData about 85,420 students aged 16 from 33 countries participating in the 2019 European School Survey Project on Alcohol and Other Drugs (ESPAD) were analyzed through a three-stage sequential probit model, specifically focusing on four types of activity: lotteries, slot machines, cards, and betting. Furthermore, predicted probabilities were calculated for subsamples of students engaging in different types of gambling activities to explore their influence on the likelihood of problem gambling behavior, conditioned on online gambling involvement. ResultsCertain groups, such as males and those with a history of school difficulties, exhibit a higher likelihood of problematic gambling behavior. Online gaming significantly influences adolescent gambling behavior, with slot machines demonstrating the highest predicted probabilities of risky behavior when combined with online gaming. Policy implicationsThe findings highlight that gambling is quite common among adolescents, and that gamblers and problem gamblers display different profiles, suggesting the importance of targeted interventions and support for vulnerable individuals. Public policies should prioritize the regulation of high-risk gambling activities, particularly slot machines, by enhancing the enforcement of age restrictions and the education on the real odds of winning and potential harms of gambling, particularly among adolescents. It is crucial to foster policies and interventions that address the risks associated with online gambling for this age group.

Unequal cannabis use among European adolescents: the mediating role of perceived access and risk

Abstract Introduction Cannabis use among adolescents is a public health concern, because of its association with the use of other illicit drugs, mental health disorders, and social problems. Most studies show that adolescents from low socioeconomic status (SE) background are more likely to use cannabis, but the causes of SE inequalities remain to be understood. We test whether access and risk perceptions of cannabis use among disadvantaged adolescents explain the SE gradient. Objectives The aim of this study was to measure the mediating effect of access perception and risk perception on the association between SE status and cannabis use among European adolescents in 2019. Methods A cross-sectional, observational, analytical study was conducted, among 16-year-old students, based on data from the European School Survey Project on Alcohol and Drugs (ESPAD) in 2019. The outcome was cannabis use (experimental, regular, and problematic) and the exposure was SE status (parental education and subjective social status). Mediating variables were perceived accessibility and perceived risk of cannabis use. We used logistic regressions, where the odds ratio (OR) reduction measures the part of the association explained by the mediators. Results Regular and problematic cannabis use was significantly more prevalent among adolescents with a lower SE background (low parental education and low subjective social status, p < 0,001). This relationship remained significant after adjustment for perceived access and risk, and the modification of ORs was of a small magnitude (a non-significant reduction of the association). Conclusions Perceived accessibility and risk showed a weak mediating effect of the association between SE background and cannabis use. Consequently, these factors cannot be considered as major explanations for the higher use among worse-off adolescents. Reinforcing information or imposing stronger barriers in access may not help reduces SE inequalities in cannabis consumption. Key messages • Perceived accessibility and risk hardly explain the association between socioeconomic background and cannabis use among European adolescents. • Reinforcing information or imposing stronger barriers in access may not help reduces socioeconomic inequalities in cannabis use.

Non-medical use of tranquilizers and sedatives by 15-16-year-old adolescents in Estonia, 2003–2019

Abstract Background Non-medical use of prescription drugs has become a global concern in recent decades. This study aimed to explore trends in non-medical tranquilizers and sedatives use (NTSU) among adolescents in Estonia from 2003 to 2019. Methods Utilizing data from the cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD) conducted in 2003-2019, study included 15-16-year-old Estonian schoolchildren (n = 11,328; 48.6% boys). Cochran-Armitage test was employed to assess changes in NTSU trends, with statistical significance set at p < 0.05. Prevalence rates and 95% CIs used as outcome measures. Results From 2003 to 2019, the lifetime prevalence of NTSU significantly increased for both genders, with girls consistently showing higher rates. Among boys, NTSU rose from 5.0% (95% CI 3.8-6.5) to 11.3% (95% CI 9.6-13.3), particularly among those reporting NTSU 1-2 times, from 3.0% (95% CI 2.1-4.2) to 8.2% (95% CI 6.7-9.9), p < 0.001. Similarly, for girls, NTSU rose from 12.6% (95% CI 10.7-14.7) to 17.5% (95% CI 15.4-19.7), p < 0.001. There was an increase among girls reporting NTSU 1-2 times from 7.5% (95% CI 6.0-9.2) to 10.6% (95% CI 9.0-12.4), p < 0.001, and those reporting NTSU three or more times, from 5.1% (95% CI 3.9-6.6) to 6.9% (95% CI 5.6-8.4), p = 0.017. Among boys reporting medical tranquilizers and sedatives use (MTSU), NTSU rose from 21.1% (95% CI 13.9 to 30.0) in 2003 to 41.4% (95% CI 32.3 to 50.9) in 2019, p = 0.006. However, there was no statistically significant change in NTSU among girls reporting MTSU, remaining at 44.1% (95% CI 36.0 to 52.4) in 2019, p = 0.951. Conclusions Study reveals a significant increase in lifetime NTSU from 2003 to 2019, with girls consistently showing higher prevalence. Targeted interventions are needed to address adolescent non-medical prescription drug use, particularly among girls. Moreover, substantial NTSU among those reporting MTSU highlights the need to monitor and address non-medical usage in this subgroup. Key messages • Estonian adolescent non-medical tranquilizers and sedatives use surged from 2003 to 2019, particularly among girls, highlighting the need for targeted interventions. • The high prevalence of non-medical tranquilizer and sedative use among those reporting medical tranquilizer and sedative use underscores the necessity for vigilant monitoring.

