Profile of Brazilian Undergraduates Who Use Electronic Cigarettes: a Cross-Sectional Study on Forbidden Use.

The use of electronic cigarettes (e-cigarettes) persists in Brazil, despite restrictions on sales, imports, and advertising. This study aimed to identify the prevalence of e-cigarette use and user profiles among university students. This cross-sectional study used a convenience sample of 3083 university students (female = 2253, male = 830; M=26.1; SD =8.43) who completed an online survey. We employed logistic regression models and network analysis to determine the profile of e-cigarette users. The prevalence of e-cigarette use in the past year was 12.2% (n =377). Men, single individuals, Caucasians, secular individuals, and non-heterosexual individuals were more likely to engage in e-cigarette use. Intense use of alcohol, tobacco products, and illicit drugs increased the likelihood of e-cigarette use. Brazilian college students continue to use electronic cigarettes despite the prohibition. The pattern of alcohol abuse and tobacco product use among e-cigarette users is concerning. These risky behaviors render young and highly educated individuals targets for public policies to control and regulate electronic cigarettes in the country.

A Qualitative Study of Chronic Hookah Use in São Paulo, Brazil.

Background: Hookah is a device commonly employed for the use of tobacco, which is becoming popular in Western countries, especially among young people. In fact, its use has become a public health problem worldwide. Few Brazilian studies have researched its use, in this way, hookah culture has not been adequately examined in the country. Objective: This study aimed to investigate in depth the culture of hookah use in the city of São Paulo, Brazil. Methods: To do so, a cross-sectional, observational qualitative study was conducted. An intentional sample made by 29 subjects was selected through key informants and the snowball sampling technique. Participants were asked to engage in a semi-structured individual interview, which was recorded with the participant's prior consent. The interviews were analyzed according to Bardin's content analysis method. Results: Most of the participants were young, single men. The use of hookah is predominantly done in groups and during festive situations. Public places such as lounges, snack bars, and on the street were most often reported locations for hookah use. Interviewees have reported using hookah for long periods of time, for instance, from 1 to 10 hours continuously. Physical and psychological effects were reported, especially unpleasant ones. Engagement in polydrug use was reported for coping with the hookah effects. Participating in games was the main reason to use hookah. Conclusions: It is worrisome that a health risk behavior such as hookah use is conducted as an entertainment activity among young people, and thus it deserves a different approach and evaluation from the appropriate authorities.

Use of Alcohol Mixed with Energy Drinks Increases the Prevalence of Driving Violations among Brazilian Truck Drivers.

Background: The use of alcohol mixed with energy drinks (AmED) has been reported to be associated with a variety of unsafe driving practices. Truck drivers are vulnerable to driving violations, particularly because of their engagement in drug use. The use of AmED among these professionals remains unknown. Aim: To estimate the prevalence of AmED use and its association with driving violations among truck drivers. Methods: 684 drivers were recruited in Sao Paulo, Brazil. The use of drugs was reported. Drivers were split into three groups: (a) alcohol abstainers (AA); (b) alcohol-only users (AO); and (c) users of AmED. Intergroup comparisons were performed by polynomial logistic regression (the reference category was AO). We also performed Poisson regression analysis to obtain the prevalence ratio; the significance level was stipulated at 5%. Results: The prevalence of drivers reporting the use of AmED was 16.8%. Users of AmED (a) were younger, (b) were less experienced drivers, (c) had a heavier pattern of alcohol use, (d) used illicit drugs more frequently, and (e) had poorer sleep quality than AO subjects. A higher prevalence of drivers who had arguments or fights while driving (PR = 1.71) and of drivers who drove unbelted (PR = 1.66) ingested AmED than of AO subjects. Conclusions/importance: The use of AmED increased the prevalence of driving violations beyond the risks commonly attributed to alcohol use. We suggest additional investments in preventative measures based on the beverage category and a revision of the work organization of truck drivers to reduce their health and social risks.

In-transition culture of experimentation with cannabis in Latin American college students: A new role within a potential drug use sequencing pattern.

