Minors and drug-facilitated sexual assaults: Between submission and chemical vulnerability. / Menores y agresiones sexuales facilitadas por drogas: Entre la sumisión y la vulnerabilidad química.

Drug-facilitated sexual assault (DFSA) is a topic of growing social concern in recent years. Despite this, few empirical studies carried out in Spain have analysed the phenomenon from a preventive approach. The aim of this study, in addition to providing new evidence on DFSA, specifically in minors, was to identify possible associated variables, thus contributing to a better understanding of the problem and to the design of more effective prevention policies. To this end, a survey was carried out among minors in the autonomous community of Galicia. A total of 7,181 students aged 12 to 17 (M = 14.79; SD = 1.57) participated. Data collection was carried out by means of a self-administered questionnaire on paper. Data concerning DFSA were collected by means of specific items, piloted beforehand. Screening instruments for problem drug use (AUDIT, CAST, CRAFFT and EUPI-a) were also used. The results allow us to estimate the rate of victimisation by DFSA in Galician minors at 1.7%, of which only 11.4% would have reported it. Beyond the socio-demographic profile of the victims (females in 2 out of 3 cases), they present different patterns with regard to the pattern of problematic consumption of alcohol and other substances and the pattern of problematic use of the Internet and social networks, with a significantly higher prevalence of online risk behaviours. This suggests that this phenomenon goes far beyond sexual violence, so it is necessary to address it at a preventive level from a comprehensive perspective, including educational and public health perspectives.

Las agresiones sexuales facilitadas por drogas (DFSA) constituyen un tópico que viene suscitando una creciente preocupación social en los últimos años. Pese a ello, son pocos los trabajos empíricos llevados a cabo en España que hayan analizado el fenómeno desde un enfoque preventivo. El objetivo de este trabajo, además de aportar nueva evidencia respecto a las DFSA, concretamente en el ámbito de los menores, ha sido identificar posibles variables asociadas, contribuyendo así a comprender mejor el problema y a diseñar políticas de prevención más eficaces. Para ello se realizó una encuesta entre menores de la comunidad autónoma gallega. Participaron 7.181 estudiantes de 12 a 17 años (M= 14,79; DT=1,57). La recogida de datos se realizó mediante un cuestionario autoadministrado. Los datos referentes a las DFSA fueron recogidos mediante ítems específicos, pilotados previamente. Se utilizaron también instrumentos para el cribado de consumos problemáticos (AUDIT, CAST, CRAFFT y EUPI-a). Los resultados permiten estimar la tasa de victimización por DFSA en menores gallegos en un 1,7%, de los que únicamente habrían denunciado el 11,4%. Más allá del perfil sociodemográfico de las víctimas (mujeres en 2 de cada 3 casos), éstas presentan patrones diferenciados respecto al patrón de consumo problemático de alcohol y otras sustancias y al patrón de uso problemático de Internet y redes sociales, con una prevalencia significativamente mayor de conductas de riesgo online. Ello sugiere que este fenómeno va mucho más allá de la violencia sexual, por lo que es preciso abordarlo a nivel preventivo desde una perspectiva integral, incluyendo la perspectiva educativa y de salud pública.

Waterpipe use among adolescents. Possible implications and related variables. / El uso de la cachimba entre los adolescentes. Posibles implicaciones y variables asociadas.

Substance use in waterpipe (generally tobacco or cannabis) constitutes an increasingly popular practice. It has become an emerging public health problem, with serious consequences at both pulmonary and addiction levels. Despite the growing concern it raises, few studies have been carried out in Spain to analyze this new practice from an early age. The aim of this study is to have new data about waterpipe use among adolescents and to analyze its possible implications and related variables. A survey was conducted among secondary school students from the Galician community. A total of 7,613 students aged 12-18 years (M = 14.97; SD = 1.69) participated. The CRAFFT, the AUDIT and the CAST were used to screen the risky use of other substances. The rates of waterpipe tobacco and cannabis use are at worrying levels (19.4% and 8.5%, respectively, for the last year), with significantly higher rates of risky substance use, drunkenness and binge drinking. The low perception risk is striking. Waterpipe use is a widespread practice in adolescence. In addition to serious health implications, is a clear indicator of a problematic underlying consumption. The low perception of risk, the "botellón" or the lack of family control are elements to take into account in community prevention.

El consumo de sustancias en cachimba (generalmente tabaco o cannabis) constituye una práctica cada vez más popular, hasta el punto de convertirse ya en un problema de salud pública emergente, con serias consecuencias tanto a nivel pulmonar, como adictivo. A pesar de la creciente preocupación que suscita, son pocos los trabajos llevados a cabo en España que se hayan ocupado de analizar esta nueva práctica desde edades tempranas. El objetivo de este trabajo no sólo es disponer de nuevos datos acerca del uso de la cachimba entre los adolescentes, sino también analizar sus posibles implicaciones y variables asociadas. Para ello, se realizó una encuesta entre estudiantes de enseñanza secundaria de la comunidad gallega. Participaron 7.613 estudiantes de 12 a 18 años (M = 14,97; DT = 1,69). Se utilizó el CRAFFT, el AUDIT y el CAST para el cribado de consumos de riesgo. Las tasas de consumo de tabaco y de cannabis en cachimba se sitúan en niveles preocupantes (19,4% y 8,5%, respectivamente, para el último año), con tasas significativamente mayores de consumos de riesgo, de borracheras y binge drinking. Llama también la atención la baja percepción de riesgo existente. El uso de la cachimba constituye una práctica relativamente extendida en la adolescencia, que además de serias implicaciones para la salud, constituye un claro indicador de un patrón de consumo subyacente realmente problemático. La escasa percepción de riesgo, la práctica del botellón o la falta de normas familiares son elementos a tener en cuenta a nivel de prevención comunitaria.

