Substance-using adolescents admitted to inpatient treatment: Characteristics and factors associated with length of time in treatment. / Adolescentes usuarios de sustancias ingresados en tratamiento: Características y factores asociados a la duración del tratamiento.

Studies of adolescents receiving inpatient substance use treatment remain limited. We explored the characteristics of adolescents who received substance use treatment as inpatients in a psychiatric hospital in Brazil and factors associated with length of time in this treatment. METHODS: A retrospective observational study was performed. Electronic treatment records of 172 young people (aged 17 and below) receiving substance use treatment at Hospital Lacan in Brazil were analysed. RESULTS: The mean age of participants was 15.18 years (SD = 1.39). The sample was characterised as predominately male (68.60%), who entered treatment involuntarily (80.81%), were out of school (89.82%), were involved with the criminal justice system (59.88%) and came from a family with substance use problems (74.67%). Re-admission to inpatient treatment for substance use problems was common. On average, adolescents received inpatient treatment for 3 months. Length of time in treatment was associated with: involuntary admission to treatment, re-admission to inpatient treatment, requests of discharge from treatment by a relative/caretaker, education level, leaving school due to aggressive behaviours and cocaine use. CONCLUSION: Findings highlight the complex profiles of adolescents receiving substance use treatment in Brazil. Cross-system collaboration between mental health, educational and justice services are needed to treat adolescents' substance use.

Los estudios sobre adolescentes ingresados para tratamiento de uso de sustancias son limitados. Analizamos las características de adolescentes ingresados para tratamiento en un hospital psiquiátrico en Brasil y los factores asociados con la duración de su tratamiento. Métodos: estudio observacional retrospectivo. Analizamos los registros electrónicos de tratamiento de 172 jóvenes (hasta los 17 años de edad) ingresados para tratamiento por uso de sustancias en el Hospital Lacan en Brasil. Resultados: La edad media de los participantes era 15,18 años (SD = 1,39). La muestra era mayoritariamente masculina (68,60%), cuyo ingreso fue involuntario (80,81%), sin escolarizar (89,82%), involucrada en el sistema de justicia penal (59,88%) y proveniente de una familia con problemas relacionados con el uso de sustancias (74,67%). La readmisión como paciente a tratamiento por problemas de uso de sustancias era frecuente. Como media, los adolescentes estuvieron ingresados para tratamiento durante 3 meses. La duración del tratamiento estaba asociada con: admisión involuntaria al tratamiento, reingreso hospitalario para tratamiento, solicitudes de alta del tratamiento por parte de familiares/cuidadores, nivel de estudios, abandono escolar debido a conducta agresiva, y uso de cocaína. Conclusión: Los hallazgos destacan los perfiles complejos de los adolescentes ingresados para tratamiento por el uso de sustancias en Brasil. Es necesaria una colaboración entre los sistemas de salud mental, educación y servicios de justicia para tratar el uso de sustancias entre adolescentes.

Factors associated with crack-cocaine early initiation: a Brazilian multicenter study.

BACKGROUND: Crack-cocaine dependence is a serious public health issue, related to several psychiatric and psychosocial problems. Crack-cocaine users are usually embedded in a context of great social vulnerability, often associated with violence, poverty, family conflict and easy and early access to alcohol, tobacco and other drugs. METHODS: This cross-sectional study enrolled a consecutive sample of 577 patients admitted to 20 therapeutic communities located in Southern Brazil, between September 2012 and September 2013. A structured interview assessed life-time exposure to risk and protective factors for drug use, such as parental monitoring in childhood, deviant behaviors and peer pressure. RESULTS: Presence of family conflict (p = 0.002), maltreatment (p = 0.016), and deviant behavior prior to age 15 in a bivariate analysis predicted an earlier age of crack-cocaine initiation, whereas adolescents experiencing parental monitoring during adolescence started use later (p < 0.001). In the multivariate model, perceptions related to ease of access of illicit drugs (marijuana: p = 0.028, 95% CI = - 3.81, - 0.22; crack-cocaine: p < 0.001, 95% CI = - 7.40, - 4.90), and deviant behavior (threatening someone with a gun: p = 0.028, 95% CI = - 2.57, - 0.14) remained independent predictors of early age of crack-cocaine initiation. CONCLUSIONS: Early onset of crack-cocaine use seems to be associated with exposure to family conflict, easy access to drugs and deviant behavior. Treatment and preventive programs should take these factors into account when designing and implementing community interventions.