INTRODUCTION AND AIMS: Given a scenario of intense discussion about the legal situation of cannabis users worldwide, this paper aims to investigate the role of cannabis within a drug use sequencing pattern. DESIGN AND METHODS: Data came from a representative sample of college students from 27 Brazilian capitals (n = 12 711). We analysed the patterns of transition from/to the first use of cannabis to/from the first use of alcohol, tobacco and seven other illegal drugs. Survival analysis methods were used to analyse age of onset data on all potential drug pairs. Drugs that were not specified as the target drug pair tested in each survival model were included as time-varying covariates in all models. RESULTS: We found significant transitions from alcohol [adjusted hazard ratio (aHR) = 1.41, 95% confidence interval (CI) 1.15-1.73, P < 0.001] and inhalants (aHR = 1.56, 95% CI 1.26-1.93, P < 0.001) to cannabis. Moreover, we found significant transitions from cannabis to alcohol (aHR = 2.40, 95% CI 1.47-3.91, P < 0.001), cocaine (aHR = 7.47, 95% CI = 4.26-13.09, P < 0.001), prescription opioids (aHR = 2.16, 95% CI 1.29-3.63, P < 0.01) and tranquilisers (aHR = 1.51, 95% CI 1.11-2.06, P < 0.01). DISCUSSION AND CONCLUSIONS: Overall, our findings point to a strategic role of cannabis within drug first use sequence pattern. We had an important and unexpected finding-the bi-directional relationship between alcohol and cannabis. In addition, the first use of cannabis still precedes the first use of cocaine and non-medical use of tranquilisers and prescription opioids. [Castaldelli-Maia JM, Nicastri S, Cerdá M, Kim JH, Oliveira LG, Andrade AG, Martins, SS. In-transition culture of experimentation with cannabis in Latin American college students: A new role within a potential drug use sequencing pattern. Drug Alcohol Rev 2017;00:000-000].

Prevalence of at-risk drinking among Brazilian truck drivers and its interference on the performance of executive cognitive tasks.

BACKGROUND: Binge drinking (BD) has been associated with an increase in the risk of alcohol-related injuries. Alcohol continues to be the main substance consumed by truck drivers, a population of special concern, since they are often involved in traffic accidents. The aim of this study was to estimate the prevalence of BD and its interference in the executive functioning among truck drivers in Sao Paulo, Brazil. METHODS: A non-probabilistic sample of 684 truck drivers was requested to answer a structured research instrument on their demographic data and alcohol use. They performed cognitive tests to assess their executive functioning and inventories about confounding variables. The participants were then divided according to their involvement in BD. RESULTS: 17.5% of the interviewees have reported being engaged in BD. Binge drinkers showed a better performance on one test, despite having done so at the expense of more mistakes and lower accuracy. More interestingly, binge drinkers took three seconds longer than non-binge drinkers to inhibit an inadequate response, which is worrisome in the context of traffic. Overall, the deleterious effect of BD on performance remained after controlling for the effects of confounding variables in regression logistic models. CONCLUSIONS: As the use of alcohol among truck drivers may be as a way to get by with their work conditions, we believe that a negotiation between their work organization and public authorities would reduce such use, preventing negative interferences on truck drivers' cognitive functioning, which by its turn may also prevent traffic accidents.

Occupational conditions and the risk of the use of amphetamines by truck drivers.

OBJECTIVE To test whether the occupational conditions of professional truck drivers are associated with amphetamine use after demographic characteristics and ones regarding mental health and drug use are controlled for.METHODS Cross-sectional study, with a non-probabilistic sample of 684 male truck drivers, which was collected in three highways in Sao Paulo between years 2012 and 2013. Demographic and occupational information was collected, as well as data on drug use and mental health (sleep quality, emotional stress, and psychiatric disorders). A logistic regression model was developed to identify factors associated with amphetamine use. Odds ratio (OR; 95%CI) was defined as the measure for association. The significance level was established as p < 0.05.RESULTS The studied sample was found to have an average age of 36.7 (SD = 7.8) years, as well as low education (8.6 [SD = 2.3] years); 29.0% of drivers reported having used amphetamines within the twelve months prior to their interviews. After demographic and occupational variables had been controlled for, the factors which indicated amphetamine use among truck drivers were the following: being younger than 38 years (OR = 3.69), having spent less than nine years at school (OR = 1.76), being autonomous (OR = 1.65), working night shifts or irregular schedules (OR = 2.05), working over 12 hours daily (OR = 2.14), and drinking alcohol (OR = 1.74).CONCLUSIONS Occupational aspects are closely related to amphetamine use among truck drivers, which reinforces the importance of closely following the application of law (Resting Act ("Lei do Descanso"); Law 12,619/2012) which regulates the workload and hours of those professionals. Our results show the need for increased strictness on the trade and prescription of amphetamines in Brazil.

