Dependence on hypnotics: a comparative study between chronic users of benzodiazepines and Z-drugs

Objective: To evaluate dependence among chronic benzodiazepine and Z-drug users in Brazil. Methods: Chronic users of benzodiazepines (n=94), Z-drugs (n=74), or both (n=11) were recruited from the community, underwent a psychiatric evaluation and completed self-report instruments on hypnotic dependence, insomnia, anxiety, and depression. Users of benzodiazepines and Z-drugs were compared using t-tests, and logistic regression models were employed to explore significant predictors of a dependence diagnosis. Results: There was no difference in the prevalence of dependence among benzodiazepine (77.2%) and Z-drug (69.4%) users. Benzodiazepine users reported increased psychosocial aspects of dependence, anxiety, and depression. Preoccupation with the availability of medication (prevalence ratio [PR] = 2.39 [1.15-5.20]) and insomnia (PR = 1.10 [1.02-1.19]) were associated with a diagnosis of dependence (n=175). Conclusion: The prevalence of dependence was similar among both drug classes. The increased self-reported dependence, anxiety, and depression among benzodiazepine users may be due to behavioral rather than pharmacological aspects of medication use. Behaviors related to hypnotic use were important predictors of dependence.

Dependence on hypnotics: a comparative study between chronic users of benzodiazepines and Z-drugs.

OBJECTIVE: To evaluate dependence among chronic benzodiazepine and Z-drug users in Brazil. METHODS: Chronic users of benzodiazepines (n=94), Z-drugs (n=74), or both (n=11) were recruited from the community, underwent a psychiatric evaluation and completed self-report instruments on hypnotic dependence, insomnia, anxiety, and depression. Users of benzodiazepines and Z-drugs were compared using t-tests, and logistic regression models were employed to explore significant predictors of a dependence diagnosis. RESULTS: There was no difference in the prevalence of dependence among benzodiazepine (77.2%) and Z-drug (69.4%) users. Benzodiazepine users reported increased psychosocial aspects of dependence, anxiety, and depression. Preoccupation with the availability of medication (prevalence ratio [PR] = 2.39 [1.15-5.20]) and insomnia (PR = 1.10 [1.02-1.19]) were associated with a diagnosis of dependence (n=175). CONCLUSION: The prevalence of dependence was similar among both drug classes. The increased self-reported dependence, anxiety, and depression among benzodiazepine users may be due to behavioral rather than pharmacological aspects of medication use. Behaviors related to hypnotic use were important predictors of dependence.

The contribution of mindfulness to outpatient substance use disorder treatment in Brazil: a preliminary study

Objective: To explore the contribution of a mindfulness-based intervention as an adjuvant to outpatient substance use disorder treatment. Outcomes included substance use behavior, depression and anxiety symptoms, and anger expression. Methods: This preliminary study for a pragmatic randomized controlled trial with stratified random allocation included three months of follow-up. In two outpatient clinics linked to public universities, a mindfulness-based intervention plus treatment as usual (experimental group n=22) was compared to treatment as usual (control group n=20). The study included data from self-report measurements and the patients' records, which were evaluated according to intention-to-treat analysis through generalized estimating equations and generalized method of moments estimation. Results: The experimental group had lower symptoms of depression (b=-6.82; 95%CI -12.45 to -1.18) and anxiety (b=-0.25; 95%CI -0.42 to -0.09), and anger expression (b=-9.76; 95%CI -18.98 to -0.54) three months after the intervention. We detected no effect on substance use behavior. Conclusion: The mindfulness-based intervention yielded promising results as an adjuvant to outpatient substance use disorder treatment, since it reduced levels of highly prevalent symptoms in this population. However, further studies with longer follow-up periods and larger samples are required.

The contribution of mindfulness to outpatient substance use disorder treatment in Brazil: a preliminary study.

OBJECTIVE: To explore the contribution of a mindfulness-based intervention as an adjuvant to outpatient substance use disorder treatment. Outcomes included substance use behavior, depression and anxiety symptoms, and anger expression. METHODS: This preliminary study for a pragmatic randomized controlled trial with stratified random allocation included three months of follow-up. In two outpatient clinics linked to public universities, a mindfulness-based intervention plus treatment as usual (experimental group n=22) was compared to treatment as usual (control group n=20). The study included data from self-report measurements and the patients' records, which were evaluated according to intention-to-treat analysis through generalized estimating equations and generalized method of moments estimation. RESULTS: The experimental group had lower symptoms of depression (b=-6.82; 95%CI -12.45 to -1.18) and anxiety (b=-0.25; 95%CI -0.42 to -0.09), and anger expression (b=-9.76; 95%CI -18.98 to -0.54) three months after the intervention. We detected no effect on substance use behavior. CONCLUSION: The mindfulness-based intervention yielded promising results as an adjuvant to outpatient substance use disorder treatment, since it reduced levels of highly prevalent symptoms in this population. However, further studies with longer follow-up periods and larger samples are required.

