Development and validation of the neighborhood environment walkability scale for youth across six continents.

BACKGROUND: The IPEN International Physical Activity and Environment Network Adolescent project was conducted using common study protocols to document the strength, shape, and generalizability of associations of perceived neighborhood environment attributes with adolescents' physical activity and overweight/obesity using data from 15 countries. Countries did not use identical versions of the Neighborhood Environment Walkability Scale for Youth (NEWS-Y) to measure perceived neighborhood environment attributes. Therefore, this study derived a measurement model for NEWS-Y items common to all IPEN Adolescent countries and developed a scoring protocol for the IPEN Adolescent version of the NEWS-Y (NEWS-Y-IPEN) that maximizes between-country comparability of responses. Additionally, this study examined between- and within-country variability, and construct validity of the NEWS-Y-IPEN subscales in relation to neighborhood-level socio-economic status and walkability. METHODS: Adolescents and one of their parents (N = 5714 dyads) were recruited from neighborhoods varying in walkability and socio-economic status. To measure perceived neighborhood environment, 14 countries administered the NEWS-Y to parents and one country to adolescents. Confirmatory factor analysis was used to derive comparable country-specific measurement models of the NEWS-Y-IPEN. Country-specific standard deviations quantified within-country variability in the NEWS-Y-IPEN subscales, while linear mixed models determined the percentage of subscale variance due to between-country differences. To examine the construct validity of NEWS-Y-IPEN subscales, we estimated their associations with the categorical measures of area-level walkability and socio-economic status. RESULTS: Final country-specific measurement models of the factor-analyzable NEWS-Y-IPEN items provided acceptable levels of fit to the data and shared the same factorial structure with five latent factors (Accessibility and walking facilities; Traffic safety; Pedestrian infrastructure and safety; Safety from crime; and Aesthetics). All subscales showed sufficient levels of within-country variability. Residential density had the highest level of between-country variability. Associations between NEWS-Y-IPEN subscales and area-level walkability and socio-economic status provided strong evidence of construct validity. CONCLUSIONS: A robust measurement model and common scoring protocol of NEWS-Y for the IPEN Adolescent project (NEWS-Y-IPEN) were derived. The NEWS-Y-IPEN possesses good factorial and construct validity, and is able to capture between-country variability in perceived neighborhood environments. Future studies employing NEWS-Y-IPEN should use the proposed scoring protocol to facilitate cross-study comparisons and interpretation of findings.

European University Students' Experiences and Attitudes toward Campus Alcohol Policy: A Qualitative Study.

BACKGROUND: Many studies indicate that a substantial part of the student population drinks excessively, yet most European universities do not have an alcohol policy. In the absence of an alcohol guideline at universities and the easy access to alcohol sold at the student cafeteria, for instance, this has the potential to place students at risk of overconsumption, which has adverse health consequences. OBJECTIVES: Therefore, our study objectives were to explore and compare university students' experiences and attitudes toward alcohol policy on their campus using a qualitative approach. METHODS: 29 focus group discussions (FGDs) were conducted among students from universities in five European countries: Belgium (4 FGDs), Denmark (6 FGDs), France (5 FGDs), Hungary (6 FGDs), and the Slovak Republic (8 FGDs), with a total number of 189 participants. RESULTS: Across the five European countries, students recognized that alcohol was a big problem on their campuses yet they knew very little, if any, about the rules concerning alcohol on their campus. CONCLUSIONS: Students will not support an on campus alcohol restriction and a policy should therefore focus on prevention initiatives.

The Association Between Physical Activity and General Life Satisfaction in Lower Secondary School Students: The Role of Individual and Family Factors.

