The Role of Personalized Normative Feedback in the Efficacy of Brief Intervention Among Argentinian University Students: A Randomized Controlled Trial.

Background: Personalized Normative Feedback (PNF) aims to modify misperceptions about peer consumption that influence one's drinking. PNF is usually a component in Brief Interventions delivered to university students. Despite this, whether PNF contributes to improving the effect of brief interventions is unclear. Objectives: This randomized controlled trial aimed to determine the role of PNF as an active ingredient in a face-to-face motivational brief intervention. Results: Participants were students from an Argentinian university (n=806; M=20.14; SD=3.17; 63.2% women) who presented at least one binge drinking episode in the last 12 months. Students were randomly assigned to 1) a Brief Intervention, 2) a Brief Intervention with PNF, or 3) an evaluation-only control group. The follow-up was three months later. After controlling sex and age, General Linear Models showed that both the brief intervention and the brief intervention with PNF reduced the quantity and frequency of alcohol consumption, binge drinking, and alcohol problems compared to the control condition. No differences were found between the brief intervention and the brief intervention with PNF. Also, treating eight students with brief intervention and 10 with brief intervention with PNF was necessary to benefit one student. Conclusions: In conclusion, this study demonstrates that brief intervention reduces alcohol consumption among Latin American university students and that PNF might not be an active ingredient of its effectiveness in this population. However, PNF could benefit students with specific characteristics, like those who overestimate their peers' drinking, highlighting the need to study moderators of effectiveness further.

Evidence of DSM-5 and ICD-11 concurrent validity among Argentineansseeking treatment for alcohol use disorders / Evidencia de la validez concurrente del DSM-5 e ICD-11 en argentinos que buscan tratamiento por trastorno por uso de alcohol

Current efforts to better understand alcohol use disorder (AUD) have led to revisions of the most used classification systems, the DSM and the ICD. There is scarce information regarding how the latest versions of those two classification systems (DSM-5 and ICD-11) relate to functional characteristics (functional impairment (FI) and subjective distress (SD)) associated with AUD. Aim:To examine how the primary diagnostic system's criteria (DSM) and guidelines (ICD) were related to two functional characteristics (FI and SD) as evidence of these systems' concurrent validity in Argentineans with AUD. Methods:We conducted a cross-sectional correlational study with a clinical sample (n=34) in 2018. Results:AUD's severity was more strongly related to SD than FI. FI was weakly related to the criterion of much time spent usingit. We found weak associations between SD and role impairment, interpersonal problems, tolerance, and physical or psychological problems due to use, withdrawal, and much time spent using. Only one of the ICD guidelines was weakly related to SD, and we found moderate positive correlations between DSM-5 and FI and between DSM-5 and SD. Conclusion:DSM-5 was more accurate than ICD-11 in identifying those with higher levels of FI and SD and, thus, had a greater concurrent validity among a clinical sample of Argentineans with AUD. Our results contribute to a better understanding of the detection of alcohol-related conditions. Keywords:alcohol-related disorders; diagnostic and statistical manual of mental disorders; international classification of diseases;psychological distress

Los esfuerzos por comprender mejor el trastorno por uso de alcohol (TUA) han dado lugar a revisiones de los sistemas de clasificación más utilizados, el DSM y la ICD. Hay escasa información sobre cómo sus últimas versiones (DSM-5 y ICD-11) se relacionan con las características funcionales (deterioro funcional (DF) y angustia subjetiva (AS)) asociadas con el TUA. Objetivo: examinar cómo los criterios de los sistemas de diagnóstico se relacionaron con dos características funcionales (DF y AS) como evidencia de la validez concurrente en argentinos con TUA. Métodos: Realizamos un estudio correlacional-transversal con una muestra clínica (n= 34) en el año 2018. Resultados: La gravedad del AUD estuvo más fuertemente relacionada con la AS que con la DF. El DF se relacionó débilmente con el criterio mucho tiempo dedicado al uso. Se encontraron asociaciones débiles entre AS y deterioro de roles, problemas interpersonales, tolerancia y problemas físicos o psicológicos debido al uso, abstinencia y mucho tiempo dedicado al uso. Sólo una de las guías de la CIE estaba débilmente relacionada con la AS, y encontramos correlaciones positivas moderadas entre el DSM-5 y AS y entre el DSM-5 y DF. Conclusión: El DSM-5 fue más preciso que la CIE-11 para identificar a aquellos con mayores niveles de AS y DF y, por tanto, tuvo una mayor validez concurrente en la población observada. Estos resultados contribuyen a una mejor comprensión de la detección de las condiciones mentales relacionadas con el uso de alcohol. Palabras clave: trastornos relacionados con alcohol; manual diagnóstico y estadístico de los trastornos mentales; clasificación internacional de enfermedades; distrés psicológico

Brief intervention and the Theory of Planned Behavior: A randomized controlled trial among adolescents / Intervención breve y teoría de la conducta planeada: Un ensayo clínico aleatorizado en adolescentes

Brief Intervention (BI) is a successful tool for reducing adolescent drinking, although little is known about how it works to change behavior. Components of the Theory of Planned Behavior (TPB) predict alcohol consumption in this population; thus, modifying them through BI could be beneficial. This study aimed to determine if BI for alcohol drinking among adolescents affects the TPB components’, considering readiness to change. Participants were 102 Argentinean high school students (age M = 15.08, SD = 1.38, 85% male). We compared two groups: 1) evaluation about alcohol consumption, TPB’s components and readiness to change 2) same evaluation plus a BI. After three months, the BI group showed a significant reduction in intention (β =-1.21; p<.05) and perceived social norms (β =-2.79; p<.01). However, readiness to change did not predict any changes in TPB’s components. This study contributes to understanding BI’s mechanisms of change and closing the evidence gap from Latin America. (AU)

La Intervencion Breve (IB) ha mostrado reducir el consumo de alcohol en adolescentes, aunque poco se sabe sobre como actúa cambiendo el comportamiento. Los componentes de la Teoría de la Conducta Planificada (TCP) predicen el consumo de alcohol en esta población, por lo tanto modificarlos mediante la IB podría ser beneficioso. El objetivo de este estudio fue determinar si la IB afecta a los componentes de la TCP considerando la disposición al cambio. Los participantes fueron 102 estudiantes argentinos (edad M = 15.08, EE = 1.38, 85% varones) de escuelas secundarias. Se compararon dos grupos que recibieron: 1) evaluación del consumo de alcohol, los componentes de la TCP y la disposición al cambio 2) la misma evaluación más una IB. Después de tres meses, la IB mostró reducciones significativas en la intención (β = -1.21; p <. 05) y la norma social percibida (β = -2.79; p <. 01). Sin embargo, la disposición al cambio no predijo modificaciones en los componente de la TCP. Este estudio contribuye a comprender los mecanismos del cambio de la IB y cerrar la brecha de evidencia para Latinoamérica.(AU)

Road traffic injury risk from alcohol and cannabis use among emergency department patients in Argentina.

