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The dynamics of substitute behaviors and associated factors remain poorly understood globally, and particularly in low- and middle-income contexts. This prospective study describes the prevalence and types of substitute behaviors as well as predictors, correlates, and motivations associated with substitution in persons (n = 137) admitted to residential substance use treatment in the Western Cape province of South Africa. The brief assessment of recovery capital, overall life satisfaction scale, and an adapted version of the addiction matrix self-report measure were completed during and post-treatment. Results indicate that substitutes were employed consciously for anticipated appetitive effects, for time-spending, (re)connecting with others, and enjoyment. At follow-up, 36% of service users had substituted their primary substance(s) with another substance or behavior; 23% had relapsed and 40% had maintained abstinence. While some service users may be especially vulnerable to developing substitute behaviors, targeted prevention and intervention efforts can reduce this risk.

Religiosity and spirituality have been considered to be protective factors of adolescent health-risk behavior (HRB). The aim of this study was to assess the relationship between adolescents&rsquo, HRB and their religiosity, taking into account their parents&rsquo, faith and their own participation in church activities. A nationally representative sample (n = 13377, 13.5 &plusmn, 1.7 years, 49.1% boys) of Czech adolescents participated in the 2018 Health Behavior in School-aged Children cross-sectional study. We measured religious attendance (RA), faith importance (FI) (both of respondents and their parents), participation in church activities and adolescent HRB (tobacco, alcohol, and cannabis use and early sexual intercourse). We found that neither RA nor FI of participants or their parents had a significant effect on adolescents&rsquo, HRB. Compared to attending respondents who participate in church activities (AP), non-attending respondents who participate in church activities were more likely to report smoking and early sexual intercourse, with odds ratios (ORs) ranging from 3.14 (1.54&ndash, 6.39) to 3.82 (1.99&ndash, 7.35). Compared to AP, non-attending respondents who did not participate in church activities were more likely to report early sexual intercourse, with OR = 1.90 (1.14&ndash, 3.17). Thus, our findings show that RA does not protect adolescents from HRB, they suggest that RA protects adolescents from HRB only in combination with participation in church activities.

Binge drinking in adolescents is a worldwide public healthcare problem. The aim of this study was to explore the perceptions about determinants of binge drinking in Spanish adolescents from the perspective of adolescents and parents. A qualitative study using fourteen semi-structured focus groups of adolescents was conducted during the 2014/2015 school year (n = 94), and four with parents (n = 19), based on the I-Change Model for health behaviour acquisition. Students had a low level of knowledge and risk perception and limited self-efficacy. Girls reported more parental control, and when they get drunk, society perceives them worse. Adolescents suggested focus preventive actions to improve self-efficacy and self-esteem. Parents were permissive about alcohol drinking but rejected binge drinking. They offered alcohol to their children, mainly during celebrations. A permissive family environment, lack of control by parents, adolescents&rsquo, low-risk perception, low self-esteem and self-efficacy, as well as the increase of binge drinking in girls as part of the reduction of the gender gap, emerge as risk factors for binge drinking. Future health programmes aimed at reducing binge drinking should focus on enhancing motivational factors, self-esteem, and self-efficacy in adolescents, supervision and parental control, as well as pre-motivational factors by increasing knowledge and risk awareness, considering gender differences.