The objective of the paper was to investigate the association between PA and general life satisfaction in adolescents, taking into account family affluence and selected psychological, family and school factors. The survey (2015) involved 4085 Polish lower-secondary school students. Life satisfaction was measured with the abridged Students' Life Satisfaction Scale (SLSS). Vigorous Physical Activity, self-esteem, family affluence, family relations and the perception of the school environment were considered as independent variables. Hierarchical and path models were applied. The mean SLSS score was M = 4.66 (SD = 2.23), and 36.9% of its variability was explained-mainly by self-esteem. The impact of PA on self-esteem became stronger when family affluence decreased, which led to the conclusion that material status may modify the impact of behavioural factors on the SLSS scores' variability in adolescence.

Trends in Perception of Psychosocial School Environment: HBSC Study 2002-2014 in the Czech Republic.

OBJECTIVE: School is a place where students spend most of their daytime hours. Previous studies indicate that the class climate significantly affects students in both positive and negative ways. The aim of our study is to describe the trends in the psychosocial school environment based on four surveyed years in the Czech Republic. METHODS: The trends in perception of school were assessed by the standardised self-reported HBSC questionnaire from data collected in 2002, 2006, 2010, and 2014. The overall sample included 8,530 girls and 8,087 boys. Data was analysed separately by gender and three age categories 11, 13, and 15 years. Trends were calculated using descriptive categories and percentages. To identify factors influencing school likeness we used binominal logistic regression. RESULTS: Results showed that school satisfaction declines with age both in boys and girls in each of four surveyed periods. Students who do not feel a high level of support from the teacher are more prone to negative perceptions of school. School duties in both genders were perceived to be greater and more stressful in 2014 than in 2002. CONCLUSIONS: Interventions to support the perception of psychosocial school environment via the educational system should, therefore, take the aforementioned variation into account.

Trends in Tobacco Smoking among Czech School-aged Children from 1994 to 2014.

OBJECTIVE: The aim of the article is to examine trends in tobacco consumption among the Czech school-age population. METHODS: For the analysis, data from the Czech Health Behaviour in School-aged Children project, conducted between 1994 and 2014 were used. Trends in tobacco smoking were determined separately for boys and girls, applying the binary logistic regression with survey period as an independent variable for the smoking status. RESULTS: The analysis showed that there have been significant changes in adolescent tobacco smoking for the recent 20 years. While the share of current school-aged smokers was continuously increasing since the mid-1990s, the trend reached its peak in the mid-2000s. CONCLUSION: In recent years, the prevalence of adolescent smokers has significantly declined in the Czech Republic. Despite this recent decline, adolescent smoking remains a major challenge for the national health policy.

The role of community social capital in the relationship between socioeconomic status and adolescent life satisfaction: mediating or moderating? Evidence from Czech data.

BACKGROUND: The concept of social capital has been extensively used to explain the relationship between socioeconomic status (SES) and adolescent health and well-being. Much less is known about the specific mechanism through which social capital impacts the relationship. This paper investigates whether an individual's perception of community social capital moderates or mediates the association between SES and life satisfaction. METHODS: This study employs cross-sectional data from the 2009-2010 Czech Health Behaviour in School-Aged Children survey: a WHO Collaborative Cross-National Study (HBSC). A sample of 4425 adolescents from the 5th, 7th and 9th grade (94.5% school response rate, 87% student response) was used to perform multilevel analysis. RESULTS: We found that pupils' life satisfaction was positively related to both family affluence and perceived wealth. Moreover, we found the cognitive component of social capital to be positively associated with life satisfaction. Additionally, a significant interaction was found, such that the social gradient in life satisfaction was flattened when pupils reported high levels of perceived community social capital. CONCLUSIONS: The present findings suggest that community social capital acts as an unequal health resource for adolescents, but could potentially represent opportunities for public health policy to close the gap in socioeconomic disparities.

Mental health outcomes in times of economic recession: a systematic literature review.

