"To me, it was Just a Vice". Stigma and Other Barriers to Gambling Treatment in Piedmont, Italy.

In Piedmont (northwestern Italy), as in the rest of the Western world, only a small percentage of the estimated problem gamblers (10-20%) turn to a treatment service to overcome their addiction issues. The study sought to gain a better understanding of the cultural factors that stand in the way of seeking help, thorough qualitative in-depth individual interviews with gamblers both in and out of treatment. A total of 30 interviews were conducted in three different health districts, most via video-call. Data were then analyzed using an abductive approach. The findings appear to indicate that the processes of stigma affecting problem gamblers and public gambling treatment services are the main barriers to seeking help. According to the interviewees, awareness of the problem is a necessary but not sufficient motivator for embarking on treatment, since social stigmatization leads them to hide the problem. Moreover, self-stigmatization processes seem to undermine the sense of self-efficacy that plays a key role in recovery. To encourage help-seeking, the study thus suggests that priority should be given to efforts to reduce stigma, i.e., through informational and educational measures together with advocacy interventions, which aim primarily to reframe the gambling problem, shifting responsibility from the individual to the collective level.

Using Photovoice to understand physical and social living environment influence on adherence to diabetes.

Within the past several years, a considerable body of research on adherence to diabetes regimen has emerged in public health. However, the focus of the vast majority of these studies has been on the individual traits and attitudes affecting adherence. Still little is known on the role of the social and physical context in supporting or hindering diabetes self-management, particularly from a qualitative standpoint. To address these limitations, this paper presents the findings of a Photovoice study on a sample of 10 type 2 diabetic older adults living in a deprived neighbourhood of an Italian city. The findings reveal that the possibility to engage in diet, exercise and blood sugar monitoring seems to be more affected by physical and social elements of the respondents' environment than by the interviewees' beliefs and attitudes. Both environmental barriers and social isolation emerge as barriers to lifestyle changes and self-care activities related to blood sugar monitoring. The predominance of bonding social capital, the scant level of trust and the negative perception of local health services result in a low level of social cohesion, a limited circulation of health information on diabetes management and, consequently, in poor health outcomes.

Variations in acceptability of heavy alcohol use and gender double standards across drinking cultures. A U.S.A. - Italy study.

Focus group data from 92 youths from Italy and the U.S.A. indicate that Italians and Americans differ in perceived threshold of acceptability of drinking to excess. Youth from the U.S.A. were more accepting of intoxication than Italian youth, reflecting features of each respective dominant drinking culture. Alcohol gender double standards existed in both countries and were conceptually connected to sexuality. However, the social construction behind such connections differed across the two groups: focusing on harms to the woman in the U.S.A. and the respectability of her social group in Italy.

The gendered relationship with drunkenness among different generations in Mediterranean and Nordic countries.

The study adopts a qualitative comparative approach to better understand how different dimensions affect social norms regulating alcohol consumption. Female and male attitudes towards drunkenness were analysed on the basis of data from 27 focus groups involving a total of 166 participants from Italy, Finland and Sweden, grouped by age cohort (17-20 and 50-65 years) and educational level. Results suggest that gendered drinking norms may be affected more by the drinking culture than by the degree of gender equality, thus providing a possible explanation of why gender differences in drinking are not always consistent with broader gender inequalities.

A Mixed Methods Cross-Cultural Study to Compare Youth Drinking Cultures in Italy and the USA.

AIMS: To compare the drinking cultures of youth in the USA and in Italy. METHOD: Sequential explanatory mixed method design. Phase 1: Multigroup latent class analysis was used to identify subgroups of drinkers from samples of 424 (61.3% female) Italian and 323 American college students (57.3% female). Phase 2: Focus group interviews with 41 Italian and 47 American youth were used to collect narratives on features of the two drinking cultures. RESULTS: Four partially invariant subgroups of drinkers were found. Most participants (>75%) in both countries concentrated drinking during weekends. Overall, US drinkers displayed greater probabilities to report risky drinking behaviors and experience negative consequences as compared to comparable subgroups of Italian drinkers. Discrepancies in terms of socialisation processes during childhood (i.e. permissiveness) and underlying cultural assumptions with regard to alcohol consumption (i.e. purposes of alcohol use) may explain differences in how alcohol is used in the two countries. CONCLUSIONS: Findings suggest that there are crucial differences in societal schema of beliefs, informal social norms, practices, and values attached to alcoholic beverages across the USA and Italy. These results demonstrate the need for culturally tailored alcohol preventive interventions and clinical practice targeted to young people that capitalise on such differences.