Gender Differences in Gambling Exposure and At-risk Gambling Behavior.

This study aimed to evaluate the differences in gambling exposure and onset of gambling problems among male and female gamblers by comparing their demographic and behavioral profiles. This study utilized data from the gambling section of the First Brazilian National Alcohol Survey and Related Behaviors. Interviews were conducted with 3007 participants who were recruited after screening for at-risk gambling behaviors. Individuals who tested positive for at-risk gambling behaviors completed the Gambling Progression Questionnaire comprising items on games of chance, and were evaluated using the DSM-IV pathological gambling criteria. The participants' "lifetime gambling exposure" was 12.5%, with 4% having experienced gambling problems during their lifetime. Majority of the male at-risk gamblers (78%) reported that they began gambling in their 20 s and took approximately 3 years to start experiencing gambling-related problems. Contrastingly, female at-risk gamblers started gambling in their 30 s and they took about 12 years to start experiencing gambling-related problems. The present results show that men were 2.3 times more at risk of gambling exposure and 3.6 times more likely to experience gambling-related problems. Male at-risk male gamblers seemed to be lonelier and to have a low socioeconomic status, while women seemed to have lower income and social insertion. Considering these significant differences, more studies evaluating gender differences in gambling behavior are necessary.

Violence and substance use in sexual minorities: Data from the Second Brazilian National Alcohol and Drugs Survey (II BNADS).

OBJECTIVE: To describe the prevalence of substance use and the associations between adverse early life experiences, sexual behaviour and violence in sexual minority (SM) individuals. METHODS: The Brazilian National Alcohol and Drugs Survey is a probabilistic household survey performed in 2012, collecting data from 4067 Brazilians aged 14 years and older. RESULTS: 3.4% of the sample declared themselves as sexual minorities, 53.8% female, 66.5% single, mean age of 29.5 years (standard deviation 16.0 years). A high prevalence of alcohol dependence (15.2%) and binge drinking (22.2%) was identified in the SM group. Respondents were more likely to use crack cocaine and hallucinogens, to have been involved in child prostitution, child sexual abuse and to report suicidal ideation in the previous year. Respondents were also more likely to engage in unprotected sex compared to non-sexual minorities. Nearly one-third referred to having suffered homophobic discrimination in their lives. Respondents also reported higher rates of domestic violence (18.9%) and urban violence (18%) among the SM. CONCLUSION: The findings reinforce that violence directed at individuals in the Brazilian SM community begins early in life and persists into adulthood when compared to non-sexual minorities. This population is also more exposed to substance use disorders.

Family members affected by multiple substance misuse relatives. / Familiares afectados por el abuso de sustancias de otros parientes: características de una muestra brasileña.

PURPOSE: The heterogenic characteristics of affected family members (AFMs) of substance misusing relative (SMR) remain understudied. This study examined the occurrence and correlates of AFMs having more than one relative with substance use problems. MATERIAL AND METHODS: A secondary analysis of a cross-sectional study on the characteristics of affected family members in Brazil was performed (N= 3157). Levels of AFM stress, strain, coping and hopefulness were assessed. Factors associated with AFMs having other substance misusing relatives (other-SMRs) were explored using univariate logistic regressions. RESULTS: The occurrence of having other-SMR was reported by 61.6% of the sample (1945/3157). Of this, 47% (904/1945) reported that the other-SMR was a member of the SMR's immediate family (spouse/partner/children/siblings). The likelihood of having other-SMRs was related to the AFM being female, from a low socioeconomic background, between the age of 35-44 years older, being SMR's mother or wife/girlfriend/fiancée, scoring higher on family member impact, psychological and physical symptoms, withdrawal coping and to have an older SMR. CONCLUSION: Information about the characteristics of AFMs is key to understanding how the experience of harm associated with the relative's problem might manifest. Our findings offer information that could be used when developing interventions aimed at reducing the harm experienced by AFMs.

