The relative contribution of ethnic identity and ethnic discrimination on alcohol, tobacco, and other drug use disorders among Hispanic/Latin American individuals.

INTRODUCTION: Racial/ethnic discrimination and ethnic identity, the affiliation and connection to one's ethnic group, are important for understanding alcohol, tobacco, and drug use disorders (AUD, TUD, DUD, respectively) among Hispanic/Latin American individuals. Although discrimination is a well-recognized risk factor, the role of ethnic identity is less understood. Moreover, no study has examined which of these factors is more important for informing AUD, TUD, and DUD. This information is necessary for creating effective prevention and treatment programs tailored for Hispanic/Latin American people. Herein we examined the role and relative importance of racial/ethnic discrimination and Hispanic ethnic identity on past year AUD, TUD, and DUD. METHODS: Hispanic/Latin American participants of the National Epidemiologic Survey on Alcohol and Related Conditions-III constituted the sample for this cross-sectional secondary data analysis. Participants (N = 7037) were 39.93 years old on average (SD = 15.32). More than half were female (56.1 %) and had family incomes below the median household income in the United States (58.7 %). Most had national origins in North America (79.3 %), including US dependent territories and Mexico. Confirmatory factor analysis (CFA) verified the psychometric properties of the discrimination and Hispanic ethnic identity measures. Logistic regressions, supplemented with dominance analysis, estimated the role and relative contribution of discrimination and Hispanic ethnic identity on the probability of past year AUD, TUD, and DUD. RESULTS: The CFAs yielded adequate convergent validity and reliability for each construct. More racial/ethnic discrimination and a higher Hispanic ethnic identity related to a higher and lower probability of AUD, TUD, and DUD, respectively. The magnitude of the association between Hispanic ethnic identity and the probability of TUD exceeded that of racial/ethnic discrimination, but the converse was the case for AUD and DUD. CONCLUSIONS: Prevention and treatment programs for TUD that highlight the value of having a strong sense of self as a member of a Hispanic ethnic group, and that encourage the individual to explore their Hispanic ancestry may prove effective among Hispanic/Latin American individuals, particularly those who have experienced racial/ethnic discrimination. Programs for AUD and DUD tailored for Hispanic Latin/American adults should also incorporate coping strategies to address experiences with racial/ethnic discrimination.

Genetic liability for substance use associated with medical comorbidities in electronic health records of African- and European-ancestry individuals.

Polygenic risk scores (PRS) represent an individual's summed genetic risk for a trait and can serve as biomarkers for disease. Less is known about the utility of PRS as a means to quantify genetic risk for substance use disorders (SUDs) than for many other traits. Nonetheless, the growth of large, electronic health record-based biobanks makes it possible to evaluate the association of SUD PRS with other traits. We calculated PRS for smoking initiation, alcohol use disorder (AUD), and opioid use disorder (OUD) using summary statistics from the Million Veteran Program sample. We then tested the association of each PRS with its primary phenotype in the Penn Medicine BioBank (PMBB) using all available genotyped participants of African or European ancestry (AFR and EUR, respectively) (N = 18,612). Finally, we conducted phenome-wide association analyses (PheWAS) separately by ancestry and sex to test for associations across disease categories. Tobacco use disorder was the most common SUD in the PMBB, followed by AUD and OUD, consistent with the population prevalence of these disorders. All PRS were associated with their primary phenotype in both ancestry groups. PheWAS results yielded cross-trait associations across multiple domains, including psychiatric disorders and medical conditions. SUD PRS were associated with their primary phenotypes; however, they are not yet predictive enough to be useful diagnostically. The cross-trait associations of the SUD PRS are indicative of a broader genetic liability. Future work should extend findings to additional population groups and for other substances of abuse.