BACKGROUND: Countries in recession experience high unemployment rates and a decline in living conditions, which, it has been suggested, negatively influences their populations' health. The present review examines the recent evidence of the possible association between economic recessions and mental health outcomes. METHODS: Literature review of records identified through Medline, PsycINFO, SciELO, and EBSCO Host. Only original research papers, published between 2004 and 2014, peer-reviewed, non-qualitative research, and reporting on associations between economic factors and proxies of mental health were considered. RESULTS: One-hundred-one papers met the inclusion criteria. The evidence was consistent that economic recessions and mediators such as unemployment, income decline, and unmanageable debts are significantly associated with poor mental wellbeing, increased rates of common mental disorders, substance-related disorders, and suicidal behaviours. CONCLUSION: On the basis of a thorough analysis of the selected investigations, we conclude that periods of economic recession are possibly associated with a higher prevalence of mental health problems, including common mental disorders, substance disorders, and ultimately suicidal behaviour. Most of the research is based on cross-sectional studies, which seriously limits causality inferences. Conclusions are summarised, taking into account international policy recommendations concerning the cost-effective measures that can possibly reduce the occurrence of negative mental health outcomes in populations during periods of economic recession.

Perception of High Alcohol Use of Peers Is Associated With High Personal Alcohol Use in First-Year University Students in Three Central and Eastern European Countries.

OBJECTIVES: The objectives of this study were to assess discrepancies between estimated peer and personal drinking behavior and to determine associations between perceptions of peer and personal drinking behavior among university students from Hungary (HU), Lithuania (LT), and the Slovak Republic (SK). METHODS: 2,554 freshman university students completed an online questionnaire on the frequency of their personal alcohol use, the number of heavy drinking occasions and on their perception concerning the corresponding drinking behavior of a typical student. Associations between perceived peer and personal use were analyzed by means of logistic regression, adjusting for sex. RESULTS: The majority of students across all countries thought their peers drink more frequently and are more often involved in heavy drinking occasions than themselves. Students who perceived the frequency of peer alcohol use to be higher were more likely to drink alcohol twice a week or more often (SR: OR = 3.81, 95% CI = 2.51-5.79; LT: OR = 3.16, 95% CI = 2.11-4.75; HU: OR = 2.10, 95% CI = 1.53-2.87) compared with students who drink alcohol monthly or less. Those who perceived the number of peer heavy drinking occasions as high were more likely to report heavy drinking weekly or more often (SR: OR = 3.16, 95% CI = 1.92-5.20; LT:OR = 3.56, 95% CI = 2.14-5.94; HU:OR = 1.41, 95% CI = 0.79-2.51) compared with students who report heavy drinking less than monthly. CONCLUSIONS/IMPORTANCE: University students perceived peer alcohol use to be higher than their personal use. Given the association between perceptions and personal alcohol use, future research should investigate if targeting perceptions in the surveyed countries may have an impact on alcohol use.

How Czech Adolescents Perceive Their Physical Activity.

Adolescence is a critical stage in the development of an individual's physical activity (PA) habits and preferences. Adolescents' perceptions of PA can influence their motivation to engage in PA and, consequently, their overall level of PA. Thus, our primary aim was to investigate whether Czech adolescents misperceive their peers' PA. Our dataset comprised cross-sectional data on 1289 adolescents aged 11-15 years. PA was measured using self-reported items used in the HBSC study. To describe the gender and school grade differences in VPA, independent samples T, ANOVA, Mann-Whitney U, and Kruskal-Wallis H tests were performed. To analyze the effect of gender, school grade, school, and participants' own PA on the underestimation of PA, binomial regression models were used. Our study points out that there is a discrepancy between self-perceived levels of PA and the perceived descriptive norms of peers' PA. Adolescents underestimate the prevalence of sufficient PA, and thus perceived descriptive norms in PA as being worse than levels of own PA. These findings indicate room for targeted interventions based on social-norms-based approaches to increase the PA of adolescents or at least strengthen their actual positive behavior.

A feasibility trial to examine the social norms approach for the prevention and reduction of licit and illicit drug use in European University and college students.