The role of drug use sequencing pattern in further problematic use of alcohol, tobacco, cannabis, and other drugs.

BACKGROUND: There has been considerable debate regarding what typically occurs after experimentation with drugs throughout the life of young people who used various drugs. AIMS: To evaluate the clinical importance of the most common sequence for the first use of a drug by two models (the "gateway model" and the "alternative model", which is the most popular sequence for Brazilian university students according to a previous study) regarding the problematic use of alcohol, tobacco, cannabis and other illegal drugs, assessed by ASSIST. METHOD: People who had already experimented with three or more drugs across different stages of the two models were selected from a representative sample of university students from 27 Brazilian capitals (n = 12 711). FINDINGS: There were no differences regarding the problematic use of the most consumed drugs in Brazil (alcohol, tobacco and cannabis) between the models. Multiple drug seekers and violators had more problematic use of illegal drugs other than cannabis than individuals in the model sequence. However, in the case of violators, this was only evident in the alternative model. CONCLUSIONS: Multiple drug seekers and violators deserve special attention due to their increased risk of problematic use of other illegal drugs.

Use transition between illegal drugs among Brazilian university students.

PURPOSE: The aim of the present study was to test whether the first use of an illicit drug increases the chance of first use of other illicit drugs. METHOD: The transitions from the first use of a drug to the first use of another drug were analyzed. Comparisons were made between first drug users and non-users. Survival analysis methods were used to compare the cumulative probability of second drug use after adjusting for socio-demographic covariates and the intermediate use of alcohol and/or tobacco. A total of 12,721 Brazilian university students participated in this study. RESULTS: Inhalants and marijuana were used prior to the use of several other drugs, whereas the opposite pattern was not found. Ecstasy was used before other drugs in several instances. Other well-examined drugs, such as amphetamines, cocaine and hallucinogens, were used both before and after other illicit drugs without any marked predominance for either of the two roles. CONCLUSIONS: This study supports the role of the use of marijuana and inhalants almost exclusively before the use of other illicit drugs, whereas the use of ecstasy has an opposite role. These roles could be linked to the prevalence of lifetime use and whether individuals were at an earlier or later age during experimentation.

The effects of alcohol mixed with energy drinks (AmED) on traffic behaviors among Brazilian college students: a national survey.

OBJECTIVE: Drinking alcohol mixed with energy drinks (AmED) may be contributing to hazardous drinking practices and risk-taking behaviors among college students. In this regard, this study aimed to assess the frequency of AmED consumption in a national sample of Brazilian college students and to estimate the risk that energy drinks pose on drinking and traffic behaviors. METHOD: A sample of 12,711 college students from across the country was asked to complete a research questionnaire on the use of drugs and other behaviors. Students who reported drinking in the previous 12 months (N = 8672) were divided into 2 groups: (a) those who reported drinking only alcohol (N = 4192) and (b) those who reported drinking AmED (N = 1119). The college students who reported the use of at least one illicit drug were excluded from data analysis. Descriptive and inferential analyses were subsequently carried out using the R library survey software 2.15.0. The null hypothesis was rejected at the level of P < .05. RESULTS: AmED users are more likely to be hazardous drinkers. Being male, single, and involved with high-risk drinking behaviors are associated to AmED. After adjusting for demographic and drinking variables, the odds of being involved in high-risk traffic behaviors--for example, driving at high speed (odds ratio [OR] = 2.6; P < .001) and driving after binge drinking (OR = 2.8; P < .001)--were higher among AmED users than alcohol only users (AUs). CONCLUSION: The current findings are consistent with the results of previous studies. Drinking AmED may make college students more vulnerable to the occurrence of risky drinking and traffic behaviors. Educational campaigns targeted to young people should be developed warning them about the potential risks of mixing alcohol with energy drinks.

[Amphetamine use by truck drivers on highways of Sao Paulo State: a risk for the occurrence of traffic accidents?]. / Uso de anfetaminas por motoristas de caminhão em rodovias do Estado de São Paulo: um risco à ocorrência de acidentes de trânsito?