Patterns of alcohol consumption and alcohol-related harm among European university students.

BACKGROUND: To compare patterns of alcohol consumption and alcohol-related harm from a survey of university students sampled from universities in Denmark, England, Germany, Italy, Portugal and Switzerland. METHODS: A total of 2191 university students (70% female, 90% white ethnic group, age range 18-25) completed the survey. Participants completed measures of demographic variables (age, age of onset, ethnic group and sex) and the Alcohol Use Disorders Identification Test (AUDIT), which was the primary outcome. RESULTS: Sixty-three percent of the sample scored negative for harmful drinking on the AUDIT (<8), with 30% categorized as hazardous drinkers, 4% harmful drinkers and 3% with probable dependence. Analysis of variance, including demographic factors as covariates, identified a main effect of country on AUDIT scores F(5, 2086) = 70.97, P < 0.001, partial eta square = 0.15. AUDIT scores were highest in England (M = 9.99; SD = 6.17) and Denmark (M = 9.52; SD = 4.86) and lowest in Portugal (M = 4.90; ° = 4.60). Post hoc tests indicated large effect size differences between scores in Denmark and England and scores in all other countries (0.79 < d < 0.94; all P's < 0.001). CONCLUSIONS: European university students in our sample mainly reported low risk patterns of alcohol consumption and alcohol-related harm. However, students from Northern European countries had significantly higher AUDIT scores compared with students from Central and Southern European countries. Research is needed to replicate the present study using nationally representative samples to estimate the prevalence of alcohol use disorders among university students in different European countries.

A School-Based Program to Promote Well-Being in Preadolescents: Results From a Cluster Quasi-Experimental Controlled Study.

Diario della Salute [My Health Diary] is a school-based program designed to enhance the subjective well-being and health of 12- to 13-year-old students. We hypothesized that providing students with the social and emotional skills to fulfill their potential and deal with common developmental tasks of adolescence (e.g., onset of puberty, identity development, increased responsibilities and academic demands) would result in improved well-being and health. The program comprises five standardized interactive lessons concerning common psychosocial and health issues in adolescence, and two narrative booklets addressed to both students and their parents. We evaluated the effectiveness of the program in terms of the students' subjective well-being, aggressive behavior, and health behavior. Using a quasi-experimental study design, schools in the intervention group implemented the full program and those in the comparison group received their regular curriculum. We administered measures of the study's objectives both before and after program implementation. Statistical analyses accounted for within-school clustering, potential socioeconomic and demographic confounding, and pre-implementation levels of these measures. We sampled 62 schools and allocated 2630 students to either an intervention or comparison group. Sociodemographic characteristics and baseline outcomes were balanced across study groups. Unexpectedly, respondents in the intervention group had 0.38 greater mean adjusted score of the WHO/Europe Health Behaviour in School-Aged Children Symptom Checklist instrument than respondents in the comparison group, indicating a reduction in subjective well-being. We did not observe any program effects on aggressive and health behaviors. The apparent reduction in subjective well-being reflected by an increased perception of psychosomatic complaints is suggestive of either increased emotional competence or, potentially, iatrogenic program effects. While greater emotional competence is positively associated with well-being over the course of life, the program in its present form should not be disseminated due to the possibility of adverse unintended effects.

Depoliticising addiction: Who gets to speak in European press reporting, 1991-2011?