Components evaluation of a web-based personalized normative feedback intervention for alcohol use among college students: a pragmatic randomized controlled trial with a dismantling design.

AIMS: To evaluate the effects of the two main components of a personalized normative feedback (PNF) [normative feedback only (NFO); and consequences feedback only (CFO)] compared with the full intervention (PNF) in reducing alcohol use and consequences. DESIGN: Three-arm pragmatic randomized controlled trial with dismantling design and 1-, 3- and 6-month follow-ups. SETTING: Web-based among Brazilian college students. PARTICIPANTS: College students (aged 18-30 years) who reported alcohol use in the last 3 months (n = 5476). INTERVENTIONS: (1) Full PNF (a) drinking profile; (b) normative comparisons; (c) practical costs; (d) alcohol consequences; (e) strategies to decrease risks; (2) NFO components (a), (b) and (e); or (3) CFO components (c), (d) and (e). MEASUREMENTS: The primary outcome was change in Alcohol Use Disorders Identification Test (AUDIT) score; secondary outcomes were the number of alcohol consequences, drinking frequency and typical/maximum number of drinks. We used mixed models with multiple imputation and a pattern-mixture model to account for attrition. Subgroup analyses considered participant motivation to know more about their drinking (less motivated versus motivated). FINDINGS: Dismantled components reduced rather than increased AUDIT score compared to full PNF, with significant effects for NFO at 1 month [b = -0.23, 95% confidence interval (CI) = -0.46; -0.002] and for CFO at 3 months (b = -0.33, 95% CI = -0.62; -0.03). Compared with PNF, NFO reduced the number of alcohol consequences at 1 month (b = -0.16, 95% CI = -0.25; -0.06) and drinking frequency at 3 months (b = -0.42, 95% CI = -0.79; -0.05), but increased the number of typical drinks at 6 months (b = 0.38, 95% CI = 0.04; 0.72). CFO reduced drinking frequency at 3 months (b = -0.37, 95% CI = -0.73; -0.01). Attrition models confirmed all results, except for the NFO effect on typical drinks and drinking frequency. Subgroup analyses indicated superiority of dismantled components among the students less motivated in knowing more about their drinking. CONCLUSIONS: There was no evidence that either the normative or the consequences components of a web-based personalized normative feedback intervention to reduce alcohol use and its consequences contributed to intervention effects. There was some evidence of adverse effects of personalized normative feedback, and these results were driven by 20% of participants who were less motivated in knowing more about their drinking.

Contributions of parenting styles and parental drunkenness to adolescent drinking

Objective: To estimate the association of parental drunkenness and parenting style with alcohol consumption among adolescents and the contributions of parental drunkenness and parenting style to the prevalence of binge drinking among adolescents. Method: Cross-sectional survey of a representative sample of secondary students aged 13 to 18 from 27 Brazilian state capitals (n=17,028). Private and public schools were included. A self-report questionnaire collected data on adolescents' alcohol drinking behavior, parenting styles, and parenting and peer models of drunkenness. Results: Non-authoritative parenting style and parental drunkenness are associated with binge drinking among adolescents. Authoritarian, indulgent, and negligent parenting styles were associated with 1.50-, 2.51-, and 2.82-fold increases in prevalence of adolescent binge drinking, and parental drunkenness, with a 1.99-fold increase. The non-authoritative parenting style made a larger contribution than parental drunkenness to adolescent binge drinking. Conclusions: Non-authoritative parenting style and parental drunkenness seem to play an important role in adolescents' binge drinking behavior. At the population level, parenting style appears associated with a greater contribution to this behavior among adolescents. Prevention strategies targeting parental drunkenness may be bolstered if a broader approach including parenting styles is in place.

Contributions of parenting styles and parental drunkenness to adolescent drinking.

