Alcohol use disorders among Slovak and Czech university students: A closer look at tobacco use, cannabis use and socio-demographic characteristics

In e na ional Jou nal o En i onmen al Resea ch and Public Heal h A icle Alcohol Use Diso de s among Slo ak and Czech Uni e si y S uden s: A Close Look a Tobacco Use, Cannabis Use and Socio-Demog aphic Cha ac e is ics Bea a Ga u o a 1,* , Vie a I anko a 2and Ma in Rigelsky 3   Ci a ion: Ga u o a, B.; I anko a, V.; Rigelsky, M. Alcohol Use Diso de s among Slo ak and Czech Uni e si y S uden s: A Close Look a Tobacco Use, Cannabis Use and Socio-Demog aphic Cha ac e is ics. In . J. En i on. Res. Public Heal h 2021, 18, 11565. h ps://doi.o g/10.3390/ ije ph182111565 Academic Edi o : S yliani (S ella) Vlachou Recei ed: 2 Oc obe 2021 Accep ed: 2 No embe 2021 Published: 3 No embe 2021 Publishe ’s No e: MDPI s ays neu al wi h ega d o ju isdic ional claims in published maps and ins i u ional a il- ia ions. Copy igh : © 2021 by he au ho s. Licensee MDPI, Basel, Swi ze land. This a icle is an open access a icle dis ibu ed unde he e ms and condi ions o he C ea i e Commons A ibu ion (CC BY) license (h ps:// c ea i ecommons.o g/licenses/by/ 4.0/). 1Cen e o Applied Economic Resea ch, Facul y o Managemen and Economics, Tomas Ba a Uni e si y in Zlín, Mos ní5139, 760 00 Zlín, Czech Republic 2Facul y o Mining, Ecology, P ocess Con ol and Geo echnologies, Technical Uni e si y o Košice, Le ná9, 042 00 Košice, Slo akia; [email p o ec ed] 3Facul y o Managemen , Uni e si y o P ešo in P ešo , Konš an íno a 16, 080 01 P ešo , Slo akia; [email p o ec ed] *Co espondence: ga u [email p o ec ed] Abs ac : The main objec i e o he esea ch was o examine he associa ions be ween p oblema ic alcohol use, obacco use and cannabis use among Czech and Slo ak uni e si y s uden s du ing he ea ly COVID-19 pandemic. The esea ch sample consis ed o 1422 pa icipan s om he Czech Republic (CZ) and 1677 om he Slo ak Republic (SK). The analyses included uni e si y s uden s who d ank alcohol in he pas yea (CZ: 1323 (93%); SK: 1526 (91%)). Rega ding he analysed measu es, he Alcohol Use Diso de s Iden i ica ion Tes (AUDIT) and i s subscales, he Glo e -Nilsson Smoking Beha io al Ques ionnai e (GN-SBQ) and he Cannabis Abuse Sc eening Tes (CAST) we e selec ed o iden i y subs ance- ela ed beha iou . Age, gende and esidence we e included in he analyses as socio-demog aphic a iables. Co ela ion and eg ession analyses we e used o achie e he main objec i e o he esea ch. The main esul s e ealed ha he use o obacco and cannabis we e posi i ely associa ed wi h alcohol use diso de s among Czech and Slo ak uni e si y s uden s. Addi ionally, males we e mo e likely o epo alcohol use diso de s. In he Czech Republic, i was ound ha s uden s li ing in do mi o ies we e cha ac e ized by a lowe AUDIT sco e. The opposi e si ua ion was ound in he Slo ak Republic. Czech and Slo ak policy-make s a e encou aged o de elop alcohol use p e en ion p og ams o uni e si y s uden s in line wi h hese indings. Keywo ds: alcohol dependence; obacco; cannabis; ma ijuana; smoking; COVID-19 pandemic; young adul s; subs ance use; socio-demog aphic 1. In oduc ion Young people, especially uni e si y s uden s, a e a popula ion g oup a isk o un- heal hy and ha m ul beha iou s in e ms o he use o addic i e subs ances such as alcohol, obacco o cannabis [ 1 – 3 ]. The ulne abili y o his popula ion g oup is e idenced by a conside able p e alence o dependence o alcohol, obacco and illici d ugs [ 4 ]. All hese ac s a e he esul o a new s age o li e ocused mo e on hei pe sonali y, as hey a e cu ious and wan o i in o he eam, expe ience sensa ion and build hei own social iden i y [5,6]. The combined use o addic i e subs ances in he uni e si y en i onmen is no an excep ional phenomenon ei he [ 7 ]. Acco ding o Nasui e al. [ 8 ], bo h male and emale uni e si y d inke s engaged in o he isky beha iou s co ela ed wi h d inking. These pa e ns o beha iou ha e many consequences, whe he i is a h ea o heal h and li e [ 9 ], educed academic pe o mance, missed classes and lowe g ades, memo y blackou s, changes in b ain unc ion, linge ing cogni i e de ici s, sexual assaul s [ 10 ], bu also poo men al heal h [ 11 ] o social p oblems [ 12 ]. Rega ding de e minan s, i is well known ha In . J. En i on. Res. Public Heal h 2021,18, 11565. h ps://doi.o g/10.3390/ije ph182111565 h ps://www.mdpi.com/jou