# Gendered mediating role of substance use in the path from internet addiction or gambling to active violence in youth in the region of Mahdia, Tunisia

## TL;DR

This study explores how substance use connects internet addiction and gambling to active violence among Tunisian youth, with notable gender differences.

## Contribution

The study identifies gender-specific mediation effects of substance use in the relationship between addictive behaviors and violence.

## Key findings

- Substance use partially mediates the link between internet addiction and active violence, especially in males.
- Gambling's link to violence is also mediated by substance use, but only in males.
- Preventive strategies targeting addictive behaviors are recommended to reduce youth violence.

## Abstract

The literature shows a gap regarding mechanisms and mediators explaining the path from IA and gambling to violence. Our study aimed to investigate the gender-specific difference in the path linking IA and gambling to active violence mediated by substance use among schooled adolescents in the region of Mahdia (Tunisia).

We performed a cross-sectional survey among schooled youth in the region of Mahdia in April 2023. We conducted a mediation analysis using in SPSS the PROCESS macro to examine the relationship between X (IA/Gambling), the mediator M (Substance use), and Y (Active violence). Causal interpretations cannot be definitively established. We used validated Arabic versions of the Internet Addiction Test, the South Oaks Gambling Screen Test, the CDC Health Appraisal section about substance use and the Hospital Anxiety and Depression Scale. We also probed violence perpetration. Data analyses were performed using SPSS version 20.

A total of 1594 students completed the questionnaire with a mean age of 17.75 ± 1.34 years. IA was noted in 52.3% of the participants. Gambling was more prevalent among males (12.1% vs 0.9%, p<0.001). Substance use was noted in 18.4% of participants (41.3% males vs 9.5% females, p<0.001). Violence perpetration was reported by 35.3% of the participants (59.9% males vs 25.8% females, p<0.001).

After accounting for anxiety and depression, substance use mediated the link between IA and active violence (mediation%= 15.7, p< 0.001) with a higher effect in males (35.8% vs 10.5%). The mediation between gambling and violence via substance use was also significant (28.2%, p < 0.001). This effect was found only among males (27.7%).

Implementing preventive strategies and focusing on addictive behaviors such as IA, gambling and substance use is urgently needed to prevent violence perpetration among youth. However, based on our results, the cross-sectional design limits causal interpretations.