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.

Changes in alcohol beliefs mediate the effects of a school-based prevention program on alcohol use among Brazilian adolescents.

OBJECTIVE: To investigate the mechanisms of the #Tamojunto2.0 program that mediated the prevention of lifetime alcohol and drug use, including drug knowledge, behavioral beliefs, attitudes, decision-making skills, and refusal skills. METHODS: A cluster-randomized controlled trial was conducted in 73 public middle schools in three Brazilian cities. The sample included 5208 students (49.4 % girls; Mage = 13.2 years). The intervention group attended twelve #Tamojunto2.0 lessons conducted by their previously trained teachers. The control group did not receive any intervention. Data were collected pre-intervention and at the 9-months follow-up. We performed multiple mediation models (for the whole sample, users, and non-users) with a post-estimation adjustment to standard errors to account for nesting. We analyzed all available mediators simultaneously according to each drug: alcohol, binge drinking, tobacco, marijuana, and inhalant lifetime use. To handle missing data, we used the "full-information maximum-likelihood" paradigm. RESULTS: Outcomes in the whole sample and among non-users showed that #Tamojunto2.0 indirectly prevented lifetime alcohol use and binge drinking by increasing negative and non-positive alcohol beliefs. Only the direct effect on decreasing lifetime alcohol consumption was statistically significant. However, an indirect increase in binge drinking was observed through knowledge about alcohol, but the direct effect was not statistically significant. No effects were reported for marijuana, tobacco, or inhalants. Among users, no statistically significant effects were found for alcohol or drug use. CONCLUSIONS: The results suggest that the #Tamojunto2.0 program was only effective in delaying alcohol consumption via increasing negative and non-positive alcohol beliefs. It seems that mediating mechanisms vary depending on contextual characteristics, differences in socializing among adolescents, features of the educational systems, psychosocial conditions, or, fidelity issues of program implementation.

Revisão sistemática sobre o efeito do programa escolar de prevenção ao uso de drogas Keepin' it REAL: traduzido e implementado no Brasil pelo PROERD / A systematic review of the effect of the school-based drug prevention program Keepin' it REAL: translated and implemented in Brazil by PROERD

Resumo O Programa Educacional de Resistência às Drogas (PROERD) é o programa escolar de prevenção mais disseminado no Brasil, seu atual currículo é baseado no programa norte-americano Keepin'it REAL (kiR). Não há na literatura evidência de efetividade do PROERD na prevenção ao uso de drogas, sendo necessários estudos complementares que auxiliem a compreensão desses achados. O objetivo do presente estudo é realizar uma síntese das evidências do efeito do currículo que deu origem ao PROERD: o kiR. Através de revisão sistemática encontrou-se 17 estudos que reportaram resultados de efeito de diferentes versões do kiR no uso de drogas e/ou violência. Com exceção do estudo brasileiro, não foram encontrados estudos que avaliassem o efeito no uso de drogas da versão aplicada por policiais (DARE-kiR), a mesma implementada pelo PROERD. Foram encontradas evidências favoráveis do kiR na prevenção ao uso de drogas para o currículo do 7º ano, que contrariam os resultados de efeito nulo do PROERD. Não foram encontradas evidências internacionais do efeito do kiR no currículo do 5º ano, assim como o estudo do PROERD. Sugere-se que revisões no currículo do 7º ano do PROERD para que ele possa refletir os resultados internacionais e que o currículo do 5º ano posso ser repensado considerando as evidências negativas internacionais.

Abstract The Drug Resistance Educational Program (PROERD) is Brazil's most widespread school-based prevention program; its current curriculum is based on the North American Keepin' it REAL (kiR) program. There is no evidence of the effectiveness of PROERD in preventing drug use, pointing to the need for further studies to understand these findings. The aim of the study was to synthesis the evidence of the effect of the kiR curriculum (PROERD) through a systematic review. We found 17 studies that reported the effects of different versions of kiR on drug use and/or violence. Except for the Brazilian study, no studies were found that assessed the effect on drug use of the version applied by police officers (DARE-kiR), the same one implemented by PROERD. Favorable evidence of kiR in drug use prevention was found for the 7th-grade curriculum, which contradicts the PROERD's null-effect results. No international evidence of the effect of kiR was found in the 5th-grade curriculum, in the same line as the PROERD's study. It is suggested that PROERD's 7th-grade curriculum should be revised to reflect international results and that the 5th-grade curriculum should be reconsidered in light of the negative international evidence.

Applying a Pattern-Centered Approach to Assess the Effect of a School-Based Drug Use Prevention Program in Brazil: A Cluster Randomized Controlled Trial.