Exclusive and dual use of electronic cigarettes among European youth in 32 countries with different regulatory landscapes

BackgroundThe Tobacco Products Directive (2014/40/EU) partially harmonised the regulation of electronic cigarettes (e-cigarettes) in Europe, but individual countries maintain jurisdiction over bans on use in public places, domestic advertising, taxation...

PREVALENCE OF PSYCHOACTIVE SUBSTANCE USE AMONG SECONDARY SCHOOL STUDENTS IN ŽUPANJA

Introduction: The use of psychoactive substances is a serious and difficult problem in many countries of the world, and is taking on epidemic proportions, especially in the youth population. Disorders caused by the psychoactive substance useinclude a wide range of disorders. Experts are finding it increasingly difficult to monitor the possible consequences that drugs can cause in the human body.Aim: To examine the prevalence of the psychoactive substance useamong high school students in Županja. Respondents and methods: A cross-sectional survey was conducted during May 2023. The first group of respondents consisted of 115 students of the third and fourth grades of the Županja Grammar School, while the second group consisted of 100 students of the third and fourth grades of the Županja Vocational School. The research instrument was a standardised internationally agreed questionnaire "European Research in Schools on Smoking, Drinking and Drug Use among Pupils" (2011). European School Survey Project on Alcohol and Other Drugs (ESPAD). Results: A statistically significant number of respondents has never used cigarettes, alcoholic beverages, adhesives and other solvents. Respondents fromthe Vocational School used cigarettes on a larger scale daily, while Grammar school students started smoking at an older age. In the last 12 months, when compared to the Vocational School students, a higher percentage of Grammar School students have used adhesives and other solvents. Grammar School students experimented with"drugs" in a higher proportion due to curiosity. Conclusion: The prevalence of the psychoactive substance use among high school youth in Županja is at a satisfactory low level.Keywords:psychoactive substances, students, secondary school

Tranquilisers and sedatives misuse and associated factors among adolescents in Estonia: findings from cross-sectional ESPAD surveys, 2003–2019

ObjectivesThis study aimed to (1) to describe trends of tranquilliser and sedative (TS) misuse in Estonia during 2003–2019 and (2) to analyse the associations between TS misuse and explanatory factors...

Cultural Divergence in Psychedelic Use among Medical Students: An ESPAD-Adapted Survey among Poles and Iraqis.

