Risk factors for the gambling, smoking and alcohol consumption triad: an observational study in Portuguese adolescents

Background: Gambling, tobacco and alcohol consumption significantly burden mental, social and physical health, often co-occurring with and heightening the risk of addiction. Evidence suggests addictive behaviors like gambling share common neurological pathways and are more prevalent in vulnerable populations, highlighting the importance of studying their interconnections. Adolescence is a critical period for habit-building, thus making it a prime target for addiction-prevention interventions.
 
This study aims to describe addiction habits of Portuguese adolescents and to understand their behavioural and socio-economic risk factors associated with the triad of gambling, smoking and alcohol consumption.
 
Methods: The study adopted a cross-sectional, observational, and analytical framework, analysing self-reported data from the 2019 ESPAD questionnaire targeted at 16-year-old adolescents. We performed a descriptive analysis to characterize the distribution and prevalence of gambling, smoking, alcohol consumption and other social, economic, and behavioural determinants. We then applied the Exact Fisher test for bivariate associations and multiple logistic regression to identify key predictors. All analyses were performed using SPSS version 29.0 and considering a statistical significance of p<0.05.
 
Results: The analysis of 4,365 responses (45.7% male) unveiled varied gambling behaviors: within the previous year, 13.1% engaged in sports/animal betting, 11.7% in lotteries, 5.8% in card/dice games and 2.4% used slot machines. Among the gamblers, 5.5% used the internet. The Lie/Bet test highlighted 272 students (6.2%) with probable problematic gambling, and 3.7% spent ≥30 minutes daily on gambling. Additionally, 8.4% exhibited Problematic Online Gaming per the POGQ-SF. In the 30 days before the survey, 14.3% smoked, 42.7% consumed alcohol, and 10.5% had had at least one binge drinking episode. The behavioral triad was found in 56 individuals (1.3%). 
 
The predictive model revealed female gender (OR = 0.39, 95% CI: 0.22-0.70) and parental Saturday night control (OR = 0.13; 95% CI: 0.07-0.25) as protective factors. Conversely, easy parental money access (OR = 1.24; 95% CI: 1.05-1.46), problematic online gaming behavior (OR = 2.01; 95% CI: 1.01-4.02) and going out at least once a week (OR = 1.43; CI 1.21-1.69) were linked to increased risk of the behavioral triad.
 
Conclusion: The results emphasize the importance of enhanced parental oversight and support from family and peers in reducing risky behaviors among adolescents. Given the pivotal role of adolescence in shaping such behaviors, there's a clear need for significant investments in public health programs within educational settings. Additionally, the implementation of strict regulations on online gambling access is critical. These measures are essential for preventing the early onset of problematic gambling, smoking, and alcohol consumption, thus protecting the health and well-being of future generations.