Significados do alcoolismo em uma reunião feminina de Alcoólicos Anônimos na cidade de São Paulo, SP, Brasil / Meanings of alcoholism in a women-only Alcoholics Anonymous in São Paulo, SP, Brazil / Significados del alcoholismo en una reunión femenina de Alcohólicos Anónimos en la ciudad de São Paulo, SP, Brasil

O objetivo deste artigo é compreender os significados do alcoolismo de uma maneira êmica, isto é, tal como ele é concebido e vivenciado por mulheres que frequentam uma reunião feminina de Alcoólicos Anônimos (AA). Realizou-se uma pesquisa qualitativa, de abordagem etnográfica, em uma reunião exclusiva de mulheres em um grupo localizado na cidade de São Paulo, Brasil. O alcoolismo está ligado às assimetrias de gênero, que estabelecem uma diferença entre homens e mulheres em relação ao uso de bebidas alcoólicas, de modo que a reunião feminina de AA possui uma dimensão política que se contrapõe à cultura patriarcal de AA ao garantir às mulheres um espaço de gênero, moral e politicamente, privilegiado para que elas possam compartilhar e significar suas experiências e, por essa via, realizar seu tratamento do alcoolismo.(AU)

The aim of this emic study of alcoholism was to understand how this problem is conceived and experienced by women attending a women-only Alcoholics Anonymous (AA) meeting. We conducted an ethnographic study with a women's AA group in São Paulo, Brazil. Alcoholism is linked to gender asymmetries, which establish a difference between men and women in relation to drinking. Women-only AA meetings therefore possess a political dimension that counterposes AA's patriarchal culture by providing women with a morally and politically unique gendered space that allows them to share and signify their experiences and, in this way, treat their alcoholism.(AU)

El objetivo de este artículo es comprender los significados del alcoholismo de una manera émica, es decir, tal como es concebido y vivido por mujeres que frecuentan una reunión femenina de Alcohólicos Anónimos (AA). Se realizó una investigación cualitativa, de abordaje etnográfico, en una reunión exclusiva de mujeres en un grupo localizado en la Ciudad de São Paulo, Brasil. El alcoholismo está vinculado a las asimetrías de género que establecen una diferencia entre hombres y mujeres con relación al uso de bebidas alcohólicas, de modo que la reunión femenina de AA tiene una dimensión política que se contrapone a la cultura patriarcal de AA al asegurar a las mujeres un espacio de género, moral y políticamente privilegiado para que ellas puedan compartir y significar sus experiencias y, por esa vía, realizar su tratamiento del alcoholismo.(AU)

Ranking lifestyle risk factors for cervical cancer among Black women: A case-control study from Johannesburg, South Africa.

BACKGROUND: Aside from human papillomavirus (HPV), the role of other risk factors in cervical cancer such as age, education, parity, sexual partners, smoking and human immunodeficiency virus (HIV) have been described but never ranked in order of priority. We evaluated the contribution of several known lifestyle co-risk factors for cervical cancer among black South African women. METHODS: We used participant data from the Johannesburg Cancer Study, a case-control study of women recruited mainly at Charlotte Maxeke Johannesburg Academic Hospital between 1995 and 2016. A total of 3,450 women in the study had invasive cervical cancers, 95% of which were squamous cell carcinoma. Controls were 5,709 women with cancers unrelated to exposures of interest. Unconditional logistic regression models were used to calculate adjusted odds ratios (ORadj) and 95% confidence intervals (CI). We ranked these risk factors by their population attributable fractions (PAF), which take the local prevalence of exposure among the cases and risk into account. RESULTS: Cervical cancer in decreasing order of priority was associated with (1) being HIV positive (ORadj = 2.83, 95% CI = 2.53-3.14, PAF = 17.6%), (2) lower educational attainment (ORadj = 1.60, 95% CI = 1.44-1.77, PAF = 16.2%), (3) higher parity (3+ children vs 2-1 children (ORadj = 1.25, 95% CI = 1.07-1.46, PAF = 12.6%), (4) hormonal contraceptive use (ORadj = 1.48, 95% CI = 1.24-1.77, PAF = 8.9%), (5) heavy alcohol consumption (ORadj = 1.44, 95% CI = 1.15-1.81, PAF = 5.6%), (6) current smoking (ORadj = 1.64, 95% CI = 1.41-1.91, PAF = 5.1%), and (7) rural residence (ORadj = 1.60, 95% CI = 1.44-1.77, PAF = 4.4%). CONCLUNSION: This rank order of risks could be used to target educational messaging and appropriate interventions for cervical cancer prevention in South African women.

