Alcohol use and risk of vehicle accidents: cross-sectional study in the city of São Paulo, Brazil

ABSTRACT BACKGROUND: Harm to other people caused by an individual under the influence of alcohol (UIA) can occur in a variety of relationship situations between the drinker and these other people. OBJECTIVES: To estimate the prevalence of the risk of vehicle accidents (RVA) involving people who are UIA, according to sociodemographic variables, respondent alcohol use and gender. DESIGN AND SETTING: Cross-sectional study, in which a household survey was carried out on a cluster-stratified representative sample of urban residents in the city of São Paulo. METHODS: The final sample was composed of 1,155 subjects aged 18-59 years, who were interviewed using the GENACIS Harm-to-Others questionnaire. Individuals were defined as having been harmed if an affirmative response was given to at least one of the questions that refers to RVA involving people who had been UIA in the last twelve months. Post-stratification weights were calculated to adjust for the study design and for no response. Since the outcome was binary, logistic regression was used in multivariable analysis. RESULTS: The final response rate was 58.6%. The overall prevalence of RVA was 13.6% (95% confidence interval, CI 11.0-16.7): 16.6% among men and 10.8% among women. After the logistic regression, age remained as a protective factor (odds ratio, OR 0.95) and binge drinking as a risk factor (OR 2.03). CONCLUSION: This study showed that binge drinking was associated with RVA.

Sexual abuse and alcohol use among women in metropolitan Sao Paulo, Brazil: a general population study / Abuso sexual e uso de alcool entre mulheres na regiao metropolitana de Sao Paulo, Brasil: um estudo em populacao geral

OBJECTIVE: The present study aimed at estimating the prevalence of lifetime sexual abuse among women and at investigating its association with alcohol consumption. METHOD: Population-based survey conducted through a representative and stratified cluster sample of metropolitan São Paulo. GENACIS questionnaire was used. Sample unit was the home, and all residents aged 18 years and over were interviewed. The outcome was lifetime sexual abuse. The univariate statistical analysis used the Rao-Scott test. Logistic regression was used for the multivariate analysis. RESULTS: The final sample totalized 1,216 women aged 18 years and over; the response rate was 75.0%. Most women were married (56.6%) and had less than 12 years of formal education (59.0%); 46.2% were aged between 25 and 44 years, and 44.4% had a low income. Of the respondents, 7.5% reported having suffered lifetime sexual abuse. Multiple logistic regression model showed an association between lifetime sexual abuse and being a heavy drinker (OR = 4.97) and being a former drinker (OR = 2.04). CONCLUSIONS: There are few population studies in Brazil investigating sexual abuse and its relation to alcohol use. Although the prevalence of lifetime sexual abuse in the present study was smaller than that observed in other studies, it is a highly expressive percentage on account of its social and economic impact, as well as its potential effect on the health system. .

Expectativas positivas com o uso de álcool e o beber se embriagando: diferenças de gênero em estudo do Projeto GENACIS, São Paulo, Brasil / Positive expectations towards alcohol use and binge drinking: gender differences in a study from the GENACIS project, São Paulo, Brazil

O objetivo deste trabalho foi investigar as expectativas de homens e mulheres com relação ao uso do álcool e a associação dessas com o comportamento de beber com embriaguez. Foi realizado inquérito epidemiológico, domiciliar, transversal, de base populacional, com amostra probabilística estratificada por conglomerados, na Região Metropolitana de São Paulo, Brasil. Foram entrevistadas 2.083 pessoas de ambos os sexos utilizando-se o questionário GENACIS (Gender, Alcohol and Culture: An International Study). Beber com embriaguez foi considerada variável dependente, e foram construídos modelos de regressão logística para cada sexo, ajustando-se os modelos para idade, escolaridade e renda. Todas as expectativas, exceto achar mais fácil falar com companheiro, associaram-se ao comportamento de beber com embriaguez. Nosso estudo mostrou que beber com embriaguez pode estar associado a expectativas com uso do álcool. Compreender essas expectativas pode contribuir para elaboração de estratégias mais efetivas de prevenção do beber excessivo.

The objective was to investigate expectations towards alcohol use among men and women and the association between these expectations and binge drinking (or heavy episodic drinking). An epidemiological cross-sectional population-based household survey with a stratified probabilistic sample was conducted in Greater Metropolitan São Paulo, Brazil. Males and females were interviewed (n = 2,083) with the GENACIS questionnaire (Gender, Alcohol, and Culture: an International Study). The dependent variable was binge drinking, and logistic regression models were constructed for each gender, adjusting for age, schooling, and income. All expectations, with the exception of increased ease in talking with one's partner, were associated with binge drinking. The study shows that binge drinking can be associated with expectations towards alcohol use. Understanding such expectations can contribute to the design of effective polices to prevent binge drinking.

