Substance use and adolescent mental health during the COVID-19 pandemic in Brazil: a longitudinal approach

Abstract Objective: To describe the changes in alcohol and drug use by Brazilian adolescents during the COVID-19 pandemic (April-August 2021), and to analyze the relationship between alcohol use changes and psychiatric symptomatology. Methods: A secondary analysis with a longitudinal approach was performed with data from a cluster-randomized controlled trial, conductedin73publicmiddleschoolsinthreeBrazilian cities, to evaluate the effectiveness of a drug use prevention program. The sample included 535 students (61% girls; Mage = 15.2 years). Data were collected pre-intervention (February-March 2019), after 9 months (November-December 2019), and after 26 months (April-August 2021), when the students were in their first year of high school. The authors analyzed drug use prevalence (alcohol, binge drinking, tobacco, inhalants, marijuana, cocaine, and crack) in a lifetime, past year, and past month periods, and the association between alcohol use change subsamples with psychiatric symptoms. Logistic regressions were adjusted by sex, age, socioeconomic status, city, and group (control and intervention). Results: The present findings suggest that the COVID-19 pandemic led to a decrease in past-year substance use and in past-month substance use frequency, despite the gradually increased (but decelerating) prevalence of lifetime use. However, some adolescents initiated, maintained, or increased the frequency of their alcohol use. Mainly, they were more likely to present behavioral problems, as well as symptoms of inattentive hyperactivity, and peer and emotional problems. Conclusions: Despite the extensive decline in substance use during the pandemic period, these results suggest an association between previous mental health conditions and behavioral risk factors, leading to increased alcohol consumption and behavioral disorders manifestations.

Substance use and adolescent mental health during the COVID-19 pandemic in Brazil: a longitudinal approach.

OBJECTIVE: To describe the changes in alcohol and drug use by Brazilian adolescents during the COVID-19 pandemic (April-August 2021), and to analyze the relationship between alcohol use changes and psychiatric symptomatology. METHODS: A secondary analysis with a longitudinal approach was performed with data from a cluster-randomized controlled trial, conducted in 73 public middle schools in three Brazilian cities, to evaluate the effectiveness of a drug use prevention program. The sample included 535 students (61% girls; Mage = 15.2 years). Data were collected pre-intervention (February-March 2019), after 9 months (November-December 2019), and after 26 months (April-August 2021), when the students were in their first year of high school. The authors analyzed drug use prevalence (alcohol, binge drinking, tobacco, inhalants, marijuana, cocaine, and crack) in a lifetime, past year, and past month periods, and the association between alcohol use change subsamples with psychiatric symptoms. Logistic regressions were adjusted by sex, age, socioeconomic status, city, and group (control and intervention). RESULTS: The present findings suggest that the COVID-19 pandemic led to a decrease in past-year substance use and in past-month substance use frequency, despite the gradually increased (but decelerating) prevalence of lifetime use. However, some adolescents initiated, maintained, or increased the frequency of their alcohol use. Mainly, they were more likely to present behavioral problems, as well as symptoms of inattentive hyperactivity, and peer and emotional problems. CONCLUSIONS: Despite the extensive decline in substance use during the pandemic period, these results suggest an association between previous mental health conditions and behavioral risk factors, leading to increased alcohol consumption and behavioral disorders manifestations.

Factors associated with attending "open bar" parties amongst early adolescents.

BACKGROUND: "Open bar" parties are events where a flat fee is paid for unlimited alcohol consumption. At these events, alcohol intoxication is frequent amongst attendees. This study explored the prevalence of "open bar" attendance amongst Brazilian youth and the factors associated with this practice. METHODS: Data was collected at the baseline of randomized controlled trial amongst 5,213 8th grade students in three Brazilian cities. Weighted logistic regression was performed. RESULTS: Mean age was of 13.23 years (SE 0.01) and 17.1% of the students have reported attending "open bar" events in the past year. Attendees were wealthier, had higher odds to engage in binge drinking, to use marijuana, to be exposed to alcohol advertising, and to report more alcohol problems and clinical psychiatric symptoms when compared with non-attendees. CONCLUSIONS: The ban on selling alcohol to minors has not been properly enforced. Legislation to restrict alcohol promotions and advertising in Brazil needs to be implemented and effectively monitored.