Bullying and Cyberbullying among Students with Cochlear Implants.

Bullying is a significant problem for young people nowadays, regardless of their identity, culture, or background. Although the scientific evidence warns of a greater impact of bullying on vulnerable groups such as cochlear implant (CI) users, few specific studies have been carried out in this regard. As such, the fundamental objective of this study was to estimate the prevalence of both traditional bullying and cyberbullying among Spanish adolescents and young people with CI. Parents with children CI users were also invited to participate to explore their perspective concerning the victimization of their children. The information was collected using one survey for students aged 11-23 year (n = 102) and another for parents (n = 127). Beyond the frequency and types of bullying suffered or the methods used for coping with victimization, results also show lower rates of bullying when students were asked specifically with a single-item question than when applying multi-item questionnaires. The results are discussed in terms of the broader international bullying and victimization literature.

Minors and Online Gambling: Prevalence and Related Variables.

Substantial access to the Internet by minors has brought about consequences that are not always positive. The increase of online gambling or betting is one of those. Although in most cases online gambling by minors does not result in a disorder, it does imply a higher probability of developing a gambling disorder in adulthood, and it can cause economic, family, school and social problems. The aim of this study, carried out in the Galician region of Spain with a sample of 3772 students aged between 12 and 17 years, was to estimate the prevalence of online gambling in minors; to characterize the profile of online gamblers; to explore the differences in Internet and smartphone usage habits, online risky practices, problematic Internet use and parental involvement between online gamblers and non-online gamblers; and to analyse the relation between online gambling and academic performance. The results revealed that 6.5% of Galician adolescents are online gamblers, a figure that has more than tripled over seven years. 9 out of 10 online gamblers are male, and their mean age is 15. Online gamblers had significantly higher rates of problematic Internet use, active sexting, cyberbullying, or contacting strangers through the Internet. Furthermore, online gamblers had higher scores on impulsiveness, lower scores on assertiveness, and were lacking parental control. These data show that online gambling is not an isolated problem, so prevention should be understood in a comprehensive manner.

The age of onset for alcohol consumption among adolescents: Implications and related variables. / La edad de inicio en el consumo de alcohol en adolescentes: implicaciones y variables asociadas.

Adolescence is a critical period in the development of addictive behaviors. In particular, the age at which adolescents start drinking is not a trivial matter, given the important consequences that it has. However, relatively little is known about what it is that causes them to start drinking at an ever earlier age. The aim of this paper is to collect new empirical data about the implications of an early age of onset and, at the same time, to identify possible associated variables. Furthermore, the mean age of onset of the different substances is updated by expanding the sample frame of the ESTUDES (14-18 years) to incorporate adolescents aged 12 and 13. The results obtained with a sample of 3,419 adolescents from the Autonomous Community of Galicia (M = 14.57 and SD = 1.76) reveal that at 13.4 years of age, the age at which adolescents tend to start drinking is lower than suggested by ESTUDES 2016-2017. In addition, those who start drinking earlier are more likely to use other substances, their rates of high-risk consumption are 3 times higher and they are more involved in potentially dangerous practices. Finally, variables such as risk perception and expectations of use yield very limited explanatory capacity, especially if they are compared with those related to drinking within the family or peer group. The results reinforce the need to delay the age of alcohol onset as one of the strategic objectives of prevention policies.

La adolescencia constituye un período crítico en el desarrollo de conductas adictivas. En particular, la edad a la que los jóvenes se inician en el consumo de alcohol no es una cuestión banal, habida cuenta de las importantes repercusiones que posee a diferentes niveles. Sin embargo se sabe relativamente poco de por qué cada vez se empieza a consumir de manera más precoz. El objetivo del presente trabajo ha sido recabar nuevos datos empíricos sobre las implicaciones de una edad de inicio temprana e identificar, al mismo tiempo, posibles variables asociadas. Se han actualizado además las edades medias de inicio de consumo de distintas sustancias, ampliando el marco muestral habitual del ESTUDES (14-18 años), incorporando a los adolescentes de 12 y 13 años. Los resultados obtenidos con una muestra de 3419 adolescentes de la comunidad gallega (M = 14,57 y DT = 1,76) permiten constatar que la edad a la que los adolescentes suelen iniciarse en el consumo de alcohol es menor de lo que sugiere el ESTUDES 2016-2017, situándose en 13,4 años. Además quienes se inician antes en su consumo presentan una mayor probabilidad de consumir otras sustancias, tasas de consumo de riesgo 3 veces superiores y se implican más en prácticas potencialmente peligrosas. Por último, variables como la percepción de riesgo o las expectativas presentan una capacidad explicativa escasa, sobre todo si se compara con otras relacionadas con el consumo del entorno familiar o entre iguales. Los resultados refuerzan la necesidad de retrasar la edad de inicio del consumo de alcohol como uno de los objetivos estratégicos de las políticas de prevención.