Objetivo: Las características heterogéneas de familiares afectados (FA) de familiares con abuso de sustancias (FAS) han sido objeto de pocos estudios. Este estudio revisó la ocurrencia y los correlatos de FA con uno o más familiares con problemas de abuso de sustancias. Materiales y Métodos: Análisis secundario de un estudio transversal sobre las características de FA en Brasil (N = 3157). Valoramos los niveles de los FA de estrés, presión, afrontamiento y esperanza. Exploramos los factores asociados con los FA que tenían otros familiares con abuso de sustancias (otros-FAS) mediante regresiones logísticas ordinales. Resultados: El 61,6% de la muestra (1945/3157) informó de la ocurrencia de otros-FAS. De estos, el 47% (904/1945) informó que los otros-FAS eran familiares directos del FAS (cónyuge/pareja/hijos/hermanos). La probabilidad de ocurrencia de otros-FAS estaba relacionada con que el FAS fuese mujer, de bajo nivel socioeconómico (NSE), con una edad entre los 35-44 años, fuese la madre o esposa/novia/prometida del FAS, obtuviese una puntuación más alta en impacto familiar, síntomas psicológicos y físicos, evitamiento como mecanismo de afrontamiento, y que tuviese un FAS mayor. Conclusión: Información sobre las características de los FA es clave para entender cómo puede manifestarse la experiencia de daños asociados con el problema del familiar. Nuestros hallazgos aportan datos que pueden ser útiles para desarrollar intervenciones con el objetivo de reducir los daños sufridos por los FA.

Factors associated with attrition rate in a supportive care service for substance using pregnant women in Brazil.

BACKGROUND AND OBJECTIVES: Retaining substance using women in antenatal care remains a major challenge. This study explored factors associated with attrition rate among women with substance use problems attending a supportive care service during pregnancy and soon after the birth of the infant. METHODS: Records of 166 women's antenatal consultations were analyzed. RESULTS: Attrition rate was high (75/166, 45.2%), and was associated with women having no schooling/primary schooling only, no family contact, having child(ren), crack-cocaine use, poly drug use, and substance use problems by the expected child's father. DISCUSSION AND CONCLUSIONS: Attrition may be the outcome of socio-demographic, family, individual, and substance use issues not fully addressed in prenatal interventions. SCIENTIFIC SIGNIFICANCE: Identification of who are at risk for dropping out affords services with an opportunity to prevent its occurrence. (Am J Addict 2017;26:676-679).

Guidelines of the Brazilian Association of Studies on Alcohol and Other Drugs (ABEAD) for diagnosis and treatment of psychiatric comorbidity with alcohol and other substance and dependence.

In recent years, several studies have been focused on the comorbidity of psychiatric disorders with alcohol and other substance dependence. In this context, the Brazilian Association of Studies on Alcohol and Other Drugs initiated a project to establish Brazilian Guidelines. The aim of this study was to review diagnostic and therapeutic criteria for the most prevalent psychiatric comorbidities. Randomized clinical trials, epidemiological studies, animal testing and other forms of research are reviewed herein. The main psychiatric comorbidities are investigated and data published in the literature are reviewed, based on guidelines adopted by other countries. Epidemiological aspects, diagnostic criteria, integrated treatment and the organization of specialized service, as well as details regarding psychotherapy and pharmacological treatment are discussed. The guidelines of the Brazilian Association of Studies on Alcohol and Other Drugs reinforce the importance of adequate diagnosis and treatment regarding alcoholic and drug dependent patients suffering of comorbid psychiatric disorders.

Assessment of Sexual Dysfunction Symptoms in Female Drug Users: Standardized vs. Unstandardized Methods.