BACKGROUND: Incorrect perceptions of high rates of peer alcohol and tobacco use are predictive of increased personal use in student populations. Correcting misperceptions by providing feedback has been shown to be an effective intervention for reducing licit drug use. It is currently unknown if social norms interventions are effective in preventing and reducing illicit drug use in European students. The purpose of this paper is to describe the design of a multi-site cluster controlled trial of a web-based social norms intervention aimed at reducing licit and preventing illicit drug use in European university students. METHODS/DESIGN: An online questionnaire to assess rates of drug use will be developed and translated based on existing social norms surveys. Students from sixteen universities in seven participating European countries will be invited to complete the questionnaire. Both intervention and control sites will be chosen by convenience. In each country, the intervention site will be the university that the local principal investigator is affiliated with. We aim to recruit 1000 students per site (baseline assessment). All participants will complete the online questionnaire at baseline. Baseline data will be used to develop social norms messages that will be included in a web-based intervention. The intervention group will receive individualized social norms feedback. The website will remain online during the following 5 months. After five months, a second survey will be conducted and effects of the intervention on social norms and drug use will be measured in comparison to the control site. DISCUSSION: This project is the first cross-national European collaboration to investigate the feasibility of a social norms intervention to reduce licit and prevent illicit drug use among European university students. FINAL TRIAL REGISTRATION NUMBER: DRKS00004375 on the 'German Clinical Trials Register'.

How Czech Adolescents Perceive Active Commuting to School: A Cross-Sectional Study.

To achieve a healthy lifestyle, adolescents must be physically active and meet physical activity (PA) guidelines. One of the most natural ways of increasing the amount of PA is active commuting (AC) to school. Recent reviews suggest that peer norms have the potential to shape PA during adolescence in particular. Thus, our primary aim was to investigate whether Czech adolescents misperceive their peers' AC behaviors and attitudes towards AC. Our dataset comprised cross-sectional data on 1586 adolescents aged 11-15 years. Basic descriptive statistics, chi-square tests, and correlation analyses were used to analyze the data. Regarding traveling to school, 68% of the Czech adolescents in this study are daily active commuters (walking, cycling, or riding a scooter or skateboard). Less than half of the respondents believed that most of their classmates were commuting to school actively almost daily. The students who believed that most of their classmates commuted to school actively had significantly higher chances of being regular active commuters themselves. The results showed that most of the Czech adolescents misperceived the AC norms of their peers. Thus, there could be potential in using a social norms approach aimed at increasing the level of AC in Czech adolescents through targeted interventions.

Social inequalities in changes in health-related behaviour among Slovak adolescents aged between 15 and 19: a longitudinal study.

BACKGROUND: Lower socioeconomic position is generally associated with higher rates of smoking and alcohol consumption and lower levels of physical activity. Health-related behaviour is usually established during late childhood and adolescence. The aim of this study is to explore changes in health-related behaviour in a cohort of adolescents aged between 15 and 19, overall and by socioeconomic position. METHODS: The sample consisted of 844 first-year students (42.8% males, baseline in 1998--mean age 14.9, follow-up in 2002--mean age 18.8) from 31 secondary schools located in Kosice, Slovakia. This study focuses on changes in adolescents' smoking, alcohol use, experience with marijuana and lack of physical exercise with regard to their socioeconomic position. Four indicators of socioeconomic position were used--adolescents' current education level and employment status, and the highest education level and highest occupational status of their parents. We first made cross tabulations of HRB with these four indicators, using McNemar's test to assess differences. Next, we used logistic regression to assess adjusted associations, using likelihood ratio tests to assess statistical significance. RESULTS: Statistically significant increases were found in all health-related behaviours. Among males, the most obvious socioeconomic gradient was found in smoking, both at age 15 and at 19. Variations in socioeconomic differences in health-related behaviour were more apparent among females. Although at age 15, almost no socioeconomic differences in health-related behaviour were found, at age 19 differences were found for almost all socioeconomic indicators. Among males, only traditional socioeconomic gradients were found (the lower the socioeconomic position, the higher the prevalence of potentially harmful health-related behaviour), while among females reverse socioeconomic gradients were also found. CONCLUSION: We confirmed an increase in unhealthy health-related behaviour during adolescence. This increase was related to socioeconomic position, and was more apparent in females.