Psychedelics can profoundly alter cognition and consciousness. Their use in Middle Eastern countries, including Iraq, is ambiguous. We aim to investigate psychedelic awareness and use among Iraqi and Polish medical students. We surveyed 739 university students from Poland (315) and Iraq (424) using 31 adapted questions from the European School Survey Project on Alcohol and Other Drugs (ESPAD). We conducted multivariable analyses based on binary logistic regression to identify the factors associated with psychedelic awareness and use. Most of the respondents were females (65.6%) and senior medical students (69.6%). Notably, the Polish students displayed a higher prevalence of psychedelic use (21.6% compared to 1.2%, p < 0.001), while the Iraqi participants exhibited a lower familiarity with psychedelics (p < 0.001). The multivariable model demonstrated a commendable level of statistical accuracy and satisfactorily conformed to the Hosmer-Lemeshow goodness-of-fit test (statistical accuracy = 91.61%, Nagelkerke R2 = 0.488, p-value = 0.848). Several factors emerged as correlates of increased psychedelic use, including lacking an intact religious belief system or commitment to its practice (OR = 7.26, 95% CI [2.33, 22.60]). Additionally, those who perceived a low risk associated with sporadic psychedelic use (3.03, [1.44, 6.36]) were likelier to engage in such behavior. Other factors included residing in Poland (2.82, [0.83, 9.55]), maintaining positive attitudes toward psychedelics (2.49, [1.20, 5.14]), frequent social nightlife activities (2.41, [1.26, 4.61]), male gender (2.05, [1.10, 3.85]), and cigarette or tobacco smoking (2.03, [1.06, 3.86]). Significant disparities exist between Poles and Iraqis, influenced by religiosity, perceptions of the usage risks, geographical location, gender, attitudes toward psychedelics, parental leniency, and social freedom, especially concerning nightlife activities. Addressing the factors influencing psychedelic usage is paramount to responsible psychedelic engagement and culturally sensitive interventions to prevent misuse.

Implications of the decline in adolescent drinking on the experience of alcohol-related consequences in the Nordic countries: A study based on data from the ESPAD project.

Aims: The aim of this study was to investigate: (1) whether self-reported acute alcohol-related consequences among adolescents in the Nordic countries have declined in concert with the decline in alcohol consumption; (2) whether the relationship between alcohol consumption and alcohol-related consequences has strengthened; and (3) whether the decline in alcohol-related consequences can be attributed to the decline in alcohol consumption. Methods: Data are from the European School Survey Project on Alcohol and Other Drugs (ESPAD) cross-sectional surveys in 2007, 2011 and 2015. Participants were students aged 15-16 years in 2007 (n = 16,035), 2011 (n = 14,765) and 2015 (n = 13,517). Alcohol consumption variables included lifetime and 12-month alcohol use, volume ethanol at last drinking occasion and heavy episodic drinking in the past 30 days. Self-reported acute alcohol-related consequences were measured as a sum index of experiencing the following at least once within the last 12 months: (1) an accident or injury; (2) being victimised by robbery or theft; or (3) had trouble with the police. Results: For all alcohol indicators, adolescent alcohol use decreased between 2007 and 2015. The highest prevalence estimates were found in Denmark, and here only the number of current drinkers decreased significantly. In addition, a decreasing trend in self-reported acute alcohol-related consequences was observed. We did not find a strengthening of the alcohol consumption consequences association from 2007 to 2015, except in Iceland. When all surveys were combined, the decrease in alcohol-related consequences could be explained by a decrease in alcohol consumption. Conclusions: Overall, adolescents aged 15-16 years exhibited decreasing trends in both alcohol consumption, less markedly in Denmark, and in our sum index of alcohol-related consequences between 2007 and 2015. Except for Iceland, we found no support for a strengthening of the alcohol-consequences association with declining drinking among adolescents.

Cannabis reduction among adolescents as spillover from successful tobacco control

BackgroundNational programs that reduce adolescent cannabis use warrant renewed attention in light of current discussions to reform cannabis legislation, including the possibility of legalization for recreational use. This study measures the size of a decrease in a country's prevalence of adolescent cannabis use that accompanies a decrease in its prevalence of adolescents who had ever smoked a cigarette. MethodsData are from the European School Survey Project on Alcohol and Other Drugs (ESPAD), which is a collaborative effort of more than 40 European countries to surveil adolescent substance use. This study uses data from the seven survey administrations in 1995, 1999, 2003, 2007, 2011, 2015, and 2019. The main analysis is a fixed-effect regression analysis of country-level, four-year changes in adolescent lifetime cannabis use prevalence on country-level, four-year changes in adolescent lifetime cigarette use prevalence. ResultsDecreases in the national prevalence of adolescents who had ever smoked a cigarette were accompanied by decreases half as large in national prevalence of adolescent lifetime cannabis use. ConclusionFor European countries considering the legalization of adult recreational cannabis use, tobacco control can offer a tool to help counter potential increases in cannabis use among adolescents.