AIMS: The aim of this study is to evaluate whether there is a difference in the identified prevalence between the assessment of symptoms of sexual dysfunction in female drug users using a standardized scale and by means of a nonstandardized set of questions about sexual dysfunctions. METHOD: A cross-sectional study was conducted with two groups of substance-dependent women using the Drug Abuse Screening Test, the Short Alcohol Dependence Data questionnaire, the Fagerström Test for Nicotine Dependence for the evaluation of the severity of dependence, and the Arizona Sexual Experience Scale. FINDINGS: In both groups, the severity of dependence and the prevalence of symptoms of sexual dysfunctions in women were similar. CONCLUSION: The use of standardized and nonstandardized instruments to assess sexual dysfunction symptoms is an essential resource for the provision of good-quality care to this clientele.

Criminality and Sexual Behaviours in Substance Dependents Seeking Treatment.

The aim of this study was to investigate the link between violence, crime, and sexual behavior among patients with substance-related disorder admitted to a specialized inpatient care unit. This was a cross-sectional study using a questionnaire on socio-demographic characteristics, drug of choice (DOC), questions about sexual behavior, and instruments to evaluate the severity of dependence (SADD, DAST, FTND), level of impulsivity (BIS-11), and a screening sex addiction scale. The sample consisted of 587 adult subjects, of which 82.3% were men, 66.4% had used cocaine (sniffed and smoked) as their DOC, 24.4% had a history with the criminal justice system, 26.8% had committed crimes, 19.3% had engaged in violent behavior, and 12.2% had been involved in drug trafficking. In this sample, crime was strongly associated with various sexual behaviors and the severity of substance dependence.

Discrepant trends in income, drinking, and alcohol problems in an emergent economy: Brazil 2006 to 2012.

BACKGROUND: To examine the association between increases in income and self-reported alcohol consumption, binge drinking, and alcohol problems in 2006 and 2012 in Brazil. METHODS: Participants were interviewed as part of 2 multistage representative cluster samples of the Brazilian household population between November 2005 and April 2006 and between November 2011 and March 2012. The number of current drinkers during these 2 intervals (n = 1,379 and n = 1,907, respectively) comprised the sample analyzed. Four past-year outcome variables-standard drinks per week, binge drinking, presence of alcohol-related social/health problems, and DSM-5 alcohol use disorder (AUD)-were estimated across income, age, and gender groups. Regression models were estimated to evaluate these and other sociodemographic effects on drinking and problem outcomes and to test for possible wave by income interactions. RESULTS: Response rates were 66.4% in 2006 and 77% in 2012. Income increases were seen in virtually all age-gender subgroups and were particularly pronounced for younger age groups and older women. Both genders reported increased drinks per week (men: 12.82, 2006; 15.78, 2012; p < 0.01; women: 4.89, 2006; 7.66, 2012; p < 0.001) and proportion binge drinking (men: 57%, 2006; 66%, 2012; p < 0.05; women: 39%, 2006; 48%, 2012; p < 0.05), although this was not seen in all gender and age groups. Social/health problem prevalence decreased among men (37%, 2006; 26%, 2012; p < 0.001) and remained the same among women (13%, 2006; 14%, 2012). DSM-5 AUD decreased among men (34%, 2006; 24%, 2012; p < 0.01) and remained stable among women (14%, 2006; 16%, 2012). CONCLUSIONS: Brazilian economic development between 2006 and 2012 led to a rise in income in several gender and age groups. Although not always directly associated with an observed increase in alcohol consumption, the rise in income may have created a sense of optimism that inhibited a rise in alcohol-related problems.

How smokers may react to cigarette taxes and price increases in Brazil: data from a national survey.