Deterioration is not the only prospect for adolescents' health: improvement in self-reported health status among boys and girls from age 15 to age 19.

AIM: To assess changes in the mental and physical health of adolescents between the ages of 15 and 19. METHODS: The study included a four-year follow-up of 844 students from 31 secondary schools located in Kosice, Slovakia (response rate 45.6%). The 36-item short form (SF-36) scales were used to assess vitality and mental health, self-rated health, long-term well-being, long-standing illness, and the number of perceived health complaints at the age of 15 and four years later. RESULTS: Both boys and girls reported significant deterioration in vitality (mean difference boys 5.3; girls 3.3; P=0.001) and mental health (mean difference boys 7.7; girls 5.7; P=0.001), while only boys reported deterioration in self-rated health (P=0.047). The proportion of boys who reported an improvement ranged from 8%-40%, while the proportion of girls who reported an improvement ranged from 8%-45%. Significantly more girls than boys reported an improvement in mental health (27% of boys vs 34% of girls) and vitality (32% of boys vs 39% of girls), while more boys than girls reported a deterioration in vitality(55% of boys vs 48% of girls)). These differences were trivial according to the effect size (Cohen's H<0.20). CONCLUSION: Although significant deterioration in mental health and vitality was detected among both genders, with boys deteriorating more substantially in self-rated health than girls, the differences between the proportion of those with improved and those with deteriorated status were trivial in size.

Differences in physical activity and nutritionand silhouette-related behaviours in male and female students in selected European countries.

INTRODUCTION: As indicated by the WHO, lifestyle plays a unique role in human health, which in turn is determined to a great extent by physical activity and nutrition. It must be borne in mind that physical activity should be systematic and regulated by an age-appropriate exercise intensity. All this indicates that learning about students' lifestyle, with a particular focus on physical activity is vital as it these young people who aspire to the role of the future elites. OBJECTIVE: The aim of the study is to evaluate the level of physical activity, nutrition- and silhouette-related behaviours of male and female students to assess the relationships between these variables in students from the Visegrad Group countries. MATERIAL AND METHODS: The study was conducted in 2015 and involved 2,497 students attending three undergraduate levels aged - x - 21,76, (SD-1,80) - 1,211 males (48.5%) and 1,286 females (51.5%). The IPAQ long-form and a questionnaire by the Polish Chief Sanitary Inspector were used. RESULTS: Physical activity was significantly higher in male than female students. An important relationship was observed among the larger number of consumed meals, level of physical activity, and silhouette-related behaviours in male students, which was not the case with females. However, there was an important correlation between physical activity in males and females who exercised to increase or decrease body weight (musculature), and took medications to increase body weight (musculature). CONCLUSIONS: Both males and females showed pro-health attitudes related to the level of physical activity and nutrition- and silhouette-related behaviours.

Level of and Factors Determining Physical Activity in Students in Ukraine and the Visegrad Countries.

Background: Examining the level of physical activity in students is a vital issue as these young people are the future social elite. Methods: The research was conducted in the years 2013⁻2016 and comprised 5008 males and females, mean age of 20.5 ± 2.1 years, including 2237 (55.3%) students from students from Eastern European National University, Lutsk, and Ternopil State Medical University, Ukraine, as well as 2237 (44.7%) from the Visegrad countries, i.e., University of Pécs in Hungary, University in Kosice, Slovakia, University of Olomunec in the Czech Republic and the State School of Higher Education in Biala Podlaska, Poland. It applied a diagnostic survey-the extended version of the International Physical Activity Questionnaire (IPAQ), supplemented with original questions regarding body weight, height, self-assessment of physical fitness and amount of leisure time. Results: The comparison of students' PA from selected European countries, members of the Visegrad group and Ukraine, is particularly vital to the latter country as it demonstrates a different level of socio-economic development. There was noted a significantly higher level of physical activity in students from the Visegrad countries than in Ukraine. Further, there was an overall lower level of physical activity in females compared to males. What was positive about the studied samples was a healthy BMI index in the majority of the male and female respondents, with a significantly higher indicator in Ukraine. Conclusions: Among the factors significantly affecting higher physical activity in both researched samples were the BMI and high self-assessment of physical fitness. There was no significant variation in the level of physical activity and the amount of leisure time, both in those studying in the Visegrad states and Ukraine.