This study evaluated the effectiveness of a drug and violence resistance educational program (Programa Educacional de Resistência às Drogas e à Violência-PROERD) on latent substance use profiles over a 9-month follow-up period. Two PROERD curricula were evaluated through a cluster randomized controlled trials with two parts that included a total of 4030 fifth-and seventh-grade students in 30 public schools in São Paulo. The intervention groups received 10 PROERD classes delivered by trained police officers, while the control group received no intervention. The primary outcome measures were drug use (any alcohol use, binge drinking, tobacco, marijuana, and inhalants) in the past 6 months, which was assessed using a pretest and a posttest 9 months later. Latent transition analysis was employed to investigate the effect of the intervention on the probabilities associated with the transition across drug use profiles. Latent drug use profiles are underlying subgroups of individuals similar to each other regarding their pattern of polysubstance use. Two different latent drug use profiles were revealed among the fifth graders (abstainers/low users and alcohol users/binge drinkers) and three drug use profiles among the seventh graders (abstainers/low users, alcohol users/binge drinkers, and polydrug users). For both, there was no evidence of the effect of PROERD on drug transition probabilities. In conclusion, the intervention was not successful in changing transitions across adolescent drug use profiles. Thus, the failure of the intervention to affect students' substance use profiles suggests that it should be reconsidered before it is implemented further in Brazilian schools.

Binge drinking in Brazilian adolescents: results of a national household survey / Consumo excessivo de álcool em adolescentes brasileiros: resultados de uma pesquisa domiciliar nacional / Consumo excesivo de alcohol en adolescentes brasileños: resultados de una encuesta domiciliaria nacional

This study aimed to estimate the prevalence of binge drinking and other alcohol consumption patterns and analyze the sociodemographic characteristics associated with binge drinking among Brazilian adolescents aged 15 to 17 years. A cross-sectional household survey including 2,315 adolescents from the 2019 Brazilian National Health Survey who answered a questionnaire on alcohol consumption (weekly frequency, average amount consumed in a drinking day, and binge drinking). A descriptive analysis of alcohol consumption by sociodemographic characteristics and a multivariable logistic regression model were performed. The prevalence of binge drinking (past 30 days) was 8.1% (95%CI: 6.2-10.3). Adolescents who did not attend school (OR = 2.8; 95%CI: 1.6-5.0) had greater odds of binge drinking than adolescents attending school. Higher socioeconomic status (measured via wealth score) was also associated with higher odds of binge drinking compared with lower socioeconomic status (e.g., 5th quintile vs. 1st quintile: OR = 2.9; 95%CI: 1.1-7.7). Girls had lower odds of binge drinking (OR = 0.5; 95%CI: 0.2-0.8) than boys. The prevalence of binge drinking among adolescents, especially boys, who did not attend school and had higher socioeconomic status was high. Monitoring alcohol consumption patterns in adolescents may provide important information on policies or actions to prevent binge drinking.

Os objetivos deste estudo foram descrever a prevalência de consumo excessivo de álcool (binge drinking) e outros padrões de consumo e analisar as características sociodemográficas associadas ao consumo excessivo de álcool em adolescentes brasileiros de 15 a 17 anos. Nesta pesquisa domiciliar transversal, 2.315 adolescentes da Pesquisa Nacional de Saúde de 2019 responderam a um questionário sobre o consumo excessivo de álcool (frequência semanal, dose média consumida em um dia e consumo excessivo de álcool). Foram realizados uma análise descritiva do consumo de álcool por características sociodemográficas e um modelo de regressão logística multivariável. A prevalência de consumo excessivo de álcool nos últimos 30 dias foi de 8,1% (IC95%: 6,2-10,3). Os adolescentes que não frequentavam a escola (OR = 2,8; IC95%: 1,6-5,0) apresentaram maiores chances de consumo excessivo de álcool do que os alunos que frequentavam a escola. Um maior nível socioeconômico (medido por meio do escore de riqueza) também foi associado a maiores chances de consumo excessivo de álcool em comparação com adolescentes com menor nível socioeconômico (por exemplo, quintil 5 vs. quintil 1: OR = 2.9; IC95%: 1,1-7,7). Meninas tiveram menores chances (OR = 0,5; IC95%: 0,2-0,8) de consumo excessivo de álcool do que meninos. Observou-se uma alta prevalência de consumo excessivo de álcool entre adolescentes, principalmente entre meninos, que não frequentam a escola e com maior nível socioeconômico. O monitoramento de padrões de consumo de álcool em adolescentes pode fornecer informações importantes sobre políticas e ações para prevenção do consumo excessivo de álcool.