OBJECTIVE: To estimate the association of parental drunkenness and parenting style with alcohol consumption among adolescents and the contributions of parental drunkenness and parenting style to the prevalence of binge drinking among adolescents. METHOD: Cross-sectional survey of a representative sample of secondary students aged 13 to 18 from 27 Brazilian state capitals (n=17,028). Private and public schools were included. A self-report questionnaire collected data on adolescents' alcohol drinking behavior, parenting styles, and parenting and peer models of drunkenness. RESULTS: Non-authoritative parenting style and parental drunkenness are associated with binge drinking among adolescents. Authoritarian, indulgent, and negligent parenting styles were associated with 1.50-, 2.51-, and 2.82-fold increases in prevalence of adolescent binge drinking, and parental drunkenness, with a 1.99-fold increase. The non-authoritative parenting style made a larger contribution than parental drunkenness to adolescent binge drinking. CONCLUSIONS: Non-authoritative parenting style and parental drunkenness seem to play an important role in adolescents' binge drinking behavior. At the population level, parenting style appears associated with a greater contribution to this behavior among adolescents. Prevention strategies targeting parental drunkenness may be bolstered if a broader approach including parenting styles is in place.

Estilos parentais como fator de proteção ao consumo de tabaco entre adolescentes brasileiros / Estilos parentales como factor protector para el consumo de tabaco entre adolescentes brasileños / Parenting styles as a tobacco-use protective factor among Brazilian adolescents

Resumo O objetivo foi analisar a associação entre o uso de tabaco (no mês e frequente) com os estilos parentais e o comportamento de fumar dos pais, em uma amostra de estudantes do Ensino Médio. Foram avaliados 17.246 estudantes do Ensino Médio de escolas públicas e privadas das 27 capitais brasileiras. A prevalência do uso de tabaco na vida foi de 25,2%, 15,3% no ano, 8,6% no mês, e 3,2% para uso frequente. Em relação aos estilos parentais, 39,2% dos pais foram classificados como negligentes, 33,3% autoritativos, 15,6% como indulgentes e 11,9% autoritários. Comparados a estudantes com pais autoritativos, filhos de pais negligentes ou indulgentes tiveram maior chance de relatar o uso no último mês ou frequente de tabaco. Observou-se uma associação entre o estilo parental e uso de cigarros por estudantes do Ensino Médio. O estilo parental autoritativo foi associado à proteção ao uso de tabaco no mês e frequente entre os adolescentes.

Resumen El objetivo fue analizar la asociación entre el consumo de tabaco (durante el mes y su frecuencia) con los estilos parentales y el hábito de fumar de los padres, en una muestra de estudiantes de secundaria. Los participantes fueron reclutados de escuelas públicas y privadas de 27 capitales estatales de Brasil (n = 17.246). La prevalencia de uso en la vida fue un 25,2%, en el último año 15,3%, en el último mes 8,6%, y 3,2% de uso frecuente. El consumo de tabaco parental fue reportado por un 28,6% de los estudiantes. 39,2% de los padres fueron clasificados como negligentes, 33,3% autoritativos, 15,6% indulgentes y 11,9% autoritarios. Comparados con los adolescentes con padres autoritativos, aquellos con padres negligentes o indulgentes reportaron más uso de tabaco durante el último mes o uso frecuente. Se encontró asociación entre estilos parentales y uso de tabaco por parte de los estudiantes. El estilo parental autoritativo se asoció con la protección para el uso del tabaco en el mes y frecuencia entre los adolescentes.

Abstract The objective was to evaluate the relationship between tobacco use (previous month and frequent use), parenting styles and parental smoking behavior in a sample of high school students. Participants were recruited from public and private high schools from 27 Brazilian state capitals (N = 17,246). The overall prevalence of tobacco use in life was 25.2%; 15.3% in the previous year; 8.6% in the previous month; and 3.2% for frequent use. Tobacco use by the parents was reported by 28.6% of the students. Regarding parenting styles, 39.2% were classified as negligent, 33.3% authoritative, 15.6% as indulgent and 11.9% authoritarian. Compared to adolescents with authoritative parents, those with negligent or indulgent parents were more prone to report tobacco use during the last month or frequent use. This study showed an association between parenting styles and tobacco use by high school students. Authoritative parents were associated with protection from frequent and previous month tobacco use among adolescents.