BACKGROUND: Despite being the third largest tobacco producer in the world, Brazil has developed a comprehensive tobacco control policy that includes a broad restriction on both advertising and smoking in indoor public places, compulsory pictorial warning labels, and a menthol cigarette ban. However, tax and pricing policies have been developed slowly and only very recently were stronger measures implemented. This study investigated the expected responses of smokers to hypothetical price increases in Brazil. METHODS: We analyzed smokers' responses to hypothetical future price increases according to sociodemographic characteristics and smoking conditions in a multistage sample of Brazilian current cigarette smokers aged≥14 years (n=500). Logistic regression analysis was used to examine the relationship between possible responses and different predictors. RESULTS: In most subgroups investigated, smokers most frequently said they would react to a hypothetical price increase by taking up alternatives that might have a positive impact on health, i.e., they would "try to stop smoking" (52.3%) or "smoke fewer cigarettes" (46.8%). However, a considerable percentage responded that they would use alternatives that would reduce the effect of price increases, such as the same brand with lower cost (48.1%). After controlling for sex age group (14-19, 20-39, 40-59, and ≥60 years), schooling level (≥9 versus ≤9 years), number of cigarettes per day (>20 versus ≤20), and stage of change for smoking cessation (precontemplation, contemplation, and preparation), lower levels of dependence were positively associated with the response "I would try to stop smoking" (odds ratio [OR], 2.19). Young age was associated with "I would decrease the number of cigarettes" (OR, 3.44). A low schooling level was strongly associated with all responses. CONCLUSIONS: Taxes and prices increases have great potential to stimulate cessation or reduction of cigarette consumption further among two important vulnerable populations of smokers in Brazil: young smokers and those of low educational level. The results from the present study also suggest that seeking illegal products may reduce the impact of increased taxes, but does not eliminate it.

Two in ten patients seeking addiction treatment within São Paulo's Crackland report recent use of Synthetic Cannabinoids.

The profile investigation of crack cocaine dependents seeking addiction treatment within Sao Paulo's open drug use scene known as "Crackland" demonstrated that 20% of them reported consuming variations of Synthetic Cannabinoids. This equated to 1.054 patients in a span of four months (between 08/05/2023 to 08/09/2023). This preliminary finding is well-timed and holds significant value making it suitable for a briefer publication format, such as a letter, that can promptly disseminate this relevant information to the scientific community. Additional and complementary evidence expanding the discussion beyond the medical aspects of SC consumption is also provided. This figure is a clear indication of the shift in the population accessing this drug, now reaching the most vulnerable segment of our nation's population. The letter brings on further insights with a more social perspective, also discussing the intricate interplay between affordability, availability price and how criminal organizations are likely involved now with SC's control and distribution in Brazil.

Intervention diversity predicts social rehabilitation indicators at discharge in Therapeutic Communities.

INTRODUCTION: The Therapeutic Community Model narrows the gap in substance use disorder's network of assistance in Brazil by offering residential treatment to socially vulnerable populations. Due to a historical lack of evidence-based approaches, the government has established treatment guidelines and has been trying to implement training and monitoring methods. METHOD: This study analysed real-world data from the monitoring system implemented in the largest network of institutions receiving public funds in the State of Sao Paulo. Data came from 8109 records of individuals admitted between 2014 and 2016 in 48 institutions. RESULTS: Results showed that less than half of the sample was exposed to at least one therapeutic activity from each of the recreational, spiritual, educational and selfcare intervention domains, as proposed by the national guidelines. Social rehabilitation outcome (SRO) defined by housing and self-support at discharge was reported by 21 % of the sample, who stayed in residential treatment for 82.6 days in average. More than half completed the therapeutic programme while 27.3 % dropout. Treatment duration and the diversity of the interventions offered were significantly associated with SRO when mutually adjusted. Chances of SRO increased nearly 5 times when residents were offered the full range of intervention domains, even when controlling for treatment duration. Treatment duration increased chances of SRO in a dose-response manner with a threefold increase for stays up to 90 days and over 9 times for stays longer than 90 days. CONCLUSION: Our findings offer evidence to promote treatment guidelines compliance and to pave the way for the implementation of monitoring systems for this modality of treatment in Brazil and abroad.

Cocaine effects on mouse incentive-learning and human addiction are linked to alpha2 subunit-containing GABAA receptors.