The use of amphetamines in Brazil is common among truck drivers, which may be an important factor in the occurrence of traffic accidents. This article seeks to estimate the prevalence of amphetamine use among truck drivers. Drivers (N = 134) were stopped on two different highways in Sao Paulo state and they were asked to answer a questionnaire and provide a urine sample for toxicological analysis. All data were analyzed on Stata 8.0. All participants were males with low levels of schooling, whose mean age was 40.8 years. The presence of amphetamines was detected in 10.8% of all urine samples collected, being commonly justified in order to make truck drivers able to maintain their state of awareness. Amphetamine use was detected among truck drivers on Sao Paulo highways. The problem is that when the stimulant effects wear off, sleepiness due to sleep deprivation reduces concentration and good driver performance, making drivers vulnerable to traffic accidents and the related effects.

The association between low alcohol use and traffic risk behaviors among Brazilian college students.

Although there are a large number of studies focused on binge drinking and traffic risk behaviors (TRB), little is known regarding low levels of alcohol consumption and its association to TRB. The aim of this cross-sectional study is to examine the association of low to moderate alcohol intake pattern and TRB in college students in Brazil. 7037 students from a National representative sample were selected under rigorous inclusion criteria. All study participants voluntarily fulfilled a structured, anonymous, and self-questionnaire regarding alcohol and drug use, social-demographic data, and TRB. Alcohol was assessed according to the average number of alcoholic units consumed on standard occasions over the past 12 months. The associations between alcohol intake and TRB were summarized with odds ratio and their confidence interval obtained from logistic regression. Compared with abstainers students who consumed only one alcohol unit had the risk of being a passenger in a car driven by a drunk driver increased by almost four times, students who reported using five or more units were increased by almost five times the risk of being involved in a car crash. Compared with students who consumed one alcohol unit, the risk of driving under the influence of alcohol increased four times in students using three alcohol units. Age group, use of illicit drugs, employment status, gender, and marital status significantly influenced occurrence of TRB among college students. Our study highlights the potential detrimental effects of low and moderate pattern of alcohol consumption and its relation to riding with an intoxicated driver and other TRB. These data suggest that targeted interventions should be implemented in order to prevent negative consequences due to alcohol use in this population.

[The role of information as a preventive drug measure among youth at risk]. / O papel da informação como medida preventiva ao uso de drogas entre jovens em situação de risco.

Illicit drug consumption among youngsters is a public health concern that requires attention. However, little research has highlighted the importance of "drug information availability" among protection factors. The objective of the study is to identify, from the point of view of youngsters at risk, what factors could prevent them to try illicit drugs, focusing on the importance of "drug information availability". An intentional sample was selected, composed by 62 youngsters divided into two groups: (NU) non illicit users N=32 and (U) users N=30. The sample was recruited through key-informants and snowball and each participant was submitted to an in-depth semi-structured interview. According to NU, "drug information availability" was reported as the main protector factor. Family-based information was the main source of knowledge followed by observation of the drug negative consequences on lives of friends who have already consumed illicit drugs in a regular-basis. Among users, a lack of drug knowledge or availability of partial information was reported. Among youngsters at risk, drug information availability is the main protection factor against experimental and regular drug consumption. Family based information was reported as its main source.

Crack, AIDS, and women in São Paulo, Brazil.

Brazil is currently experiencing a growing number of newly recorded cases of HIV infection among women, with transmission mainly occurring by sex. This increase may be associated with the development of sexually risky behavior among female crack users who, according to informal reports, prostitute themselves for drugs or for money to be used for buying drugs. Since epidemiologic studies have not yet addressed this phenomenon, the aim of this study was to investigate this in depth using a qualitative ethnographic approach. An intentional sample was utilized, composed of 75 female crack users in S?o Paulo, who were selected by specific criteria using the snowball strategy and key informants. Fourteen different chains of users were investigated, allowing us to include the largest possible number and variety of users. Each participant was submitted to a semi-structured in-depth interview that was guided by a questionnaire. Verbal information was corroborated and extended using participative observation. These 14?45-year-old women, who had little schooling and no job connections, opted to sell their bodies as a strategy to obtain drugs and to satisfy their compulsive use of crack. The subjects engaged in up to nine acts of sexual intercourse per day, in unsafe locations and with multiple partners who were approached in a besieging way and selected using subjective criteria. These crack users generally exchanged sex under craving for ridiculously low prices and left the use of protection up to the client. Because the users used inadequate pipes to smoke crack, it was common for them to have lesions on their lips and mouths. Since they often provided oral sex, they exposed themselves to considerable risk for infection with STDs including HIV, because of the contact of their partners? semen with their open wounds. These women make up an important risk group with respect to the transmission of STDs including AIDS.