Los objetivos de este estudio fueron describir la prevalencia del consumo excesivo de alcohol (binge drinking) y otros niveles de consumo, así como analizar las características sociodemográficas asociadas al consumo excesivo de alcohol por adolescentes brasileños de entre los 15 y los 17 años. La encuesta domiciliaria transversal aplicó un cuestionario sobre consumo excesivo de alcohol (frecuencia semanal, dosis promedio consumida al día y consumo excesivo de alcohol) a 2.315 adolescentes de la Encuesta Nacional de Salud de 2019. Se realizaron un análisis descriptivo del consumo de alcohol desde las características sociodemográficas y un modelo de regresión logística multivariado. La prevalencia de consumo excesivo de alcohol en los últimos 30 días fue del 8,1% (IC95%: 6,2-10,3). Los adolescentes que no asistían a la escuela (OR = 2,8; IC95%: 1,6-5,0) tenían más probabilidades de consumir alcohol en exceso que los estudiantes que asistían a la escuela. El mayor nivel socioeconómico (medido por la escala de riqueza) también se asoció con mayores probabilidades de consumir alcohol en exceso en comparación con los adolescentes con un nivel socioeconómico más bajo (por ejemplo, quintil 5 vs. quintil 1: OR = 2,9; IC95%: 1,1-7,7). Las mujeres tenían menos probabilidades (OR = 0,5; IC95%: 0,2-0,8) de consumir alcohol en exceso que los varones. Se encontró una alta prevalencia de consumo excesivo de alcohol entre los adolescentes, especialmente entre los varones, que no asistían a la escuela y con un nivel socioeconómico más alto. El seguimiento de los niveles de consumo de alcohol en adolescentes puede aportar información importante para las políticas o acciones destinadas a la prevención del consumo excesivo de alcohol.

Effects of a School-Based Drug Prevention Program on Sexual Risk Behavior Among Adolescents in Brazilian Schools.

Sexual risk behaviors are closely related to the use of alcohol, tobacco, and other illicit drugs as well as teen dating violence. School-based drug prevention programs that teach social and personal skills could potentially also reduce sexual risk behaviors. We examined the effects of the #Tamojunto program on youth sexual risk behaviors. A randomized controlled trial was conducted with 6391 7th and 8th grade students in 72 public schools in six Brazilian cities. Baseline data were collected prior to program implementation. Two waves of follow-up assessments occurred after 9 and 21 months. Analyses were performed taking into account the multilevel structure of the data. We used intention-to-treat to evaluate changes in the prevalence of sexual risk behaviors over time and between groups. Adolescent age ranged from 11 to 15 years, with a mean of 12.6 ± 0.8 years, and 51.0% were female. Among all participants, receipt of #Tamojunto was associated with higher risk of lifetime sex at 21 months follow-up (OR 1.27, 95% CI [1.03, 1.56]). Among girls, at 9 months follow-up, the program was associated with higher likelihood of having engaged in sex in the last month (OR 1.76, 95% CI [1.13, 2.74]). At 21 months follow-up, girls receiving the program were more likely to report engaging in condomless sex in the last month (OR 1.64, 95% CI [1.07, 2.50]). #Tamojunto may be ineffective and possibly harmful for preventing sexual risk behaviors, especially among girls. We suggest further investigation of the possible mediating role of life skills intervention components on girl's sexual behaviors.

A cluster randomized controlled trial evaluating the effectiveness of the school-based drug prevention program #Tamojunto2.0.

AIMS: The study aimed to evaluate the effectiveness of the government school-based program #Tamojunto2.0, the third Brazilian version of the European drug prevention program, Unplugged, in preventing the use of alcohol and other drugs. DESIGN: A parallel, two-arm cluster randomized controlled trial was conducted in 205 classes in 73 public schools (37 intervention and 36 control) with a baseline assessment and follow-up after 9 months. SETTING: Schools in the cities of São Paulo, Fortaleza and Eusebio in Brazil. PARTICIPANTS: A total of 5208 students in the 8th grade with a mean age of 13.2 years (standard deviation = 0.8 years) and an equal gender ratio. INTERVENTION: In 2019, the intervention group attended 12 classes of the program #Tamojunto2.0, under the supervision of a team from the Ministry of Health. The control group did not receive any intervention to prevent alcohol and drug use. MEASUREMENTS: The primary outcome measured was prevalence of binge drinking (five or more doses of alcohol in an occasion) within the past month. Secondary outcomes were prevalence of initiation and use of alcohol, tobacco, inhalants, marijuana and cocaine within the past month. FINDINGS: A statistically significant difference was not found in the prevalence of binge drinking within the past month between intervention and control groups [odds ratio (OR) = 0.934; 95% confidence interval (CI) = 0.761-1.146]. However, students who were exposed to the program were less likely to initiate alcohol use than those in the control group (OR = 0.782; 95% CI = 0.636-0.961). The Bayes factor for reduction in binge drinking was 0.01, providing evidence in favor of the null hypothesis for this variable. CONCLUSIONS: The drug prevention program #Tamojunto 2.0 reduced alcohol initiation, but appeared not to reduce past-month binge drinking among 8th grade students in Brazil.

