This study provides an overview of substance use and gambling among adolescents in Italy, focusing on differences between natives and migrants according to their origin and cultural background.

Our results highlight a higher prevalence of current smoking among girls compared to boys, confirming the Italian trend of a reversal in frequency between the two genders [15]. This trend, in turn, distinguishes itself from the overall European trend, which instead shows an increasingly greater smoothing of the aforementioned differences [2]. Nevertheless, substantial differences between Italians and migrants from different areas of origin did not emerge. This suggests that regarding cigarette smoking, habits from the country of origin tend to level out and resemble those of the host country. This phenomenon has also been observed in adults and has been found to be associated with the increasing time since migration [57].

In our opinion, alcohol-related risk behaviors require more complex interpretation. In general, alcohol consumption, drunkenness, and binge drinking were less frequent among girls, in line with European data [2], and among migrants from non-Western/non-European countries. However, when modeling risks of engaging in the aforementioned risk behaviors, boys from this area seem to be protected in comparison with natives, and girls showed a non-significant increased risk of drunkenness and binge drinking. However, the risk of binge drinking became more than double, and statistically significant, when considering first-generation migrants. The coexistence of numerous cultures in this area of origin makes the interpretation of these results complex. However, one can imagine that acculturation stress plays a role in increasing the risk of first-generation migrant adolescents, considering that their culture is often very different from that of the host country. On the other hand, greater family cohesion and adherence to home country traditions may play a protective role against substance use. This may be true for areas of North Africa, the Middle East, and parts of sub-Saharan Africa, where the predominant religion is Islam, which prohibits alcohol consumption [6,58]. In contrast, the non-Western/non-European group also includes migrants from Central and South America, regions where substance use is still a concern, despite a decline in recent years [59]. Indeed, when comparing migrants from North Africa/Middle East, Central/South America, and Asia/Far East, significant differences emerged in terms of prevalences of the investigated risk behaviors. Specifically, alcohol consumption, binge drinking, and drunkenness turned out to be more frequent among students from Central/South America. However, in general, what emerged is a protective effect that can be attributed to the culture and religion of the country of origin, despite the fact that this effect seems to be lower in the first generation of migrants, likely due to acculturative stress. On the other hand, boys from Eastern European countries showed a higher risk of drunkenness, and likewise for girls with binge drinking compared to natives. This trend is most prominent in the first generation of migrants. Historically these countries have high rates of alcohol consumption and heavy drinking [60,61], so our results may align with the theory that first-generation immigrants adopt behaviors similar to those in the country of origin, while second-generation immigrants tend to adapt to those in the host country. However, a recent study on 2014 HBSC data [62] found no significant differences in alcohol use between native Italian and native Romanian adolescents, who are the most represented group from Eastern Europe in our country. Even in less represented Eastern European countries, drinking habits among young people have been decreasing in the last decade [63]. Therefore, rather than adherence to traditions from the country of origin, it seems that the increased risk of drunkenness and binge drinking may be determined by acculturative stress, which primarily affects first-generation migrants and decreases in the second one [25,26,62].

When considering cannabis use, less than one out of six adolescents consumed it for at least three days in their lifetime. Boys showed a higher prevalence, while differences between natives and migrants were not evident, with the only exception of boys from non-Western/non-European countries, who showed the highest prevalence. Again, migrants appear to share similar risks of engaging in this risk behavior with native peers, although European studies show conflicting evidence [6,64]; while some studies are in line with our results, others show increased or even decreased prevalence of cannabis use among migrants [6]. In particular, two studies conducted in Spain [65] and Norway [66], that considered migrants from Muslim regions separately, showed a lower prevalence of cannabis use compared to non-migrant peers. As a consequence of these conflicting findings, no acculturative hypothesis or cultural protective role influence on this risk behavior during adolescence has been proven yet [6].

Similarly to cannabis, the prevalence of multiple substance use was similar among immigrants and natives, as well as in the two genders. Only girls from non-Western/non-European countries consumed at least two substances in the last month less frequently, consistent with the lower prevalence of current alcohol use described above. This results in a decreased risk of multiple substance use compared to native girls, which seems to be more pronounced in the second generation of migrants. In contrast, boys from Western countries showed a higher risk of engaging in this composed risk behavior, which was characteristic of the second generation. This result seems to contradict the acculturation theory, which suggests that the first generation of immigrants might be more exposed to unhealthy behaviors than the second generation, which is generally considered more acculturated [25]. In this sense, our findings provide new insights into multiple substance use in migrant adolescents, suggesting that the underlying mechanisms might be different from those related to smoking, alcohol, or cannabis use. Since most studies consider them separately, it is desirable that further studies evaluate this behavior to define risk or protective factors and appropriate interventions against it.