Effectiveness of an educational intervention to improve the safety culture in primary care: a randomized trial.

BACKGROUND: Fostering a culture of safety is an essential step in ensuring patient safety and quality in primary care. We aimed to evaluate the effectiveness of an educational intervention to improve the safety culture in the family and community medicine teaching units in an Atlantic European Region. METHODS: Randomized study conducted in family and community medicine teaching units in Galicia (Spain). Participants were all fourth-year residents and their tutors (N = 138). Those who agreed to participate were randomized into one of two groups (27 tutors/26 residents in the intervention group, 23 tutors/ 23 residents in the control one).All were sent the Survey on Patient Safety Culture. After that, the intervention group received specific training in safety; they also recorded incidents over 15 days, documented them following a structured approach, and had feedback on their performance. The control group did not receive any action. All participants completed the same survey four months later. Outcome measures were the changes in safety culture as quantified by the results variables of the Survey: Patient Safety Grade and Number of events reported. We conducted bivariate and adjusted analyses for the outcome measures. To explore the influence of participants' demographic characteristics and their evaluation of the 12 dimensions of the safety culture, we fitted a multivariate model for each outcome. RESULTS: Trial followed published protocol. There were 19 drop outs. The groups were comparable in outcome and independent variables at start. The experiment did not have any effect on Patient safety grade (- 0.040) in bivariate analysis. The odds of reporting one to two events increased by 1.14 (0.39-3.35), and by 13.75 (2.41-354.37) the odds of reporting 3 or more events. Different dimensions had significant independent effects on each outcome variable. CONCLUSION: A educational intervention in family and community medicine teaching units may improve the incidents reported. The associations observed among organizational dimensions and outcomes evidence the complexity of patient safety culture measurement and, also, show the paths for improvement. In the future, it would be worthwhile to replicate this study in teaching units from different settings and with different health professionals engaged. TRIAL REGISTRATION: It was retrospectively registered with ( ISRCTN41911128 , 31/12/2010).

Cannabis use among adolescents: Risk pattern, implications and possible explanatory variables. / Consumo de cannabis entre adolescentes: patrón de riesgo, implicaciones y posibles variables explicativas.

In contrast to the achievements with other substances, it has not yet been possible to reduce the levels of cannabis use, the most used illegal substance among Spanish adolescents. The objective of this paper consists of updating levels of use (incorporating ages 12 and 13), estimating high-risk use and analyzing possible associated variables. For this purpose, a correlational method was used consisting of the administration of a survey to compulsory secondary school and high school students from the autonomous community of Galicia (Spain) in 2016. Results obtained from a sample of 3,882 Galician adolescents aged 12 to 18 (M = 14.52; SD = 1.72) reveal that the percentage of adolescents currently using tobacco and cannabis is higher than that of those using tobacco alone (12.7% vs 10.5%). This implies not only a higher probability of using other illegal substances, but also of developing rather high-risk use pattern, binge drinking or even experiencing problematic Internet use or cyberbullying. From a preventive perspective, the results reveal that personal variables such as self-esteem, assertiveness, social skills or impulsiveness have really weak explanatory power compared with other variables related to the setting of rules and limits by parents. One of the main conclusions of this paper is the need to adopt a comprehensive prevention approach.

Contrariamente a lo que ocurre con el resto de sustancias todavía no se han logrado disminuir los niveles de consumo de cannabis, que sigue siendo la droga ilegal más consumida entre los adolescentes españoles. El objetivo de este estudio consiste en actualizar los niveles de consumo (incorporando la franja de edad de 12-13 años), estimar los consumos propiamente de riesgo y analizar las posibles variables asociadas. Para ello se ha utilizado una metodología correlacional consistente en la realización de una encuesta a estudiantes de ESO y Bachillerato de la comunidad autónoma de Galicia (España) en el año 2016. La muestra final estuvo compuesta por 3.882 adolescentes gallegos de entre 12 y 18 años (M = 14,52 y DT = 1,72). Los resultados obtenidos revelan que a día de hoy es ya mayor el porcentaje de adolescentes que consumen tabaco y cannabis que únicamente tabaco (12,7% vs 10,5%) y que ello no sólo implica una mayor probabilidad de consumir otras sustancias ilegales, sino también de desarrollar un patrón consumo de alcohol de riesgo, de Binge Drinking o incluso de experimentar un Uso Problemático de Internet o de ciberacoso. Las variables personales como la autoestima, la asertividad, las habilidades sociales o la impulsividad tienen una capacidad explicativa realmente débil, en comparación con otras variables vinculadas al establecimiento de normas y límites por parte de los padres. Una de las principales conclusiones de este trabajo es la necesidad de adoptar un enfoque de prevención integral.

Empirical validation of the CRAFFT Abuse Screening Test in a Spanish sample. / Validación empírica del CRAFFT Abuse Screening Test en una muestra de adolescentes españoles.