Type D personality and metabolic syndrome among Finnish female municipal workers.

BACKGROUND: Type D personality is a combination of high negative affectivity (NA) and high social inhibition (SI). This personality trait is suspected to impair cardiovascular patients' recovery. The 2016 European Guidelines on cardiovascular disease prevention in clinical practice recommend screening of psychosocial risk factors as Type D personality. The aim of this study was to assess the relationship between Type D personality and Metabolic syndrome (MetS) in working-age female population. METHODS: Six hundred thirty-four female employees with mean age of 48 ± 10 years were evaluated. Type D personality and its components (NA) and (SI) were screened with DS14 questionnaire. The definition of MetS was based on measurements done by trained medical staff. We investigated the relationship between Mets and Type D personality, NA and SI using the logistic regression models adjusting for age, education years, leisure-time physical activity, smoking, alcohol use and depressive symptoms. RESULTS: The prevalence of Type D personality was 10.6% (n = 67) [95% CI: 8.3 to 13.2] and MetS 34.7% (n = 220). Type D personality or its subcomponents were not associated with MetS. Women with Type D personality had significantly worse quality of sleep and lower LTPA. They were also more often unsatisfied with their economic situation, they had more often depressive symptoms and psychiatric disorders than non-D type persons. There were no differences in risk factors for cardiovascular diseases. CONCLUSION: Screening for Type D personality among working- age, reasonably healthy female population seems not to be practical method for finding persons with risk for cardiovascular disease.

Contribution of Alcohol and Nicotine Dependence to the Prevalence of Depressed Mood in Different Ethnic Groups in The Netherlands: The HELIUS Study.

Objective: Ethnic minorities report different levels of drinking and smoking and higher rates of depression compared to native populations. In this study we aimed to investigate in six ethnic groups whether tobacco and alcohol use were associated with depressive symptoms, which are more prevalent in ethnic minorities.Methods: Cross-sectional data from the multi-ethnic Healthy Life in an Urban Setting (HELIUS) study sample (N = 22,471) was used, comprising 4,580 native Dutch participants which were compared with participants from five ethnic minority groups (3,259 South Asian Surinamese, 4,292 African Surinamese, 2,262 Ghanaian, 3,891 Turkish, and 4,187 Moroccan).Results: Alcohol misuse was positively associated with depressed mood in all ethnic groups except for the Dutch and the Ghanaians. Nicotine dependence was positively associated with depressed mood in all ethnic groups except for the Ghanaian group.Conclusions: Alcohol misuse and nicotine dependence were significantly associated with depressed mood in most but not all ethnic groups and especially in men. However, across all groups the contribution of alcohol misuse and nicotine dependence to depressed mood was small. Prospective multi-ethnic studies should confirm whether the relations are causal and elucidate their direction.

Do stress, life satisfaction, depression and alcohol use predict quitting among Aboriginal and Torres Strait Islander smokers?

OBJECTIVE: To examine whether baseline measures of stress, life satisfaction, depression and alcohol use predict making or sustaining quit attempts in a national cohort of Aboriginal and Torres Strait Islander smokers. METHODS: We analysed data from the nationally representative quota sample of 1,549 Aboriginal and Torres Strait Islander adults who reported smoking at least weekly in the Talking About The Smokes baseline survey (April 2012-October 2013) and the 759 who completed a follow-up survey a year later (August 2013-August 2014). RESULTS: More smokers who reported negative life satisfaction, feeling depressed, higher stress or drinking heavily less often than once a week at baseline made a quit attempt between the baseline and follow-up surveys. In contrast, of these smokers who had made quit attempts between surveys, more who reported higher stress were able to sustain abstinence for at least one month; other associations were inconclusive. Conclusions and implications for public health: Health staff and Aboriginal and Torres Strait Islander smokers need not see being more stressed as an obstacle to quitting among Aboriginal and Torres Strait Islander people. Health staff should emphasise the benefits to mental health that come with successfully quitting smoking.