Objective: To report the risk from alcohol, cannabis, and their combined use for non-fatal road traffic injuries for drivers, passengers, and pedestrians. Methods: Risk was estimated using the case-crossover method. Participants (N= 306) were injured patients from an emergency department in Mar del Plata, Argentina. Results: Alcohol use (OR= 6.78, CI 95% 3.75-12.25) as well as combined alcohol and cannabis use (OR= 7.05, CI 95% 1.16-42.73) significantly increased the risk of a road traffic injuries. Alcohol use increased the risk in both, women (OR= 8.87, CI 95% 2.69-29.21) and men (OR= 6.16, CI 95% 3.10-12.23); in those >30 years old (OR= 6.01, CI 95% 2.09-17.24) and those <30 years old (OR= 7.15, CI 95% 3.49-14.65). This last group also had an increased risk after combined alcohol and cannabis use (OR= 7.05, CI 95% 1.16-42.75). Both drivers (OR= 6.40, CI 95% 3.23-12.69) and passengers (OR= 13.83, CI 95% 2.87-66.42) had an increased risk after alcohol consumption. Conclusions: To our knowledge, these are the first estimates of the risk of having a road traffic injury after alcohol and cannabis consumption in one of the countries of the Southern Cone (Argentina, Chile, and Uruguay). These results highlight the urgent need to implement and enforce comprehensive alcohol control measures. Furthermore, given the global trend towards legalizing cannabis for recreational use, our results could also inform policymakers to enact or amend impaired driving laws.

Road traffic injury risk from alcohol and cannabis use among emergency department patients in Argentina

[ABSTRACT]. Objective. To report the risk from alcohol, cannabis, and their combined use for non-fatal road traffic injuries for drivers, passengers, and pedestrians. Methods. Risk was estimated using the case-crossover method. Participants (N= 306) were injured patients from an emergency department in Mar del Plata, Argentina. Results. Alcohol use (OR= 6.78, CI 95% 3.75-12.25) as well as combined alcohol and cannabis use (OR= 7.05, CI 95% 1.16-42.73) significantly increased the risk of a road traffic injuries. Alcohol use increased the risk in both, women (OR= 8.87, CI 95% 2.69-29.21) and men (OR= 6.16, CI 95% 3.10-12.23); in those >30 years old (OR= 6.01, CI 95% 2.09-17.24) and those <30 years old (OR= 7.15, CI 95% 3.49-14.65). This last group also had an increased risk after combined alcohol and cannabis use (OR= 7.05, CI 95% 1.16-42.75). Both drivers (OR= 6.40, CI 95% 3.23-12.69) and passengers (OR= 13.83, CI 95% 2.87-66.42) had an increased risk after alcohol consumption. Conclusions. To our knowledge, these are the first estimates of the risk of having a road traffic injury after alcohol and cannabis consumption in one of the countries of the Southern Cone (Argentina, Chile, and Uruguay). These results highlight the urgent need to implement and enforce comprehensive alcohol control measures. Furthermore, given the global trend towards legalizing cannabis for recreational use, our results could also inform policymakers to enact or amend impaired driving laws.

[RESUMEN]. Objetivo. Informar sobre el riesgo lesiones por accidentes de tránsito debido al consumo de alcohol, cannabis o su combinación en conductores, pasajeros y peatones. Métodos. Se estimó el riesgo mediante el método de casos cruzados. Los participantes (N = 306) fueron pacientes que habían sufrido lesiones, provenientes de una sala de urgencias en Mar del Plata (Argentina). Resultados. El consumo de alcohol (OR = 6,78, IC95% 3,75-12,25), así como el consumo combinado de alcohol y cannabis (OR = 7,05, IC95% 1,16-42,73) aumentaron significativamente el riesgo de traumatismos por accidentes de tránsito. El consumo de alcohol aumentó el riesgo tanto en mujeres (OR = 8,87, IC95% 2,69-29,21) como en hombres (OR = 6,16, IC95% 3,10-12,23); así como en mayores de 30 años (OR = 6,01, IC95% 2,09-17,24) y en menores de 30 años (OR = 7,15, IC95% 3,49-14,65). Este último grupo también tuvo mayor riesgo tras un consumo combinado de alcohol y cannabis (OR = 7,05, IC95% 1,16-42,75). Tanto los conductores (OR = 6,40, IC95% 3,23-12,69) como los pasajeros (OR = 13,83, IC95% 2,87-66,42) presentaron mayor riesgo después del consumo de alcohol. Conclusiones. Hasta donde sabemos, estas son las primeras estimaciones del riesgo de sufrir lesiones por accidentes de tránsito tras el consumo de alcohol y cannabis en uno de los países del Cono Sur (Argentina, Chile y Uruguay). Estos resultados ponen de relieve la urgente necesidad de aplicar y hacer cumplir medidas integrales de control del alcohol. Además, dada la tendencia mundial hacia la legalización del cannabis para consumo recreativo, nuestros resultados también podrían orientar a los responsables de las políticas para que promulguen o enmienden las leyes sobre la conducción con capacidades alteradas debido al consumo de sustancias.