nal/ije ph In . J. En i on. Res. Public Heal h 2021,18, 11565 2 o 16 he male gende cha ac e is ic is a signi ican ac o associa ed wi h inc eased alcohol use [ 13 , 14 ] and is he e o e conside ed a p edic o o alcohol use diso de s [ 15 , 16 ]. This jus i ies espec ing gende di e ences in esea ch. In addi ion o gende cha ac e is ics, he e a e many o he possible de e minan s o p oblema ic alcohol use such as li ing away om pa en s’ home du ing semes e s [ 1 , 17 ], pa en a achmen [ 18 ], smoking [ 15 ], men al heal h p oblems and sa is ac ion wi h li e [ 19 , 20 ], o age o alcohol consump ion onse [ 21 ]. The need o cons an ly moni o his p oblem is unde lined by he ac ha uni e si y s uden s who su e om p oblema ic alcohol use wi h he isk o dependence a e also cha ac e ized by he use o o he addic i e subs ances, such as obacco, cannabis o cocaine [ 22 ]. All hese ac o s can con ibu e o highe le els o alcohol use, which is an undesi able phenomenon in socie y. Thus, ac o s such as esidence, age, gende , li ing condi ions, smoking, o illici subs ance use should be included in esea ch in o alcohol use diso de s among uni e si y s uden s. I is ue ha he COVID-19 pandemic is an unknown si ua ion, and mo e p essu e can be expec ed in s uden s’ li es. Young adul s ace a ious impulses o isky beha iou du ing he pandemic [ 23 – 25 ]. Thus, in he con ex o he pandemic, inc eased a en ion should be paid o he psychological dis ess ha is associa ed wi h hea y d inking and a high- isk le el o d ug use among uni e si y s uden s [ 26 ]. Jackson e al. [ 27 ] examined COVID-19- ela ed changes in d inking among uni e si y s uden d inke s ha we e a - ibu able o changes in con ex , pa icula ly a shi away om hea y d inking wi h pee s o ligh e d inking wi h amily. Thei esul s e ealed ha educed social oppo uni ies and/o se ings, limi ed access o alcohol, and easons ela ed o heal h and sel -discipline we e e lec ed in dec eased alcohol use. On he o he hand, inc eased alcohol use was a ibu ed o g ea e oppo uni y (mo e ime) and bo edom and, o a lesse ex en , o a lowe pe cei ed isk o ha m and o cope wi h dis ess. As a esul , poo men al heal h, as well as alcohol abuse, can be obse ed among uni e si y s uden s [ 28 ]. All hese ac s indica e ha subs ance use beha iou should be moni o ed, especially in a c i ical si ua ion such as he COVID-19 pandemic. All he abo e-men ioned indings indica e ha alcohol use a ec s many dimensions in uni e si y s uden s’ li es and is he e o e a se ious bu den. In his ega d, inc eased esea ch a en ion should be paid o each egion. Jia e al. [ 29 ] emphasized he need o in es iga e d ug use among s uden s also in e ms o geog aphical di e ences, which may ha e s ong links o socio-economic and demog aphic cha ac e is ics o he egions. This allows he design o success ul in e en ions ailo ed o a geog aphical egion wi h unique cha ac e is ics. As o he Czech Republic and he Slo ak Republic, hese coun ies sha e no only a common Cen al Eu opean space, bu also a common his o y, cul u e, p io i ies, alues and in e es s o s eng hen he s abili y o socie y. This ac can also be applied in he ield o addic ology [ 30 ]. The Czech Republic and he Slo ak Republic o med one uni , bu we e di ided. On he o he hand, each coun y beha es as an indi idual li ing o ganism, he co e o which is a e lec ion o hei own social needs and p inciples. Fo hese easons, hei examina ion is wa an ed [ 31 ]. A p e ious s udy sugges ed po en ial di e ences in alcohol- ela ed p oblems be ween indi idual egions o he coun ies o he o me Czechoslo akia [ 32 ]. Howe e , i was Nue o e al. [ 33 ] who emphasized conside able di e ences in alcohol use be ween hese wo coun ies, which we e poli ically ga he ed in he ecen pas . The Slo ak Republic domina ed in hea y d inke s. In his con ex , he abuse o addic i e subs ances, including alcohol, was also conside ed a mo e ele an p oblem in he Slo ak Republic compa ed o he Czech Republic in a sample o he gene al popula ion [ 34 ]. In he p e-pandemic pe iod, signi ican di e ences we e also con i med among uni e si y s uden s om ou coun ies, including he Czech Republic and he Slo ak Republic [35]. Despi e he ac ha p oblema ic alcohol use among s uden s and i s de e minan s is a well- esea ched issue in he wo ld, he Czech Republic and he Slo ak Republic a e coun ies ha ha e long o e looked and neglec ed his p oblem. Insu