Alcohol use during the COVID-19 pandemic in Latin America and the Caribbean / El consumo de alcohol durante la pandemia de COVID-19 en América Latina y el Caribe / Uso de álcool durante a pandemia de COVID-19 na América Latina e no Caribe

ABSTRACT Objective. To assess the association between drinking behaviors during the COVID-19 pandemic and quarantine, anxiety symptoms, and sociodemographic characteristics in Latin America and the Caribbean (LAC). Method. Data was collected through a cross-sectional online survey (non-probabilistic sample) conducted by the Pan American Health Organization between May 22 and June 30, 2020, in 33 countries and two territories of LAC. Participants were 18 years of age or older and must not have traveled outside of their country since March 15, 2020 (n= 12 328, M age= 38.1 years, 65% female). Four drinking behaviors (online socializing drinking [OSD], drinking with child present [DCP], drinking before 5 p.m. [DB5]), heavy episodic drinking [HED]) were response variables, and quarantining, anxiety symptoms and sociodemographic covariables were explanatory variables. Results. Quarantine was positively associated with a higher frequency of OSD and with DCP, but negatively associated with a higher frequency of HED. Anxiety symptoms were associated with a higher frequency of HED, more OSD, and DB5. Higher incomes seemed to be more associated with all the studied drinking behaviors. Women tended to report less DB5 and less HED during the pandemic. Conclusions. Quarantine during the COVID-19 pandemic seems to affect drinking behavior and mental health indicators like anxiety symptoms. This study is the first effort to measure the consequences of the quarantine on alcohol consumption and mental health in LAC during the COVID-19 pandemic. Considering the associations found, screenings and brief interventions targeting alcohol consumption and mental health are recommended.

RESUMEN Objetivo. Evaluar la asociación entre comportamientos relacionados con el consumo de alcohol durante la pandemia de COVID-19 y la cuarentena, los síntomas de ansiedad y las características sociodemográficas en América Latina y el Caribe. Método. Se recopilaron datos mediante una encuesta transversal en línea (muestra no probabilística) realizada por la Organización Panamericana de la Salud entre el 22 de mayo y el 30 de junio del 2020 en 33 países y 2 territorios de América Latina y el Caribe. Los participantes tenían 18 años o más y no tenían que haber viajado fuera de su país después del 15 de marzo del 2020 (n= 12 328, edad M= 38,1 años, 65% mujeres). Las variables de respuesta eran cuatro comportamientos relacionados con el consumo de alcohol: beber socializando en línea, beber en presencia de niños, beber antes de las 5 de la tarde o consumo excesivo episódico. La cuarentena, los síntomas de ansiedad y las covariables sociodemográficas fueron las variables explicativas. Resultados. La cuarentena se relacionó positivamente con una mayor frecuencia de consumo de alcohol socializando en línea y en presencia de niños, pero negativamente con una mayor frecuencia de consumo excesivo episódico. Los síntomas de ansiedad se relacionaron con una mayor frecuencia de consumo excesivo de alcohol, un mayor consumo de alcohol socializando en línea y con beber antes de las 5 de la tarde. Aparentemente los ingresos más altos estuvieron más asociados con todos los comportamientos relacionados con el consumo del alcohol estudiados. Las mujeres tendieron a notificar menos consumo de alcohol antes de las 5 de la tarde y menos consumo excesivo episódico de alcohol durante la pandemia. Conclusiones. La cuarentena durante la pandemia de COVID-19 parece afectar el comportamiento relacionado con el consumo de alcohol y los indicadores de salud mental, como los síntomas de ansiedad. Este estudio es la primera iniciativa para medir las consecuencias de la cuarentena sobre el comportamiento relacionado con el consumo de alcohol y la salud mental en América Latina y el Caribe durante la pandemia de COVID-19. Dadas las asociaciones encontradas, se recomienda llevar a cabo pruebas de tamizaje e intervenciones breves para abordar el consumo del alcohol y la salud mental.

RESUMO Objetivo. Avaliar a associação entre comportamentos relacionados ao uso de álcool durante a pandemia de COVID-19 e quarentena, sintomas de ansiedade e características sociodemográficas na América Latina e no Caribe (ALC). Métodos. Os dados foram coletados em uma pesquisa transversal online (amostra não probabilística) realizada pela Organização Pan-Americana da Saúde (OPAS) em 33 países e dois territórios da ALC entre 22 de maio e 30 de junho de 2020. Participaram da pesquisa pessoas com 18 anos ou mais de idade que não haviam feito viagens ao exterior desde 15 de março de 2020 (n = 12 328, mediana [M] de idade = 38,1 anos, 65% do sexo feminino). Quatro comportamentos relacionados ao uso de álcool (socialização online com o uso de álcool, uso de álcool na presença de crianças, uso de álcool antes das 5 da tarde e episódios de consumo excessivo de álcool) foram as variáveis de resposta e quarentena, sintomas de ansiedade e covariáveis sociodemográficas foram as variáveis explicativas. Resultados. A quarentena teve uma associação positiva com uma maior frequência de socialização online com o uso de álcool e o uso de álcool na presença de crianças, mas demonstrou uma associação negativa com uma maior frequência de episódios de consumo excessivo de álcool. Sintomas de ansiedade foram associados a uma maior frequência de episódios de consumo excessivo de álcool, socialização online com uso de álcool e uso de álcool antes das 5 da tarde. Houve uma aparente associação entre maior nível de renda e todos os comportamentos relacionados ao uso de álcool estudados. As mulheres em geral relataram menos uso de álcool antes das 5 da tarde e menos episódios de consumo excessivo de álcool durante a pandemia. Conclusões. A quarentena durante a pandemia de COVID-19 parece influenciar o comportamento relacionado ao uso de álcool e indicadores de saúde mental, como sintomas de ansiedade. Este é o primeiro estudo que procurou dimensionar a repercussão da quarentena no uso de álcool e na saúde mental das pessoas na ALC durante a pandemia de COVID-19. Diante das associações observadas, recomenda-se rastrear problemas relacionados ao uso de álcool e de saúde mental e oferecer intervenções breves.