Influence of parental employment status on Dutch and Slovak adolescents' health.

BACKGROUND: Recent research shows the possibility that the link between parental employment status and children's health can be affected by different cultural or societal settings. The aim of this study was to explore whether the effect of father's and mother's employment status on several aspects of adolescents' health differs between Slovakia and the Netherlands. METHODS: Two data sets were used: 2616 Slovak adolescents (mean age 14.9) and 2054 Dutch adolescents (mean age 16.3). Self-rated health, GHQ-12, long-term well-being and Rosenberg self-esteem scale were used to assess the health of adolescents. Parental employment status was classified into the following categories: employed, unemployed, disabled, housewife (among mothers only). Logistic regression analyses were done separately for males and females. RESULTS: Results indicate that having an unemployed father negatively influences self-rated health and long-term well-being of Slovak male adolescents, but has no effect on the health of Dutch adolescents. Secondly, having a disabled father has a negative effect on the psychological well-being of Dutch males and the self-rated health of females, but does not influence the health of Slovak adolescents. Thirdly, having a mother who is disabled, unemployed or a housewife has a negative effect on the self-esteem of Slovak adolescents. Fourthly, Dutch males whose mother was a housewife had worse long-term well-being than those with an unemployed mother, whereas Dutch females whose mother was a housewife reported better psychological well-being than those with an employed mother. CONCLUSION: To conclude briefly our results, father's unemployment seems to be a better predictor of health for Slovak adolescents, father's disablement of health for Dutch ones. Mother's employment status seemed to be important for the self-esteem of Slovak adolescents and mother as a housewife for the health of Dutch ones. This suggests that the link between parental employment status and the health of their children may vary between countries, and therefore further studies involving various cultures are needed.

Normative Perceptions of Cannabis Use Among European University Students: Associations of Perceived Peer Use and Peer Attitudes With Personal Use and Attitudes.

OBJECTIVE: Perceptions of peer behavior and attitudes exert considerable social pressure on young adults to use substances. This study investigated whether European students perceive their peers' cannabis use and approval of cannabis use to be higher than their own personal behaviors and attitudes, and whether estimations of peer use and attitudes are associated with personal use and attitudes. METHOD: University students (n = 4,131) from Belgium, Denmark, Germany, the Slovak Republic, Spain, Turkey, and the United Kingdom completed an online survey as part of the Social Norms Intervention for Polysubstance usE in students (SNIPE) Project, a feasibility study of a web-based normative feedback intervention for substance use. The survey assessed students' (a) personal substance use and attitudes and (b) perceptions of their peers' cannabis use (descriptive norms) and attitudes (injunctive norms). RESULTS: Although most respondents (92%) did not personally use cannabis in the past 2 months, the majority of students thought that the majority of their peers were using cannabis and that their peers had more permissive attitudes toward cannabis than they did. When we controlled for students' age, sex, study year, and religious beliefs, perceived peer descriptive norms were associated with personal cannabis use (odds ratio [OR] = 1.42; 95% CI [1.22, 1.64]) and perceived injunctive norms were associated with personal attitudes toward cannabis use (OR = 1.46; 95% CI [1.09, 1.94]). CONCLUSIONS: European students appear to possess similar discrepancies between personal and perceived peer norms for cannabis use and attitudes as found in North American students. Interventions that address such discrepancies may be effective in reducing cannabis use.

Health status among young people in Slovakia: comparisons on the basis of age, gender and education.