[RESUMO]. Objetivo. Relatar o risco de lesões não fatais no trânsito atribuível ao álcool, à cannabis e a seu uso combinado para motoristas, passageiros e pedestres. Métodos. O risco foi estimado usando o método clínico cruzado (case-crossover). Os participantes (N=306) eram feridos atendidos em um pronto-socorro em Mar del Plata, Argentina. Resultados. O uso de álcool (OR = 6,78, IC95% 3,75; 12,25) e o uso combinado de álcool e cannabis (OR= 7,05, IC95% 1,16; 42,73) aumentaram significativamente o risco de lesões no trânsito. O uso de álcool aumentou o risco tanto em mulheres (OR = 8,87, IC95% 2,69; 29,21) quanto em homens (OR = 6,16, IC95% 3,10; 12,23); naqueles >30 anos de idade (OR = 6,01, IC95% 2,09; 17,24) e <30 anos de idade (OR = 7,15, IC95% 3,49; 14,65). Esse último grupo também apresentou um risco maior após o uso combinado de álcool e cannabis (OR = 7,05, IC95% 1,16; 42,75). Tanto motoristas (OR = 6,40, IC95% 3,23; 12,69) quanto passageiros (OR = 13,83, IC95% 2,87; 66,42) apresentaram risco maior após o consumo de álcool. Conclusões. Até onde sabemos, estas são as primeiras estimativas do risco de lesões de trânsito após o consumo de álcool e cannabis em um dos países do Cone Sul (Argentina, Chile e Uruguai). Os resultados destacam a necessidade urgente de implementar e aplicar medidas abrangentes de controle do álcool. Além disso, considerando a tendência global de legalização da cannabis para uso recreativo, nossos resultados também poderiam ajudar os formuladores de políticas a decretar ou alterar as leis sobre a condução sob efeito de substâncias psicoativas.

Efficacy of Brief Intervention for Alcohol Consumption during Pregnancy in Argentinean Women: A Randomized Controlled Trial.

INTRODUCTION: Although Brief Intervention (BI) has proven to reduce alcohol consumption during pregnancy in high income countries, there is no evidence from the Southern Cone of America. Thus, we conducted a study to assess BI efficacy among Argentinean pregnant women. METHOD AND MATERIALS: We collected data on pregnant women receiving prenatal care at the public health system in Mar del Plata, Argentina. Women with less than 26 weeks of gestation (n = 486) were randomized to brief advice (BA) or BI. Three months later they were re-assessed; women with more than 26 weeks of gestation constituted a screening only control group (SC) (n = 154). Self-reported quantity and frequency of alcohol consumption, frequency of binge drinking, and related problems after three months were used as outcomes. We performed generalized estimating equations and clinical significance analyses. Also, we obtained newborn health indicators from the city's health system database to use as objective outcomes. Women who did not participate in any of the three former conditions were randomly selected to constitute a non-screening control group (NSC) (n = 150). We compared objective outcomes among BI, BA, and NSC groups using the Wilcoxon rank test. RESULTS: In comparison with SC, BI and BA reduced alcohol consumption, without differences between the latter two. Newborns of women who received BI and BA had better health indicators compared with the NSC group. CONCLUSIONS: performing either a BI or BA reduces alcohol consumption among Argentinean pregnant women and might lead to healthier newborns.

Profiles of alcohol use disorder criteria: Help-seeking vs self-achieved remission in Argentinean hospital patients.

This study aimed to identify alcohol use disorder (AUD) criteria that better characterized those who seek treatment and those who recover on their own. We gathered data from help-seeking (HS) patients in an alcohol unit and compared them with self-achieved remission (SAR) patients. The best criteria to predict HS were psychological problems due to use, physical problems due to use, repeated attempts or desire to stop using, and not being able to stop drinking. The best criteria to predict SAR were tolerance, craving, hazardous use, much time spent, larger/longer use than intended, and role impairment. We discuss the impact of these results in current efforts to improve the accuracy of AUD diagnosis.

Road traffic injury risk from alcohol and cannabis use among emergency department patients in Argentina / Riesgo de lesiones por accidentes de tránsito debido al consumo de alcohol y cannabis en pacientes de urgencias en Argentina / Risco de lesões no trânsito devido ao uso de álcool e cannabis entre pacientes atendidos em um pronto-socorro na Argentina

ABSTRACT Objective. To report the risk from alcohol, cannabis, and their combined use for non-fatal road traffic injuries for drivers, passengers, and pedestrians. Methods. Risk was estimated using the case-crossover method. Participants (N= 306) were injured patients from an emergency department in Mar del Plata, Argentina. Results. Alcohol use (OR= 6.78, CI 95% 3.75-12.25) as well as combined alcohol and cannabis use (OR= 7.05, CI 95% 1.16-42.73) significantly increased the risk of a road traffic injuries. Alcohol use increased the risk in both, women (OR= 8.87, CI 95% 2.69-29.21) and men (OR= 6.16, CI 95% 3.10-12.23); in those >30 years old (OR= 6.01, CI 95% 2.09-17.24) and those <30 years old (OR= 7.15, CI 95% 3.49-14.65). This last group also had an increased risk after combined alcohol and cannabis use (OR= 7.05, CI 95% 1.16-42.75). Both drivers (OR= 6.40, CI 95% 3.23-12.69) and passengers (OR= 13.83, CI 95% 2.87-66.42) had an increased risk after alcohol consumption. Conclusions. To our knowledge, these are the first estimates of the risk of having a road traffic injury after alcohol and cannabis consumption in one of the countries of the Southern Cone (Argentina, Chile, and Uruguay). These results highlight the urgent need to implement and enforce comprehensive alcohol control measures. Furthermore, given the global trend towards legalizing cannabis for recreational use, our results could also inform policymakers to enact or amend impaired driving laws.