Religijos-viktimizacijos modulio link tarptautinio jaunimo delinkvencijos ir viktimizacijos tyrimo (ISRD) kontekste: mokymasis iš praeities pavyzdžių

The concept of postsecular society highlights the increasing relevance of religion in social, cultural, and political affairs. Given this trend, criminology should pay increasing attention to how religion is linked to victimization and offending. Since the religion–crime studies have traditionally focused on offending, the research lacunae are biggest in the study of victimization. The inclusion of religion is particularly relevant in international surveys in religiously heterogeneous communities. In this article, we aim to develop a survey module suggestion for use in the context of the International Self-Report Delinquency Study (ISRD). We first examine the current content of the ISRD-4 sweep. To locate lacunae in it, we move to review how international surveys have tackled the dimension of religion, including the Health Behaviour in School-aged Children (HBSC) study, the European School Survey Project on Alcohol and Other Drugs (ESPAD), the European Social Survey (ESS), the World Values Survey (WVS), and the International Crime Victim Survey (ICVS). Building on these state-of-the-art examples, we propose a new ISRD module (Appendix) for studying the religion–victimization link in international crime surveys with limited space. In conclusion, we argue that criminology would benefit from increasing attention to religion and other cultural variables alongside traditional socioeconomic, structural, and individual factors.

Have there been changes in daily smoking and cigarette consumption among adolescents? Investigation between 1999 and 2019 among Finnish adolescents.

It is postulated that due to decreased smoking rates and increased denormalisation of smoking, those who start and maintain smoking have more socially disadvantaged characteristics and are more dependent on nicotine than those who do not (the so-called 'hardening' hypothesis). The aim of this study was to measure changes in daily smoking and cigarette consumption among Finnish adolescents according to background factors. A repeated cross-sectional study using data from European School Survey Project on Alcohol and other Drugs (ESPAD) on six representative cross-sections of 15- to 16-year-old students between 1999 and 2019 in Finland. A total of 11 377 males and 12 247 females. The outcome measures included the proportion of daily smokers among current smokers, daily smoking and the estimated mean number of smoked cigarettes per day (CPD). Substance use, parental monitoring and school performance were used as independent variables. All measures were self-reported. Daily smoking decreased over time and daily smokers constituted a smaller part of current smokers in 2019 compared with 1999 (the ratio among boys 0.68 and 0.43, respectively; among girls 0.59 and 0.43). Boys using cannabis (interaction between cannabis*survey year: P = 0.020; in 2019 odds ratio [OR]: 3.68, 95% confidence interval [CI] 2.23-6.08) and girls with heavy episodic drinking (interaction between heavy episodic drinking*survey year: P = 0.006, in 2019 OR: 9.00, 95% CI 5.61-14.42) had elevated adjusted odds for daily smoking over time. The estimated mean number of CPD decreased among daily smokers from 9.0 in 1999 to 7.2 in 2019 (P = 0.0002) and the differences diminished between groups based on gender, snus/alcohol use and parental monitoring. The between-group differences remained with regard to cannabis use (P = 0.0233 in 2019) and school performance (P = 0.0111 in 2019). Among currently smoking Finnish adolescents, the proportion of daily smokers decreased between 1999 and 2019, as did the number of cigarettes smoked per day (CPD) among daily smokers, suggesting an absence of 'hardening' in this group. However, differences were observed related to the odds of daily smoking and the mean number of CPD, indicating the change has been less favorable among some adolescent groups than others.

Odds of gambling among adolescents: a secondary analysis of the cross-sectional European School Survey Project on Alcohol and Other Drugs