Substance Use Outcomes for Hispanic Emerging Adults Exposed to Incarceration of a Household Member during Childhood.

This study investigates whether Hispanic emerging adults exposed to household incarceration before age 18 report higher rates of past 30-day cigarette, alcohol, binge drinking, marijuana use, and negative substance use consequences, relative to participants not exposed to incarceration of a household member. Respondents were matched on key characteristics to create balanced groups of exposed and nonexposed respondents. Negative binomial regression models assessed primary research questions. There were significant long-term associations between household incarceration and the frequency of past 30-day binge drinking, marijuana use, and number of negative substance use consequences. Policies and health programs addressing household incarceration may be a promising prevention approach to reduce negative substance use outcomes among Hispanic emerging adults.

What is the alcohol, tobacco, and other drug prevalence among culturally and linguistically diverse groups in the Australian population? A national study of prevalence, harms, and attitudes.

In Australia, one in three people are born overseas, and one in five households speak languages other than English. This study explores substance use prevalence, related harms, and attitudes among these large groups in the population. Analysis was conducted using cross-sectional data (N = 22, 696) from the 2013 National Drug Strategy Household Survey. General linear model and binary logistic regression were used to assess substance use and harms, using stabilized inverse propensity score weighting to control for potential confounding variables. Between culturally and linguistically diverse populations and the population born in Australia, United Kingdom, or New Zealand who speak only English at home, there is no statistically significant variation in the likelihood of current smoking; using analgesics, tranquilizers, or sleeping pills; or administering drugs via injection. Culturally diverse populations are less likely to drink alcohol or use cannabis or methamphetamines. No difference between these two major groups in the population is observed in substance-related abuse from strangers; but culturally diverse respondents are less likely to report substance-related abuse from known persons. Lower substance use prevalence is not observed among people from culturally diverse backgrounds who have mental health issues. Australian-, UK-, or New Zealand-born respondents who speak only English at home are more likely to oppose drug and tobacco policies, including a range of harm reduction policies. We discuss the practical and ethical limitations of this major Australian data set for examining the burden of drug-related harms experienced by specific migrant populations. Avenues for potential future research are outlined.

Modeling Heterogeneous Peer Assortment Effects Using Finite Mixture Exponential Random Graph Models.

This article develops a class of models called sender/receiver finite mixture exponential random graph models (SRFM-ERGMs). This class of models extends the existing exponential random graph modeling framework to allow analysts to model unobserved heterogeneity in the effects of nodal covariates and network features without a block structure. An empirical example regarding substance use among adolescents is presented. Simulations across a variety of conditions are used to evaluate the performance of this technique. We conclude that unobserved heterogeneity in effects of nodal covariates can be a major cause of misfit in network models, and the SRFM-ERGM approach can alleviate this misfit. Implications for the analysis of social networks in psychological science are discussed.

Genome-wide Association Study of Maximum Habitual Alcohol Intake in >140,000 U.S. European and African American Veterans Yields Novel Risk Loci.

