title: Effects of lifetime tobacco, alcohol and drug use on psychological and behavioral problems among 10th grade students in Istanbul.
abstract: OBJECTIVE
  The aim of this study was to determine the effects of life-time tobacco, alcohol, and substance use on psychological and behavioral variables among 10th grade students in Istanbul/Turkey.
  
  
  METHODS
  This study employed a cross-sectional online self-report survey conducted in 45 schools from the 15 districts in Istanbul. The questionnaire featured a section about use of substances, including tobacco, alcohol, and drugs. The depression, anxiety, anger, assertiveness, sensation seeking and impulsiveness subscales of the Psychological Screening Test for Adolescents (PSTA) were used. The analyses were conducted based on 4957 subjects.
  
  
  RESULTS
  Logistic regression analyses were conducted with each school with the related and behavioral variables as the dependent variables. Gender, tobacco, alcohol, and drug use being the independent variables. All four independent variables predicted the dependent variables. Lifetime tobacco and drug use had significant effects on all the subscale score, whereas lifetime alcohol use had significant effects on all the subscale scores other than lack of assertiveness, and male gender was a significant covariant for all the subscale scores. Drug use showed the highest effect on dependent variables. Interaction was found between effects of tobacco and alcohol on anxiety, whereas interactions were found between effects of tobacco and drugs on lack of assertiveness and impulsiveness.
  
  
  CONCLUSIONS
  The findings suggested that male students with lifetime tobacco, alcohol or drug use have particularly high risk of psychological and behavioral problems. The unique effects of substance clusters on these problems may be useful in developing secondary preventive practices for substance use and abuse problems in Istanbul.
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Evren
authors.forename: Bilge
authors.initials: B
authors.lastname: Evren
authors.forename: Muge
authors.initials: M
authors.lastname: Bozkurt
authors.forename: Arzu
authors.initials: A
authors.lastname: Ciftci-Demirci
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000187:drug effects / Q000523:psychology*; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000453:epidemiology / Q000523:psychology; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D000066553:Problem Behavior / Q000523:psychology*; D012309:Risk-Taking; D057566:Self Report; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D012923:Social Class; D013334:Students / Q000523:psychology / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires; D013995:Time; D014421:Turkey / Q000453:epidemiology