Patterns and Correlates of Co-occurring Smoking, Alcohol Use, Gambling, and High Internet Use Among University Students: A Cross-Sectional Study in Türkiye.

University life may facilitate multiple addictive behaviors that tend to cluster rather than occur in isolation. The aim of this study was to estimate the prevalence and co-occurrence patterns of daily cigarette smoking, past-30-day alcohol use, gambling, and high daily internet use, and to evaluate...

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Published in:Journal of Community Health Vol. 51; no. 3; pp. 479 - 494
Main Authors: Avcu, Ahmet Burak, Gündoğdu, Sena Nur, Sülü, Merve, Kekilli, Cengiz Çağdaş, Boz, Gülseda, Baran, Ayşe, Genç, Metin Fikret
Format: Article
Published: Springer Nature Jun2026
Subjects:
Online Access:View this record in EBSCOhost
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      dt: Jun2026
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      pub: Springer Nature
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        10.1007/s10900-026-01563-0
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        atl: Patterns and Correlates of Co-occurring Smoking, Alcohol Use, Gambling, and High Internet Use Among University Students: A Cross-Sectional Study in Türkiye.
      aug:
        au:
          Avcu, Ahmet Burak
          Gündoğdu, Sena Nur
          Sülü, Merve
          Kekilli, Cengiz Çağdaş
          Boz, Gülseda
          Baran, Ayşe
          Genç, Metin Fikret
        affil:
          https://ror.org/04asck240 Department of Public Health, Inonu University School of Medicine, Malatya, Türkiye
          https://ror.org/03cc0mm23 Department of Psychiatry, Nassau University Medical Center, East Meadow, NY, USA
      su:
        Türkiye
        Internet addiction
        Cross-sectional method
        Income
        Smoking
        Sex distribution
        Alcoholism
        Psychology of college students
        Sociodemographic factors
        Educational attainment
        Statistical sampling
        Logistic regression analysis
        Questionnaires
        Gambling
        Descriptive statistics
        Odds ratio
        Confidence intervals
        Data analysis software
      sug:
        subj:
          Internet addiction
          Cross-sectional method
          Income
          Smoking
          Sex distribution
          Alcoholism
          Psychology of college students
          Sociodemographic factors
          Educational attainment
          Türkiye
          Other Gambling Industries
          Marketing Research and Public Opinion Polling
          Statistical sampling
          Logistic regression analysis
          Questionnaires
          Gambling
          Descriptive statistics
          Odds ratio
          Confidence intervals
          Data analysis software
      keyword:
        Addictive behaviors
        Alcohol
        Medical and Health Sciences Public Health and Health Services
        University students
        Addictive behaviors
        Alcohol
        Medical and Health Sciences Public Health and Health Services
        University students
      ab: University life may facilitate multiple addictive behaviors that tend to cluster rather than occur in isolation. The aim of this study was to estimate the prevalence and co-occurrence patterns of daily cigarette smoking, past-30-day alcohol use, gambling, and high daily internet use, and to evaluate their sociodemographic and behavioral associations among undergraduate students in Türkiye. This cross-sectional study was conducted at Inonu University (Malatya, Türkiye) between February–May 2024. Using stratified random sampling, n = 366 students were included. Outcomes were daily smoking, past-30-day alcohol use, past-year gambling, and high daily internet use (≥ 5 h/day). Analysis included UpSet framework for co-occurrence and logistic regression models. A Firth-penalized model assessed smoking factors. Prevalence was 39.1% for high internet use, 30.1% for daily smoking, 22.1% for gambling, and 7.7% for alcohol use. Overall, 59.0% reported at least one behavior, 27.6% reported ≥ 2, and 10.4% reported ≥ 3; the most common triple combination was high internet use, smoking, and gambling (6.3%). Male sex was associated with smoking (adjusted odds ratio [aOR] = 3.19) and gambling (aOR = 5.95). Smoking was independently associated with alcohol use (aOR = 5.34) and gambling (aOR = 2.25). High internet use was associated with highest family income (aOR = 2.81), alcohol (aOR = 2.54), and gambling (aOR = 2.73). Peer smoking showed an association with daily smoking (aOR = 17.25 for 2–3 friends vs. none). Risk behaviors are common and frequently cluster, particularly internet use, smoking, and gambling. These findings support integrated campus prevention and screening strategies that address multiple behaviors simultaneously rather than in isolation.
      pubtype: Academic Journal
      doctype: Article
      src: R
    language: English
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