BACKGROUND: Habitual alcohol use can be an indicator of alcohol dependence, which is associated with a wide range of serious health problems. METHODS: We completed a genome-wide association study in 126,936 European American and 17,029 African American subjects in the Veterans Affairs Million Veteran Program for a quantitative phenotype based on maximum habitual alcohol consumption. RESULTS: ADH1B, on chromosome 4, was the lead locus for both populations: for the European American sample, rs1229984 (p = 4.9 × 10-47); for African American, rs2066702 (p = 2.3 × 10-12). In the European American sample, we identified three additional genome-wide-significant maximum habitual alcohol consumption loci: on chromosome 17, rs77804065 (p = 1.5 × 10-12), at CRHR1 (corticotropin-releasing hormone receptor 1); the protein product of this gene is involved in stress and immune responses; and on chromosomes 8 and 10. European American and African American samples were then meta-analyzed; the associated region at CRHR1 increased in significance to 1.02 × 10-13, and we identified two additional genome-wide significant loci, FGF14 (p = 9.86 × 10-9) (chromosome 13) and a locus on chromosome 11. Besides ADH1B, none of the five loci have prior genome-wide significant support. Post-genome-wide association study analysis identified genetic correlation to other alcohol-related traits, smoking-related traits, and many others. Replications were observed in UK Biobank data. Genetic correlation between maximum habitual alcohol consumption and alcohol dependence was 0.87 (p = 4.78 × 10-9). Enrichment for cell types included dopaminergic and gamma-aminobutyric acidergic neurons in midbrain, and pancreatic delta cells. CONCLUSIONS: The present study supports five novel alcohol-use risk loci, with particularly strong statistical support for CRHR1. Additionally, we provide novel insight regarding the biology of harmful alcohol use.

Developing an ecological framework of factors associated with substance use and related harms among Aboriginal and Torres Strait Islander people: protocol for a systematic review.

INTRODUCTION: Aboriginal and Torres Strait Islander people experience high rates of substance use and related harms. Previous prevention programmes and policies have met with limited success, particularly among youth, and this may be a result of inadequately targeting the unique risk and protective factors associated with substance use for Aboriginal and Torres Strait Islander people. The purpose of this systematic review is to therefore synthesise the risk and protective factors associated with substance use and related harms among Aboriginal and Torres Strait Islander people, and critically appraise the methodological quality of the included studies. METHODS AND ANALYSIS: A total of seven peer-reviewed (Cochrane, Embase, PsychInfo, Medline, ProQuest, Informit, and CINAHL) and two grey literature (Heath InfoNet and Closing the Gap Clearinghouse) databases will be systematically searched using search terms in line with the aims of this review and based on previous relevant reviews. Studies published between 1 January 1990 and 31 April 2018 will be included if they identify risk and/or protective factors for substance use or related harms in a study sample that consists of at least 50% Aboriginal and Torres Strait Islander people. A narrative synthesis will be undertaken where the identified factors will be organised using an ecological approach into individual, relationship, community, societal and cultural levels. A critical appraisal of study quality will be conducted using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data and the qualitative assessment tool by Godfrey and Long. ETHICS AND DISSEMINATION: Formal ethics approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publication, conference presentations and social media. PROSPERO REGISTRATION NUMBER: CRD42017073734.

Stress and Resilience: Key Correlates of Mental Health and Substance Use in the Hispanic Community Health Study of Latino Youth.

This study examined associations of immigrant generation, acculturation, and sources of stress and resilience with four outcomes-depression symptoms, anxiety symptoms, alcohol susceptibility, and smoking susceptibility. We used data from 1466 youth (ages 8-16) enrolled in the Hispanic Community Health Study of Latino Youth (SOL Youth), a probability sample of Hispanic/Latino youth living in Chicago (IL), Miami (FL), Bronx (NY), and San Diego (CA). We found no evidence of an immigrant paradox. Greater children's acculturative stress was associated with depression/anxiety symptoms; greater parent's acculturative stress was associated with smoking susceptibility. Family functioning and children's ethnic identity were associated with fewer depression/anxiety symptoms and lower alcohol/smoking susceptibility. Although acculturation-related stressors increase youths' risks for poor mental health and substance use, the development of positive ethnic identities and close, well-functioning family support systems can help protect Latino/Hispanic children from the negative behavioral and health-related consequences of stress.

Impairment of functioning and substance use in a Latino population.

