Being lonely or using substances with friends? A cross-sectional study of Hungarian adolescents’ health risk behaviours

Studying adolescents’ health risk behaviours, including alcohol use and smoking habits,
is oddly significant in Central and Eastern European Countries. According to an Italian
study from 2013, 60 % of smokers smoked the first cigarette at the age of 18 or earlier.
It is more aggravating that 33.6 % of smokers started to smoke at the age of 16 or
younger 1]. A Hungarian study also established that social psychological and social behavioural
factors correlated with health risk behaviours in adolescence; moreover, these two
factors also often covaried. Social behavioural factor proved to be a better determinant,
but a number of personality and psychological factors were also related to smoking
and drinking 2]. Therefore, we aim to include both social psychological and social behavioural factors
in the present study.

Among social psychological factors, loneliness, shyness, competitiveness and need
to belong can potentially be contributors to youth health risk behaviours, according
to Hungarian data 2], 3]. The relationship between social psychological aspects of personality and health
risk behaviours was highly established (by studies from the USA and Hong Kong) among
both adults and adolescents 4], 5]. Although the correlation between competitive attitudes and alcohol use was only
indirectly investigated in many researches, the prevalence of alcohol use was higher
among adults with type-A personality 4]. In adolescence, type-A personality is correlated with higher risk of both alcohol
use and smoking. In addition, intense competitiveness is one of the main characteristics
of type-A personality 4]. Only a few studies focused directly on the correlation between competitiveness and
health risk behaviours, but significant relationship with smoking was already described
by a study from the USA 6]. According to a Canadian sample, competitive attitude is also related with higher
level of risk taking behaviours and sensation seeking, which could increase the risk
of smoking and drinking 7]. A Hungarian study also reported significantly higher level of health risk behaviours
among adolescents with competitive attitudes 3].

Shyness and loneliness are also associated with smoking. According to the Norwegian
TOPP study survey among 14–17-year-old students, adolescents’ shyness increases the
probability of smoking 8]. Loneliness has the same effect on smoking according to a study from Northern California,
USA 9]. In addition, loneliness is also a risk factor of adolescent alcohol use, stated
by Brazilian studies 10], 11]. On the other hand, studies (from the United States) about the correlation between
adolescent alcohol use and shyness show inconsistent results 12], 13]. Not surprisingly, a study from the USA stated that shyness may lead to behavioural
inhibition, that is, less health risk behaviours 14]. This was also described by a review paper in the case of loneliness, which has a
particular significance in adolescence 15]; while some studies reported a positive relationship between substance use and loneliness,
other studies failed to find differences in health risk behaviour patterns of lonely
and non lonely youth. Moreover, these two variables are not independent. Lack of friends
may increase the feeling of loneliness, and shyness can block adolescents in making
connections with their classmates 9].

The relationship between need to belong and health risk behaviours has not been studied
yet among adolescents. Thus, there is only indirect proof that higher level of (unmet)
need to belong can be a risk factor of smoking and alcohol use among this age group:
lack of relationships and extrovert personality was found to be connected with higher
level of need to belong, according to an adolescent sample from the United States
16]. Studies from the USA and The Netherlands stated that these interrelationships may
increase the chance of health risk behaviours 17], 18].

Besides social psychological factors, social behavioural variables can also have an
influence on adolescents’ health risk behaviours. Several studies (from the USA, Canada,
Poland, Finland and Kenya) established that cigarette and alcohol use of the peer
group increase the chance of health risk behaviours 19]–23]. This is true not only in the case of the same behaviour, but cross-correlation can
also be verified by a sample among US adolescents. That is, friends’ smoking increases
the risk of alcohol use, and vice versa 24], 25].

The goal of this study is to examine the relationship between social psychological
and social behavioural variables and health risk behaviours among Hungarian high school
students. We presume that in parallel with the international results, both groups
of factors included in our study may correlate with health risk behaviours in this
sample of adolescents. According to previous results, we hypothesize that among social
psychological variables need to belong and competitiveness would correlate positively
with smoking and drinking, while in the case of shyness and loneliness we would like
to provide further information to the controversial results. We also expect that alcohol
use and smoking of the adolescents’ best friend and peer group would positively relate
to their health risk behaviours.