iciency can be seen no only in he esea ch a ea, bu also a he le el o managemen o heal h policies a ge ed In . J. En i on. Res. Public Heal h 2021,18, 11565 3 o 16 a a speci ic g oup o he popula ion such as s uden s, esul ing in insu icien e idence- based in e en ions in he uni e si y en i onmen . In o he wo ds, he applica ion o esea ch indings in p ac ice is minimal in his egion. Unde s anding he si ua ion is pa icula ly impo an in he cu en pandemic pe iod o he de elopmen o success ul s a egies and p og ams aimed a educing alcohol use among s uden s, who a e seen as he d i ing o ce o he economy in he u u e, bu also as po en ial consume s o social suppo and heal h ca e. These ac s ein o ce he impo ance o he indings o e ed by he p esen ed s udy, especially in he geog aphical egion o he Czech Republic and he Slo ak Republic. Wi hou subs an ia ed e idence, i is no possible o design and implemen s uden - a ge ed p og ams ha a e lacking in he coun ies. On his basis, he objec i e o he p esen ed esea ch was o examine he associa ions be ween p oblema ic alcohol use, obacco use and cannabis use among Czech and Slo ak uni e si y s uden s du ing he ea ly COVID-19 pandemic. The s udy p o ides a aluable pla o m o in o ma ion on p oblema ic alcohol use accompanied by obacco use, cannabis use and o he cha ac e is ics o indi iduals, acili a ing public heal h leade s’ decision-making. 2. Ma e ials and Me hods 2.1. Resea ch Ques ions This s udy p o ides a deepe insigh in o he issue o alcohol use diso de s among uni e si y s uden s and b ings e idence om he Czech Republic and he Slo ak Republic du ing he ea ly COVID-19 pandemic. In he esea ch, emphasis was placed on obacco use, cannabis use and se e al socio-demog aphic cha ac e is ics. Based on he main aim, h ee esea ch ques ions we e o mula ed: RQ 1: Wha a e he di e ences in alcohol use diso de s be ween Slo ak and Czech uni e si y s uden s? RQ 2: Wha is he como bidi y be ween obacco use, cannabis use, and alcohol use diso de s among Czech and Slo ak uni e si y s uden s? RQ 3: Wha a e he associa ions o alcohol use diso de s wi h obacco use, cannabis use, age, male gende , and esidency? 2.2. Resea ch Sample and Da a Collec ion P ocess The pa icipan s in ol ed in he p esen ed esea ch we e Czech and Slo ak uni e si y s uden s. The esea ch sample was o med on he basis o quo a sampling wi h a ocus on all Czech and Slo ak uni e si ies. The pu pose was o co e all uni e si ies, as well as all ields o s udy, wi h a leas 30 obse a ions. P io o da a collec ion, uni e si ies in bo h coun ies we e mapped, including hei numbe and hei app oxima e size acco ding o he numbe o s uden s and ields o s udy. The ambi ion was o include e e y ield o s udy, which succeeded. In his way, da a was collec ed om 80% o uni e si ies. This ac makes he p esen ed esea ch unique, as such a la ge sample has no ye been s udied in he examined egion. The da a collec ion was pe o med using an online ques ionnai e dis ibu ed du ing he i s wa e o COVID-19 in 2020. The ques ionnai e was dis ibu ed h ough uni e si y ep esen a i es ( ec o s, ice- ec o s, deans, ice-deans, uni e si y eache s and lec u e s) and adminis a i e s a who we e asked o sha e i wi h s uden s. A he same ime, delega es o he s uden council o highe educa ion we e con ac ed wi h a eques o dis ibu e he ques ionnai e among s uden s. Finally, s uden s we e add essed di ec ly on social ne wo ks in s uden g oups. The whole su ey was conduc ed in bo h languages; hus, he pa icipan s we e p o ided wi h he ques ionnai e in Czech and Slo ak. A e emo ing i ele an esponses, he sample consis ed o 1422 pa icipan s om he Czech Republic and 1677 om he Slo ak Republic, wi h he da a collec ion aking place du ing he i s wa e o he COVID-19 pandemic in 2020. When excluding esponses, he c i e ia included disag eemen wi h pa icipa ion in he esea ch, inco ec answe in he con ol i em (one million has six ze os, while a nume ical exp ession was also gi en), In . J. En i on. Res. Public Heal h 2021,18, 11565 4 o 16 o he han Slo ak o Czech na ionali y, o s udy in ano he coun y. Table 1shows he equency o selec ed iden i ie s in he esea ch sample. Table 1. Resea ch sample iden i ie s. F equency CZ SK N%N% Field o s udy: Educa ion 277 19.5 80 4.8 Humani ies and a s 101 7.1 78 4.7 Social, economic and legal sciences 665 46.8 671 40.0 Na u al science 50 3.5 73 4.4 Design, echnology, p