This study investigated the association of academic outcomes, romantic relationships, and substance use (tobacco, marijuana, cocaine) with alcohol dependence in a sample of Latino (N = 1,143) college students. Secondary data analysis was conducted on measures of grade point average in college, relationship satisfaction, drug use, and alcohol dependence. Latino college students who reported alcohol dependency had significant relational dissatisfaction and poor academic outcomes. Thus, lower grade point average and relationship dissatisfaction were associated with alcohol dependence. By focusing specifically on a Mexican American population, this study adds important information to current research regarding the commonality and differences across cultural groups regarding drug use and dependence and further clarifies the risk factors associated with substance use and dependency in a population that is vulnerable for at-risk behaviors. This study also offers insight into potential targets of treatment and intervention for this cultural group.

Onset, Comorbidity, and Predictors of Nicotine, Alcohol, and Marijuana Use Disorders Among North American Indigenous Adolescents.

North American Indigenous (i.e., American Indian and Canadian First Nations) youth experience inequities in rates of substance abuse and dependence. Despite this, few longitudinal studies examine the developmental course of substance use disorders (SUD) among community-based samples of Indigenous youth. The purpose of the study was to examine onset and predictors of nicotine dependence, alcohol use disorders, marijuana use disorders, any SUD, and multiple SUDs across the entire span of adolescence among a longitudinal sample (N = 744) of reservation/reserve Indigenous youth in the upper-Midwest of the United States and Ontario, Canada. Using discrete time survival analysis, the results show that rates of meeting criteria for SUDs by late adolescence were 22% for nicotine, 43% for alcohol, and 35% for marijuana. Peak periods of risk for new nicotine dependence and marijuana use disorder cases occurred around 14 years of age, whereas peak periods of risk for new alcohol use disorder cases emerged slightly later around 16 years of age. We found high rates of SUD comorbidity, and the cumulative probability of developing two or more SUDs during adolescence was 31%. Internalizing disorders increased the odds of nicotine dependence and multiple SUDs, while externalizing disorders increased the odds of all outcomes except nicotine dependence. Gender, age, and per capita family income were inconsistently associated with SUD onset. The findings are embedded within broader substance use patterns identified among Indigenous youth, and prevention, intervention, and treatment implications are discussed.

Significados en torno al desarrollo del consumo problemático y la dependencia alcohólica en comunidades mapuches rurales de la región de la Araucanía, Chile, 2016-2017 / Meanings regarding the development of problematic consumption and alcohol dependence in rural Mapuche communities of the Araucanía region, Chile, 2016-2017

RESUMEN Esta investigación indaga las concepciones, significados y prácticas involucradas en el desarrollo del consumo problemático y la dependencia alcohólica en comunidades mapuches rurales del sur de Chile, en los años 2016 y 2017. Se caracterizan significados en torno al consumo de riesgo, escenarios y procesos protectores de la salud y de riesgo, e identifican elementos socioculturales para la proyección de actuaciones preventivas. La metodología empleada fue de tipo cualitativa-etnográfica. Se realizaron nueve entrevistas en profundidad a personas adultas con consumo de riesgo, recuperadas y no consumidoras de alcohol, y observaciones etnográficas en talleres participativos con la comunidad. Los resultados vinculan procesos de transculturación, pérdida y vitalidad cultural a dinámicas sociorelacionales que están en la base del desarrollo del consumo problemático de alcohol, lo que configura un escenario de alta complejidad que requiere, en su abordaje, la superación de la dicotomía factores de riesgo/protección.

ABSTRACT This research looks in to the conceptions, meanings and practices involved in the development of problematic consumption and alcohol dependence in rural Mapuche communities in southern Chile in the years 2016-2017. It characterizes the meanings surrounding at-risk consumption as well as scenarios and processes that protect health and those that facilitate risk, and identifies sociocultural elements to potentiate preventive actions. The methodology used was qualitative-ethnographic. Nine in-depth interviews were conducted with adults with at-risk consumption, recovered alcohol users, and non-consumers of alcohol, and ethnographic observations were carried out in participatory workshops with the community. The results link processes of transculturation, loss and cultural vitality with socio-relational dynamics that are at the base of the development of problematic alcohol consumption, marking a scenario of high complexity that requires overcoming the traditional dichotomy of risk/protection factors.

