Patterns and Correlates of Co-occurring Smoking, Alcohol Use, Gambling, and High Internet Use Among University Students
A Cross-Sectional Study in Türkiye
Bibliographic Data
| ID | 21426822 |
|---|---|
| Authors | Ahmet Burak Avcu (0009-0007-8240-3928, Inonu University, corresponding author), Sena Nur Gündoğdu (0009-0006-5201-7164, Inonu University), Merve Sülü (0009-0006-3938-6942, Inonu University), Cengiz Çağdaş Kekilli (0009-0003-4494-0918, Nassau University Medical Center), Gülseda Boz (0000-0003-1959-0226, Inonu University), Ayşe Baran (0000-0002-2317-0489, Inonu University), Metin Genç (0000-0002-6244-0517, Inonu University) |
| Year | 2026 |
| Volume | 51 |
| Issue | 3 |
| Pages | 479-493 |
| Publication date | 2026-06-01 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Journal of Community Health (JOURNAL) |
| Journal identifiers | ISSN: 0094-5145 • E-ISSN: 1573-3610 |
| Publisher | Springer Science and Business Media LLC (PUBLISHER) |
| DOI | 10.1007/s10900-026-01563-0 |
| PMID | 41860748 |
| OpenAlex | W7139059545 |
| Language | EN |
| References cited | 34 |
University life may facilitate multiple addictive behaviors that tend to cluster rather than occur in isolation. The aim of this study was to estimate the prevalence and co-occurrence patterns of daily cigarette smoking, past-30-day alcohol use, gambling, and high daily internet use, and to evaluate their sociodemographic and behavioral associations among undergraduate students in Türkiye. This cross-sectional study was conducted at Inonu University (Malatya, Türkiye) between February–May 2024. Using stratified random sampling, n = 366 students were included. Outcomes were daily smoking, past-30-day alcohol use, past-year gambling, and high daily internet use (≥ 5 h/day). Analysis included UpSet framework for co-occurrence and logistic regression models. A Firth-penalized model assessed smoking factors. Prevalence was 39.1% for high internet use, 30.1% for daily smoking, 22.1% for gambling, and 7.7% for alcohol use. Overall, 59.0% reported at least one behavior, 27.6% reported ≥ 2, and 10.4% reported ≥ 3; the most common triple combination was high internet use, smoking, and gambling (6.3%). Male sex was associated with smoking (adjusted odds ratio [aOR] = 3.19) and gambling (aOR = 5.95). Smoking was independently associated with alcohol use (aOR = 5.34) and gambling (aOR = 2.25). High internet use was associated with highest family income (aOR = 2.81), alcohol (aOR = 2.54), and gambling (aOR = 2.73). Peer smoking showed an association with daily smoking (aOR = 17.25 for 2–3 friends vs. none). Risk behaviors are common and frequently cluster, particularly internet use, smoking, and gambling. These findings support integrated campus prevention and screening strategies that address multiple behaviors simultaneously rather than in isolation
Addiction · Alcohol · Behavioral addiction · Cluster (spacecraft) · Logistic regression · Odds · Odds ratio · Peer group · The Internet · Education Practices and Challenges · Gambling Behavior and Treatments · Impact of Technology on Adolescents
Addiction Is a Brain Disease, and It Matters
DSM-5 Criteria for Substance Use Disorders
A systematic review on the clustering and co-occurrence of multiple risk behaviours
Assessing the Association Between Internet Addiction Disorder and Health Risk Behaviors Among Adolescents and Young Adults
Problematic online gambling among adolescents
Problematic internet use by university students and associated predictive factors
Alcohol consumption among university students in Asean countries
Prevalence and Factors Associated with Problematic Internet Use in a Population of Spanish University Students
Patterns and associated factors of cigarette smoking among medical students in 2020
Post-Covid gambling habits of adolescents and young adults in Aragon, Spain
Identification of health-related behavioural clusters and their association with demographic characteristics in Irish university students
| Highly cited | No |
|---|