oduc ion and communica ions 93 6.5 164 9.8 Ag icul u al and e e ina y sciences 67 4.7 53 3.2 Heal h se ice 54 3.8 180 10.7 Se ices ( ou ism, spo s, secu i y, anspo , logis ics, . . . ) 69 4.9 240 14.3 In o ma ics, ma hema ics, in o ma ion and communica ion echnologies 46 3.2 138 8.2 Fo m o s udy: Full- ime 1041 73.2 1550 92.4 Pa - ime 381 26.8 127 7.6 Deg ee o s udy: Bachelo ’s 658 46.3 1140 68.0 Mas e ’s/Enginee ing 380 26.7 428 25.5 Combined (Bachelo ’s and Mas e ’s/Enginee ing) 50 3.5 41 2.4 Doc o al 334 23.5 68 4.1 Gende : Male 349 24.5 606 36.1 Female 1073 75.5 1071 63.9 Residence—uni e si y: Do mi o y 243 17.1 702 41.9 P i a e accommoda ion 287 20.2 139 8.3 Wi h amily 202 14.2 68 4.1 Wi h a iend 40 2.8 30 1.8 A home 650 45.7 738 44.0 Residence—home: Coun yside 457 32.1 823 49.1 Ci y wi h up o 10,000 inhabi an s 254 17.9 198 11.8 Ci y o 10,001 o 100,000 inhabi an s 459 32.3 525 31.3 Ci y o 100,001 o 1,000,000 inhabi an s 169 11.9 119 7.1 Ci y wi h o e 1,000,001 inhabi an s 83 5.8 12 0.7 No e: N—numbe , CZ—Czech Republic, SK—Slo ak Republic. As can be seen om Table 1, he esea ch sample om he Slo ak Republic was sligh ly mo e balanced han he esea ch sample om he Czech Republic. Despi e his ac , he o al esea ch sample could be conside ed su icien ly eliable o analy ical p ocesses. The iden i ie s included in he eg ession analysis we e con e ed o he dicho omous scale desc ibed in he gi en pa o he analy ical p ocess. Table 1indica es ha he mos equen o m o s udy was he ull- ime o m o s udy, which is a common o m in he uni e si y en i onmen in he examined egion. Addi ionally, he esea ch sample consis ed mainly o pa icipan s s udying a bachelo ’s deg ee, which could be due o he ac ha no e e y ield o s udy con inues wi h a mas e ’s/enginee ing deg ee. Female s uden s domina ed o e male s uden s, and he mos common esidence ype was li ing a home. Do mi o y li ing was mo e equen in he Slo ak sample han in he Czech one. A conside able p opo ion o he pa icipan s li ed in he coun yside and in ci ies wi h 10,001 o 100,000 inhabi an s. 2.3. Go e nance and E hics The esea ch was app o ed by he e hics commi ee o he Gene al Uni e si y Hospi al in P ague as indi idual esea ch (Re . 915/20 S–IV). A he beginning o he ques ionnai e, In . J. En i on. Res. Public Heal h 2021,18, 11565 5 o 16 all impo an in o ma ion on esea ch and p ocessing o pe sonal da a was p o ided. The su ey was comple ely anonymous and pe sonal da a was p o ec ed. All pa icipan s in ol ed in his esea ch con i med in o med consen in he ques ionnai e. All aspec s in his esea ch we e conduc ed wi h espec o he se en h e ision o he Wo ld Med- ical Associa ion Decla a ion o Helsinki [ 36 ] and he second e ision o he Fa ming on Consensus [37]. 2.4. Resea ch Ins umen s and Va iables The analyses used in his esea ch included a iables iden i ying a pa icipan ’s a i ude o subs ance use a a pa icula ime. In his way, he analyses included a a iable de e mining whe he pa icipan s d ank alcohol in he pas yea (CZ: No = 84 (5.9%), Yes = 1323 (93%), blank = 15 (1.1%); SK: No = 151 (9%), Yes = 1526 (91%)). Acco dingly, he esea ch sample consis ed o 1323 Czech pa icipan s and 1526 Slo ak pa icipan s. Subsequen ly, his esea ch sample was he basis o a a iable de e mining whe he pa icipan s smoked obacco in he las h ee mon hs (CZ: No = 873 (66%), Yes = 450 (34%); SK: No = 1102 (72.2%), Yes = 424 (27.8%)) and o a a iable de e mining whe he hey smoked cannabis in he pas yea (CZ: No = 1047 (79.1%), Yes = 276 (20.9%); SK: No = 1226 (80.3%), Yes = 300 (19.7%)). The analyses included h ee indica o s o subs ance use, namely alcohol, obacco and cannabis. The Alcohol Use Diso de s Iden i ica ion Tes (AUDIT) [ 38 ] was used o iden i y alcohol use. The AUDIT measu e was de eloped o de ec p oblema ic alcohol use and i s in ensi y. This b ie ool consis s o 3 domains (haza dous alcohol use, alcohol use wi h dependence symp oms, ha m ul alcohol use) and o 10 i ems. The AUDIT i ems a e sco ed om 0 o 4, and he o al sco e is he sum o he indi idual i ems. The highe he o al sco e, he highe he le el o isk o alcohol use diso de . The isk le els a e iden i ied as ollows (Zone— ecommended in e en ion): (i) low isk wi hou po en ial alcohol use diso de (Zone I—alcohol educa ion), (ii) mild isk (Zone II—simple ad ice), (iii) mode a e isk (Zone III—simple ad ice plus b ie counselling and con inued moni o