Moralidades sobre o uso problemático de álcool em uma unidade da Estratégia Saúde da Família no Rio de Janeiro / Moralities about problematic alcohol use in a unit of the Family Health Strategy in Rio de Janeiro

Neste trabalho, analiso as práticas e os discursos de profissionais de saúde de uma unidade da Estratégia Saúde da Família (ESF) do município do Rio de Janeiro - RJ em relação ao uso de álcool. Realizei uma pesquisa etnográfica nessa unidade de saúde ao longo de cinco meses, de agosto a dezembro de 2018, que incluiu observação-participante na unidade, nas salas de reuniões, nas consultas e no território adscrito, além de entrevistas semiestruturadas com nove profissionais de saúde dessa unidade. O uso de álcool é um ato social muito difundido e aceito em diversos contextos. Pela sua variabilidade social, podemos nos referir no plural a usos de álcool. Determinados padrões desses usos são considerados como problema de saúde, caracterizando o diagnóstico de uso problemático de álcool. Este foi escolhido como recorte para compreender as moralidades que atravessam as práticas dos profissionais da unidade onde realizei esta pesquisa. O uso problemático de álcool contempla uma ampliação da classificação médica relacionada ao uso de álcool considerado desviante, que foi definido anteriormente, de forma mais restrita, como alcoolismo. Diversas publicações na área da saúde assinalam que, considerando as estimativas epidemiológicas, o uso problemático de álcool é pouco diagnosticado e, consequentemente, uma proporção significativa de pessoas que poderiam ser classificadas de acordo com esse diagnóstico não estão recebendo o tratamento que seria indicado. Nesta pesquisa, busquei problematizar a produção de conhecimento hegemônica no campo da saúde e estranhar práticas que eram familiares para mim. Os dados produzidos referem-se às especificidades da realidade do local onde realizei a pesquisa e foram contextualizados em relação às políticas de saúde do SUS e da Estratégia Saúde da Família, as publicações da Organização Mundial de Saúde (OMS) e no campo da Saúde Mental Global (SMG). Esses dados foram analisados a partir de dois eixos temáticos e suas subdivisões. O primeiro dele refere-se à interface do controle e do cuidado nos seguintes níveis: individual, familiar e comunitário. O segundo eixo temático contempla uma compreensão dessas moralidades a partir dos conceitos de desvio (BECKER, 2008), acusação (VELHO, 2003), estigma (GOFFMAN, 2002) e medicalização (CONRAD, 2007)

In this work, I analyze the practices and speeches of health professionals from a unit of the Family Health Strategy of the municipality of Rio de Janeiro - RJ in relation to alcohol use. I carried out an ethnographic research in this health unit over a period of five months, from August to December 2018, which included participant observation in the unit, in the meeting rooms, in the consultations and in the assigned territory, as well as semi-structured interviews with nine health professionals of this unit. The use of alcohol is a very widespread and accepted social act in many contexts. By its social variability, we can refer in the plural to uses of alcohol. Certain patterns of these uses are considered as a health problem, characterizing the diagnosis of problematic alcohol use. This was chosen as a category to understand the moralities that cross the practices of the professionals of the unit where I carried out this research. The problematic alcohol use contemplates an amplification of the medical classification related to the use of alcohol considered deviant, which was previously defined, more restrictively, as alcoholism. Several publications in the health area indicate that, considering epidemiological estimates, the problematic alcohol use is poorly diagnosed and, consequently, a significant proportion of people that could be classified according to this diagnosis is not receiving the treatment that would be indicated. In this research, I tried to problematize the production of hegemonic knowledge in the field of health and to describe, from another perspective, practices that were familiar to me. The data produced refer to the specificity of the reality of the place where the research was carried out and were contextualized in relation to the Brazilian National Health System (SUS) and Family Health Strategy (FHS) policies, World Health Organization (WHO) publications and in the field of Global Mental Health (GMH). These data were analyzed on two thematic axes and their subdivisions. The first one refers to the interface of control and care at the following levels: individual, family and community. The second thematic axis contemplates an understanding of these moralities from the concepts of deviance (BECKER, 2008), accusation (VELHO, 2003), stigma (GOFFMAN, 2002) and medicalization (CONRAD, 2007)