Being bullied and using drugs are associate with eating disorder symptoms in Brazilian students.

OBJECTIVE: This study's main purpose is to evaluate factors associated with eating disorder (ED) symptoms among Brazilian adolescents. METHOD: The sample consisted of 5,213 students, mean age 13.24 (SD ±0.01), in the eighth grade of 93 public schools from three Brazilian cities. Data were collected through an anonymous self-report questionnaire, assessing: sociodemographics, use of alcohol, tobacco, illicit drugs, binge drinking, bullying, and ED symptoms. We used confirmatory factor analysis and multivariate linear regression. RESULTS: We found that high levels of bullying victimization, binge drinking and the use of unprescribed weight-loss substances were associated with higher levels of ED symptoms to both genders. However, only among girls, the higher age (ß = .10; 95% CI = 0.02; 0.17) and the use of illicit drugs (ß = .21; 95% CI = 0.094; 0.34) were associated with increase in the ED symptoms. DISCUSSION: We demonstrate a significant association of ED symptoms with drug use and bullying, highlighting the importance of addressing these factors in the development of ED prevention strategies.

Binge drinking and frequent or heavy drinking among adolescents: prevalence and associated factors / Binge drinking e beber frequente ou pesado entre os adolescentes: prevalência e fatores associados

Abstract Objective: To analyze the sociodemographic, school, and family factors associated with the patterns of binge drinking and frequent or heavy drinking among adolescents. Methods: This was a cross-sectional study, nested in a randomized controlled trial, of 6285 seventh and eighth grade adolescent students from Brazilian public schools. The associations between binge drinking (consumption of five or more doses of alcohol on a single occasion) in the last 12 months and frequent or heavy drinking (alcohol consumption on six or more days) in the last month and the several factors were analyzed through weighted logistic regression. Results: 16.5% of the students reported binge drinking in the year before the interview and 2.2% reported frequent/heavy drinking in the previous month. The factors associated with binge drinking were cigarette smoking (OR = 6.7, 95% CI = 3.96; 11.23), use of marijuana (OR = 2.2, 95% CI = 1.17; 4.31), use of inhalant drugs (OR = 3.0, 95% CI = 1.98; 4.43), exposure to a drunk relative (OR = 2.1, 95% C = 1.67; 2.53), practice of bullying (OR = 1.8, 95% CI = 1.47; 2.17), verbal aggression (OR = 1.7, 95%CI = 1.40; 2.14), and intermediate/low school grades (OR = 1.7, 95% CI = 1.35; 2.20). The factors associated with frequent/heavy drinking were cigarette smoking (OR = 2.5, 95% CI = 1.16; 5.22), use of marijuana (OR = 3.2, 95% CI = 1.32; 7.72), and physical aggression (OR = 2.2, 95% CI = 1.36; 3.50). Conclusions: The analyzed outcomes showed an association between the risk consumption of alcohol in early adolescence and low academic performance, involvement with other drugs, aggressiveness, and witnessing episodes of a family member's drunkenness. Considering the impact on public health of the damages caused by alcohol consumption during adolescence, these factors that showed such association should be considered in the development of preventive interventions.

Resumo Objetivo Analisar os fatores sociodemográficos, escolares e familiares associados aos padrões binge drinking, beber frequente ou beber pesado em adolescentes. Métodos Estudo transversal aninhado em ensaio controlado randomizado entre 6.387 estudantes do 7° e 8° anos de escolas públicas brasileiras. Associações entre o binge drinking (consumo de cinco ou mais doses de álcool em uma única ocasião) nos últimos 12 meses e o beber frequente/beber pesado (consumo de álcool em seis ou mais dias) no último mês e os diversos fatores foram analisados por meio de regressão logística ponderada. Resultados Dos estudantes, 16,5% reportaram ter praticado binge drinking no ano anterior à entrevista e 2,2% praticaram beber frequente/beber pesado no último mês. Os fatores associados ao binge drinking foram consumo de cigarro (OR = 6,7, IC95% = 3,96; 11,23), maconha (OR = 2,2, IC95% = 1,17; 4,31), uso de inalantes (OR = 3,0, IC95% = 1,98; 4,43), exposição a algum familiar embriagado (OR = 2,1, IC95% = 1,67; 2,53), prática de bullying (OR = 1,8, IC95% = 1,47; 2,17), agressão verbal (OR = 1,7, IC95% = 1,40; 2,14), notas médias e baixas (OR = 1,7, IC95% = 1,35; 2,20). Os fatores associados ao beber frequente/beber pesado foram o consumo de cigarro (OR = 2,5, IC95% = 1,16; 5,22), maconha (OR = 3,2, IC95% = 1,32; 7,72), agressão física (OR = 2,2, IC95% = 1,36; 3,50). Conclusões Os desfechos analisados evidenciaram associação do consumo de risco de álcool no início da adolescência com o baixo desempenho escolar, envolvimento com outras drogas, agressividade e vivência de episódios de embriaguez dos familiares. Considerando o impacto na saúde pública dos prejuízos decorrentes do consumo de risco de álcool na adolescência, estes fatores que evidenciaram associação devem ser considerados na construção de intervenções preventivas.