The CRAFFT Substance Abuse Screening Instrument, developed by the Center for Adolescents Substance Abuse Research (CeASAR) (Knight et al., 1999), is a screening tool for high-risk alcohol and drug risk consumption designed for use with adolescents. Since its publication it has been the subject of translations and validations in different countries, populations and contexts that have demonstrated its enormous potential. However, there is still no empirical validation study that would ensure its good psychometric performance in Spain. The aim of this paper is to develop an adapted version of the CRAFFT in Spanish and to analyze its psychometric properties in a sample of Spanish adolescents. For this purpose an individual interview was conducted on 312 adolescents aged between 12 and 18 years of age (M = 15.01; SD = 1.83) from the Galician community. The interview included a part of the Adolescent Diagnostic Interview (ADI) and the Problem Oriented Screening Instrument for Teenagers (POSIT). The results obtained, similar to those found in other countries, allow us to report that the Spanish version of the CRAFFT has a good psychometric behaviorproperties. It was found to have a satisfactory internal consistency with a Cronbach’s alpha value of .74. In terms of sensitivity and specificity, values of 74.4% and 96.4% respectively, were obtained and the area under the ROC curve was .946. The Spanish version of the CRAFFT is made available to researchers and professionals in the field of addictive behaviors, so that it can be used with the necessary psychometric guarantees.

El CRAFFT Abuse Screening Test, desarrollado por el Center for Adolescents Substance Abuse Research (CeASAR) (Knight et al., 1999), es una herramienta de cribado del consumo de riesgo de alcohol y otras sustancias diseñada para su uso con adolescentes. Desde su publicación ha sido objeto de numerosas traducciones y validaciones en diferentes países, poblaciones y contextos que han dado cuenta de su enorme potencial. No obstante, seguimos sin disponer de estudios de validación empírica que garanticen su adecuado comportamiento psicométrico en España. El objetivo del presente trabajo consiste en desarrollar una versión adaptada del CRAFFT en castellano y analizar sus propiedades psicométricas en una muestra de adolescentes españoles. Para ello, se realizó una entrevista individual a 312 adolescentes de entre 12 y 18 años (M = 15,01; DT = 1,83) de la comunidad gallega, que incluyó una parte de la Adolescent Diagnostic Interview (ADI) y del Problem Oriented Screening Instrument for Teenagers (POSIT). Los resultados obtenidos, similares a los encontrados en otros países, permiten informar que la versión española del CRAFFT presenta un buen comportamiento psicométrico. A nivel de consistencia interna se obtuvo un a de Cronbach satisfactorio de ,74. En cuanto a la sensibilidad y especificidad se obtuvieron unos valores del 74,4% y el 96,4% respectivamente, con un área bajo la curva COR de ,946. Por lo tanto, queda a disposición de investigadores y profesionales del ámbito de las conductas adictivas la versión española del CRAFFT, para que pueda ser utilizada en adelante con las garantías psicométricas necesarias.

Psychometric validation of the POSIT for screening alcohol and other drugs risk consumption among adolescents. / Validación psicométrica del POSIT para el cribado del consumo de riesgo de alcohol y otras drogas entre adolescentes.

Early detection of alcohol and drug abuse among adolescents is decisive not only for rapid referral and intervention in cases of risk, but also as an indicator for use in the evaluation of prevention programs and public policies to reduce consumption. One of the most widely-used screening instruments in the world is the Problem Oriented Screening Instrument for Teenagers (POSIT) (Rahdert, 1991), whose substance use and abuse subscale (POSITUAS) is a brief tool of enormous applied potential. However, there is still no empirical validation study that would ensure its good psychometric performance in Spain. The aim of this paper is to analyse the psychometric properties of POSITUAS among Spanish adolescents. For this purpose, 569 students aged between 12 and 18 years (M = 14.71; SD = 1.79) were personally interviewed. The study sample was selected through two-stage sampling. The results obtained, using the Adolescent Diagnostic Interview (Winters & Henly, 1993) as the gold criterion, allow us to inform that the Spanish version of the POSITUAS has excellent psychometric behaviour, both at the level of internal consistency (a  = .82) as well as regards sensitivity (94.3%) and specificity (83.9%), with an area under the ROC curve of .953. Also, the realisation of a Confirmatory Factor Analysis allows for verifying the one-dimensional character of the scale. As a result, POSITUAS is made available to researchers and professionals in the field of addictive behaviours for use with a minimum of psychometric guarantees.

La detección precoz del consumo abusivo de alcohol y otras drogas en adolescentes resulta decisiva no sólo para una derivación e intervención rápida en los casos de riesgo, sino también como un indicador a utilizar en la evaluación de los programas de prevención y en las políticas públicas de reducción del consumo. Uno de los instrumentos de screening más utilizados a nivel internacional es el Problem Oriented Screening Instrument for Teenagers (POSIT) (Rahdert, 1991), cuya subescala de Uso y Abuso de Sustancias (POSITUAS) constituye una herramienta breve de enorme potencial aplicado. Sin embargo, en España no existe todavía ningún estudio de validación empírica que permita garantizar su adecuado funcionamiento psicométrico. El objetivo del presente trabajo consiste precisamente en analizar las propiedades psicométricas del POSITUAS en adolescentes españoles. Para ello fueron entrevistados de forma personal 569 estudiantes de entre 12 y 18 años (M = 14,71; DT = 1,79), seleccionados a partir de un muestreo bietápico. Los resultados obtenidos, utilizando la Adolescent Diagnostic Interview (Winters & Henly, 1993) como criterio, permiten informar que la versión española del POSITUAS posee un excelente comportamiento psicométrico, tanto a nivel de consistencia interna (a=,82), como de sensibilidad (94,3%) y especificidad (83,9%), con un área bajo la curva ROC de ,953. Asimismo, la realización de un Análisis Factorial Confirmatorio permite constatar el carácter unidimensional de la escala. Como consecuencia se pone a disposición de investigadores y profesionales del ámbito de las conductas adictivas el POSITUAS, que puede ser utilizado en adelante con las garantías psicométricas requeridas.