Standardised alcohol screening in primary health care services targeting Aboriginal and Torres Strait Islander peoples in Australia.

INTRODUCTION AND AIMS: Aboriginal and Torres Strait Islander Community Controlled Health Services (ACCHSs) around Australia have been asked to standardise screening for unhealthy drinking. Accordingly, screening with the 3-item AUDIT-C (Alcohol Use Disorders Identification Test-Consumption) tool has become a national key performance indicator. Here we provide an overview of suitability of AUDIT-C and other brief alcohol screening tools for use in ACCHSs. METHODS: All peer-reviewed literature providing original data on validity, acceptability or feasibility of alcohol screening tools among Indigenous Australians was reviewed. Narrative synthesis was used to identify themes and integrate results. RESULTS: Three screening tools-full AUDIT, AUDIT-3 (third question of AUDIT) and CAGE (Cut-down, Annoyed, Guilty and Eye-opener) have been validated against other consumption measures, and found to correspond well. Short forms of AUDIT have also been found to compare well with full AUDIT, and were preferred by primary care staff. Help was often required with converting consumption into standard drinks. Researchers commented that AUDIT and its short forms prompted reflection on drinking. Another tool, the Indigenous Risk Impact Screen (IRIS), jointly screens for alcohol, drug and mental health risk, but is relatively long (13 items). IRIS has been validated against dependence scales. AUDIT, IRIS and CAGE have a greater focus on dependence than on hazardous or harmful consumption. DISCUSSION AND CONCLUSIONS: Detection of unhealthy drinking before harms occur is a goal of screening, so AUDIT-C offers advantages over tools like IRIS or CAGE which focus on dependence. AUDIT-C's brevity suits integration with general health screening. Further research is needed on facilitating implementation of systematic alcohol screening into Indigenous primary healthcare.

The relationship between symptoms of common mental disorders and drug and alcohol misuse among persons seeking an HIV test.

We studied 500 South Africans who sought an HIV test in a community outreach setting. On average, both men and women in the sample indicated hazardous and harmful alcohol use, as well as possible alcohol dependence. Men but not women among the sample experienced drug-related problems. Men were 1.64 times more likely than females to report problematic alcohol use and 4.88 times more likely than females to report drug use. Symptoms of posttraumatic stress, anxiety, and depression significantly explained 16.5% of the variance in alcohol misuse. Symptoms of posttraumatic stress significantly explained 23.5% of the variance in drug use. Implications are explored in the context of HIV testing.

Role of religious social support in longitudinal relationships between religiosity and health-related outcomes in African Americans.

This study tested a longitudinal model of religious social support as a potential mediator of the relationship between religious beliefs and behaviors, and multiple health-related outcomes (e.g., depressive symptoms, functioning, diet, alcohol use, cancer screening). A national probability sample of African Americans enrolled in the religion and health in African Americans study completed three waves of telephone interviews over a 5-year period (N = 766). Longitudinal structural equation models indicated that religious behaviors, but not beliefs, predicted the slowing of a modest overall decline in positive religious social support, while negative interactions with congregational members were stable. Positive religious support was associated with lower depressive symptoms and heavy drinking over time, while negative interaction predicted increases in depressive symptoms and decreases in emotional functioning. Positive religious support mediated the relationship between religious behaviors and depressive symptoms and heavy drinking. Findings have implications for mental health interventions in faith-based settings.