Substance Use among Belgian Higher Education Students before and during the First Wave of the COVID-19 Pandemic.

The COVID-19 pandemic prompted many countries to issue far-reaching policy measures that may have led to increased substance use. Higher education students may have been disproportionally affected due to the rearrangement of educational life and their susceptibility to psychosocial distress and substance use. The current study examined associations between pandemic-related stressors, psychosocial distress, and self-reported alcohol, tobacco, and cannabis use before and during the first wave of the pandemic. Data were collected in Belgium as part of the COVID-19 International Student Well-being Study (C19 ISWS) and analyzed using multinomial logistic regression analyses. The sample contained 18,346 higher education students aged 17 to 24 (75% women). Overall use of alcohol, tobacco, and cannabis as well as binge drinking decreased during the pandemic, perhaps due to limited social gatherings. Moving back to the parental home was associated with decreased substance use, while depressive symptoms were associated with increased substance use. Perceived threat and academic stress were associated with increased binge drinking among heavy bingers and increased tobacco use. Decreases among students who moved back to their parental home may be explained by increased informal social control. Increased substance use was associated with a number of stressors and psychosocial distress, which suggests that some students may have been self-medicating to manage their mental health amidst the pandemic. Public health policy concerning substance use may prove to be less effective if not tailored to particular subgroups within the student population.

Use and misuse of prescription stimulants by university students: a cross-sectional survey in the french-speaking community of Belgium, 2018.

BACKGROUND: Misuse of prescription stimulants (PS) has been reported among students to enhance academic performance in Flanders (Belgium). However, PS misuse among students in the French-speaking community is unknown. The main purpose of the study was to estimate the prevalence of medical use and misuse of PS by university students in the French-speaking community (Belgium), and to investigate the reasons and sources associated with PS misuse. METHODS: A cross-sectional online survey was performed in 2018. All university students 18 years and older were invited to participate and asked about PS use, including medical (i.e., used for therapeutic purposes) and nonmedical reasons and sources of PS. RESULTS: In total, 12 144 students participated in the survey (median age = 21 years, 65.5% female). The estimated prevalence of PS use was 6.9% (ever use) and 5.5% (past-year). Among ever users, 34.7% were classified as medical users and 65.3% as misusers. Lifetime prevalence of misuse was estimated at 4.5%. The most common reason for medical use was treatment of attention disorder (85.9%). Reasons for misuse were mainly to improve concentration (76.1%) or to stay awake and study longer (50.7%). Friends or acquaintances inside the student community and general practitioners were the main sources of PS for misuse (41.5% and 23.5%, respectively). CONCLUSIONS: This study found that rates of misuse of PS in French-speaking universities in Belgium were in line with studies conducted in Flanders and Europe. Academic institutions can use these results to tailor their drug prevention campaigns.

Personal, Social and Cultural Predictors of Intention to Misuse Prescription Stimulants among Medical Students: A Test of the Theory of Triadic Influence.

OBJECTIVE: The misuse of prescription stimulants among students has been identified as a public health problem. To date, most research has focused on individual-level determinants of stimulant misuse, making research on the socio-cultural context of students' misuse a priority. This study aims to test the applicability of the Theory of Triadic Influence, capturing three influence streams (personal, social and cultural) and three causational levels (ultimate, distal and proximal). METHOD: A questionnaire on stimulant misuse was distributed among all bachelor's and master's students from the five Flemish medical faculties. In total, 3159 students participated (48.99% response rate). Data were analyzed using structural equation modeling. RESULTS: Multiple personal (i.e., fear of failure, procrastination, self-perceived ADHD, sensation-seeking, academic stress, controllability), social (i.e., living situation, peer endorsement, social norm) and cultural (i.e., competitive study-environment, financial worries, positive and negative expectancies, attitude) factors were identified as risk factors of misuse intention. The strongest ultimate to distal pathway was found between self-perceived ADHD and positive expectancies, meaning that students who believed they have ADHD, although not diagnosed, were more likely to have positive expectancies about stimulants. Moreover, the strongest distal to proximal pathways were found between expectancies and attitudes toward stimulant misuse (i.e., more positive and fewer negative expectancies were associated with more favorable attitudes). Finally, attitudes were most strongly related to misuse intention. CONCLUSIONS: The current study shows that the TTI is an important framework to understand the risk factors of stimulant misuse among medical students. This study offers a strong basis for prevention initiatives.

The role of the household in the social inclusion of children with special needs in Uganda - a photovoice study.

BACKGROUND: Social inclusion establishes a basis for the overall wellbeing of children with special needs. Although children's lives are centred around the household, little is known about the household's influence on social inclusion. Therefore, the aim is to investigate the household's role in the social inclusion of children with special needs in Uganda. METHODS: Twelve carers of children with special needs participated in this photovoice study on the outskirts of Kampala, Uganda - including a training workshop, home visits, in-depth individual interviews and focus group discussion. RESULTS: The social inclusion of children with special needs is highly complex because it has the potential to both benefit and cause harm. The results show that when a disability is socially devalued to a certain degree, carers and their household members have to deal with the ongoing process of stigma management. Depending on the characteristics of the child, carer and household, this can lead to an upward spiral towards visibility or a downward spiral towards concealment - reinforcing social inclusion or stigma, respectively. CONCLUSIONS: Despite the fact that there is disability among Ugandan children it remains a 'hidden reality'. This research helps to reveal this hidden reality by understanding the role of the household in social inclusion in a stigmatized context.