RESUMEN Objetivo. Informar sobre el riesgo lesiones por accidentes de tránsito debido al consumo de alcohol, cannabis o su combinación en conductores, pasajeros y peatones. Métodos. Se estimó el riesgo mediante el método de casos cruzados. Los participantes (N = 306) fueron pacientes que habían sufrido lesiones, provenientes de una sala de urgencias en Mar del Plata (Argentina). Resultados. El consumo de alcohol (OR = 6,78, IC95% 3,75-12,25), así como el consumo combinado de alcohol y cannabis (OR = 7,05, IC95% 1,16-42,73) aumentaron significativamente el riesgo de traumatismos por accidentes de tránsito. El consumo de alcohol aumentó el riesgo tanto en mujeres (OR = 8,87, IC95% 2,69-29,21) como en hombres (OR = 6,16, IC95% 3,10-12,23); así como en mayores de 30 años (OR = 6,01, IC95% 2,09-17,24) y en menores de 30 años (OR = 7,15, IC95% 3,49-14,65). Este último grupo también tuvo mayor riesgo tras un consumo combinado de alcohol y cannabis (OR = 7,05, IC95% 1,16-42,75). Tanto los conductores (OR = 6,40, IC95% 3,23-12,69) como los pasajeros (OR = 13,83, IC95% 2,87-66,42) presentaron mayor riesgo después del consumo de alcohol. Conclusiones. Hasta donde sabemos, estas son las primeras estimaciones del riesgo de sufrir lesiones por accidentes de tránsito tras el consumo de alcohol y cannabis en uno de los países del Cono Sur (Argentina, Chile y Uruguay). Estos resultados ponen de relieve la urgente necesidad de aplicar y hacer cumplir medidas integrales de control del alcohol. Además, dada la tendencia mundial hacia la legalización del cannabis para consumo recreativo, nuestros resultados también podrían orientar a los responsables de las políticas para que promulguen o enmienden las leyes sobre la conducción con capacidades alteradas debido al consumo de sustancias.

RESUMO Objetivo. Relatar o risco de lesões não fatais no trânsito atribuível ao álcool, à cannabis e a seu uso combinado para motoristas, passageiros e pedestres. Métodos. O risco foi estimado usando o método clínico cruzado (case-crossover). Os participantes (N=306) eram feridos atendidos em um pronto-socorro em Mar del Plata, Argentina. Resultados. O uso de álcool (OR = 6,78, IC95% 3,75; 12,25) e o uso combinado de álcool e cannabis (OR= 7,05, IC95% 1,16; 42,73) aumentaram significativamente o risco de lesões no trânsito. O uso de álcool aumentou o risco tanto em mulheres (OR = 8,87, IC95% 2,69; 29,21) quanto em homens (OR = 6,16, IC95% 3,10; 12,23); naqueles >30 anos de idade (OR = 6,01, IC95% 2,09; 17,24) e <30 anos de idade (OR = 7,15, IC95% 3,49; 14,65). Esse último grupo também apresentou um risco maior após o uso combinado de álcool e cannabis (OR = 7,05, IC95% 1,16; 42,75). Tanto motoristas (OR = 6,40, IC95% 3,23; 12,69) quanto passageiros (OR = 13,83, IC95% 2,87; 66,42) apresentaram risco maior após o consumo de álcool. Conclusões. Até onde sabemos, estas são as primeiras estimativas do risco de lesões de trânsito após o consumo de álcool e cannabis em um dos países do Cone Sul (Argentina, Chile e Uruguai). Os resultados destacam a necessidade urgente de implementar e aplicar medidas abrangentes de controle do álcool. Além disso, considerando a tendência global de legalização da cannabis para uso recreativo, nossos resultados também poderiam ajudar os formuladores de políticas a decretar ou alterar as leis sobre a condução sob efeito de substâncias psicoativas.

Alcohol industry, corporate social responsibility and country features in Latin America.

INTRODUCTION AND AIMS: Research on corporate behaviour can contribute to the understanding of the possible adverse impacts of alcohol-industry corporate social responsibility (CSR) initiatives and their potential influence on policymaking. This study explores the association between alcohol-industry CSR activities and selected country features in Latin America and the Caribbean. DESIGN AND METHODS: Nine health experts evaluated 148 CSR activities using a standardised protocol; activities were classified into the categories risk management CSR (rmCSR), that is, to avoid/rectify externalities (n = 67), and strategic CSR, that is, to fulfill philanthropic responsibilities (n = 81). We evaluated the associations, separately, between the number of rmCSR and of strategic CSR actions in each country with threats from public health measures (specifically, the level of research into alcohol consumption and harms, the existence of an alcohol surveillance system and the number of governmental alcohol policy actions) and per capita alcohol consumption; we adjusted by economic indices (country income level and the gross domestic product) and population size. RESULTS: Multivariate analyses showed that the higher the level of alcohol research within a country and its per capita consumption, the more likely rmSCR activities were to occur, independently of the country's economic development or population. DISCUSSION AND CONCLUSIONS: Results suggest rmSCR actions could be implemented as a way to preserve markets by counteracting scientific evidence about alcohol related harms. This evidence could serve as a starting point to future research, contributing to the understanding of alcohol industry behaviour and the advancement of effective public policies.

Normas sociales y consumo de alcohol en mujeres embarazadas de la Argentina / Social norms and alcohol consumption in pregnant women of Argentina

Resumen La exposición prenatal al alcohol puede derivar en un espectro de trastornos congénitos, dentro de los cuales el Síndrome Alcohólico Fetal (SAF) es el más severo. Esto es 100 % prevenible si no se consume alcohol durante la gestación, por lo que conocer los factores que determinan que una mujer consuma alcohol estando embarazada es fundamental. El objetivo de este trabajo es evaluar si características del entorno (como son las normas sociales prescriptivas o NSP) se relacionan con el consumo de alcohol durante la gestación en mujeres de la ciudad de Mar del Plata, Argentina. Para ello, se realizó un muestro probabilístico de 852 mujeres gestantes durante el año 2016 en los principales centros de atención primaria a la salud de la ciudad. Se evaluó el consumo de alcohol antes y durante la gestación a través del Test de Identificación de Trastornos por Consumo de Alcohol y las NSP con preguntas construidas ad hoc. El 87 % consideró que las otras gestantes consumen alcohol; de ellas, 53 % cree que el consumo es igual, 10 % cree que es mayor y el resto menor. El 90 % reconoció que las personas importantes para ellas desaprobarían el consumo durante la gestación. Las mujeres con un entorno favorable hacia el consumo se correspondieron con ingesta de alcohol en el embarazo, mientras que se observó lo contrario en los casos en los que el entorno era desfavorable. Estos resultados indican que podría ser beneficioso diseñar estrategias preventivas que se focalicen no solo en la gestante, sino en el entorno cercano.