Binge drinking among adolescents: prevalence, risk practices and related variables. / Consumo intensivo de alcohol en adolescentes: prevalencia, conductas de riesgo y variables asociadas.

According to the last Survey on Drug Use among Secondary School Students (ESTUDES 2014-2015), consumption levels of alcohol and other substances have decreased in the last years in Spain. However, available data on binge drinking remain worrying, given the negative consequences related with this pattern. The aim of this paper is to analyse binge drinking among adolescents, providing updated data on prevalence in addition to information about the consequences and some predictive factors of binge drinking. A correlational method was used for this purpose, comprised of administering a survey to Compulsory Secondary School, High School and Vocational Training students. Based on a sample of 3,419 Galician adolescents aged between 12 and 18 years (M = 14.57; SD = 1.76), the results show that binge drinking is a common and global practice, with few socio-demographic differences but related with a wide range of risk practices. Furthermore, variables such as consumption expectancies, consumption by family and friends, as well as curfew time and allowance money have been identified as interesting predictive factors that should be taken into account at the preventive level.

Según la última Encuesta sobre uso de drogas en Enseñanzas Secundarias (ESTUDES 2014-2015), los niveles de consumo tanto de alcohol como de otras sustancias han disminuido en España en los últimos años. No obstante, siguen siendo preocupantes los datos referidos al consumo intensivo de alcohol (CIA), sobre todo habida cuenta las graves repercusiones asociadas a este patrón. El objetivo del presente trabajo ha sido analizar el consumo intensivo de alcohol entre los adolescentes, ofreciendo datos actualizados no sólo de su prevalencia, sino también de sus consecuencias y posibles factores de pronóstico. Para ello se utilizó una metodología correlacional, consistente en la realización de una encuesta a estudiantes de ESO, Bachillerato y FP de grado medio. La muestra final estuvo compuesta por 3.419 adolescentes gallegos de entre 12 y 18 años (M = 14,57; SD = 1,76). Los resultados obtenidos revelan que el CIA es una práctica frecuente y globalizada, con escasas diferencias a nivel sociodemográfico, pero asociada a un amplio abanico de conductas de riesgo. Por otra parte, variables como las expectativas de consumo, el consumo entre los pares y en el entorno familiar, así como la hora de llegada a casa o el dinero disponible han sido identificadas como interesantes factores de pronóstico que debieran ser tenidos en cuenta en el plano preventivo.

The relationship between consumption of alcohol and other drugs and problematic Internet use among adolescents. / Relación entre el consumo de alcohol y otras drogas y el uso problemático de Internet en adolescentes.

Alcohol and drug use among adolescents has been causing great concern for decades in Spain and in the European Union as a whole. In addition, the technology boom experienced over the last two decades has contributed to the emergence of a new public healthcare issue: problematic Internet use. The increasing importance that both problems have been gaining in recent years has led some authors to analyze the relationship between alcohol and the consumption of other drugs alongside problematic Internet use, and to provide relevant empirical evidence. Based on a sample of 3,882 Spanish adolescents aged between 12 and 18, the results obtained confirm that there is a relationship between the consumption of alcohol (measured by the AUDIT) and other drugs (measured by the CRAFFT and the CAST), and problematic Internet use (measured by the EUPI-a). Problematic Internet users among them not only have more significant levels of substance use, but also a three-times greater chance of developing hazardous drug use (39.4% vs 13.3%). This highlights the need to develop transversal prevention capable of acting on the common variables to both issues, beyond developing programs focused on specific behaviors. In this sense, values-based education and life skills training should be given priority in prevention.

En España y en el conjunto de la Unión Europea el consumo de alcohol y otras drogas entre los adolescentes viene causando una enorme preocupación social desde hace décadas. Por otra parte, el auge tecnológico experimentado en las dos últimas décadas ha contribuido a la aparición de un nuevo problema sociosanitario: el uso problemático de Internet. El creciente protagonismo que ambos problemas han ido adquiriendo en los últimos años ha llevado a algunos autores a analizar la relación entre el consumo de alcohol y otras drogas y el uso problemático de Internet, aportando evidencias empíricas al respecto. La realización del presente trabajo, a partir de una muestra de 3882 adolescentes españoles de entre 12 y 18 años, ha permitido constatar que efectivamente existe una estrecha relación entre el consumo de alcohol (medido a través del AUDIT) y otras drogas (medido a través del CRAFFT y del CAST) y el uso problemático de Internet (medido a través del EUPI-a). No solo se han encontrado unos niveles de consumo significativamente mayores entre los usuarios problemáticos, sino que la probabilidad de desarrollar un consumo de riesgo de drogas llega a ser incluso 3 veces mayor entre éstos (39,4% vs 13,3%). Ello pone de manifiesto la necesidad de desarrollar una prevención transversal capaz de actuar sobre las variables comunes a ambas problemáticas, más allá de desarrollar programas centrados en conductas específicas. En este sentido, la educación en valores y habilidades de vida debieran ocupar un lugar prioritario en materia de prevención.