AIMS: The article presents an analysis of sources of information employed in mainstream print media reporting on addiction problems in Finland, Italy and Poland in the 1990s and 2000s. METHOD: A quantitative content analysis of frequency of different sources employed in articles in daily newspapers from Finland (N = 258), Italy (N = 296), and Poland (N = 212) from the years 1991, 1998 and 2011. Semantic units were coded in Atlas.ti. The societal spheres represented were identified using a common coding scheme broadly inspired by Boltanski and Thévenot's typology of polities of worth. Transformations were identified in line with van Leeuwen's framework for trends in discourse salience over time. RESULTS: The study highlights different patterns of coverage of addictions in the three countries. Over time, increased salience is given to the individuals affected by addictions and experts who represent biomedical sciences. This process occurred with varying intensity and expressiveness in all countries under study. CONCLUSIONS: Social and political sources were employed to less extent over time. The media focus seemed to shift to the affected individuals and scientific expertise. This confirms results from previous studies on a general move towards individualisation and an increased focus on more personal and technical aspects of addiction problems in the mass media.

A Commentary on the Limits of Alcoholic Beverage Policies.

Providing one set of policy measures for all countries as if they were a single, homogeneous entity does not appear to be evidence-based, according to recent research on the effectiveness of alcoholic beverage control policies. Contextual and cultural determinants-social, economic, demographic, cultural and political-appear to be major factors of influencing change in drinking trends, drinking patterns and drinking-related harms. The variable interplay between contextual determinants and alcohol control policy measures implies diverse impacts on consumption and harm according to time, and to the different countries and groups of countries. In addition, epidemiology research manifests some limitations when applied to alcohol drinking and results are transferred from one culture to another. The conditions of individual cultures and countries should be considered when planning and evaluating alcohol control policies.

European longitudinal study on the relationship between adolescents' alcohol marketing exposure and alcohol use.

BACKGROUND AND AIMS: This is the first study to examine the effect of alcohol marketing exposure on adolescents' drinking in a cross-national context. The aim was to examine reciprocal processes between exposure to a wide range of alcohol marketing types and adolescent drinking, controlled for non-alcohol branded media exposure. DESIGN: Prospective observational study (11-12- and 14-17-month intervals), using a three-wave autoregressive cross-lagged model. SETTING: School-based sample in 181 state-funded schools in Germany, Italy, Netherlands, Poland. PARTICIPANTS: A total of 9075 eligible respondents participated in the survey (mean age 14 years, 49.5% male. MEASUREMENTS: Adolescents reported their frequency of past-month drinking and binge drinking. Alcohol marketing exposure was measured by a latent variable with 13 items measuring exposure to online alcohol marketing, televised alcohol advertising, alcohol sport sponsorship, music event/festival sponsorship, ownership alcohol-branded promotional items, reception of free samples and exposure to price offers. Confounders were age, gender, education, country, internet use, exposure to non-alcohol sponsored football championships and television programmes without alcohol commercials. FINDINGS: The analyses showed one-directional long-term effects of alcohol marketing exposure on drinking (exposure T1 on drinking T2: ß = 0.420 (0.058), P < 0.001, 95% confidence interval (CI) = 0.324-0.515; exposure T2 on drinking T3: ß = 0.200 (0.044), P < 0.001, 95% CI = 0.127-0.272; drinking T1 and drinking T2 on exposure: P > 0.05). Similar results were found in the binge drinking model (exposure T1 on binge T2: ß = 0.409 (0.054), P < 0.001, 95% CI = 0.320-0.499; exposure T2 on binge T3: ß = 0.168 (0.050), P = 0.001, 95% CI = 0.086-0.250; binge T1 and binge T2 on exposure: P > 0.05). CONCLUSIONS: There appears to be a one-way effect of alcohol marketing exposure on adolescents' alcohol use over time, which cannot be explained by either previous drinking or exposure to non-alcohol-branded marketing.

Gender Differences in Heroin Addiction and Treatment: Results from the VEdeTTE Cohort.