Sports practices related to alcohol and tobacco use among high school students

Objective: To examine the relationship between alcohol and tobacco use and sports in a national sample of secondary students. Methods: This cross-sectional study enrolled a representative sample of secondary students from public and private schools from all 27 Brazilian state capitals. Students were assessed in 2010 by a self-report questionnaire including questions on drug use and sport activity in the last month (n=13,872). Results: Subjects who played sports exhibited a higher frequency of alcohol use and heavy episodic drinking than their peers who did not play sports. Practices that were associated with higher odds of heavy episodic drinking in the last month included gym, weight training (adjusted odds ratio [aOR]: 2.0, 95% confidence interval [95%CI] 1.6-2.4), and soccer (aOR: 1.3, 95%CI 1.1-1.5). Fighting, martial arts, or capoeira were associated with smoking (aOR: 1.9, 95%CI 1.2-3.2). Conclusion: These results suggest a relationship between some sports preferences and a higher risk of alcohol or tobacco use among Brazilian secondary students. This relationship should be considered in preventive programs. .

Sports practices related to alcohol and tobacco use among high school students.

OBJECTIVE: To examine the relationship between alcohol and tobacco use and sports in a national sample of secondary students. METHODS: This cross-sectional study enrolled a representative sample of secondary students from public and private schools from all 27 Brazilian state capitals. Students were assessed in 2010 by a self-report questionnaire including questions on drug use and sport activity in the last month (n=13,872). RESULTS: Subjects who played sports exhibited a higher frequency of alcohol use and heavy episodic drinking than their peers who did not play sports. Practices that were associated with higher odds of heavy episodic drinking in the last month included gym, weight training (adjusted odds ratio [aOR]: 2.0, 95% confidence interval [95%CI] 1.6-2.4), and soccer (aOR: 1.3, 95%CI 1.1-1.5). Fighting, martial arts, or capoeira were associated with smoking (aOR: 1.9, 95%CI 1.2-3.2). CONCLUSION: These results suggest a relationship between some sports preferences and a higher risk of alcohol or tobacco use among Brazilian secondary students. This relationship should be considered in preventive programs.

Parenting styles as a tobacco-use protective factor among Brazilian adolescents.

The objective was to evaluate the relationship between tobacco use (previous month and frequent use), parenting styles and parental smoking behavior in a sample of high school students. Participants were recruited from public and private high schools from 27 Brazilian state capitals (N = 17,246). The overall prevalence of tobacco use in life was 25.2%; 15.3% in the previous year; 8.6% in the previous month; and 3.2% for frequent use. Tobacco use by the parents was reported by 28.6% of the students. Regarding parenting styles, 39.2% were classified as negligent, 33.3% authoritative, 15.6% as indulgent and 11.9% authoritarian. Compared to adolescents with authoritative parents, those with negligent or indulgent parents were more prone to report tobacco use during the last month or frequent use. This study showed an association between parenting styles and tobacco use by high school students. Authoritative parents were associated with protection from frequent and previous month tobacco use among adolescents.

Nonprescribed use of tranquilizers and use of other drugs among Brazilian students.

OBJECTIVES: To describe patterns of nonprescribed use of tranquilizers by students aged 10 to 18 years and assess the sociodemographic characteristics of these adolescents and their use of other substances. METHODS: A randomized and stratified sample of 47,979 students from state and private schools of the 27 Brazilian state capitals completed a self-report questionnaire. Poisson regression was used to estimate the associations between tranquilizer use and sociodemographic factors, as well as the use of other psychotropic substances. RESULTS: The lifetime prevalence of nonprescribed use of tranquilizers was 3.9%. Use was most common among girls, wealthier adolescents, and those from private schools. An association was found between use of tranquilizers and lifetime use of alcohol (prevalence ratio [PR] = 3.15; 95% confidence intervals [95%CI] 2.58-3.85), tobacco (PR = 2.61; 95%CI 2.31-2.95), illicit drugs (PR = 3.70; 95%CI 3.19-4.29), and other prescription drugs (PR = 7.03; 95%CI 6.18-7.99). As the number of substances adolescents reported having used increased, so did the nonprescribed use of tranquilizers. CONCLUSIONS: Nonprescribed use of tranquilizers by adolescents might indicate the use of other substances, including high-risk combinations such as tranquilizers and alcohol. The risks of this association should be addressed during the early stages of drug prevention programs.