BackgroundGambling among adolescents is associated with gambling disorder in adulthood. This study investigated factors associated with gambling and excessive gambling in adolescents. MethodsThis secondary analysis of the cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD) used nationally representative data from the Irish cohort of the 2019 ESPAD wave. Data were collected between March and May 2019. We included 1949 students aged 15–16 years (946 [48·5%] male, 1003 [51·5%] female), with a response rate of 85%. We calculated past year gambling prevalence as the rate of those who had gambled for money on at least one of four games of chance (slot machines, cards or dice, the lottery, betting on sports or animals) in the past 12 months. An adapted version of the three-item Consumption Screen for Problem Gambling was used to identify excessive gambling (score ≥4). We carried out descriptive and logistic regression analyses using binary covariates with Stata v16.1. We included 19 variables in the multivariable analysis. Ethics approval was granted by Dublin Institute of Technology's Ethics Committee. Non-consent forms were issued to all parents to opt out. FindingsOverall, 447 (23%) of 1949 students gambled in the past year, of whom 45 (10%) engaged in excessive gambling. Using a mutually adjusted multivariable logistic regression analysis, past year gambling was associated with alcohol use (adjusted odds ratio [aOR] 1·6, 95% CI 1·1–2·2), experiencing serious arguments (aOR 1·4, 1·1–1·9), and trouble with the police (aOR 1·9, 1·2–2·8). Female gender was a protective factor (aOR 0·6, 0·4–0·9). In the univariable analysis, excessive gambling was associated with gaming (OR 2·3, 1·0–5·1), tobacco use (2·1, 1·1–4·2), e-cigarette use (2·1, 1·1–4·1), heavy episodic drinking (2·7, 1·4–5·1), trouble with the police (2·8, 1·5–5·4, p<0·01), and deliberately hurting themselves (2·8, 1·4–5·6). Female gender (OR 0·3, 0·1–0·6) and social media use (0·4, 0·2–0·8) were protective factors. Excessive gambling was also associated with betting on sports and animals (OR 3·6, 1·6–8·4), slot machines (2·9, 1·5–5·8), card or dice (2·4, 1·2–4·6), and online gambling (4·2, 2·0–8·0). InterpretationA large proportion of 15–16 year olds in Ireland have gambled for money in the past year, with one in ten of those having engaged in excessive gambling. This number is likely to be underestimated due to recall and social desirability bias. Reducing the availability, access, and appeal of gambling products in Ireland should be addressed through ongoing gambling reform. FundingInstitute of Public Health.

Country and sex measurement invariance of the Cannabis abuse screening test (CAST) in European Youth

BackgroundMonitoring the prevalence of problematic cannabis use is an important public health issue. International surveys need invariant measurement tools to allow reliable comparisons across countries and between sexes. The Cannabis abuse screening test (CAST) has been developed for this purpose. This study is the first assessing its country and sex invariance in a sample of European pupils. MethodsThe data come from the self-administered questionnaires completed in 2019 by pupils aged 15-16 in the European school survey project (Espad). The analytical sample was restricted to the 17 countries where at least 300 pupils reported a previous-year cannabis use (n = 8740); multigroup confirmatory factor analyses were used to assess the configural, metric and scalar invariance of the CAST toward country and sex in the 2019 Espad release. ResultsConfigural, metric and scalar invariance toward country hold for the 17 countries: Austria, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Greece, Italia, Latvia, Poland, Portugal, Slovakia, Slovenia and Spain. Scalar invariance toward sex was met in the 17 countries as a whole and in 11 of the 12 countries where the test could be run. Scalar invariance toward country was met with 6 additional countries comprising at least 250 respondents: Ireland, Lithuania, Malta, Montenegro, the Netherlands and Norway. ConclusionThe CAST is a suitable test for comparing the measurement of problematic cannabis use amongst adolescents in Europe.

Substance Use, Internet Risk Behavior, and Depressive Symptoms as Predictors of Self-harm Thoughts in Adolescents: Insights from the 2019 ESPAD Survey in Croatia.

Self-harm has become a nonspecific symptom of mental distress that is most prevalent in the adolescent population. Since it is often a hidden problem, it is important to focus on preventing it. This study used the data from the Croatian leg of the European School Survey Project on Alcohol and Other Drugs to assess certain risk factors and possible protective factors for self-harm thoughts among 16-year-olds in Croatia. Using binary logistic regression, we identified that being female, having less family support and less parental knowledge of adolescents' activities, more frequent cannabis use, more compulsive Internet use and more frequent depressive symptoms significantly increased the likelihood of self-harm thoughts in this sample. Identifying factors that lead to thoughts of self-harm may open a potential space for self-harm prevention before those thoughts progress into behavior.

Differential associations of adolescent versus young adult cannabis initiation with longitudinal brain change and behavior.