ing), and (i ) mode a e/se e e isk (zone IV— e e al o specialis o diagnos ic e alua ion and ea men ). The AUDIT measu e is commonly used in he p o essional and scien i ic communi y. This is e idenced by se e al s udies, in which his ool was used also in a sample o uni e si y s uden s [ 39 , 40 ]. In he Slo ak Republic, i s eliabili y was e i ied by Jano skáe al. [41]. The Glo e -Nilsson Smoking Beha io al Ques ionnai e (GN-SBQ) [ 42 ] was used o iden i y obacco use. This simple 11-i em ques ionnai e was able o assess beha iou al de- pendence; in o he wo ds, o iden i y aspec s o smoking dependence ha a e beha iou al in na u e. The GN-SBQ measu e is commonly used by physicians, heal h ca e p o ide s, and obacco in e en ionis s. The ollowing answe s we e p o ided o GN-SBQ i ems: (0) no a all, (1) somewha , (2) mode a ely so, (3) e y much so, and (4) ex emely so. This measu e p o ides a o al sco e, and he highe he o al sco e, he highe he dependence. Based on he o al sco e, dependence is iden i ied a he ollowing le els: mild (<12), mode a e (12–22), s ong (23–33), and e y s ong (>33). Thus, high sco es in he GN-SBQ measu e indica e he need o g ea e emphasis by physicians on beha iou al managemen . The Cannabis Abuse Sc eening Tes (CAST) [ 43 , 44 ] was used o iden i y cannabis use. The CAST measu e p o ides psychome ic p ope ies o assessing p oblema ic o ms o cannabis use among young people and o iden i ying pa e ns o cannabis use leading o nega i e social o heal h consequences o indi iduals. This sho measu e consis s o six i ems. The CAST i ems o e ed he ollowing answe s: (0) ne e , (1) a ely, (2) om ime o ime, (3) ai ly o en, (4) e y o en. 2.5. S a is ical Analysis The ollowing s a is ical me hods we e used o achie e he main objec i e o his esea ch. Desc ip i e analysis was used o p esen he basic s a is ical cha ac e is ics o alcohol- ela ed a iables (mean, median, a iance (Va ), s anda d de ia ion (S . De .), In . J. En i on. Res. Public Heal h 2021,18, 11565 6 o 16 in e qua ile ange (IQR), minimum (Min), maximum (Max)). The signi icance o di e - ences be ween coun ies wi h espec o da a cha ac e is ics was in es iga ed using he nonpa ame ic Mann–Whi ney U es . Due o he na u e o he da a, Spea man’s co ela ion coe icien ( ρ ) was used o assess he ela ionships. Two eg ession models we e used o e alua e he e ec s, namely he o dina y leas squa es (OLS) model and he nega i e bino- mial gene alized linea model (NB) model [ 45 ]. Signi ican he e oscedas ici y occu ed in he OLS models; he e o e, a obus es ima ion based on he HC3 es ima o was p e e ed. Analy ical calcula ions we e pe o med using he p og amming language R e sion 4.0.2 (RS udio, Inc., Bos on, MA, USA), nickname: Taking o Again [46]. 3. Resul s This sec ion p esen s he esul s o a desc ip i e analysis in o de o o e a close look a selec ed a iables and poin ou a cu en si ua ion in he examined issue. This sec ion is also de o ed o he examina ion o he ela ionships be ween alcohol use diso de s and obacco use, cannabis use and selec ed socio-demog aphic cha ac e is ics o he pa icipan s. This made i possible o map he si ua ion in he egion, whe e his p oblem has been o e looked o a long ime and a deepe insigh in o he issue was lacking. In addi ion, he esul s help o poin ou he como bidi y and he associa ion be ween subs ance use among Czech and Slo ak uni e si y s uden s du ing he ea ly COVID-19 pandemic. Table 2shows he esul s o he desc ip i e analysis o he o al AUDIT sco e and i s indi idual subscales. Wi h a ocus on he s a is ical measu es o he cen al endency o AUDIT To al, AUDIT Haza dous Alcohol Use and AUDIT Dependence Symp oms, i was possible o obse e he ac ha Czech pa icipan s domina ed o e Slo ak pa icipan s. Haza dous alcohol use and dependen alcohol use indica e a isk o mild and mode - a e/se e e alcohol- ela ed diso de s. In e ms o AUDIT Ha m ul Alcohol Use, he opposi e si ua ion was ound, i.e., a highe mean sco e was iden i ied o Slo ak pa icipan s. Re- ga ding he mean alues o he o al AUDIT sco e, i could be s a ed ha Czech and Slo ak s uden s epo ed a low isk o alcohol use diso de du ing he ea ly COVID-19 pandemic. Howe e , i should be no ed ha he sco es we e almos on he h eshold be ween low and mild isk. Table 2. Desc ip i e s a is ics o selec ed alcohol- ela ed a iables. AUDIT To al AUDIT Haza dous Alcohol Use AUDIT Dependence Symp oms AUDIT Ha m ul Alcohol Use ALL CZ SK ALL CZ SK ALL CZ SK ALL CZ SK Mean 6.08 6.12 6.05 3.58 3.64 3.52 0.59 0.63 0.55 1.92 1.85 1.98 Median 5.00 5.00 5.00 3.00 4.00 3.00 0.00 0.00 0.00 1.00 1.00 1.00 Va 21.85 20.30 23.21 4.15 3.60 4.61 1.36 1.30 1.42 5.85 5.33 6.30 S . De . 