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.

Actitudes y creencias de los trabajadores de salud mental acerca del tratamiento de los trastornos por consumo de sustancias. Un estudio en el sistema público de salud en la ciudad de Mar del Plata (Argentina) / Mental health workers' attitudes and beliefs about the treatment of substance use disorders. A study in the public health system in the city of Mar del Plata (Argentina)

Los trastornos por consumo de sustancias constituyen un problema de salud pública de alcance mundial. En el intento por comprender factores que afectan al desarrollo y resultado de los tratamientos por dichos trastornos, los estudios se han centrado en aspectos internos al tratamiento. Sin embargo, se sabe muy poco sobre la importancia de factores psicosociales externos al tratamiento, como las actitudes y creencias de los trabajadores. En este trabajo se estudiaron actitudes y creencias de los trabajadores de salud mental hacia el tratamiento de los trastornos por consumo de sustancias y hacia el paciente. Se analizaron creencias y actitudes de acuerdo al rol, años de experiencia, e importancia otorgada a los procedimientos terapéuticos. Se conformó una muestra casual no probabilística de n=93 trabajadores de salud mental del ámbito público del Partido de General Pueyrredón que trabajaban en el tratamiento de los trastornos por consumo de sustancias. Los resultados mostraron correlaciones significativas y bajas entre las actitudes hacia el tratamiento, las actitudes hacia el paciente y las creencias que entienden a los trastornos como una enfermedad. Asimismo, las actitudes hacia el paciente y las creencias que conciben a los trastornos como enfermedad correlacionaron con la importancia otorgada a los procedimientos terapéuticos. Finalmente, se observaron diferencias en las correlaciones entre las actitudes, las creencias y la importancia otorgada a los procedimientos en función del rol ejercido. Este trabajo permite advertir la importancia de los factores psicosociales extra-terapéuticos en el tratamiento de los trastornos por consumo de sustancias, y señala la necesidad de desarrollar programas que propicien la auto-evaluación y el reconocimiento de las creencias y actitudes de los trabajadores

The problem of substance use is a worldwide public health problem. To understand factors that affect the development and result of addiction interventions, studies have focused almost exclusively on internal aspects of treatment. Very little is known however about the importance of psychosocial factors external to treatment, such as workers’ attitudes and beliefs. This article studied mental health workers’ attitudes and beliefs as regards treatment of substance use disorders and in respect of the patient. Attitudes and beliefs were analyzed based on the role, years of experience, and importance given to the therapeutic procedures. A non-probabilistic sample was created of n=93 mental health workers working in the public sector of addictions in General Pueyrredón District. The results showed significant and low correlations between attitudes toward treatment, attitudes to patients and beliefs that understand substance use disorders as a disease. Attitudes toward patient and beliefs about substance use disorders as a disease also correlated with the importance given to the therapeutic procedures. Finally, correlations between attitudes, beliefs and importance given to the procedures were different depending on job roles. This study shows the importance of extra-therapeutic psychosocial factors in the treatment of substance use disorders, and point outs the need to develop programs encouraging self-evaluation and recognition of workers’ attitudes and beliefs

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.

Validez de los cuestionarios de expectativas hacia el consumo de alcohol / Validity of alcohol expectancy questionnaires

Introducción: las expectativas hacia el consumo de alcohol se definen como creencias de los efectos del alcohol sobre el comportamiento y podrían predecir su consumo. El objetivo de este trabajo es resumir la información disponible sobre los cuestionarios que las miden y su validez. Métodos: se realizaron búsquedas en las bases de datos Pubmed, Scopus, PsycINFO, Lilacs y Scielo, seleccionando estudios sobre la validez de los cuestionarios. La calidad del material se evaluó con la guía CASP y la síntesis de datos fue cualitativa. Resultados: de las 133 referencias resultantes, 56 se eliminaron por repetirse, 52 por no ser de la temática/objetivo, y se agregaron 7 de otras fuentes. Se hallaron 16 instrumentos con buenos índices de fiabilidad y validez, algunos de ellos utilizados eficazmente para predecir el consumo de alcohol. Conclusión: los cuestionarios de expectativas hacia el consumo de alcohol podrían constituir una herramienta útil para la investigación, evaluación clínica y tamizaje.