Abstract Prenatal alcohol exposure can lead to a spectrum of congenital disorders for the fetus with permanent consequences, known as fetal alcohol spectrum disorders (FASD), within which Fetal Alcohol Syndrome (SAF) is its most severe extreme. All FASD are 100 % preventable if no alcohol is consumed during pregnancy, so knowing the factors that determine that a woman decides to drink while pregnant is essential to develop effective prevention plans. Among these factors are the phenomena of social influence such as perceived social norms (PSN), both descriptive and prescriptive. The PSN are transmitted by social interaction and produced based on the perception of the beliefs or behaviors of others, beyond their real actions. It has been identified that PSN predict alcohol consumption in various populations, such as university students, but research is almost non-existent with pregnant women. The aim of this study is to assess whether environmental characteristics (such as PSN) are related to alcohol consumption during pregnancy in pregnant women in the city of Mar del Plata, Argentina. Method: a probabilistic sample of 852 pregnant women was carried out during 2016 in the main primary health care centers of the city of Mar del Plata. Alcohol consumption was assessed before and during pregnancy through the AUDIT and the PSN was assessed with five questions constructed ad hoc by specialists in the area of alcohol consumption. Descriptive analyses were performed to categorized social norms and the prescriptive ones were re-categorized into four groups: 1. It is bad for the health of the baby or the mother; 2. It is wrong for cultural or moral reasons; 3. consumption is accepted; 4. It does not know/does not matter. To describe them based on alcohol consumption, latent class analyses were performed. Models of two to four classes were estimated, reproduced 50 times to avoid local maximums, with the software R. Results: 87 % of pregnant women believed that others in their same condition consume alcohol. 53 % of them believed they consume the same as before pregnancy, 10 % believed they consume more and the rest that they reduced their consumption. The belief about the average amount that other pregnant women would consume is more than three drinks, the equivalent of one bottle of beer per occasion of consumption. 90 % recognized that people important to them would disapprove consumption during pregnancy because doing so would cause harm to the baby, the mother, pregnancy in general or because alcohol is considered harmful to health. 6 % considered that people important to them would approve consumption because few amounts are tolerated or because alcohol is good for breastfeeding. The latent class analysis indicated a better fit for the two-class model. Class 1 was made up of women who claimed that for their people, alcohol consumption during pregnancy was acceptable and they themselves consumed alcohol during pregnancy. Class 2 conglomerated women who thought that others would see their consumption as bad at this stage and there was a low probability that they themselves consumed during pregnancy. Conclusions: These results indicate that it could be beneficial to design preventive strategies that focus not only on the future mother, but on the nearby environment (couple, family, friends), and even throughout the community, where social norms are established and reproduced.

The Association Between Early Drinking and Dependence Varies by Drinking Context.

Evidence regarding the association between early drinking (ED) and later dependence is controversial. It has been alternately hypothesized that ED either plays a causal role in the development of dependence or that it is an early marker of increased psychosocial vulnerabilities. Despite a clear rationale for delaying youth consumption, it is important to discern this relationship. However, most epidemiological evidence comes from individual studies and high-income countries. If there is a causal link between ED and dependence, an association at the aggregate level would be expected. Furthermore, if the link is due to biological mechanisms, the association should be rather invariable regardless of the drinking context, while if the association is due to psychosocial factors, a wider variability is to be expected. We explored whether the association between ED and dependence varied across countries clustered by their shared contextual drinking characteristics. We used data from 169 countries from the Global Information System on Alcohol and Health of the World Health Organization: ED, alcohol dependence, heavy episodic drinking (HED), actual drinkers, and alcohol policy. To cluster countries by their shared drinking characteristics (prevalences of HED and actual drinkers, and alcohol policy), we used, sequentially, two multivariate data reduction techniques: a multiple correspondence analysis (MCA) and a hierarchic classification. To estimate the association between ED and alcohol dependence, beta regressions were performed, and then adjusted by country income-level and repeated by gender. The results indicated four country clusters: primarily abstainers (class 1), low drinking countries (class 2), high drinking countries (class 3), and very high drinking countries (class 4). Positive relationships between ED and alcohol dependence were found for all the countries in the world and for those in classes 1 and 2. No significant relationships were found for class 3 or class 4. These results were similar for males, but not for females, where no significant relationships were found after adjusting for income level. The association between ED and dependence varies according to the drinking context. Our findings either suggest that the ED-dependence association may be due to individual or environmental vulnerabilities that promote consumption outside cultural norms or that, if there is a causal link between ED and dependence, it is strongly moderated by psychosocial characteristics.

A Multilevel Model of Alcohol Outlet Density, Individual Characteristics and Alcohol-Related Injury in Argentinean Young Adults.

OBJECTIVES: Previous research from high-income countries has consistently shown an association between alcohol-related harms and neighborhood characteristics such as alcohol outlet density, but this research has not been extended to middle- and low-income countries. We assessed the role of neighborhood characteristics such as alcohol outlet density, overcrowding and crime rates, and individual characteristics including gender, age, alcohol and marijuana use, and geographic mobility associated with alcohol-related injuries in university students in Argentina. METHODS: Data were collected from a randomized sample of students attending a national public university (n = 1346). Descriptive, bivariable, and multilevel logistic regression analyses were performed. RESULTS: In the final model, on-premises alcohol outlet density-but not off-premises outlet density, overcrowding or crime-was associated with past-year and lifetime alcohol-related injury (median odds ratio=1.16). At the individual level, quantity (odds ratio (OR)=1.05, 95% CI=(1.01, 1.10)) and frequency (OR=1.66, 95% CI=(1.41,1.97)) of alcohol consumption and age (OR=0.81, 95% CI=(0.74, 0.88)) were associated with past-year and lifetime alcohol-related injury. CONCLUSIONS: This study contributes to an area with a paucity of information from non-high-income countries, finding differences with previous literature.