4.67 4.51 4.82 2.04 1.90 2.15 1.17 1.14 1.19 2.42 2.31 2.51 IQR 5.00 5.00 5.00 3.00 3.00 3.00 1.00 1.00 1.00 3.00 3.00 3.00 Min 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Max 30.00 28.00 30.00 12.00 11.00 12.00 10.00 8.00 10.00 16.00 13.00 16.00 No e: AUDIT—Alcohol Use Diso de s Iden i ica ion Tes , CZ—Czech Republic, SK—Slo ak Republic, Va — a iance, S . De .—s anda d de ia ion, IQR—in e qua ile ange, Min—minimum, Max—maximum. The nonpa ame ic Mann–Whi ney es o di e ences was applied o hese da a, while signi ican di e ences we e e ealed only in AUDIT Haza dous Alcohol Use (s a is ic: 951,900, p- alue: 0.008) and in AUDIT Dependence Symp oms (s a is ic: 944,764, p- alue: <0.001). Table 3shows he desc ip i e analysis esul s o GN-SBQ and CAST measu es, in gene al as well as o indi idual coun ies. The alues o he cen al endency measu es we e highe in he Slo ak Republic, especially in he case o GN-SBQ. Based on he mean alues o he o al GN-SBQ sco e, a mode a e smoking dependence in beha iou al na u e was ound in bo h coun ies du ing he i s wa e o he COVID-19 pandemic. Howe e , he mode a e le el o dependence anged om 12 o 22, and he e o e i could be s a ed ha he Czech pa icipan s epo ed an almos h eshold alue be ween mild and mode a e In . J. En i on. Res. Public Heal h 2021,18, 11565 7 o 16 dependence. By ocusing on he median o he o al CAST sco es, he measu ed alues did no indica e a high isk o cannabis abuse among uni e si y s uden s in bo h coun ies du ing he ea ly COVID-19 pandemic. Table 3. Desc ip i e s a is ics o selec ed a iables ela ed o obacco and cannabis. GN-SBQ CAST ALL CZ SK ALL CZ SK Mean 13.15 12.21 14.17 3.58 3.56 3.60 Median 13.00 12.00 14.50 2.00 2.00 2.00 Va 66.83 76.23 55.09 17.20 16.63 17.94 S . De . 8.17 8.7. 7.42 4.15 4.07 4.24 IQR 13.00 13.00 11.00 5.00 5.00 5.00 Min 0.00 0.00 0.00 0.00 0.00 0.00 Max 41.00 41.00 31.00 22.00 18.00 22.00 No e: GN-SBQ—Glo e -Nilsson Smoking Beha io al Ques ionnai e, CAST—Cannabis Abuse Sc eening Tes , CZ—Czech Republic, SK—Slo ak Republic, Va — a iance, S . De .—s anda d de ia ion, IQR—in e qua ile ange, Min—minimum, Max—maximum. Rega ding he da a on obacco and cannabis use, he nonpa ame ic Mann–Whi ney es o di e ences did no show any signi ican di e ences be ween coun ies. The ollowing analy ical p ocedu es a e de o ed o he ela ionships be ween p ob- lema ic alcohol use and obacco and cannabis use. Thus, he analyses included he AUDIT measu e and i s subscales, bu also he GN-SBQ measu e and he CAST measu e. Table 4shows he esul s o he co ela ion analysis be ween he in es iga ed a iables ela ed o addic i e subs ances. The i s column ( ρ ) p o ides he a e o co ela ion, he second column (Sig.) shows a p- alue and he hi d column (N) o e s in o ma ion on he numbe o obse a ions. A his poin , i should be no ed ha he analysis included da a on pa icipan s who smoked obacco in he las h ee mon hs (GN-SBQ) and also d ank alcohol in he pas yea , as well as da a on pa icipan s who smoked cannabis (CAST) and also d ank alcohol in he pas yea . In gene al, he e we e mo e signi ican co ela ions in he Slo ak Republic han in he Czech Republic. The a e o co ela ions could be conside ed as low o medium. Table 4. Co ela ion analysis. Spea man ρ CZ SK ρSig. N ρSig. N The Glo e -Nilsson Smoking Beha io al Ques ionnai e (GN-SBQ) AUDIT To al 0.098 0.038 450 0.242 <0.001 424 AUDIT Haza dous Alcohol Use 0.091 0.053 450 0.159 0.001 424 AUDIT Dependence Symp oms 0.070 0.137 450 0.179 <0.001 424 AUDIT Ha m ul Alcohol Use 0.100 0.035 450 0.229 <0.001 424 Cannabis Abuse Sc eening Tes (CAST) AUDIT To al 0.143 0.017 276 0.243 <0.001 300 AUDIT Haza dous Alcohol Use 0.109 0.072 276 0.145 0.012 300 AUDIT Dependence Symp oms 0.075 0.214 276 0.176 0.002 300 AUDIT Ha m ul Alcohol Use 0.145 0.016 276 0.265 <0.001 300 No e: AUDIT—Alcohol Use Diso de s Iden i ica ion Tes , CZ—Czech Republic, SK—Slo ak Republic, ρ —co ela ion a e, Sig.