Binge drinking and frequent or heavy drinking among adolescents: prevalence and associated factors.

OBJECTIVE: To analyze the sociodemographic, school, and family factors associated with the patterns of binge drinking and frequent or heavy drinking among adolescents. METHODS: This was a cross-sectional study, nested in a randomized controlled trial, of 6285 seventh and eighth grade adolescent students from Brazilian public schools. The associations between binge drinking (consumption of five or more doses of alcohol on a single occasion) in the last 12 months and frequent or heavy drinking (alcohol consumption on six or more days) in the last month and the several factors were analyzed through weighted logistic regression. RESULTS: 16.5% of the students reported binge drinking in the year before the interview and 2.2% reported frequent/heavy drinking in the previous month. The factors associated with binge drinking were cigarette smoking (OR=6.7, 95% CI=3.96; 11.23), use of marijuana (OR=2.2, 95% CI=1.17; 4.31), use of inhalant drugs (OR=3.0, 95% CI=1.98; 4.43), exposure to a drunk relative (OR=2.1, 95% C=1.67; 2.53), practice of bullying (OR=1.8, 95% CI=1.47; 2.17), verbal aggression (OR=1.7, 95%CI=1.40; 2.14), and intermediate/low school grades (OR=1.7, 95% CI=1.35; 2.20). The factors associated with frequent/heavy drinking were cigarette smoking (OR=2.5, 95% CI=1.16; 5.22), use of marijuana (OR=3.2, 95% CI=1.32; 7.72), and physical aggression (OR=2.2, 95% CI=1.36; 3.50). CONCLUSIONS: The analyzed outcomes showed an association between the risk consumption of alcohol in early adolescence and low academic performance, involvement with other drugs, aggressiveness, and witnessing episodes of a family member's drunkenness. Considering the impact on public health of the damages caused by alcohol consumption during adolescence, these factors that showed such association should be considered in the development of preventive interventions.

Decision-making skills as a mediator of the #Tamojunto school-based prevention program: Indirect effects for drug use and school violence of a cluster-randomized trial.

BACKGROUND: The aim of the present study was to evaluate a formal mediation analysis effect of the #Tamojunto program on adolescents' drug use and violent behavior in schools through decision-making skills using a potential outcomes approach. METHODS: An in-cluster randomized controlled trial was conducted in 2014-2015 with 6691 7th- and 8th-grade students in 72 public schools in 6 Brazilian cities to evaluate the effects of the European drug prevention program Unplugged, called #Tamojunto in Brazil. Baseline data were collected prior to program implementation, and follow-up data were collected 9 and 21 months later. Mediation analysis using a potential outcomes approach, in which counterfactuals are modeled if positivity is met, was used to evaluate the indirect effects of the program #Tamojunto on the third-wave of drug use (alcohol, tobacco, marijuana, inhalants, and binge drinking) and school violence (bullying or physical, verbal and sexual aggression) assessment through decision-making skills. RESULTS: When controlling for all covariates, the Total Natural Indirect Effect (TNIE) was significant only for past-year drug use (TNIE = 0.003, 95%CI = 0.001; 0.007). In the adjusted models, 37.5% of the effect of the intervention on drug use was mediated by decision-making skills. CONCLUSIONS: The #Tamojunto program increased drug use through decreasing decision-making skills. The findings demonstrate that this program changes decision-making skills but in the opposite direction proposed by the theoretical model of the program, suggesting that modifications are needed to produce the intended effect of the program.

Evaluating the effects of parenting styles dimensions on adolescent drug use: secondary analysis of #Tamojunto randomized controlled trial.