Adaptation and Validation of the Hooked on Nicotine Checklist (HONC) with Spanish Adolescents.

INTRODUCTION: The expansion of new tobacco consumption formats and electronic vapor products threatens to reverse the trend of declining smoking rates that had been observed among younger people in recent decades. Early detection in the health sector requires screening tools that have been adapted and validated in our context. This study aims to translate, culturally adapt, pilot and empirically validate the Hooked on Nicotine Checklist (HONC) with Spanish adolescents. METHODS: The process of translation and cultural adaptation included the following stages: direct translation, synthesis of translations, back translation, consolidation with a committee of experts and pre-test, along with a cognitive interview, which served as pilot testing. Empirical validation was conducted with a sample of 1027 adolescents aged between 12 and 18 (M=15.40; SD=1.638). RESULTS: The results obtained confirm that the HONC is a brief, clear and easy-to-understand tool, with appropriate psychometric properties. A Cronbach's alpha value of 0.90 was obtained. Sensitivity, specificity, PPV and NPV indices reached values of 0.56, 0.94, 0.79 and 0.83, respectively. Cut-off point 1 is the one reaching the best balance between the two values. CFA showed a model good overall fit. CONCLUSION: This study makes the Spanish version of the HONC available to researchers and clinicians, so that it can be used with sufficient psychometric guarantees.

Underage Problem Gambling: With Whom, Where and Why

BACKGROUND: Underage gambling is a widespread phenomenon with its own characteristics that differentiate it from adult gambling. In addition, problem gambling has shown a remarkable prevalence in previous studies. The present study examines underage gambling behaviour, studying its characteristics, as well as motivational and contextual aspects, and estimating the volume of problem gambling and possible moderating variables. METHOD: A sample of 9,681 students aged between 12 and 17 years old reported their involvement in gambling and filled in the Brief Adolescent Gambling Screen (BAGS), with 4,617 of them completing a questionnaire about gambling behaviours. RESULTS: Almost a quarter (23.5%) of the students reported having gambled in their lifetime (16.2% in-person, 1.4% online and 6% in both modalities), and 1.9% presented symptoms of problem gambling (BAGS ≥ 4). In-person gamblers preferred sport-betting machines, usually gambled in bars, and did not have their age checked. Online gamblers reported mainly sports betting, doing so on websites and paying with PayPal-like services and credit cards. Most gambled with friends and to win money. Problem gamblers were similar but gambled more frequently. CONCLUSIONS: These results present an image of the gambling situation among minors and, more importantly, of its context and related variables.

Psychometric properties of CAST for early detection of problematic cannabis use in Spanish adolescents.

The high prevalence rates of cannabis use in adolescents and its early onset constitutes a major public health problem, raising the need for its early detection. The availability of validated tools to analyze early cannabis use is essential to detect problematic use at an early age. The Cannabis Abuse Screening Test (CAST) (Legleye et al., 2007) is widely applied in Europe; however, the CAST cut-off scores vary according to the setting, the screening objective, and the correction version (CAST-f or CAST-b), creating therefore confusion in its application. Moreover, the psychometric properties of the CAST as a tool for detecting problematic cannabis use are understudied. To fill this gap, such psychometric properties have been analyzed in a sample of Spanish adolescents while using different cut-off scores for CAST-f and CAST-b. Based on our findings, the optimal cut-off scores are 2 points for CAST-b and 4 points for CAST-f. The internal reliability of CAST-f (α = 0.83) and CAST-b (KR-20 = 0.80) are satisfactory. Factorial analysis suggested the assumption of a one-dimension model. The CAST seems to be a valid and reliable tool for early screening of problematic cannabis use in Spanish adolescents.

Adverse events analysis as an educational tool to improve patient safety culture in primary care: a randomized trial.

BACKGROUND: Patient safety is a leading item on the policy agenda of both major international health organizations and advanced countries generally. The quantitative description of the phenomena has given rise to intense concern with the issue in institutions and organizations, leading to a number of initiatives and research projects and the promotion of patient safety culture, with training becoming a priority both in Spain and internationally. To date, most studies have been conducted in a hospital setting, even though primary care is the type most commonly used by the public, in our experience. Our study aims to achieve the following:--Assess the registry of adverse events as an education tool to improve patient safety culture in the Family and Community Teaching Units of Galicia.--Find and analyze educational tools to improve patient safety culture in primary care.--Evaluate the applicability of the Hospital Survey on Patient Safety Culture by the Agency for Healthcare Research and Quality, Spanish version, in the context of primary health care. DESIGN: Experimental unifactorial study of two groups, control and intervention. STUDY POPULATION: Tutors and residents in Family and Community Medicine in last year of studies in Galicia, Spain. SAMPLE: From the population universe through voluntary participation. Twenty-seven tutor-resident units in each group required, randomly assigned. INTERVENTION: Residents and their respective tutor (tutor-resident pair) in teaching units on Family and Community Medicine from throughout Galicia will be invited to participate. Tutor-resident pair that agrees to participate will be sent the Hospital Survey on Patient Safety Culture. Then, tutor-resident pair will be assigned to each group--either intervention or control--through simple random sampling. The intervention group will receive specific training to record the adverse effects found in patients under their care, with subsequent feedback, after receiving instruction on the process. No action will be taken in the control group. After the intervention has ended, the survey will once again be provided to all participants. OUTCOME MEASURES: Change in safety culture as measured by Hospital Survey on Patient Safety CultureCONSORT Extension for Non-Pharmacologic Treatments 2008 was applied. DISCUSSION: The most significant limitations on the project are related to selecting a tool to measure the safety environment, the training calendar of residents in Family and Community Medicine in last year of studies and the no-answer bias inherent to research conducted through self-administered surveys.The development and application of a safety culture in the health sector, specifically in primary care, is as yet limited. Thus, identifying the strengths and weaknesses in the safety environment may assist in designing strategies for improvement in the primary care health centers of our region. TRIAL REGISTRATION: ISRCTN: ISRCTN41911128.