—signi icance, N—numbe . The alcohol- ela ed a iables p esen ed abo e we e dependen a iables in he e- g ession analysis. Independen a iables we e ep esen ed by a iables such as Smoking ( obacco smoke s in he las h ee mon hs = 1, obacco non-smoke s = 0), Cannabis (cannabis smoke s in he pas yea = 1, cannabis non-smoke s = 0), Age (CZ: mean = 24.7, median = 23, s anda d de ia ion = 6.08; SK: mean = 23.36, median = 22, s anda d de ia ion = 4.24), Male In . J. En i on. Res. Public Heal h 2021,18, 11565 8 o 16 (males = 1, emales = 0), Coun yside (coun yside = 1, ci y = 0), Do mi o y (do mi o y = 1, o he han do mi o y = 0). In he ollowing pa o he analy ical p ocedu e, he esul s o eg ession models ( he OLS model and he NB model) we e p esen ed o indi idual coun ies. Be o e using he eg ession models, he assump ions o he applica ion o he models we e i s e alua ed, p edominan ly o he OLS model. A mul icollinea i y was es ed by he a iance in la ion ac o (VIF) me hod, while he highes alue was measu ed o Cannabis (VIF: CZ = 1.09; SK = 1.11). The cons ancy o a iabili y o he esidues was es ed using he B eusch–Pagan es , and signi ican he e oscedas ici y was ound in all analysed cases. On his basis, he HC3es ima o was used o es ima e he coe icien s o he OLS model. Table 5p esen s he esul s o he OLS and NB eg ession models, con i ming he signi ican associa ions o he AUDIT indica o s wi h selec ed a iables (Smoking, Cannabis, Age, Male, Coun yside, Do mi o y). In he analysed cases o Smoking and Cannabis, a sig- ni ican posi i e associa ion was ound in all AUDIT indica o s in he Czech Republic, as well as in he Slo ak Republic. This inding poin s o he ac ha he use o obacco and cannabis was posi i ely associa ed wi h p oblema ic alcohol use among Czech and Slo ak uni e si y s uden s du ing he ea ly COVID-19 pandemic. In e ms o Age, signi - ican nega i e associa ions could be obse ed. Fo Czech uni e si y s uden s, Age was signi ican ly and nega i ely associa ed wi h AUDIT To al,AUDIT Haza dous Alcohol Use and AUDIT Ha m ul Alcohol Use. In con as , only one signi ican nega i e associa ion was ound in Slo ak uni e si y s uden s, namely be ween Age and AUDIT Haza dous Alcohol Use.Male showed a posi i e and signi ican coe icien in all o he analysed cases. Thus, a male gende was posi i ely associa ed wi h p oblema ic alcohol use in he Czech Repub- lic, as well as in he Slo ak Republic, du ing he i s wa e o he COVID-19 pandemic. In con as , no e ec a he signi icance le el o α < 0.05 was ound o Coun yside. The only disc epancy be ween he examined coun ies in e ms o di ec ion o associa ions was obse ed in Do mi o y. This a iable showed a nega i e associa ion wi h AUDIT To al and AUDIT Ha m ul Alcohol Use in he Czech Republic. On he o he hand, a signi ican posi i e associa ion wi h all AUDIT indica o s was iden i ied in he Slo ak Republic. Table 5. Reg ession analysis. DV AUDIT To al AUDIT Haza dous Alcohol Use AUDIT Dependence Symp oms AUDIT Ha m ul Alcohol Use Model OLS NB OLS NB OLS NB OLS NB CZ In e cep 5.43 †1.73 †3.37 †1.23 †0.37 *** −0.88 †5.43 †0.59 † Smoking 2.47 †0.39 †1.01 †0.26 †0.54 †0.82 †2.47 †0.49 † Cannabis 2.44 †0.34 †0.79 †0.19 †0.47 †0.59 †2.44 †0.52 † Age −0.04 ** −0.01 *** −0.02 *** −0.01 ** <0.001 −0.01 −0.04 ** −0.02 ** Male 1.62 †0.24 †1.04 †0.26 †0.16 ** 0.26 ** 1.62 †0.22 *** Coun yside 0.38 0.05 0.1 0.02 0.04 0.08 0.38 0.11 Do mi o y −0.7 *** −0.12 ** −0.19 −0.05 −0.1 −0.22 −0.7 *** −0.23 ** R20.197 −0.201 −0.11 −0.124 − R2Adjus ed 0.194 −0.198 −0.106 −0.12 − Nagelke ke −0.2 −0.178 −0.112 −0.11 AIC −6974.4 −5114.9 −2733 −4747.5 SK In e cep 4.06 †1.5 †2.88 †1.09 †−0.08 −1.57 †4.06 †0.33 Smoking 3.12 †0.48 †1.31 †0.34 †0.53 †0.83 †3.12 †0.6 † Cannabis 3.01 †0.4 †1.09 †0.26 †0.45 †0.61 †3.01 †0.59 † Age −0.02 −0.01 −0.02 ** −0.01 ** 0.01 0.01 −0.02 −0.01 Male 1.82 †0.3 †1.05 †0.29 †0.28 †0.44 †1.82 †0.26 † Coun yside −0.11 −0.04 0.06 0.01 −0.02 −0.12 −0.11 −0.11 * Do mi o y 1.09 †0.19 †0.41 †0.11 †0.21 †0.42 †1.09 †0.28 † In . J. En i on. Res. Public Heal h 2021,18, 11565 9 o 16 Table 5. Con . DV AUDIT To al AUDIT Haza dous Alcohol Use AUDIT Dependence Symp oms AUDIT Ha m ul Alcohol Use Model OLS NB OLS NB OLS NB OLS NB R20.246 −0.228 −0.104 −0.162 − R2Adjus ed 0.243 −0.225 −0.1 −0.158 − Nagelke ke −0.254 −0.226 −0.108 −0.141 AIC −8036.8 −6092.3 −2822.5 −5570.3 No e: *—p- alue < 0.1; **—p- alue < 0.05; ***—p- alue < 0.01; †—p- alue < 0.001. 