Predictores de la intención de consumo intensivo episódico de alcohol en adolescentes

El consumo intensivo episódico (CIEA) constituye un problema de salud pública que afecta a los más jóvenes. El estudio de los determinantes cognitivo motivacionales de este patrón de consumo es un área reciente y en creciente desarrollo. Una de las teorías que se ha mostrado adecuada para la explicación de esta conducta es la Teoría del Comportamiento Planeado (TCP). Este trabajo tiene como objetivo estudiar la relación entre la intención de CIEA, la actitud, la norma subjetiva y la percepción de control conductual en estudiantes secundarios diferenciándolos por género. Método: La muestra fue intencional, de estudiantes secundarios (n = 185) de la ciudad de Mar del Plata (Argentina) de 12-18 años. Se utilizó un cuestionario que indagaba sobre: patrones de consumo, variables de la TCP, edad y sexo. Se realizaron análisis de regresión jerárquica para varones y mujeres por separado, considerando la intención como variable dependiente. Resultados: La principal variable que predice la intención de CIEA, tanto para varones como mujeres es la actitud. La norma subjetiva resultó predictora únicamente en mujeres. Conclusiones: las creencias y evaluaciones respecto al CIEA juegan un importante papel en la disposición para realizar el comportamiento. En el caso de las mujeres también incide la norma subjetiva. Si bien este estudio posee algunas limitaciones, sus resultados permiten aproximarse al estudio de los factores cognitivos motivacionales relacionados con el CIEA en adolescentes, de acuerdo al género.(AU)

Binge drinking (BD) is a public health problem that affects younger people. The study of cognitive motivational determinants of this consumption pattern is a growing and recently developed area. One theory that has proved to be adequate for the explanation of this behavior is the Theory of Planned Behavior (TPB). This paper aims to study the relationship between BD intention, attitude, subjective norm and perceived behavioral control in high school students, by gender. Method: The sampling was intentional, comprising high school students (n = 185) of the city of Mar del Plata (Argentina) from 12 -18 years old. A questionnaire was developed inquiring about: habitual consumption pattern, TPB variables, age and gender. Hierarchical regression analyses were conducted for men and women separately, considering intention as the dependent variable. Results: The main variable that predicted intention of BD, for both, males and females, was the attitude. The subjective norm was a predictor only in females. Conclusions: Beliefs and evaluations regarding the BD play a significant role in the disposition for the behavior. For females, subjective norms also affected intention of BD. While this study had some limitations, results highlight the importance of the study of cognitive motivational factors related to BD in adolescents by gender.(AU)

Predictores de la intención de consumo intensivo episódico de alcohol en adolescentes / Binge drinking intention predictors in adolescents

El consumo intensivo episódico (CIEA) constituye un problema de salud pública que afecta a los más jóvenes. El estudio de los determinantes cognitivo motivacionales de este patrón de consumo es un área reciente y en creciente desarrollo. Una de las teorías que se ha mostrado adecuada para la explicación de esta conducta es la Teoría del Comportamiento Planeado (TCP). Este trabajo tiene como objetivo estudiar la relación entre la intención de CIEA, la actitud, la norma subjetiva y la percepción de control conductual en estudiantes secundarios diferenciándolos por género. Método: La muestra fue intencional, de estudiantes secundarios (n = 185) de la ciudad de Mar del Plata (Argentina) de 12-18 años. Se utilizó un cuestionario que indagaba sobre: patrones de consumo, variables de la TCP, edad y sexo. Se realizaron análisis de regresión jerárquica para varones y mujeres por separado, considerando la intención como variable dependiente. Resultados: La principal variable que predice la intención de CIEA, tanto para varones como mujeres es la actitud. La norma subjetiva resultó predictora únicamente en mujeres. Conclusiones: las creencias y evaluaciones respecto al CIEA juegan un importante papel en la disposición para realizar el comportamiento. En el caso de las mujeres también incide la norma subjetiva. Si bien este estudio posee algunas limitaciones, sus resultados permiten aproximarse al estudio de los factores cognitivos motivacionales relacionados con el CIEA en adolescentes, de acuerdo al género.