Alcohol screening instruments in elderly male: a population-based survey in metropolitan São Paulo, Brazil / Instrumentos de detecção do uso de álcool em homens idosos: um estudo populacional na região metropolitana de São Paulo, Brasil

OBJECTIVE: This study compares the efficacy of the AUDIT (gold standard) with the more easily and quickly applied instruments CAGE, TWEAK, and T-ACE for men aged > 60 using data from a representative stratified sample of the general population of metropolitan São Paulo. METHOD: The GENACIS questionnaire was administered to a total sample of 2,083 people aged over 18, with a response rate of 74.5 percent. The elderly male sample consisted of 169 men. Sensitivity, specificity, positive and negative predictive values, area under the receiver operating characteristic curve, and confidence intervals were calculated for each instrument (95 percent CI). RESULTS: Respondents were predominantly married (81.7 percent), had up to 11 years of education (61.3 percent) and a monthly per capita income of up to 300 US dollars. Current abstinence rate was high (61.6 percent) and 38 percent reported being former drinkers. There were no statistically significant differences among the instruments tested; however, the TWEAK had a higher area under the receiver operating characteristic curve (95 percent CI; 0.90-0.99). CONCLUSION: Research in the general population with screening instruments is scarce, especially among the elderly. However, it can provide specific information concerning this age group and be useful in the formulation of policies and prevention strategies.

OBJETIVO: Este estudo compara a eficácia do AUDIT (padrão-ouro) com o CAGE, TWEAK, e T-ACE, instrumentos mais fáceis e rápidos de aplicar, entre homens com > 60 anos de idade, utilizando dados de uma amostra representativa estratificada da população da região metropolitana de São Paulo. MÉTODO: Foi utilizado o questionário GENACIS em uma amostra total de 2.083 entrevistados de 18 anos ou mais de idade. A taxa de resposta foi de 74,5 por cento. A amostra de homens idosos (> 60 anos) foi constituída por 169 homens. Foram calculados para cada instrumento a sensibilidade, especificidade, valor preditivo positivo e negativo, área sob a curva ROC (receiver-operating characteristic) e intervalos de confiança (IC 95 por cento). RESULTADOS: Houve predominância de homens casados (81,7 por cento), com até 11 anos de estudo (61,3 por cento) e com renda per capita de até 300 dólares. A taxa de abstinência atual foi alta (61,6 por cento), dos quais 38 por cento relataram ter sido ex-bebedores. Não foram encontradas diferenças estatisticamente significativas entre os instrumentos testados. No entanto, o TWEAK apresentou maior área sob a curva ROC (0,95; IC 95 por cento 0,90-0,99). CONCLUSÃO: As pesquisas em população geral com instrumentos de rastreamento são escassas, principalmente entre idosos. No entanto, podem fornecer informações específicas para essa faixa etária e são úteis para a formulação de políticas e estratégias de prevenção.

Alcohol use and falls among the elderly in Metropolitan São Paulo, Brazil / Consumo de álcool e ocorrência de quedas entre idosos na Região Metropolitana de São Paulo, Brasil

The objectives of this study are to identify the pattern of alcohol use among the elderly and to analyze its association with falls. A population-based survey was conducted in a sample of Metropolitan São Paulo, Brazil, using the GENACIS questionnaire, Gender, Alcohol and Culture: An International Study. Adjusted prevalence ratios were calculated using Poisson Regression with robust variance, and the dependent variable was the occurrence of falls. Interviews were carried out with 432 subjects whose average age was 69.5 years. Regarding alcohol use 50.9 percent were lifetime abstainers, 25.5 percent had not drunk in the previous year and 23.6 percent were current drinkers. Among the latter, 14 (13.7 percent) were heavy drinkers. In the previous year 24.5 percent people had falls, which were associated with being a heavy drinker and being older. Although a relationship between being a heavy drinker and falls found in this survey does not allow for inferences on causality, this association supports the hypothesis that alcohol abuse in later life might be related with health problems.

Este estudo se propõe a identificar o padrão de uso de álcool entre idosos e analisar sua associação com quedas. Foi conduzido um estudo transversal, de base populacional, com amostra estratificada da Região Metropolitana de São Paulo, Brasil, utilizando-se o questionário Gênero, Álcool e Cultura: Um Estudo Internacional (GENACIS). A análise estatística utilizou o teste de qui-quadrado e a regressão de Poisson, com variância robusta. A ocorrência de quedas foi considerada a variável dependente. Entrevistas foram conduzidas com 432 sujeitos, com idade média de 69,5 anos. Em relação ao uso de álcool, 50,9 por cento nunca haviam feito uso, 25,5 por cento não bebeu no último ano e 23,6 por cento fizeram uso de álcool no último ano. Entre os bebedores, 14 (13,7 por cento) relataram uso de risco de álcool. No ano anterior, 24,5 por cento relataram quedas, que se associou a uso de risco de álcool e a ser mais velho. Embora a relação entre uso de risco de álcool e quedas encontrada neste estudo não permita inferir causalidade, tal associação sustenta a hipótese de que abuso de álcool entre idosos pode estar relacionado a problemas de saúde.