Approximately one in eight adolescents exhibited at-risk/problem gambling behavior, with boys having a prevalence more than twice than girls. Eastern European immigrants were found to gamble more than natives, as well as boys from non-Western/non-European countries, who also had the highest prevalence, with around one out of four adolescents at-risk/problem gamblers. Some specific risk factors related to gambling need to be considered in order to understand these differences. In particular, since immigrants frequently find themselves in a worse socio-economic condition, their desire for redemption can lead to an increased predisposition to engage in such behavior [22,67,68]. On the other hand, gambling can provide an opportunity for immigrants who have lost their social connections to socialize and rebuild their networks [69,70]. When combined with the effect of acculturation stress, the aspects described above may explain the differences and the corresponding increase in gambling risk observed among boys from Eastern European and non-Western/non-European areas compared to natives, which mainly affects the first generation in both cases and decreases slightly in the second. This is in line with previous research on 2013/2014 HBSC data [22] and other non-European studies [38,39], which found a higher risk of gambling in the first generation than in the second-generation migrant adolescents. However, our results should be read with caution because of the large number of missing values, which are probably not random. In fact, out of a slightly lower proportion of missing (55%), females seem less likely to respond, as do immigrants from Eastern European countries or non-Western/non-European countries. Finally, the higher proportion of non-responders in students who were born abroad could be partly explained by the fact that the questionnaires were proposed only in Italian.

Prevalences of high teacher and family support were higher among boys than girls. While no differences were evident between migrants and natives for teacher support, lower prevalences of family support was found among adolescents coming from non-Western/non-European countries and girls from Eastern European countries. Teacher and family support are confirmed to play an important role in preventing unhealthy habits [20,21,22,66,71,72], as in our analyses were strong protective factors for each risk behavior, independent from the area of origin considered. This suggests that substance use prevention should be carried out through not only school-based but also family-oriented interventions [21,73,74] and can potentially be effective in adolescents with an immigration background. Some authors argue that family connectedness contributes to the protective role of adherence to the country of origin’s habits against risk behaviors, as second-generation immigrants show a deterioration of those old cultural and family values and attitudes in favor of new ones [75], thus increasing susceptibility to substance use [32,37]. In this line, enhancing family presence and commitment could mitigate these negative behaviors deriving from acculturation [76].

This study draws on data from the Italian HBSC survey, which boasts validated questions and a very large number of students attending schools throughout Italy. Consequently, our materials are of high quality and extensive, allowing for an evaluation of the phenomenon of risk behaviors among native and migrant populations at a national level. However, there are some limitations. Firstly, comparisons between migrants and non-migrants may be affected by a large difference in sample size between the two groups, as native-born Italians account for nearly 85% of the total sample. Second, the power of the analyses is progressively reduced by stratifying first by gender and then by generation, resulting in less precise estimates. Third, within the migrant group from the non-Western/non-European area, many cultures, including very different ones, are considered, making it less homogeneous and difficult to interpret. Fourth, it is important to recognize that the influence of peer groups also plays a significant role in adolescents’ substance use [23]. Unfortunately, it was not possible to account for this factor as a confounding variable in our analyses of multiple substance use because it was not addressed in the Italian HBSC questionnaire [45]. Fifth, the large number of nonrandom missing values in items related to gambling may increase the bias when assessing the association between migrants’ origin and this risk behavior. Sixth, the characteristics of non-respondents were not collected, which could affect the representativeness of the sample of Italian 15-year-old adolescents, especially immigrants due to cultural differences. However, since the response rate was 97.1%, we can assume that our sample was sufficiently representative of Italian 15-year-olds, including the migrant population [77]. Finally, a factor that may be relevant in the migrant acculturation process, especially for first-generation immigrants, is the length of stay in the host country [78] or age at migration [79]. Unfortunately, in the context of the HBSC survey, this question is not included, thus this potential confounding variable remains unmeasured.