4. Discussion 4.1. P oblema ic Alcohol Use in he Czech Republic and he Slo ak Republic Based on he main esul s o he di e ence analysis, signi ican di e ences in p oblem- a ic alcohol use we e ound be ween he examined coun ies in domains such as AUDIT Haza dous Alcohol Use and AUDIT Dependence Symp oms. This inding cla i ies he answe o he esea ch ques ion 1 (RQ1) and encou ages u he in es iga ion a e he pandemic. A highe alue was measu ed in he Czech Republic. Rega ding he p e-pandemic pe iod, e y simila esul s we e iden i ied by Kalina e al. [ 35 ], who examined da a om 2016 and ound ha Czech uni e si y s uden s epo ed he highes mean AUDIT sco es in e ms o haza dous alcohol use and alcohol use wi h dependence symp oms compa ed o uni e si y s uden s om he Slo ak Republic, Hunga y and Li huania. On he o he hand, his inding con adic s he e idence e ealed by Nue o e al. [ 33 ] and Slach o áe al. [ 34 ], who conside ed he Slo ak Republic o be a coun y wi h g ea e alcohol- ela ed p oblems. The disc epancy may ha e been due o he ac ha he p esen ed esea ch was aimed only a uni e si y s uden s. In explaining he esul s o his s udy, i can be assumed ha Czech and Slo ak s uden s may ha e had di e en es ic ions and educa ional condi ions du ing he i s wa e o he COVID-19 pandemic. This could lead o di e en d inking oppo uni ies and beha iou s among s uden s in hese wo coun ies. In gene al, he mean alue o he o al AUDIT sco e was 6.12 in he Czech Republic and 6.05 in he Slo ak Republic, indica ing a low le el o isk (Zone I—alcohol educa ion). Al hough his alue does no ep esen a po en ial alcohol use diso de , i should be emphasized ha he limi alue be ween Zone I and Zone II wi h a mild isk o alcohol use diso de is 7. Thus, his unheal hy pa e n should be moni o ed among Czech and Slo ak uni e si y s uden s. Tó ho á[ 47 ] ound simila esul s among Slo ak uni e si y s uden s in he p e-pandemic pe iod, while mos s uden s we e included in Zone I. The esul s o his s udy a e consis en wi h he esul s o Kalina e al. [ 35 ], who measu ed e y simila alues in all indi idual AUDIT domains based on p e-pandemic da a. This indica es ha Czech and Slo ak uni e si y s uden s did no change hei d inking du ing he pandemic. The explana ion can be ound in he ac ha , despi e ba s, pubs, ca es, clubs and es au an s we e closed, indi iduals could s ill d ink alcohol om he s o e [ 48 , 49 ]. A he same ime, o -p emises alcohol use may no be appa en in he sho ime since he onse o he pandemic [49]. 4.2. Tobacco and Cannabis Use in he Czech Republic and he Slo ak Republic When assessing obacco use measu ed by he GN-SBQ sco e, he pa icipan s om bo h coun ies epo ed highe alues (CZ: 12.21, SK: 14.17), which could be included in he second le el o beha iou al dependence, e lec ing he p e alence o smoking in Cen al and Eas e n Eu ope om he p e-pandemic pe iod [ 50 , 51 ]. As his was a mean alue, a en ion should be paid o his smoking- ela ed indica o . Rega dless o he pandemic pe iod, a mode a e smoking dependence ound in bo h coun ies indica es he need o g ea e emphasis by physicians on beha iou al managemen in he uni e si y en i onmen . The CAST sco e did no indica e a high isk o cannabis abuse among uni e si y s uden s; howe e , he impo ance o moni o ing should also be emphasized o his pa e n o unheal hy beha iou [52,53]. In . J. En i on. Res. Public Heal h 2021,18, 11565 16 o 16 66. O e, C.; Coone, A.; Ame , J.; Gomila, M.A.; Pascual, B. E idence-based p ac ice and aining needs in d ug p e en ion: The in e es and iabili y o he Eu opean p e en ion cu iculum in p e en ion aining in Spain. Adik ologie 2020,20, 37–46. 67. Aaby, A.; F iis, K.; Ch is ensen, B.; Rowlands, G.; Maindal, H.T. Heal h li e acy is associa ed wi h heal h beha iou and sel - epo ed heal h: A la ge popula ion-based s udy in indi iduals wi h ca dio ascula disease. Eu . J. P e . Ca diol. 2017 ,24, 1880–1888. [C ossRe ] 68. Rolo a, G. Heal h li e acy in esiden ial addic ion ea men p og ams: S udy p o ocol o a c oss-sec ional s udy in people wi h subs ance use diso de s. Adik ologie 2020,20, 145–150. 69. Rolo a, G.; Ga u o a, B.; Pe uzelka, B. Heal h li e acy, sel -pe cei ed heal h, and subs ance use beha io among young people wi h alcohol and subs ance use diso de s. In . J. En i on. Res. Public Heal h 2021,18, 4337. [C ossRe ] 70. Sa ikhani, Y.; Bas ani, P.; Ra iee, M.; Ka osi, Z.; Ra anga d, R. Key ba ie s o he p o ision and u iliza ion o men al heal h se ices in low-and middle-income coun ies: A scope s udy. Communi y Men . Heal h J. 2020,57, 836–852. [C ossRe ]