Have countries offered the best data to the Pan American Health Organization? Evidence of potential inconsistencies found in a study on alcohol policies in Brazil.

OBJECTIVE: The objective of this study was to verify the agreement between the alcohol policies score estimated from documental analysis of Brazilian federal regulatory documents (RD), with primary data collection, and the results previously presented by the Pan American Health Organization (PAHO) in its Alcohol Policy Scoring (APS) report. STUDY DESIGN: Document identification and content analysis. METHODS: Documental research was carried out in two phases: a document identification and content analysis. In the first phase, we carried out the search, identification, and systematization of laws, decrees, and federal ordinances in Brazil, with primary data collection. The second phase consisted of three steps: 1) an RD content analysis and classification into the 10 PAHO/World Health Organization (WHO) policy domains; 2) a score estimation of alcohol policies, based on the APS instrument attached to their report; and 3) comparison of the results for Brazil presented at the APS report and the one estimated by the researchers. RESULTS: The study showed divergences between the results for APS published by PAHO about Brazil and the one achieved with primary data collection. 1146 federal promulgated RD were identified, of which 21 were eligible for content analysis. Only the domains "Community and workplace action" (Domain 3) and "Reducing the public health impact of illicit and informally produced alcohol" (Domain 9) had convergent scores. On the other domains, usually the APS score estimated by PAHO differs from the one estimated with the primary data collection. CONCLUSIONS: We conclude that Brazil is not providing the best data for PAHO/WHO estimate its APS report, leading to the dissemination of imprecise results worldwide.

Sociodemographic factors associated with smoking risk perception in adolescents in São Paulo, Brazil

Objective: We examined the sociodemographic factors associated with smoking risk perceptions (SRP) in youth living in two very different neighborhoods in the city of São Paulo, Brazil: a middle-class central area (Vila Mariana) and a poor outer-city area (Capão Redondo). Methods: A cross-sectional survey was conducted with 180 public school-attending youth (all aged 12 years) and their parents. SRP was evaluated through self-reports. Weighted multinomial logistic regression was used to examine factors associated with SRP. Results: Smoking was considered a high-risk behavior by 70.9% of adolescents. There were significant differences in SRP associated with socioeconomic status (SES) and maternal smoking status. Having a non-smoking mother was positively associated with perceiving smoking as having low to moderate risk versus no risk (OR=3.91 [95%CI 1.27-12.02]). Attending school in Capão Redondo was associated with perceiving smoking as having high risk compared to no risk (OR=3.00 [95%CI 1.11-8.12]), and low SES was negatively associated with perceiving at least some risk in smoking versus perceiving no risk in this behavior. Conclusions: Youth whose mothers smoke appear to have lower SRP than those whose mothers do not smoke. Living in a poor outer-city area was associated with higher SRP.

Sociodemographic factors associated with smoking risk perception in adolescents in São Paulo, Brazil.

OBJECTIVE: We examined the sociodemographic factors associated with smoking risk perceptions (SRP) in youth living in two very different neighborhoods in the city of São Paulo, Brazil: a middle-class central area (Vila Mariana) and a poor outer-city area (Capão Redondo). METHODS: A cross-sectional survey was conducted with 180 public school-attending youth (all aged 12 years) and their parents. SRP was evaluated through self-reports. Weighted multinomial logistic regression was used to examine factors associated with SRP. RESULTS: Smoking was considered a high-risk behavior by 70.9% of adolescents. There were significant differences in SRP associated with socioeconomic status (SES) and maternal smoking status. Having a non-smoking mother was positively associated with perceiving smoking as having low to moderate risk versus no risk (OR=3.91 [95%CI 1.27-12.02]). Attending school in Capão Redondo was associated with perceiving smoking as having high risk compared to no risk (OR=3.00 [95%CI 1.11-8.12]), and low SES was negatively associated with perceiving at least some risk in smoking versus perceiving no risk in this behavior. CONCLUSIONS: Youth whose mothers smoke appear to have lower SRP than those whose mothers do not smoke. Living in a poor outer-city area was associated with higher SRP.