Neuropsychological assessment of current and past crack cocaine users.

BACKGROUND: Cognitive changes due to crack cocaine consumption remain unclear. METHODS: For clarification, 55 subjects were assigned to three groups: control group, crack cocaine current users, and ex-users. Participants were submitted to Mini-Mental State Examination (MMSE) and tasks evaluating executive functioning and verbal memory. Mood state was also measured. Intergroup comparisons were carried out. RESULTS: Control group performance on the MMSE was better than that of users and ex-users. Verbal memory performance for logical memory of users was impaired. Ex-users scored lower on DSST and Trail Making Test (Part B). CONCLUSION: Chronic crack cocaine use seems to disrupt general cognitive functioning (MMSE), verbal memory, and attentional resources, but findings suggest that some of these effects could be reversed by abstinence.

Religiosity as a protective factor against the use of drugs.

Although many studies have suggested that risk and protective factors are related to the use of drugs, their role has not been given due importance. More attention to protective factors could make them a fundamental tool in prevention programs. Since low socioeconomic level and adolescence are known as risk factors, the aim of this study was to identify which factors would prevent Brazilian adolescents from low-income families from using drugs. A qualitative method and an intentional sample selected by criteria were adopted for this investigation. During 2003, sixty-two youngsters, ages 16 to 24 years old, 30 drug users, and 32 nonusers were administered a semistructured interview. The subjects perceived family and religiosity as important protective factors in their lives. With regard to religiosity, 81% of nonusers believed in and practiced a religion, whereas only 13% of users considered themselves as being religious. The belief in and practice of a religion were also more evident among family members of nonusers (74%) than those of users (33%). These results indicated that religion may be a relevant protective factor for the sample studied, helping the family unit in keeping youth away from drugs. The study's limitations were noted.

[Main reasons for non-use of illicit drugs by young population exposed to risk situations]. / Razões para o não-uso de drogas ilícitas entre jovens em situação de risco.

OBJECTIVE: Although there are many studies on risk factors for drug use, little has been known about the reasons that prevent people away from drug use. The aim of this study was to identify the reasons that would prevent low-income youngsters against psychotropic drug experimentation and use, even when living in a drug dealing environment. METHODS: A qualitative study was carried out in an intentional sample selected according to a set of criteria. Sixty-two youngsters, aged between 16 and 24 years, from low-income families who have never used psychotropic drugs (32 subjects) or who were heavy drug users (30 subjects) were interviewed. Each interview lasted on average 110 minutes. RESULTS: Among non-users, access to information and a protective family structure were identified as major reasons from preventing youngster from drug use. Comprehensive information on the outcomes of drug use and affective bonds between parents and their children, assured by feelings of support and respect, seems to be important in helping them avoid drug use. The importance of these two factors as reasons to keep youngsters away from drugs is emphasized when their lack is mentioned and censured by drug users. CONCLUSIONS: The outlook of those who have never used drugs in their lifetime and their reasons should be considered in the development of drug prevention programs targeting low-income youngsters.

Trihexyphenidyl (Artane): a Brazilian study of its abuse.

In Brazil, the medicinal misuse of trihexyphenidyl (Artane) has been observed among several segments of society. The present study was conducted in the city of São Paulo during 2002 to characterize this abuse. A sample of 21 users and 16 ex-users was interviewed using qualitative methodology; the subjects were single, unemployed, male polydrug users, who used trihexyphenidyl in order to attain states of mental alterations, mainly hallucinations and deliriums. Trihexyphenidyl is consumed in association with alcohol, other licit drugs (benzodiazepines), or illicit drugs, impairing cognitive functions such as memory, attention, and learning, intervening with some activities of users' daily life.