OBJECTIFS: Des recherches antérieures menées dans des pays à revenu éléve ont constamment montré une association entre les méfaits liés à l'alcool et les caractéristiques du quartier telles que la densité des points de vente d'alcool, mais cette recherche n'a pas été étendue aux pays à revenu moyen et faible. Nous avons évalué le rôle des caractéristiques du quartier telles que la densité des points de vente d'alcool, la surpopulation et les taux de criminalité, et les caractéristiques individuelles, y compris le sexe, l'âge, la consommation d'alcool et de marijuana, et la mobilité géographique associée aux blessures liées à l'alcool chez les étudiants universitaires en Argentine. MÉTHODES: Les données ont été recueillies auprès d'un échantillon aléatoire d'étudiants fréquentant une université publique nationale (n=1 346). Des analyses de régression logistique descriptives, bivariables et multiniveaux ont été effectuées. RÉSULTATS: Dans le modèle final, la densité des points de vente d'alcool sur place - mais pas la densité des points de vente hors établissement, le surpeuplement ou la criminalité - était associée aux blessures liées a l'alcool au cours de la dernière année et au cours de la vie (rapport de cotes médian=1.16). Au niveau individuel, quantité (OR=1.05, IC à 95%=(1.01, 1.10)) et fréquence (OR=1.66, IC à 95%=(1.41,1.97)) de consommation d'alcool et âge (OR=0.81, 95% IC=(0.74, 0.88)) étaient associés à des blessures liées à l'alcool au cours de la dernière année et de leur vie entière. CONCLUSIONS: Cette étude contribue à un domaine où les informations sur les pays qui ne sont pas à revenu élevé sont rares, trouvant des différences avec la littérature précédente.

Alcohol consumption's attributable disease burden and cost-effectiveness of targeted public health interventions: a systematic review of mathematical models.

BACKGROUND: Around 6% of total deaths are related to alcohol consumption worldwide. Mathematical models are important tools to estimate disease burden and to assess the cost-effectiveness of interventions to address this burden. METHODS: We carried out a systematic review on models, searching main health literature databases up to July 2017. Pairs of reviewers independently selected, extracted data and assessed the quality of the included studies. Discrepancies were resolved by consensus. We selected those models exploring: a) disease burden (main metrics being attributable deaths, disability-adjusted life years, quality-adjusted life years) or b) economic evaluations of health interventions or policies, based on models including the aforementioned outcomes. We grouped models into broad families according to their common central methodological approach. RESULTS: Out of 4295 reports identified, 63 met our inclusion criteria and were categorized in three main model families that were described in detail: 1) State transition -i.e Markov- models, 2) Life Table-based models and 3) Attributable fraction-based models. Most studies pertained to the latter one (n = 29, 48.3%). A few miscellaneous models could not be framed into these families. CONCLUSIONS: Our findings can be useful for future researchers and decision makers planning to undertake alcohol-related disease burden or cost-effectiveness studies. We found several different families of models. Countries interested in adopting relevant public health measures may choose or adapt the one deemed most convenient, based on the availability of existing data at the local level, burden of work, and public health and economic outcomes of interest.

Caracterización de aspectos económicos, jurídico legales y epidemiológicos útiles para impulsar una agenda publica orientada a disminuir el consumo de alcohol en Argentina / Characterization of Economic, Legal and Epidemiological Aspects Useful to Promote a Public Agenda Aimed at Reducing Alcohol Consumption in Argentina

NTRODUCCIÓN: El consumo de alcohol es uno de los principales factores de riesgo. Para relevar las condiciones previas al establecimiento de políticas públicas orientadas a disminuir el consumo de alcohol en Argentina, se fijaron tres objetivos: a) caracterizar la demanda y oferta de bebidas alcohólicas; b) evaluar la situación normativa respecto de políticas de control de publicidad, promoción y patrocinio, y las pautas de publicidad televisiva; c) definir qué modelos de carga de enfermedad atribuible y costo-efectividad de las intervenciones podrían ser aplicables. MÉTODOS: Se analizaron datos de la Encuesta Nacional de Gasto de los Hogares 2004/5 y 2012/3 y de la base Euromonitor Internacional. Se examinaron el marco normativo y las acciones televisivas de publicidad, promoción y patrocinio. Se revisó la literatura sobre modelos de carga de enfermedad y costo-efectividad de intervenciones. RESULTADOS: El consumo de bebidas alcohólicas no se modificó entre 2004/5 y 2012/3, y la industria está muy concentrada. El marco de regulación de la publicidad es laxo; más de la mitad de los avisos de TV se emiten en horario diurno, por lo que se expone a menores y se incumplen los acuerdos internacionales subscritos. Hay tres enfoques principales de modelamiento epidemiológico y económico que podrían ser aplicables. CONCLUSIONES: Se caracterizaron aspectos económicos, jurídico-legales y epidemiológicos útiles para impulsar una agenda pública orientada a disminuir el consumo de alcohol

Is the alcohol industry doing well by 'doing good'? Findings from a content analysis of the alcohol industry's actions to reduce harmful drinking.

OBJECTIVES: The aims of this study were to: (1) describe alcohol industry corporate social responsibility (CSR) actions conducted across six global geographic regions; (2) identify the benefits accruing to the industry ('doing well'); and (3) estimate the public health impact of the actions ('doing good'). SETTING: Actions from six global geographic regions. PARTICIPANTS: A web-based compendium of 3551 industry actions, representing the efforts of the alcohol industry to reduce harmful alcohol use, was issued in 2012. The compendium consisted of short descriptions of each action, plus other information about the sponsorship, content and evaluation of the activities. Public health professionals (n=19) rated a sample (n=1046) of the actions using a reliable content rating procedure. OUTCOME MEASURES: WHO Global strategy target area, estimated population reach, risk of harm, advertising potential, policy impact potential and other aspects of the activity. RESULTS: The industry actions were conducted disproportionately in regions with high-income countries (Europe and North America), with lower proportions in Latin America, Africa and Asia. Only 27% conformed to recommended WHO target areas for global action to reduce the harmful use of alcohol. The overwhelming majority (96.8%) of industry actions lacked scientific support (p<0.01) and 11.0% had the potential for doing harm. The benefits accruing to the industry ('doing well') included brand marketing and the use of CSR to manage risk and achieve strategic goals. CONCLUSION: Alcohol industry CSR activities are unlikely to reduce harmful alcohol use but they do provide commercial strategic advantage while at the same time appearing to have a public health purpose.