Patterns of drinking and driving offenses among nightclub patrons in Brazil.

BACKGROUND: Brazil has a strict drinking and driving law known as the Brazilian "Dry Law". The aim of the present study was to investigate characteristics associated with the breaking of the Brazilian traffic law, on drinking and driving, at nightclub exit among a representative sample of nightclub patrons in the city of São Paulo, Brazil. METHODS: Portal survey realized with a two-stage cluster sampling survey design to collect data from 2422 patrons at the entrance and 1822 patrons at the exit of 31 nightclubs in the city of São Paulo, Brazil. Patrons' breath alcohol concentrations (BrACs) at the entrance and exit of the nightclubs were categorized according to the law as either a "traffic offense" or a "traffic offense and crime". Weighted multinomial logistic regression was used to analyze factors associated with different patterns of drinking and driving offenses. RESULTS: Of the subjects, 16.5% (n=369) were identified as driving patrons at the entrance and exit of the nightclubs. At entry, 80.1% of the patrons had a zero BrAC, 14.9% had a BrAC meeting the traffic offense criteria and 5.0% had a BrAC meeting the traffic offense and crime criteria. Women were less likely to have BrACs meeting the traffic offense criteria. At nightclub exit, 63.4% of patrons had maintained a zero BrAC, 24.7% had a BrAC that had increased and now met the traffic offense and crime criteria, and 11.9% had a decreased or stable BrAC. An increased BrAC was more frequently identified in patrons who were men, were single, and had used illicit drugs inside the nightclub. CONCLUSION: Despite the existence of a strict law regarding drinking and driving, a significant proportion of nightclub patrons in the city of São Paulo had violated this law, suggesting a perception of impunity and need for law enforcement.

Binge Drinking Associations with Patrons' Risk Behaviors and Alcohol Effects after Leaving a Nightclub: Sex Differences in the "Balada com Ciência" Portal Survey Study in Brazil.

The purpose of the present study was to investigate the potential associations of binge drinking detected at the exit of nightclubs and risk behaviors and alcohol effects just after leaving the venue in a representative sample of Brazilian nightclub patrons according to sex. For this purpose, a portal survey study called Balada com Ciência was conducted in 2013 in the megacity of São Paulo, Brazil, using a two-stage cluster sampling survey design. Individual-level data were collected in 2422 subjects at the entrance and 1822 subjects at the exit of 31 nightclubs, and breath alcohol concentration (BrAC) was measured using a breathalyzer. The following day, 1222 patrons answered an online follow-up survey that included questions about risk behaviors and alcohol effects practiced just after leaving the nightclub. Weighted logistic regressions were used to analyze binge drinking associated with risk behaviors by sex. For both sexes, the most prevalent risk behaviors practiced after leaving a nightclub were drinking and driving (men=27.9%; women=20.4%), the use of illicit drugs (men=15.8%; women=9.4%) and risky sexual behavior (men=11.4%; women=6.8%). The practice of binge drinking increased the behavior of illicit drug use after leaving the nightclub by 2.54 times [95% CI: 1.26-5.09] among men who drank and increased the risk of an episode of new alcohol use by 5.80 times [95% CI: 1.50-22.44] among women who drank. Alcoholic blackouts were more prevalent among men [OR=8.92; 95% CI: 3.83-20.80] and women [OR= 5.31; 95% CI: 1.68-16.84] whose BrAC was equivalent to binge drinking compared with patrons with a lower BrAC. Public policies aiming to reduce patrons' BrAC at the exit of nightclubs, such as staff training in responsible beverage service and legislation to prevent alcohol sales to drunk individuals, would be useful to protect patrons from the risk behaviors associated with binge drinking in nightclubs.