The medicalisation of female genital cutting: Harm reduction or social norm?

Today, female genital cutting is increasingly practised by trained healthcare providers. While opposition to medicalised female genital cutting (FGC) is strong, little is known about the underlying motivation for this medicalisation trend in practising communities. We formulated three hypotheses based on medicalisation theories. The medicalisation of FGC: (i) is stratified and functions as a status symbol, (ii) functions as a harm-reduction strategy to conform to social norms while reducing health risks and (iii) functions as a social norm itself. Conducting multilevel multinomial regressions using the 2005, 2008 and 2014 waves of the Egyptian Demographic Health Survey, we examined the relationship between the mother's social position, the normative context in which she lives and her decision to medicalise her daughter's cut, compared to the choice of a traditional or no cut. We found that an individual woman's social position, as well as the FGC prevalence and percentage of medicalisation at the governorate level, was associated with a mother's choice to medicalise her daughter's cut. Further research on factors involved in decision-making on the medicalisation of FGC is recommended, as an in-depth understanding of why the decision is made to medicalise the FGC procedure is relevant to both the scientific field and the broader policy debate.

Students' stimulant use for cognitive enhancement: A deliberate choice rather than an emotional response to a given situation.

BACKGROUND: Prescription stimulants such as methylphenidate are usually prescribed to treat attention deficit (and hyperactivity) disorders (ADHD). Recently, these drugs have gained popularity among college students, because of the belief that they can help improve academic performance. OBJECTIVES: This study assessed whether engaging in nonmedical use of prescription stimulants for cognitive enhancement is a rational or a more spontaneous decision-making process. METHOD: A survey was conducted among 661 students (63.5 % females, n = 420, Mage = 21.40). Data were analyzed using structural equation modeling. RESULTS: A total of 15.9 % (n = 105) of the students had previously taken stimulants to improve their academic performance. The use of stimulants was significantly higher among males (22.4 %) than females (12.1 %). Positive attitudes toward stimulant use for cognitive enhancement were strongest related to students' intention to take stimulants for increasing their academic performance, followed by the norm of parents. Additionally, the more the students identified themselves with the prototype of a student using stimulants for cognitive enhancement, the more likely they were to be willing to misuse stimulants. CONCLUSIONS: The findings suggest that using stimulants for cognitive enhancement is a rational choice rather than an unplanned one.

A Social Ecological Approach to Hazardous Alcohol Use among Flemish Higher Education Students.

Hazardous use of alcohol is a global public health concern. Statistics suggest that this is particularly common in Europe, and among higher education students. Although it has been established that various factors-ranging from the individual to the overarching societal level-are associated with misuse of alcohol, few studies take multiple levels of influence into account simultaneously. The current study, therefore, used a social ecological framework to explore associations between variables from multiple levels of influence and the hazardous use of alcohol. Data were obtained from a representative sample of higher education students from Flanders, Belgium (n = 21,854), and explored using hierarchical multiple regression analyses. The results demonstrated that the individual, interpersonal, organizational, community, and policy levels, were all associated with risky alcohol consumption. When devising interventions, policymakers should, therefore, take into consideration that variables from multiple levels of influence are at play. Students' capacities to change or maintain their alcohol consumption behaviors may be undermined if social settings, overarching environments, social norms, and policies are not conducive to their motivations and social expectations.

Off-label prescribing of stimulant medication to students: a qualitative study on the general practitioner perspective.

Students' use of prescription stimulants to enhance study performance is increasingly under the spotlight. Medical guidelines discourage general practitioners (GPs) from prescribing stimulants to students without a diagnosis; yet a considerable proportion of students acquire them from GPs. Building on Eisenberg's theoretical framework on clinical decision-making and Conrad's sociological concept of biomedical enhancement, this study examined the social context of GPs' off-label prescribing decisions for stimulants, using data from 21 semi-structured interviews, including vignettes, undertaken with Flemish GPs. Results identified two groups of GPs: (1) hard-liners who strictly follow medical guidelines and who would only prescribe in case of an appropriate diagnosis and (2) context-dependent GPs who would prescribe stimulants depending on the patients' symptoms and extent of need. GPs' decisions depend on one-on-one doctor-patient interactions (i.e. the extent of empathy from the doctor and the extent of assertiveness from the patient); the extent to which GPs define concentration problems as medical problems; GPs' interactions with fellow health care workers; as well as GPs' interaction with the wider community. By disentangling these influences, this paper advances both theoretical and practical understanding of the sociological context in which GPs' off-label prescribing behaviour occurs.

Popping smart pills in medical school: Are competition and stress associated with the misuse of prescription stimulants among students?