Nonprescribed use of tranquilizers and use of other drugs among Brazilian students

Objectives: To describe patterns of nonprescribed use of tranquilizers by students aged 10 to 18 years and assess the sociodemographic characteristics of these adolescents and their use of other substances. Methods: A randomized and stratified sample of 47,979 students from state and private schools of the 27 Brazilian state capitals completed a self-report questionnaire. Poisson regression was used to estimate the associations between tranquilizer use and sociodemographic factors, as well as the use of other psychotropic substances. Results: The lifetime prevalence of nonprescribed use of tranquilizers was 3.9%. Use was most common among girls, wealthier adolescents, and those from private schools. An association was found between use of tranquilizers and lifetime use of alcohol (prevalence ratio [PR] = 3.15; 95% confidence intervals [95%CI] 2.58-3.85), tobacco (PR = 2.61; 95%CI 2.31-2.95), illicit drugs (PR = 3.70; 95%CI 3.19-4.29), and other prescription drugs (PR = 7.03; 95%CI 6.18-7.99). As the number of substances adolescents reported having used increased, so did the nonprescribed use of tranquilizers. Conclusions: Nonprescribed use of tranquilizers by adolescents might indicate the use of other substances, including high-risk combinations such as tranquilizers and alcohol. The risks of this association should be addressed during the early stages of drug prevention programs. .

Inhalants as intermediate drugs between legal and illegal drugs among middle and high school students.

The aims of this study are to: (1) describe the prevalence and sociodemographic characteristics of inhalant use among middle and high school students in Brazil, and (2) test the hypothesis of inhalants being intermediate drugs between legal and illegal drug use. A representative sample of 5226 students from private schools in São Paulo, Brazil, was selected to answer a self-report questionnaire. Weighted data was analyzed through Cox proportional hazards models. In the overall sample, inhalants seems to be an intermediate drug, since prior inhalant initiation was associated with first marijuana use, adjusted for previous alcohol and tobacco initiation.

Nonprescribed use of tranquilizers or sedatives by adolescents: a Brazilian national survey.

BACKGROUND: Although the nonprescribed use of tranquilizers or sedatives by adolescents is a cause for concern in many countries, there is a shortage of data from low and middle income countries (LAMIC). The present study aims to estimate the prevalence of nonprescribed use of tranquilizers/sedatives by adolescents in Brazil, and to assess how socioeconomic and demographic circumstances, as well as indicators of access to these substances are associated with their use and with risk perception. METHODS: A cross-sectional study was conducted using a multi-stage probability sample of 18131 high school students from public and private schools from all 27 Brazilian state capitals. A self-reporting questionnaire was used to obtain information on social and economic circumstances, nonprescribed use of tranquilizers or sedatives and risk perception of their use. RESULTS: Lifetime nonprescribed use of tranquilizers or sedatives was reported by 5% of respondents, more commonly among females (OR: 2.19, 95% CI: 1.75-2.75) and those attending private schools (OR: 1.47, 95% CI: 1.17-1.84). The use of tranquilizers/sedatives by relatives or friends was associated with nonprescribed use by the participant (OR: 4.26, 95% CI: 3.46-5.23) and a majority of lifetime users obtained these substances from a family environment (82%). Previous medical prescription was independently associated with nonprescribed use (OR: 6.61, 95% CI: 4.87-8.98) and with low risk perception (OR: 2.42, 95% CI: 1.12-5.24). CONCLUSIONS: A substantial proportion of Brazilian adolescents use nonprescribed tranquilizers/sedatives. Easy access to these substances seems to play an important role in this use and should be tackled by preventive and treatment interventions.

Social rank and inhalant drug use: the case of lança perfume use in São Paulo, Brazil.