Leveraging ~10 years of prospective longitudinal data on 704 participants, we examined the effects of adolescent versus young adult cannabis initiation on MRI-assessed cortical thickness development and behavior. Data were obtained from the IMAGEN study conducted across eight European sites. We identified IMAGEN participants who reported being cannabis-naïve at baseline and had data available at baseline, 5-year, and 9-year follow-up visits. Cannabis use was assessed with the European School Survey Project on Alcohol and Drugs. T1-weighted MR images were processed through the CIVET pipeline. Cannabis initiation occurring during adolescence (14-19 years) and young adulthood (19-22 years) was associated with differing patterns of longitudinal cortical thickness change. Associations between adolescent cannabis initiation and cortical thickness change were observed primarily in dorso- and ventrolateral portions of the prefrontal cortex. In contrast, cannabis initiation occurring between 19 and 22 years of age was associated with thickness change in temporal and cortical midline areas. Follow-up analysis revealed that longitudinal brain change related to adolescent initiation persisted into young adulthood and partiallymediated the association between adolescent cannabis use and past-month cocaine, ecstasy, and cannabis use at age 22. Extent of cannabis initiation during young adulthood (from 19 to 22 years) had an indirect effect on psychotic symptoms at age 22 through thickness change in temporal areas. Results suggest that developmental timing of cannabis exposure may have a marked effect on neuroanatomical correlates of cannabis use as well as associated behavioral sequelae. Critically, this work provides a foundation for neurodevelopmentally informed models of cannabis exposure in humans.

Relationship between Gaming and other game related activities: Italian validation of the Screening Test for Problematic Gaming (STPG)

IntroductionGaming is a common leisure activity among adolescents which may have risky implications. The aim of the present study is to validate the Italian version of a short screening instrument, the Screening Test for Problematic Gaming (STPG), which is composed of three items and it is able to distinguish between problematic and non-problematic gamers in a non-clinical population. MethodsData were collected through the ESPAD (European School Survey Project on Alcohol and Other Drugs) questionnaire. It is a cross-sectional school survey that investigates risky behaviours in a representative sample of Italian high-school students (N = 12,237; 50.8% girls) aged between 15 and 19 years (mean = 17.02 years). ResultsAfter the STPG was translated and adapted for Italian use, Principal Component Analysis and Multiple Correspondence Analysis were performed to investigate psychometric properties of STPG and calculate the optimal scaling for each item. Cronbach’s alpha was good (0.769).Finally, confirmatory factor analysis using Structural Equation Modelling was performed, showing a correlation between STPG score and time/money spent gaming (β = 0.467 and β = 0.238, respectively), places where students played (β = 0.142) and gaming apparatus (β = 0.165). ConclusionsThe STPG could be a short and useful instrument for school surveys, to detect problematic gaming among adolescents early on.

Changes in co-use of alcohol and cannabis among Nordic adolescents in the 21st century: Results from the European School Survey Project on Alcohol and Other Drugs study.

In the 21st century, there has been a decline in alcohol use among adolescents in most Nordic countries, while trends of cannabis use have diverged. We explore how alcohol and cannabis use, respectively, and co-use of the two substances, have changed among Nordic adolescents. Three hypotheses are used to frame the study: (i) cannabis use has substituted alcohol use; (ii) there has been a parallel decline in both substances; and/or (iii) there has been a 'hardening' of users, implying that alcohol users increasingly use cannabis. Data from the European School Survey Project on Alcohol and Other Drugs, conducted among 15- to 16-year-olds in Denmark, Finland, Iceland, Norway and Sweden (N = 74,700, 49% boys), were used to explore trends of past-year alcohol and cannabis use in the period 2003-2019. The proportion of adolescents reporting alcohol use decreased significantly in all Nordic countries except Denmark. The proportion of those using cannabis only was low (0.0%-0.7%) and stable in all countries. The total number of substance use occasions declined among all adolescents in all countries but Denmark. Among alcohol users, cannabis use became increasingly prevalent in all countries but Denmark. We found no support for the 'parallel decline hypothesis' in alcohol and cannabis use among Nordic adolescents. Partially in line with the 'substitution hypothesis', cannabis use accounted for an increasing proportion of all substance use occasions. Our results suggests that the co-use of alcohol and cannabis has become more common, thus also providing support to the 'hardening' hypothesis.

School segregation, selective education, and adolescents’ alcohol use – is there a connection?