BACKGROUND: There has been increasing attention in both popular and scientific circles to the misuse of prescription stimulants by students. However, it is unclear which student groups are most vulnerable and what environmental factors could influence this misuse. Medical students might be more at risk because of high levels of competition and related stress in medical school, making them a relevant population to explore these interrelationships. OBJECTIVES: This study aims to answer two research questions: (1) Does competition lead to higher stress and greater likelihood of misuse? and (2) Do the levels of and interrelationships between competition, stress and misuse vary between students with different post-graduate aspirations? METHODS: In total, 3159 Flemish medical students (48.99% response rate) participated anonymously in a 2016 questionnaire on stimulants. Misuse was defined as use to enhance study performance, but not as part of an applicable treatment. We performed (multiple group) structural equation modeling to answer the research questions. RESULTS: Results indicate significant associations between competition, stress and misuse: the higher the perception of medical school as being competitive, the higher the stress level and the more likely the misuse. Against our expectations, the association between competition and stress was significantly stronger for future general practitioners (GPs) compared to future specialists. CONCLUSION: The competitive climate in medical school creates high stress levels, rendering students vulnerable to misuse of stimulants. Students need to be educated about how to cope with stress in a non-pharmaceutical way, making them more resilient to stress during studentship and in their future careers.

Problem drinking among Flemish students: beverage type, early drinking onset and negative personal & social consequences.

BACKGROUND: Although alcohol is socially accepted in most Western societies, studies are clear about its associated negative consequences, especially among university and college students. Studies on the relationship between alcohol-related consequences and both beverage type and drinking onset, however, are scarce, especially in a European context. The aim of this research was, therefore, twofold: (1) What is the relationship between beverage type and the negative consequences experienced by students? and (2) Are these consequences determined by early drinking onset? We will examine these questions within the context of a wide range of alcohol-related consequences. METHODS: The analyses are based on data collected by the inter-university project 'Head in the clouds?', measuring alcohol use among students in Flanders (Belgium). In total, a large dataset consisting of information from 19,253 anonymously participating students was available. Negative consequences were measured using a shortened version of the Core Alcohol and Drug Survey (CADS_D). Data were analysed using negative binomial regression. RESULTS: Results vary depending on the type of alcohol-related consequences: Personal negative consequences occur frequently among daily beer drinkers. However, a high rate of social negative consequences was recorded for both daily beer drinkers and daily spirits drinkers. Finally, early drinking onset was significantly associated with both personal and social negative consequences, and this association was especially strong between beer and spirits drinking onset and social negative consequences. CONCLUSIONS: Numerous negative consequences, both personal and social, are related to frequent beer and spirits drinking. Our findings indicate a close association between drinking beer and personal negative consequences as well as between drinking beer and/or spirits and social negative consequences. Similarly, early drinking onset has a major influence on the rates of both personal and social negative consequences. The earlier students started drinking, the more negative consequences they experienced during college or university. Several (policy) interventions are discussed. This study is the first to incorporate detailed information on both beverage type and drinking onset, and its associated negative consequences, as measured by the CADS_D, in a large student population.

The psychometric properties of a shortened Dutch version of the consequences scale used in the Core Alcohol and Drug Survey.

BACKGROUND: Alcohol and drug misuse among college students has been studied extensively and has been clearly identified as a public health problem. Within more general populations alcohol misuse remains one of the leading causes of disease, disability and death worldwide. Conducting research on alcohol misuse requires valid and reliable instruments to measure its consequences. One scale that is often used is the consequences scale in the Core Alcohol and Drug Survey (CADS). However, psychometric studies on the CADS are rare and the ones that do exist report varying results. This article aims to address this imbalance by examining the psychometric properties of a Dutch version of the CADS in a large sample of Flemish university and college students. METHODS: The analyses are based on data collected by the inter-university project 'Head in the clouds', measuring alcohol use among students. In total, 19,253 students participated (22.1% response rate). The CADS scale was measured using 19 consequences, and participants were asked how often they had experienced these on a 6-point scale. Firstly, the factor structure of the CADS was examined. Two models from literature were compared by performing confirmatory factor analyses (CFA) and were adapted if necessary. Secondly, we assessed the composite reliability as well as the convergent, discriminant and concurrent validity. RESULTS: The two-factor model, identifying personal consequences (had a hangover; got nauseated or vomited; missed a class) and social consequences (got into an argument or fight; been criticized by someone I know; done something I later regretted; been hurt or injured) was indicated to be the best model, having both a good model fit and an acceptable composite reliability. In addition, construct validity was evaluated to be acceptable, with good discriminant validity, although the convergent validity of the factor measuring 'social consequences' could be improved. Concurrent validity was evaluated as good. CONCLUSIONS: In deciding which model best represents the data, it is crucial that not only the model fit is evaluated, but the importance of factor reliability and validity issues is also taken into account. The two-factor model, identifying personal consequences and social consequences, was concluded to be the best model. This shortened Dutch version of the CADS (CADS_D) is a useful tool to screen alcohol-related consequences among college students.