The Effectiveness of a Brief Intervention for Reducing Adolescent Alcohol Consumption / Efectividad de una intervención breve para reducir el consumo de alcohol en adolescentes / Efetividade de uma Intervenção breve para reduzir o consumo de álcool em adolescentes

Abstract Introduction: Although alcohol consumption affects more than half of all adolescents, there are no known studies to assess the effectiveness of interventions to prevent or reduce consumption at a local level. The aim of this randomized clinical trial was to determine the effectiveness and clinical significance of a brief intervention program to reduce the consumption of alcohol and related problems in an educational setting in Argentina. Materials and methods: Systematically selected high school students (N = 167) were randomly assigned to one of three conditions: two control groups (screening, screening and evaluation) and one experimental group (screening, assessment and intervention). With the approval of an Ethics Committee, we implemented a protocol based on international guidelines. The effectiveness measures used were reduction in usual quantity, in high-risk alcohol drinking or in alcohol-related problems. We performed descriptive analyses, linear and logistic regressions, estimates of relative and absolute risk reduction, and the number of patients needed to reduce an event. In the follow-up (N = 150), the quantity of consumption and high-risk consumption were higher in the control groups. Results: The intervention effectively reduced alcohol consumption and related problems in about one out of seven adolescents, with a minimal investment in training and implementation. However, we did not find significant differences in alcohol-related problems among the groups, which decreased under all conditions. Conclusion: Long-term studies could determine whether this change primarily affects the intervention group.

Resumen Introducción: A pesar de que el consumo de alcohol afecta a más de la mitad de los adolescentes, se desconoce la efectividad de intervenciones para evitarlo o reducirlo a nivel local. Este ensayo clínico aleatorizado se propuso determinar la efectividad y significancia clínica de un programa de intervención breve para reducir el consumo de bebidas alcohólicas y problemas relacionados en un contexto educativo de Argentina. Materiales y métodos: Los participantes, estudiantes de educación media seleccionados sistemáticamente (N = 167) fueron asignados aleatoriamente a una de tres condiciones: dos grupos control (tamizaje, tamizaje y evaluación) y uno experimental (tamizaje, evaluación e intervención). Con el aval de un Comité de Ética, se implementó un protocolo basado en lineamientos internacionales. Las medidas de efectividad utilizadas fueron disminución de la cantidad habitual, del consumo de alto riesgo, y de los problemas relacionados con el alcohol. Se realizaron análisis descriptivos, regresiones lineales y logísticas, y estimaciones de reducción relativa y absoluta del riesgo y del número de pacientes a tratar para reducir un evento. En la etapa de seguimiento (N = 150), la cantidad y el consumo de alcohol de alto riesgo fueron mayores en los grupos control. Resultados: la intervención redujo efectivamente el consumo de alcohol y sus problemas en aproximadamente uno de cada siete adolescentes, con una mínima inversión en entrenamiento y aplicación. Sin embargo, no se encontraron diferencias significativas en los problemas relacionados, que disminuyeron en todas las condiciones. Conclusión: Estudios a largo plazo podrían dilucidar si el cambio se sostiene mayormente en el grupo de intervención.

Resumo Introdução: A pesar de que o consumo de álcool afeta a mais da metade dos adolescentes, desconhece-se a efetividade de intervenções para evitá-lo ou reduzi-lo no nível local. Este ensaio clínico aleatorizado se propôs determinar a efetividade e significância clínica de um programa de intervenção breve para reduzir o consumo de bebidas alcoólicas e problemas relacionados em um contexto educativo da Argentina. Materiais e métodos: Os participantes, estudantes de educação média selecionados sistematicamente (N = 167) foram assignados aleatoriamente a três condições: dois grupos controle (peneiração, peneiração e avaliação) e um experimental (peneiração, avaliação e intervenção). Com o aval de um Comitê de Ética, se implementou um protocolo baseado em diretrizes internacionais. As medidas de efetividade utilizadas foram diminuição da quantidade habitual, do consumo de alto risco, e dos problemas relacionados com o álcool. Realizaram-se análises descritivas, regressões lineais e logísticas e estimações de redução relativa e absoluta do risco e do número de pacientes a tratar para reduzir um evento. Na etapa de seguimento (N = 150), a quantidade e o consumo de álcool de alto risco foram maiores nos grupos controle. Resultados: A intervenção reduziu efetivamente o consumo de álcool e seus problemas em aproximadamente um de cada sete adolescentes, com um mínimo investimento em treinamento e aplicação. No entanto, não se encontraram diferenças significativas nos problemas relacionados, que diminuíram em todas as condições. Conclusão: Estudos a longo prazo poderiam dilucidar se a mudança se sustenta maiormente no grupo de intervenção.