Because GABA(A) receptors containing alpha2 subunits are highly represented in areas of the brain, such as nucleus accumbens (NAcc), frontal cortex, and amygdala, regions intimately involved in signaling motivation and reward, we hypothesized that manipulations of this receptor subtype would influence processing of rewards. Voltage-clamp recordings from NAcc medium spiny neurons of mice with alpha2 gene deletion showed reduced synaptic GABA(A) receptor-mediated responses. Behaviorally, the deletion abolished cocaine's ability to potentiate behaviors conditioned to rewards (conditioned reinforcement), and to support behavioral sensitization. In mice with a point mutation in the benzodiazepine binding pocket of alpha2-GABA(A) receptors (alpha2H101R), GABAergic neurotransmission in medium spiny neurons was identical to that of WT (i.e., the mutation was silent), but importantly, receptor function was now facilitated by the atypical benzodiazepine Ro 15-4513 (ethyl 8-amido-5,6-dihydro-5-methyl-6-oxo-4H-imidazo [1,5-a] [1,4] benzodiazepine-3-carboxylate). In alpha2H101R, but not WT mice, Ro 15-4513 administered directly into the NAcc-stimulated locomotor activity, and when given systemically and repeatedly, induced behavioral sensitization. These data indicate that activation of alpha2-GABA(A) receptors (most likely in NAcc) is both necessary and sufficient for behavioral sensitization. Consistent with a role of these receptors in addiction, we found specific markers and haplotypes of the GABRA2 gene to be associated with human cocaine addiction.

Drinking patterns and associated problems in Brazil.

This paper describes patterns of alcohol consumption and associated problems in Brazil. Data came from a multicluster random sample of 2,346 Brazilians 18 years of age and older. The survey was conducted in 2005-2006 and had a response rate of 66.4%. About 35% of the men and 59% of the women did not drink in the past 12 months, while 39% of the men and 13% of the women consumed alcohol at least once a week. Further, 38% of the men and 17% of the women consumed 5 or more drinks "usually", and 40% of the men and 18% of the women reported binge drinking in the past 12 months. The prevalence of alcohol use disorders (DSM-4 abuse and/or dependence) was 19% among men and 4% among women. Although abstinence in Brazil is relatively high, binge drinking is frequent and, thus, alcohol problems and alcohol use disorders are also frequent.

Real world evidence in involuntary psychiatric hospitalizations: 64,685 cases.

OBJECTIVE: We explored hospitalization patterns and the clinical and individual characteristics of a large cohort of patients who underwent involuntary psychiatric hospitalization in Brazil (n=64,685). METHODS: Data were collected from the District Attorney's Office of the State of São Paulo (Ministério Público do Estado de São Paulo) on all involuntary psychiatric hospitalizations in the city of São Paulo between January 2003 and February 2020. The annual involuntary psychiatric hospitalization rate was calculated and descriptive statistics of the characteristics were produced. RESULTS: Involuntary psychiatric hospitalizations increased from 5.8 to 25.5 per 100,000 population, with an eight-folder increase in the first 10-year period (2003-2013). The majority of admissions were to public institutions (86.6%), involved a psychotic disorder in the primary diagnosis (26.1%), involved more than one diagnosis (83.7%), and lasted less than 7 days (52.4%). The majority of the patients were aged 18 to 39 years and were single, and readmission was relatively common (13%). Although the reason for admission was missing in many reports (44%), the risk of harm to self or others was the most common (68.5%). CONCLUSION: This is one of the largest cohorts of involuntary psychiatric hospitalization records ever explored. These findings build upon existing international evidence about involuntary psychiatric hospitalizations and show recent trends in admission rates in the largest city in Brazil.

Religiosity as a potential mediator for violence in childhood and adulthood: results from a Brazilian nationally representative survey.