The present study examined parenting style dimensions (demandingness and responsiveness) as predictors of adolescent drug use and also evaluated whether parenting styles dimensions moderate the effects of the implemented prevention program. 6.391 students in the 7th and 8th grades at 72 Brazilian public schools participated in a three-wave randomized controlled trial to evaluate a school drug-use prevention program. We used structural equation modeling to test if baseline parenting style dimensions (demandingness and responsiveness) would predict the use of drugs (alcohol, binge drinking, cannabis, inhalants, and tobacco) after 21 months. Additionally, we evaluated an interaction version of the above-described model to test if the effect of the prevention program would be moderated by either or both parenting style dimensions. Higher levels of parent demandingness predicted lower chances of adolescent drug use (e.g., Cigarette use OR 0.76, 95% CI 0.64-0.89); responsiveness on the five outcomes showed p value superior to 0.01. The effect of the #Tamojunto intervention is unlikely to be conditioned to either parenting style dimensions on the assessed outcomes.Clinical trial registration Brazilian Register of Clinical Trials (REBEC): #RBR-4mnv5g ( https://www.ensaiosclinicos.gov.br/rg/?q=tamojunto ).

Randomized clinical trial to change parental practices for drug use in a telehealth prevention program: a pilot study / Ensaio clínico randomizado para mudar as práticas de uso de drogas dos pais em um programa telessaúde de prevenção: estudo piloto

Abstract Objectives: Programs for parents have been found to have a direct positive impact on reducing the consumption of psychoactive substances by adolescents, as well as having an indirect impact on reducing risk factors and increasing protective factors. The present study aimed to verify if a telehealth prevention program based on a brief motivational intervention helps to reduce parental risk practices and increase parental protective practices for drug use in comparison with psychoeducation. Methods: A pilot randomized controlled trial was performed at the National Service of Guidance and Information on Drug Use (Ligue 132), from September 2014 to December 2015, with the parents of adolescents (n = 26). The outcome measures were parental style, risk, and protective parental practices. Results: The brief motivational intervention was found to be more effective than psychoeducation in reducing the negligent behavior of parents. Furthermore, when comparing pre‐ and post‐intervention data, the brief motivational intervention helped to change parental style and the large majority of parental practices: increasing positive monitoring, as well as decreasing physical abuse, relaxed discipline, inconsistent punishment, and negative monitoring. Conclusions: These results demonstrate that the telehealth intervention is effective in modifying the parental practices known to help in preventing drug use. Studies with more number of subjects are required so that the results can be substantiated and generalized.

Resumo Objetivos: Os programas para pais parecem ter um impacto positivo direto sobre a redução do consumo de substâncias psicoativas por adolescentes, bem como um impacto indireto sobre a redução dos fatores de risco e aumento dos fatores protetores. O presente estudo visou a verificar se um programa telessaúde de prevenção com base em uma intervenção breve motivacional ajuda a reduzir as práticas de risco dos pais e aumentar as práticas protetoras com relação ao uso de drogas, em comparação à psicoeducação. Métodos: Um ensaio piloto controlado randomizado foi feito no Serviço Nacional de Informações e Orientações sobre Drogas (Ligue 132), de setembro de 2014 a dezembro de 2015, com os pais de adolescentes (n = 26). As medições dos resultados foram o estilo dos pais e as práticas de risco e protetoras dos pais. Resultados: A intervenção breve motivacional parece ser mais eficaz do que a psicoeducação na redução dos comportamentos negligentes dos pais. Adicionalmente, quando comparada aos dados pré e pós-intervenção, a intervenção breve motivacional ajudou a mudar o estilo dos pais e a grande maioria das práticas dos pais: aumentou o monitoramento positivo e reduziu o abuso físico, disciplina permissiva, punição não condizente e monitoramento negativo. Conclusões: Esses resultados demonstram que a intervenção telessaúde é eficaz na mudança das práticas dos pais, conhecida por ajudar a prevenir o uso de drogas. Estudos com maior número de indivíduos são necessários para que os resultados possam ser comprovados e generalizados.

The role of normative beliefs in the mediation of a school-based drug prevention program: A secondary analysis of the #Tamojunto cluster-randomized trial.

AIMS: To investigate the mediating effects of normative beliefs of drug use on the effects of the #Tamojunto school-based prevention program (Unplugged). DESIGN: Secondary analysis of a cluster randomized controlled trial. SETTING: Brazil. Participants: A total of 6,391 adolescents (12.68 y.o) from 72 public schools in 6 Brazilian cities. Intervention: Schools were assigned to an experimental condition (#Tamojunto curriculum) or a control condition (no prevention program). Measurements: Baseline data were collected prior to program implementation, and follow-up data were collected 9 and 21 months later. The substances examined were alcohol (including binge drinking), tobacco, marijuana and inhalants. Five in-parallel mediation models evaluated whether the positive and negative beliefs were mediators of the likely effects of the intervention on drug use. FINDINGS: Lack of evidences regarding differences in normative beliefs or drug use were found between the intervention and control groups. However, there was a clear association between negative drug beliefs and lower consumption (i.e. OR = 0.78; 95% CI 0.70; 0.87, for cannabis use) as well as between positive drug beliefs and higher consumption (i.e. OR = 1.77; 95% CI 1.56; 2.02, for cannabis use) independent of the assigned group. CONCLUSIONS: These results suggest that there is a lack of evidence that the program impact the normative beliefs, as proposed by the theoretical model of the program, suggesting that modifications are needed to produce the intended effect of the program. Negative normative beliefs seem to be a potential protective factor for drug use, but the program's effect itself on drug use via normative beliefs was not found to be statistically significant. Program activities intended to affect normative beliefs should be improved.