This study examines the health status of young people in Slovakia. Six subjective health indicators (self-rated health, long-standing illness, vitality, mental health, long-term well-being over the last year and occurrence of health complaints during the previous month) were used to assess the health status of three age groups: first grade secondary school students (mean age 15.9 years), third grade students (mean age 17.8 years) and secondary school leavers (mean age 19.6 years). Females rated their health worse than males on all six indicators (most of these differences were statistically significant). For males, younger age was associated with better self-rated health, less long-standing illness and higher levels of long-term well-being during the previous year. For females, the age differences were more complicated: third grade females reported significantly worse health status in terms of vitality, long-standing illness and number of health complaints than the other two age groups. An analysis of health status by educational level (attendance at or completion of grammar, technical or apprentice school), revealed that grammar school third grade females reported worse health than all other respondents on all six indicators. The third grade of grammar school in Slovakia puts particular stresses on students and, since it has been suggested that females may react more negatively than males to stressful events, this may contribute to their more negative self reports.

Personal and Perceived Peer Use of and Attitudes Toward Alcohol Among University and College Students in Seven EU Countries: Project SNIPE.

OBJECTIVE: The objective of this study was to explore perceptions of peer substance use and related attitudes among European students. Challenging perceptions about peer substance use has become the basis of a form of prevention and intervention known as the social norms approach, which can be delivered using personalized online feedback. This article reports baseline alcohol use and attitudes data for university students across Europe collected as part of the Social Norms Intervention for the prevention of Polydrug usE project (Project SNIPE). METHOD: Students from universities in Belgium, Denmark, Germany, the Slovak Republic, Spain, Turkey, and the United Kingdom were recruited to take part in an online survey by the use of email invitations, social media, classroom announcements, flyers, and stalls in social areas, such as in cafeterias and bars on campus. A total of 4,482 students agreed to participate. RESULTS: Overall, respondents reported both perceived alcohol use and perceived acceptance of alcohol use among their peers that were higher than their own use or acceptance. Perceived peers' behaviors and attitudes were found to be predictive of personal behaviors and attitudes, with some variation across countries and by sex. CONCLUSIONS: The results suggest that students at the participating institutions across selected European countries exhibit overall similar patterns of perceptions as have been found on American college campuses. In conjunction with the finding that the perceived norm is predictive of personal behavior and attitudes, this research provides support to the view that the social norms approach may be a viable method to reduce alcohol consumption among students at European universities.

Normative misperceptions of tobacco use among university students in seven European countries: baseline findings of the 'Social Norms Intervention for the prevention of Polydrug usE' study.

INTRODUCTION: Research conducted in North America suggests that students tend to overestimate tobacco use among their peers. This perceived norm may impact personal tobacco use. It remains unclear how these perceptions influence tobacco use among European students. The two aims were to investigate possible self-other discrepancies regarding personal use and attitudes towards use and to evaluate if perceptions of peer use and peer approval of use are associated with personal use and approval of tobacco use. METHODS: The EU-funded 'Social Norms Intervention for the prevention of Polydrug usE' study was conducted in Belgium, Denmark, Germany, Slovak Republic, Spain, Turkey and United Kingdom. In total, 4482 students (71% female) answered an online survey including questions on personal and perceived tobacco use and personal and perceived attitudes towards tobacco use. RESULTS: Across all countries, the majority of students perceived tobacco use of their peers to be higher than their own use. The perception that the majority (>50%) of peers used tobacco regularly in the past two months was significantly associated with higher odds for personal regular use (OR: 2.66, 95% CI: 1.90-3.73). The perception that the majority of peers approve of tobacco use was significantly associated with higher odds for personal approval of tobacco use (OR: 6.49, 95% CI: 4.54-9.28). CONCLUSIONS: Perceived norms are an important predictor of personal tobacco use and attitudes towards use. Interventions addressing perceived norms may be a viable method to change attitudes and tobacco use among European students, and may be a component of future tobacco control policy.