Violência entre parceiros íntimos e álcool: prevalência e fatores associados / Violence between intimate partners and alcohol use: prevalence and associated factors

OBJETIVO: Estimar a violência física entre parceiros íntimos e examinar a associação entre a violência e variáveis sociodemográficas, uso de álcool e outros fatores relacionados. MÉTODO: Inquérito epidemiológico realizado com amostra probabilística estratificada por conglomerados, representativa dos níveis socioeconômicos e educacionais do Município de São Paulo, que utilizou o questionário do projeto multidisciplinar internacional GENACIS (Gender, Alcohol and Culture: An International Study). A unidade amostral foi o domicílio, onde todas as pessoas maiores de 18 anos eram candidatas à entrevista. A amostra final incluiu 1 631 pessoas. A análise estatística utilizou o teste de Rao Scott e regressão logística. RESULTADOS: A taxa de resposta foi de 74,5 por cento. Predominaram mulheres (58,8 por cento) e pessoas com menos de 40 anos de idade (52 por cento) e com 5 a 12 anos de escolaridade. Nesse grupo, 5,4 por cento relataram ter sido vítimas de violência física por parceiro íntimo e 5,4 por cento ter sido agressores de parceiros íntimos nos últimos 2 anos. Predominou entre os homens o relato de que, na ocasião da agressão, ninguém havia bebido e, entre as mulheres, de que ninguém ou apenas o homem o havia feito. Ser vítima, assim como ser agressor, associou-se a ser mais jovem e ter um parceiro com consumo pesado de álcool. Homens vítimas estiveram associados à baixa renda. As mulheres sofreram agressões mais graves, necessitando de cuidados médicos e, diante da agressão, expressaram mais raiva e aborrecimento quando comparadas aos homens. CONCLUSÕES: Os resultados ressaltam a importância da associação entre uso de álcool e risco de agressão entre parceiros íntimos e têm importantes implicações para a elaboração de políticas públicas que enfocam esse problema.

OBJECTIVE: To estimate physical violence between intimate partners and to examine the association between violence and sociodemographic variables, use of alcohol, and other related factors. METHOD: This epidemiologic survey included a stratified probabilistic sample representative of the population from the city of São Paulo in economic and educational terms. The Gender, Alcohol and Culture: An International Study (GENACIS) questionnaire was employed. The sampling unit was the home, where all individuals older than 18 years were candidates for interview. The final sample included 1 631 people. Statistical analysis employed the Rao Scott test and logistic regression. RESULTS: The response rate was 74.5 percent. Most participants were female (58.8 percent), younger than 40 years of age (52 percent), or had 5 to 12 years of schooling. Of the overall group, 5.4 percent reported having been victims of physical violence by an intimate partner and 5.4 percent declared having been aggressors of intimate partners in the past 2 years. Most men declared that none of those involved had ingested alcohol at the moment of aggression. Most women reported that nobody or only the man had drunk. Being a victim or an aggressor was associated with younger age and having a heavy-drinking partner. Women suffered more serious aggression, requiring medical care, and expressed more anger and disgust at aggression than men. CONCLUSIONS: The results underscore the importance of the association between alcohol use and risk of aggression between intimate partners, and may contribute to the design of public policies aimed to control this situation.

Drinking patterns between men and women in two distinct Brazilian communities / Diferenças nos padrões de consumo de álcool entre homens e mulheres em duas comunidades brasileiras distintas

OBJECTIVE: A survey was conducted to compare gender differences in patterns of drinking in two stratified, urban and representative samples from two communities (B and RJr). METHOD: The Genacis (Gender, Alcohol, and Culture: an International Study) questionnaire was used. RESULTS: There were several significant differences in the demographics and patterns of alcohol use between these two samples. One had an older, more Catholic, educated, Caucasian population, with more women in the labor force. Data from B community showed that women and men had similar patterns of drinking. RJr had much higher use of alcohol among men, and almost 22 percent of those under 49 years old were binge drinkers. DISCUSSION: Access, smoking, income and having a heavy drinker partner were important risk factors for women's drinking. CONCLUSIONS: This study shows that when women's roles become more similar to men's, so do their drinking patterns.

OBJETIVO: Realizou-se um inquérito para comparar diferenças de gênero nos padrões de consumo de álcool em duas amostras urbanas, estratificadas e representativas de duas comunidades (B e RJr). MÉTODO: O questionário Genacis (Gênero, Álcool e Cultura: Um Estudo Internacional Gender, Alcohol, and Culture: An Internacional Study) foi utilizado. RESULTADOS: Houve várias diferenças significativas em dados sociodemográficos e de padrões de uso de álcool entre essas duas amostras. Uma delas tinha população mais velha, educada, católica, branca e mais mulheres na força de trabalho. Dados da comunidade B mostraram que mulheres e homens tiveram padrões similares de consumo de álcool. RJr teve uso de álcool mais alto entre homens e 22 por cento dos homens abaixo de 49 anos de idade tinham padrão de uso do tipo binge. DISCUSSÃO: O acesso, tabagismo, renda e ter um parceiro com consumo pesado de álcool foram fatores de risco importantes para o consumo das mulheres. CONCLUSÕES: Este estudo mostra que quando os papéis das mulheres se tornam similares aos dos homens, modificam seu padrão de consumo de álcool.