ABSTRACT This study examines the connection between studying in selective classes and students’ alcohol use using data from the European School Survey Project on Alcohol and Other Drugs (ESPAD) from Finland. Linear probability models were used to investigate whether (1) studying in selective classes is associated with students’ recent heavy episodic drinking, and (2) whether parental education, students’ school success, and their friends’ alcohol use mediate the association. The results show that Finnish students who are selected for classes with a special emphasis engage less in heavy episodic drinking compared to their peers in non-selective classes. Parental education, school success, and friends’ alcohol use mediate part of the association. The results suggest that having the opportunity to apply for classes with a special emphasis might increase segregation between student groups and schools regarding risky behaviour such as heavy episodic drinking. Implications of urban and school policies on segregation are further discussed.

E-cigarette use and conventional cigarette smoking among European students: findings from the 2019 ESPAD survey.

Representative data on e-cigarette use among European adolescents are scant. This study reports current vaping and tobacco smoking individual and country-specific correlates among European students. Cross-sectional survey: 2019 European School Survey Project on Alcohol and Other Drugs (ESPAD) collecting data on risk behaviours on a representative sample of 16-year-old students. A total of 35 European countries, 25-30 with Tobacco Control Scale (TCS) and TCS components PARTICIPANTS: A total of 99 648 students (49.1% males) turning 16 years in the survey year. Data on current cigarette and e-cigarette use were gathered through a self-administered questionnaire which also collected socio-demographics and individual and family characteristics. ESPAD data were integrated with country-level data on TCS and selected TCS parameters to assess their association with the prevalence of current cigarette and e-cigarette use. Of the 99 648 participating students, 12.4% were current e-cigarette users, from 5.5% in Serbia to 41.4% in Monaco; 19.3% current smokers, from 5.1% in Iceland to 32.4% in Italy. Compared with non-users, current e-cigarette users less frequently came from an average well-off family [odds ratio (OR) =0.85, 95% confidence interval (CI) =0.80-0.90] and lived in countries with higher cigarette prices (OR =0.71, 95% CI =0.50-0.99), restrictive measures on tobacco advertising and promotion (OR =0.79, 95% CI =0.63-0.99) and intermediate implementation of tobacco control measures (OR =0.57, 95% CI =0.38-0.85). Current vapers were more frequently life ever smokers (OR =7.31, 95% CI =6.47-8.25), were early smokers (OR =4.35, 95% CI =3.66-5.17), males (OR =1.61, 95% CI =1.55-1.67), from non-traditional families (OR =1.43, 95% CI =1.34-1.53), with relatively low parental education (OR =1.15, 95% CI =1.10-1.20). Compared with non-smokers, current smokers had similar family characteristics to vapers, and were less likely to live in countries with higher cigarette prices (OR =0.70, 95% CI =0.49-0.99) and higher spending on public anti-tobacco media campaigns (OR =0.23, 95% CI =0.10-0.50). E-cigarette use among European adolescents is associated with weaker tobacco control measures, particularly on tobacco price, advertising and promotion. Besides preventing tobacco smoking, the adoption of governmental tobacco control policies in European countries also seems to contribute to the prevention of vaping among adolescents.

The Declining Trend in Adolescent Drinking: Do Volume and Drinking Pattern Go Hand in Hand?

Traditionally, adolescent drinking cultures differed between Nordic and Mediterranean countries; the former being characterised by low volume and relatively frequent heavy episodic drinking (HED). Across these drinking cultures, we examined the associations between alcohol volume and HED with respect to (i) secular trends at the country level and (ii) individual-level associations over time. The data stem from the European School Survey Project on Alcohol and Other Drugs (ESPAD) conducted among 15–16-year-olds in Finland, Iceland, Norway, Sweden, France and Italy, employing six cross-sectional surveys from 1999 to 2019 (n = 126,126). Both consumption volume and HED frequency decreased in all Nordic countries and displayed a curvilinear trend in France and Italy. In all countries, consumption volume and HED correlated highly over time at the country level. At the individual level, the correlation was positive but with a varying magnitude over time and between countries. In 1999/2003, the alcohol volume–HED correlation was significantly higher in the Nordic compared to the Mediterranean countries but became significantly weaker in Finland, Norway and Sweden and remained stable in France, Iceland and Italy during the period. In conclusion, while trends in consumption volume and drinking patterns went hand in hand at the aggregate level, the association at the individual level weakened over time in several Nordic countries, along with the substantial decline in adolescent drinking since 2000.