Cyberbullies, the Cyberbullied, and Problematic Internet Use: Some Reasonable Similarities.

BACKGROUND: The spread of the internet and Information and Communications Technologies (ICT) have completely changed society in the last few decades. The transfer of traditional face-to-face bullying to the virtual environment is one of the risks adolescents face in this new reality. The present study sought to explore the relationship between involvement in cyberbullying and behaviours such as internet and mobile usage and other risky online behaviours. METHOD: The sample consisted of 3,188 adolescents aged 12-17 years old (Mean= 14.44; SD= 1.67). RESULTS: The application of the European Cyberbullying Intervention Project Questionnaire (ECIPQ) found that 5.2% were victims, 4.5% perpetrators and 4.3% bully-victims. CONCLUSIONS: Results also showed that cyberbullying seems to be associated with both Problematic Internet Use and behaviours such as sexting, gambling and contacting strangers, which suggests a need for a comprehensive approach for preventing all these issues. Moreover, parental monitoring could serve as a modulating factor, which should also be taken into account in the development of appropriate prevention strategies.

Underage Problem Gambling: With Whom, Where and Why / El Juego de Azar Problemático en Menores de Edad: Con Quién, Dónde y Por Qué

Background: Underage gambling is a widespread phenomenon with its own characteristics that differentiate it fromadult gambling. In addition, problem gambling has shown a remarkable prevalence in previous studies. The presentstudy examines underage gambling behaviour, studying its characteristics, as well as motivational and contextualaspects, and estimating the volume of problem gambling and possible moderating variables. Method: A sample of 9,681students aged between 12 and 17 years old reported their involvement in gambling and filled in the Brief AdolescentGambling Screen (BAGS), with 4,617 of them completing a questionnaire about gambling behaviours. Results:Almost a quarter (23.5%) of the students reported having gambled in their lifetime (16.2% in-person, 1.4% online and6% in both modalities), and 1.9% presented symptoms of problem gambling (BAGS ≥ 4). In-person gamblers preferredsport-betting machines, usually gambled in bars, and did not have their age checked. Online gamblers reported mainlysports betting, doing so on websites and paying with PayPal-like services and credit cards. Most gambled with friendsand to win money. Problem gamblers were similar but gambled more frequently. Conclusions: These results present animage of the gambling situation among minors and, more importantly, of its context and related variables.(AU)

Antecedentes: La participación de menores de edad en juegos de azar es un fenómeno extendido con característicasdiferenciales respecto a las personas adultas y muestra una elevada prevalencia. El presente estudio examina la conductade juego en menores, estudiando sus características, aspectos motivacionales y contextuales, el volumen de juegoproblemático y las posibles variables moderadoras. Método: La muestra está compuesta por 9.681 estudiantes de 12 a17 años que cumplimentaron el Brief Adolescent Gambling Screen (BAGS), 4.617 adolescentes completaron ademásun cuestionario sobre hábitos. Resultados: El 23,5% ha apostado alguna vez en su vida (presencial: 16,2%; online:1,4%; ambas: 6%) y el 1,9% presenta síntomas de juego problemático (BAGS≥4). Quienes juegan presencialmenteprefieren las máquinas de apuestas deportivas; suelen apostar en bares y generalmente sin acreditar su edad. Quienesjuegan online principalmente hacen apuestas deportivas, a través de páginas web y pagan con servicios tipo PayPal ytarjetas de crédito. Suelen apostar con amigos y para ganar dinero, aunque mayoritariamente reconocen que es pocoprobable que esto llegue a ocurrir. Los/as jugadores/as problemáticos muestran características similares, pero apuestancon mayor frecuencia. Conclusiones: Estos resultados muestran la situación del juego en menores y permite determinarsus variables contextuales relacionadas.(AU)

El uso de la cachimba entre los adolescentes. Posibles implicaciones y variables asociadas / Waterpipe use among adolescents. Possible implications and related variables