OBJECTIVES: Although previous studies have investigated the role of religiosity in violence outcomes, there is a lack of studies including this aspect as a mediator for violence in childhood and adulthood. This study aimed to investigate the relationship between religiosity and violence in childhood, as well as the possible mediating role of religiosity between suffering violence in childhood and suffering and/or perpetrating violence in adulthood. DESIGN: Cross-sectional population-based study carried out from November 2011 to March 2012. SETTING: Face-to-face surveys (at participants' homes) were performed in a Brazilian nationally representative sample. PARTICIPANTS: A total of 3378 adults (aged 19 years and above) were included. PRIMARY AND SECONDARY OUTCOMES MEASURES: The association between suffering violence in childhood and religiosity, and the mediating role of religiosity between childhood and adulthood violence were analysed using logistic regression models. RESULTS: Religiosity was associated with childhood violence, showing that those who suffered less violence in childhood were more religious in adulthood and considered religion more important in their lives. However, while there was a significant association between suffering violence during childhood and suffering and/or perpetrating violence in adulthood, religiosity did not mediate this relationship. CONCLUSIONS: Although religious individuals self-reported less violence suffered in childhood, religiosity did not show evidence of being a potential mediator for childhood and adulthood violence (experienced and/or perpetrated). These results could help researchers explore this phenomenon, and aid health professionals and managers when proposing future interventions.

Rape, Child Sexual Abuse, and Mental Health in a Brazilian National Sample.

The objective of this study is to evaluate the prevalence of self-reported rape and its associations with other forms of violence and mental health outcomes. The Brazilian National Alcohol and Drugs Survey is a probabilistic household survey that collected data from 4,283 Brazilians aged 14 years and older in 2012. The prevalence of rape was 2.3% (n = 107) and the majority (n = 81) of rapes were reported by women. Female gender increased the chances of rape (adjusted odds ratio [AOR] = 2.7, 95% confidence interval [CI] = [1.7, 4.3]). Adults aged 35 to 46 years (AOR = 2.0, 95% CI = [1.2, 4.4]) and being without religion (AOR = 2.2, 95% CI = [1.3, 3.8]) were also associated with increased chances of rape. Participants with a history of childhood sexual abuse (CSA) were 16.5 times (95% CI = [10.1, 26.7]) more likely to report having been raped. Other outcomes related to been raped were history of child prostitution (AOR = 5.1, 95% CI = [2.1, 13.4]) and witnesses of violence during childhood (AOR = 2.4, 95% CI = [1.5, 3.8]). People without social support (AOR≅3, 95% CI = [1.8, 4.3]), victims of multiple recent negative events (AOR = 3.7, 95% CI = [2.4, 5.8]), people with depression (AOR = 2.6, 95% CI = [1.7, 3.9]), history of suicidal ideation (AOR = 3.8, 95% CI = [2.0, 7.1]), and history of suicide attempts (AOR = 2.2, 95% CI = [1.1, 4.3]) are other outcomes related to having been raped. In this sample, rape was related to gender and to other forms of violence and victimization. Self-reports of rape appear to underestimate the true prevalence as the figures obtained from the survey were low. Other methods should be used to investigate this issue.

Cannabis Consumption Onset and Addiction: Data from the Second Brazilian Drugs and Alcohol Survey (BNADS).

The objective of this study was to provide rates of cannabis use and dependence and risk factors, proposing a conditional path model for cannabis addiction. A subsample of adult participants from a Brazilian household survey was analyzed to estimate cannabis dependence. Estimation of prevalence rates and association between dependence and age of cannabis use initiation were performed. The conditional model was applied to investigate the mediation of depressive symptoms and alcohol consumption in the association of early cannabis use and dependence. Lifetime and last year cannabis use were 6.47% and 2.81%, respectively. Moderate and severe cannabis dependence were 0.74% and 0.18% in the population, and 26.47% and 6.38% among last year's cannabis users. A Parallel Multiple Mediator Model revealed strong association between cannabis use initiation age and dependence, when depressive symptoms or alcohol consumption mediate this association. The proportion of cannabis users displaying dependence symptoms is elevated and it is associated with the age of cannabis use initiation. The results show the importance of primary prevention interventions, prioritizing the delay of cannabis and alcohol experimentation. Our findings can enrich the debate on drugs policies and legislation, reinforcing the need for stronger restrictions of adolescent drug access and ensuring its enforcement.