Binge drinking (BD) is a public health problem that affects younger people. The study of cognitive motivational determinants of this consumption pattern is a growing and recently developed area. One theory that has proved to be adequate for the explanation of this behavior is the Theory of Planned Behavior (TPB). This paper aims to study the relationship between BD intention, attitude, subjective norm and perceived behavioral control in high school students, by gender. Method: The sampling was intentional, comprising high school students (n = 185) of the city of Mar del Plata (Argentina) from 12 -18 years old. A questionnaire was developed inquiring about: habitual consumption pattern, TPB variables, age and gender. Hierarchical regression analyses were conducted for men and women separately, considering intention as the dependent variable. Results: The main variable that predicted intention of BD, for both, males and females, was the attitude. The subjective norm was a predictor only in females. Conclusions: Beliefs and evaluations regarding the BD play a significant role in the disposition for the behavior. For females, subjective norms also affected intention of BD. While this study had some limitations, results highlight the importance of the study of cognitive motivational factors related to BD in adolescents by gender.

DRINKING PATTERNS AND DSM-IV ALCOHOL USE DISORDERS' CRITERIA IN ARGENTINEAN EMERGENCY DEPARTMENT PATIENTS.

BACKGROUND: Previous studies have shown cultural variations in normative drinking and furthermore, in the quantity and frequency of drinking related to alcohol use disorders. AIM: The main goal of this study is to characterize alcohol drinking patterns in Argentinean Emergency Department patients, and secondly, to explore the association between those drinking patterns and DSM-IV alcohol use disorders. METHOD: Data were collected from a probability sample of patients admitted to the Emergency Department of a large public hospital in Mar del Plata, Argentina. Data analyzed here pertain to those who reported consuming at least one drink during the last twelve months (n=529). A factor analysis of multiple correspondences and a hierarchic classification were performed. For the factor analysis, usual quantity and frequency of drinking (for the last 12 months) were considered active variables; number of DSM-IV dependence criteria met, positive or negative diagnostic status for abuse, positive or negative diagnostic status for dependence (both for the last 12 months), and socio-demographic characteristics (age, gender and economic level) were considered illustrative variables. RESULTS: The first five factorial axes were retained, accounting for 88% of the total variance. Hierarchic classification resulted in six distinctive classes of drinking patterns. Two patterns were associated with a positive diagnosis of abuse and dependence, respectively. One, drinking between 4 and 6 drinks per occasion mostly on a weekly basis, was associated with a diagnosis of abuse; this pattern was also associated with meeting one or two dependence criteria (dependence orphans). The other, drinking 7 or more drinks per occasion, was associated with a diagnosis of dependence, and also with a diagnostic orphan condition. This class, composed primarily of males, was not characterized by any particular frequency of drinking. The other four drinking patterns were not associated with a positive diagnosis of an alcohol use disorder. Two of them were characterized by drinking low quantities with a low frequency (either monthly or yearly). Participants in both of these classes tended to be female. The other two patterns were characterized by drinking less than 3 drinks per occasion, either daily or weekly: the former associated with being older than 35 years, and the later with no distinctive socio-demographic characteristics. CONCLUSIONS: Results demonstrated six distinct drinking patterns, two of them related to a positive diagnosis of an alcohol use disorder. Our findings support previous research indicating that dependence orphans share some characteristics with abuse and dependence cases. Given the lack of similar studies in the region, these findings, although descriptive, enrich the knowledge of alcohol use disorders in the regional context. Furthermore, they may contribute to the development of local drinking guidelines and prevention strategies.