El consumo de sustancias en cachimba (generalmente tabaco o cannabis) constituye una práctica cada vez más popular, hasta el punto de convertirse ya en un problema de salud pública emergente, con serias consecuencias tanto a nivel pulmonar, como adictivo. A pesar de la creciente preocupación que suscita, son pocos los trabajos llevados a cabo en España que se hayan ocupado de analizar esta nueva práctica desde edades tempranas. El objetivo de este trabajo no sólo es disponer de nuevos datos acerca del uso de la cachimba entre los adolescentes, sino también analizar sus posibles implicaciones y variables asociadas. Para ello, se realizó una encuesta entre estudiantes de enseñanza secundaria de la comunidad gallega. Participaron 7.613 estudiantes de 12 a 18 años (M = 14,97; DT = 1,69). Se utilizó el CRAFFT, el AUDIT y el CAST para el cribado de consumos de riesgo. Las tasas de consumo de tabaco y de cannabis en cachimba se sitúan en niveles preocupantes (19,4% y 8,5%, respectivamente, para el último año), con tasas significativamente mayores de consumos de riesgo, de borracheras y binge drinking. Llama también la atención la baja percepción de riesgo existente. El uso de la cachimba constituye una práctica relativamente extendida en la adolescencia, que además de serias implicaciones para la salud, constituye un claro indicador de un patrón de consumo subyacente realmente problemático. La escasa percepción de riesgo, la práctica del botellón o la falta de normas familiares son elementos a tener en cuenta a nivel de prevención comunitaria. (AU)

Substance use in waterpipe (generally tobacco or cannabis) constitutes an increasingly popular practice. It has become an emerging public health problem, with serious consequences at both pulmonary and addiction levels. Despite the growing concern it raises, few studies have been carried out in Spain to analyze this new practice from an early age. The aim of this study is to have new data about waterpipe use among adolescents and to analyze its possible implications and related variables. A survey was conducted among secondary school students from the Galician community. A total of 7,613 students aged 12-18 years (M = 14.97; SD = 1.69) participated. The CRAFFT, the AUDIT and the CAST were used to screen the risky use of other substances. The rates of waterpipe tobacco and cannabis use are at worrying levels (19.4% and 8.5%, respectively, for the last year), with significantly higher rates of risky substance use, drunkenness and binge drinking. The low perception risk is striking. Waterpipe use is a widespread practice in adolescence. In addition to serious health implications, is a clear indicator of a problematic underlying consumption. The low perception of risk, the “botellón” or the lack of family control are elements to take into account in community prevention. (AU)

Screening of Problematic Internet Use Among Spanish Adolescents: Prevalence and Related Variables.

The opportunities and challenges related to Internet use continue to grow, as well as the social concern around problematic Internet use (PIU), online risky behaviors, and the intensive use of Internet, mainly among adolescents. The aim of this study was to conduct a general screening of PIU in a large sample of school-based adolescents in Spain (n = 40,955), providing updated prevalence data of PIU and different online risky practices, as well as rates of Internet and social network use. Differences between problematic and nonproblematic users were explored in terms of demographics, parental control, and motivations for using. The association between PIU and the involvement in other online risky behaviors was also analyzed, as well as the role of intensive use. The findings show that the global prevalence of PIU among Spanish adolescents is 16.3 percent although this is higher among females, those in their late teens, intensive users, and those without parental control. Logistic regression confirmed that both PIU and intensive use are risk factors for being involved in any online risky behavior. A tentative explanation could be that there is a common deficit of personal and social skills underlying PIU, intensive use, and most online risky practices. From our perspective, value-based education and life skills training are the best way to reach responsible and sensible use of Internet among adolescents. Parents, schools, institutions, and adolescents themselves are called upon to actively engage in facing this problem.

Hábitos de juego y síntomas de adicción a los videojuegos en adolescentes españoles / Gambling habits and symptoms of video game addiction in Spanish adolescents

El trastorno por uso de videojuegos ha recibido mayor atención desde su inclusión en la CIE-11. Sin embargo, apenas hay investigación en menores de edad en el contexto español. El presente trabajo tiene como objetivo de explorar los hábitos de uso de videojuegos y la sintomatología del trastorno por uso de videojuegos en esta población, así como analizar la relación entre ambos. Los hábitos fueron evaluados como la frecuencia y las horas semanales jugadas y la “Escala de adicción al juego para adolescentes” (GASA) fue aplicada a una muestra de 3748 estudiantes de entre 12 y 17 años. Los resultados mostraron que el 13,5% presentaba síntomas de juego problemático y el 3,3% una posible adicción a los videojuegos. También fue encontrada una relación entre los hábitos de juego y la presencia de síntomas de adicción. Estos resultados se comparan con los de otros estudios y se pone de manifiesto la heterogeneidad de datos disponibles en este ámbito. Además, se discuten las implicaciones de los resultados para posibles acciones preventivas llevadas a cabo por desarrolladores y familias. (AU)

Gaming disorder has been receiving increased attention since its inclusion in the ICD-11. However, there are still few studies on minors in the Spanish context. The present study aimed to explore the gaming habits and symptomatology of gaming disorder in this population, as well as analyzing the relationship between both. Gaming habits were assessed such as frequency and weekly hours played and the Game Addiction Scale for Adolescents was applied to a sample of 3748 students between 12 and 17 years old. It was found that 13.5% presented symptoms of problematic gaming and 3.3% a possible video game addiction. There was also a relationship between gambling habits and the presence of addiction symptoms. These results are compared to other studies and the heterogeneity of data available in the field is highlighted. Additionally, the implications of the results for preventive actions carried out by developers and families are discussed. (AU)