Effectiveness evaluation of the school-based drug prevention program #Tamojunto in Brazil: 21-month follow-up of a randomized controlled trial.

INTRODUCTION: A school-based randomized controlled trial was conducted in 2014/2015 with students in 7th and 8th grades in 72 public schools in 6 Brazilian cities. A total of 5028 students were linked (75, 7%) in at least one of the two waves of follow-up (9 months and 21 months later). The principal research question was whether this 12-lesson program delays the initiation of alcohol, tobacco, inhalants and binge drinking among early adolescents when compared to usual care, that is, no prevention program in Brazilian schools, after 21 months of follow up. METHODS: Cox regression models were adjusted to evaluate the incidence of drug use. Generalized linear latent mixed models (GLLAMM) were used to evaluate changes in the prevalence of each drug over time and between groups. Findings The incidence analysis showed a negative effect of the program for alcohol initiation (aHR = 1.13, 95%CI 1.01; 127) but an opposite protective effect for the initiation of inhalant use (aHR = 0.79, 95%CI 0.66; 0.95). After 21 months, the prevalence of past-year use of alcohol changed from 30.1% to 49.8% in the intervention group and from 29.9% to 45.8% in the control group. Adolescents in the intervention group were 30% more likely to have reported past-year use of alcohol than students in the control group at 21 months (aOR = 1.30, 95%CI 1.02; 1.65). No effects of the program on past-month drug use were found. The Brazilian version of the Unplugged program may be misinterpreted by public school students, perhaps arousing their curiosity regarding alcohol use.

A latent transition analysis of a cluster randomized controlled trial for drug use prevention.

OBJECTIVE: The objective of the study was to evaluate the impact of #Tamojunto, a Brazilian adaptation of the Unplugged prevention program, on patterns of drug use among adolescents and to characterize their trajectories of drug use over time. METHOD: An in-cluster randomized controlled trial was conducted in 2014-2015 with 2 parallel arms (intervention and control). The intervention group attended 12 weekly classes of the #Tamojunto intervention. The control schools did not offer a prevention program. The target population was students attending seventh and eighth grades. The primary dichotomous outcome measures were use of drugs (any alcohol use, binge drinking, tobacco, marijuana, inhalants, and cocaine) in the past year assessed using a questionnaire before intervention and in 2 waves of follow-up (9 and 21 months). RESULTS: A latent transition analysis in 6,391 students from 72 public schools in 6 Brazilian cities revealed 3 distinct patterns of drug use behavior: abstainers/low users (81.54% at baseline, 70.61% after 21 months), alcohol users/binge drinkers (16.65% at baseline, 21.45% after 21 months), and polydrug users (1.80% at baseline, 7.92% after 21 months). No differences in the probabilities of transitions between these drug use patterns were found between the intervention and control groups. The most likely trajectory was no transition between patterns, regardless of the intervention and baseline pattern. CONCLUSIONS: The intervention was not successful in changing adolescent drug use patterns over time, showing that the components of the Brazilian adaptation of the Unplugged prevention program should be reevaluated. (PsycINFO Database Record

The #Tamojunto Drug Prevention Program in Brazilian Schools: a Randomized Controlled Trial.

A randomized controlled trial was conducted in 2014 with 7th and 8th grade students from 72 public schools in 6 Brazilian cities. This trial aimed to evaluate the effects of an adapted European school-based drug prevention program Unplugged, called #Tamojunto in Brazil, which was implemented by the Ministry of Health as part of public policy. The experimental group (n = 3340) attended 12 classes in the #Tamojunto program, and the control group (n = 3318) did not receive a school prevention program. Baseline data were collected prior to program implementation, and follow-up data were collected 9 months later, allowing a matching of 4213 adolescents in both waves. The substances examined were alcohol, tobacco, marijuana, inhalants, cocaine, and crack. Multilevel analyses were used to evaluate the changes in consumption of each drug between time points and between groups. The intervention and control groups had similar baseline characteristics. The mean age of the adolescents was 12.5 ± 0.7 years, and 51.3% were female. The program seemed to increase alcohol use initiation (first alcohol use); students in the experimental group had a 30% increased risk of initiating alcohol use during the 9-month follow-up (aRR = 1.30, 95% confidence interval (95%CI) 1.13-1.49, p < 0.001) compared to the control group. The opposite was found for the first inhalant use: the risk of using inhalants for the first time after baseline was lower in the experimental group (aRR = 0.78, 95%CI 0.63-0.96, p = 0.021) than the control group. The results of the #Tamojunto program suggest that the content and lessons regarding alcohol may enhance curiosity about its use among adolescents. We suggest a re-evaluation of the expansion of the #Tamojunto program in schools while analyzing why the program's effects were inconsistent with those of previous European studies.