BACKGROUND: Gender differences strongly affect heroin addiction, from risk factors to patterns of consumption, access to treatments, and outcomes. OBJECTIVES: To investigate gender differences in the VEdeTTE cohort of heroin addicts. METHODS: VEdeTTE is a cohort of 10,454 heroin users enrolled between 1998 and 2001 in 115 public drug treatment centres in Italy. Clinical and personal information were collected at intake through a structured interview. Treatments were recorded using a standardized form. Gender differences were explored with regard to characteristics at intake, treatments, and retention in methadone maintenance and therapeutic community. Cox Proportional models were carried out to identify risk factors for treatment abandon. RESULTS: Compared with men, at their first access to treatment women with drug addiction were younger, more frequently married, legally separated, divorced or widow, unemployed though better educated, HIV+; more frequently they lived with their partner and sons. They reported a higher use of sedatives, but a lower use of alcohol; more frequently they had psychiatric comorbidity, including depression, self-injuries, and suicide attempts. Psychotherapy was more frequently prescribed to women, pharmacological treatments to men. Methadone maintenance was less frequently abandoned by women. Drug abuse severity factors predicted abandon of methadone among women. High methadone doses and the combination with psychotherapy improved treatment retention in both genders. Low education level and severity factors among women and young age among men predicted abandon of therapeutic community. CONCLUSIONS: Gender differences in the VEdeTTE cohort suggest the need of a gender sensitive approach to improve treatment outcomes among heroin addicts.

The Italian politics of alcohol: The creation of a public arena at the end of the 20th century.

BACKGROUND: Political concern with alcohol as a social problem arose in Italy only at the end of last century, when consumption and the death rate from alcohol-related causes had both been trending down for decades. The main aim of this case study is to investigate - applying Wiener's theoretical framework - the role of different stakeholders in the process that led to the approval of the first alcohol framework law in 2001. METHODS: Fourteen individual interviews with stakeholders were conducted, covering all the main topics involved in Italian alcohol policies. In addition, 19 bills introduced in the Italian parliament were analysed to reconstruct the legislative process. Stakeholders' role was analysed, assessing their positions, contrasts and coalitions. The rhetoric employed in the course of public debate was also deciphered. RESULTS: All three of the main processes used by Wiener to describe the building of a public arena around alcohol - animating the problem, legitimizing it and demonstrating it - were found. The Club of Alcoholics in Treatment and professionals working with alcoholics in Local Addiction Services appeared to be the most active groups in supporting the law. They did so by establishing a strong alliance, even if their visions about the problem and how to solve it differed. CONCLUSIONS: The study showed that a shared vision is not as essential as 'combining for strength' in order to create a public arena around a social problem. Furthermore, not even scientific data are essential for demonstrating a problem, as the use of rhetoric seems to be more effective in building ideologies.

From criminals to celebrities: perceptions of "the addict" in the print press from four European countries from nineties to today.

The article reviews portrayals of "the addict" in press items from Italy, Finland, Poland, and The Netherlands. The dataset consists of 1,327 items from four national newspapers published in 1991, 1998, 2011. The portrayals varied according to country, period, and type of addiction problem. Results can be read as four cases where different conceptualizations ("the sinner," "the sick," "the social problem," "the criminal," and "the famous") assume diverse importance. These conceptual frames-of-reference are clearly neither unambiguous nor fixed. They are constantly modified and part of different trends.

Stakeholders' role in contemporary "substitute drug" prescribing policies in Italy.

This article, part of a comparative research project (WP2) funded by FP7 ALICE RAP, is based upon a review of literature and documents and 18 individual interviews with Italian national stakeholders (SHs) conducted in 2012. The goal was to identify the main shifts in opioid "substitution drug" treatment policies and understand the role played by different SHs during the last 30 years. The study confirms that opioid "substitution drug" treatment is a particularly suitable theme for improving knowledge in the field of SH analysis, even if results show that changes in policies are mainly due to external factors rather than to the action of SHs.

Alcohol consumption and quality of life among young adults: a comparison among three European countries.

The study aims to investigate the relationship between alcohol consumption and quality of life (QoL) on a representative sample of adults aged 25-34 living in France, Italy, and the Netherlands (4,841 subjects). The data was collected in 2008 using telephone interviews and analyzed with cluster analysis using Ward's method. Results show that the impact of alcohol consumption on QoL depends mainly on predominant consumption style and drinking culture that should be investigated further to identify protective factors.