Características de los Instrumentos de Tamizaje del Trastorno por Uso de Alcohol en Jóvenes Universitarios de Argentina / Characteristics of alcohol use disorder screening tests in young university students in Argentina

Los trastornos por uso de alcohol son preocupantemente altos en la población universitaria. Contar con instrumentos de tamizaje es fundamental para la medición epidemiológica y la práctica clínica. El objetivo de este trabajo es comparar el desempeño de los instrumentos de tamizaje más usados a nivel internacional (AUDIT, AUDIT-C, TWEAK, RAPS-QF y CAGE) en estudiantes universitarios de Argentina. Los instrumentos de tamizaje, junto a la Entrevista Diagnóstica Compuesta Internacional, que permite obtener diagnósticos compatibles con el DSM 5, fueron administrados a una muestra probabilística (N = 2,430) de estudiantes de una universidad pública nacional. Entre otros, se evaluaron los puntos de corte óptimos, la sensibilidad, la especificidad, la consistencia interna y la estabilidad temporal, así como la presencia y la capacidad de discriminación de los ítems. La apreciación global de los resultados sugiere que tanto el AUDIT como el RAPS-QF serían los instrumentos preferibles para detectar la presencia de trastorno por uso de alcohol en esta población

The prevalence of alcohol use disorders in university students is alarmingly high. Screening instruments are fundamental for both, epidemiological research and clinical practice. The aim of this article is to compare the performance of the most widely used screening instruments (AUDIT, AUDIT-C, TWEAK, RAPS-QF, and CAGE) in Argentinean university students. Screening tests, along with the Alcohol Section of the Composite International Diagnostic Interview that yields DSM 5 compatible diagnoses were administered to a probabilistic sample (N = 2,430) of university students from a national public university. The following characteristics were evaluated among others: optimal cut-off points, sensitivity, specificity, internal consistency, temporal stability, and item presence and discrimination capacity. The global appraisal of results suggests that the AUDIT and RAPS-QF would be preferable for evaluating AUD in this population

Epidemiology of alcohol consumption and related problems in Latin American countries: Contributions of psychology.

Alcohol consumption is the leading risk factor for morbi-mortality in many Latin American Countries. However, epidemiologic studies are relatively scarce. Among factors such as limited research capacity, disciplinary traditions and an emphasis on psychopathology within the field of psychology, have been postulated to account for this. The aim of this article is to review epidemiologic research on alcohol in Spanish Speaking Latin American Countries, and to measure the contribution of psychology to the field. A systematic search was performed in English and Spanish using regional and international data bases. We identified 269 articles. Most focused on consumption patterns in youth, with samples from a single school and using a variety of measures. With the exception of multinational efforts like Emergency Room Collaborative Alcohol Analysis Project or those supported by World Health Organization/Pan American Health Organization, studies reviewed reflected little cross country collaboration. Mexico accounted for most of the productivity, while many countries had very few or no articles. Most research was performed by health science researchers with a small contribution from psychology, but which increased significantly over time. The results of this review provide a broad identification of patterns regarding epidemiologic research on alcohol, and demonstrate the need for national scientific policies to promote research on public health topics.

Razones para reducir el consumo de alcohol en universitarios / Reasons to reduce alcohol consumption in university students

Las razones para reducir el consumo de alcohol pueden ser definidas como motivos que llevan a una persona a disminuir el consumo de alcohol o mantener la sobriedad. Este tema suele ser poco estudiado, particularmente en países latinoamericanos y en poblaciones en riesgo. El objetivo de esta investigación de diseño secuencial exploratorio fue explorar las razones para cambiar el consumo de alcohol en universitarios que lo hayan modificado (N = 100), de la ciudad de Mar del Plata, Argentina, con una pregunta abierta. A su vez, la descripción se realizó sobre la base de la experiencia previa de consumo excesivo episódico del alcohol, trastornos por uso de alcohol, y el sexo de los participantes. Los resultados indican que el motivo más frecuente es el disgusto o indiferencia por la sustancia en casi todos los grupos considerados. Sin embargo, cuando el trastorno por uso de alcohol fue grave o moderado, se observaron diferencias. Se discuten los aportes teóricos de la investigación, entre ellos, comprender qué lleva a cada grupo a cambiar su consumo alcohol, y las implicancias para el desarrollo de intervenciones específicas basadas en esta información.

The reasons to reduce alcohol consumption may be defined as the causes leading a person to decrease alcohol consumption or to stay sober. This topic is not often widely studied, particularly in Latin American countries and at-risk populations. The aim of this sequential exploratory research was to explore, through an open question, the reasons why university students (N = 100) of the city of Mar del Plata, Argentina, changed their alcohol consumption. Additionally, the description was based on previous heavy episodic alcohol consumption, disorders caused by alcohol use, and participants' gender. The results indicate that almost all studied groups reduced alcohol consumption due to their distaste or indifference for the substance. However, when disorders caused by alcohol use were severe or moderate, differences were observed. The theoretical contributions of this research are discussed, including the understanding of what leads each group to change its alcohol consumption, and the implications for the development of specific interventions based on this information.

Alcohol and Road Traffic Injuries in Latin America and the Caribbean: A Case-Crossover Study.

BACKGROUND: This study reports dose-response estimates for the odds ratio (OR) and population attributable risk of acute alcohol use and road traffic injury (RTI). METHODS: Data were analyzed on 1,119 RTI patients arriving at 16 emergency departments (EDs) in Argentina, Brazil, Costa Rica, Dominican Republic, Guatemala, Guyana, Mexico, Nicaragua, Panama, and Trinidad and Tobago. Case-crossover analysis, pair-matching the number of standard drinks consumed within the 6 hours prior to the RTI with 2 control periods (prior d/wk), was performed using fractional polynomial analysis for dose-response. RESULTS: About 1 in 6 RTI patients in EDs were positive for self-reported alcohol 6 hours prior to the injury (country range 8.6 to 24.1%). The likelihood of an RTI with any drinking prior (compared to not drinking) was 5 times higher (country range OR 2.50 to 15.00) and the more a person drinks the higher the risk. Every drink (12.8 g alcohol) increased the risk of an RTI by 13%, even 1 to 2 drinks were associated with a sizable increase in risk of an RTI and a dose-response was found. Differences in ORs for drivers (OR = 3.51; 95% CI = 2.25 to 5.45), passengers (OR = 8.12; 95% CI = 4.22 to 15.61), and pedestrians (OR = 6.30; 95% CI = 3.14 to 12.64) and attributable fractions were noted. Acute use of alcohol was attributable to 14% of all RTIs, varying from 7% for females to 19% for being injured as a passenger. CONCLUSIONS: The finding that the presence of alcohol increases risk among drivers and nondrivers alike may further help to urge interventions targeting passengers and pedestrians. Routine screening and brief interventions in all health services could also have a beneficial impact in decreasing rates of RTIs. Higher priority should be given to alcohol as a risk factor for RTIs, particularly in Latin America and the Caribbean.