BACKGROUND: Lanca perfume (chloroform/ether) is an inhalant used mainly by higher social class students in Brazil. In light of the social and epidemiological features of lanca use, supply, and distribution, this investigation tests hypotheses about the degree to which use of inhalant lanca might be occurring in clusters, consistent with social sharing and diffusion, and might show a direct association with social rank even within the relatively privileged social context of private schools in a large mega-city of Latin America. METHODS: Epidemiologic self-report survey data were from a large representative sample of urban post-primary private school students in São Paulo city, Brazil, in 2008. Newly incident lanca use was studied, first with estimates of clustering from the alternating logistic regressions (ALR) and then with conditional logistic regressions to probe into the hypothesized direct social rank association. RESULTS: ALR disclosed a clustering of newly incident lanca users within private school classrooms (pairwise odds ratio (PWOR)=2.1; 95% CI=1.3, 3.3; p=0.002) as well as clusters of recently active lanca use (PWOR=1.9; 95% CI=1.1, 3.3; p=0.02). Occurrence of lanca use within private school classrooms was directly associated with social rank (odds ratio (OR)=0.2; 95% CI=0.1, 0.8; p=0.03 in the contrast of lowest socio-economic status (SES) versus highest SES strata within classrooms). Thereafter, study of other drugs disclosed similar patterns. CONCLUSIONS: The clustering estimates are consistent with concepts of person-to-person sharing of lanca within private school classrooms as well as other dynamic processes that might promote lanca clusters in this context. An observed direct association with social rank is not specific to lanca use. Direct SES estimates across a broad profile of drug compounds suggests causal processes over and above the more specific initially hypothesized social rank gradients in the lanca diffusion process. A novel facet of the evidence is greater occurrence of drug use among the higher social rank private school students, which should be of interest in the social science community.

Binge drinking among Brazilian students: a gradient of association with socioeconomic status in five geo-economic regions.

BACKGROUND: Socioeconomic status (SES) may be directly associated with binge drinking (BD) and country inequality. The aims of this study were to describe the characteristics of BD among high school students in Brazil and the association of BD with students' socioeconomic status in the five different Brazilian macro-regions. METHODS: A national cross sectional survey was carried out using a multistage probabilistic sample of 17,297 high school students aged 14-18 years drawn from 789 public and private schools in each of the 27 Brazilian state capitals. Self-report data about BD behaviors and SES were analyzed via weighted logistic regressions and a funnel plot. RESULTS: Almost 32% of the students engaged in BD in the past-year. Being in the highest SES stratum doubled the risk of BD among students in all five Brazilian macro-regions. There was a gradient in the association between past-year BD and socioeconomic status: as SES increased; the chance of having recently engaged in BD also increased. In Brazilian capitals as a whole, being a boy versus being a girl (adjusted odds ratio - aOR=1.40 [95%CI 1.26; 1.58]), being older (aOR=1.47 [95%CI 1.40; 1.55]) and attending private versus public schools (aOR=1.39 [95%CI 1.18; 1.62]) were associated with greater risk for BD. CONCLUSIONS: Contrary to what is observed in developed countries, students living in Brazilian capitals may be at an increased risk of BD when they belong to the highest socioeconomic status. There might be similar associations between high SES and BD among adolescents growing up in other emerging economies.

Drug use among street children and adolescents: what helps? / Uso de drogas entre crianças e adolescentes em situação de rua: o que ajuda?

The aim of this study was to investigate factors associated to frequent and heavy drug use among street children and adolescents aged 10 to 18 years. A sample of 2,807 street children and adolescents from the 27 Brazilian state capital cities was analyzed. A World Health Organization questionnaire for non-students was adapted for use in Brazil. Data analysis was performed using logistic regression and decision tree models. Factors inversely associated with frequent and heavy drug use were: being age nine to 11 years (OR = 0.1); school attendance (OR = 0.3); daily time (one to five hours) spent on the streets (OR = 0.3 and 0.4); not sleeping on the streets (OR = 0.4); being on the streets for less than one year (OR = 0.4); maintenance of some family bonds (OR = 0.5); presence on the streets of a family member (OR = 0.6); not suffering domestic violence (OR = 0.6); being female (OR = 0.8). All of these variables were significant at the p < 0.05 level. The findings suggest that being younger, having family bonds and engagement in school are important protective factors that affect drug use among this population and should be considered in the formulation of public policies.

O objetivo do estudo foi verificar fatores associados ao uso frequente e pesado de drogas entre adolescentes em situação de rua no Brasil. Estudo transversal com amostra representativa nacional de 2.807 crianças e adolescentes (10-18 anos). Foi usado um questionário da Organização Mundial da Saúde adaptado para o Brasil e análise dos dados, modelo de regressão logística. Fatores inversamente associados ao uso frequente e pesado de drogas: faixa etária entre 9-11 anos (OR = 0,1); frequentar escola (OR = 0,3); permanecer entre 1 e 5 horas na rua (OR = 0,3 e 0,4); não dormir na rua (OR = 0,4); estar na rua há menos de um ano (OR = 0,4); manter algum vínculo familiar (OR = 0,5); permanecer na rua com algum membro da família (OR = 0,6); não ter sofrido violência doméstica (OR = 0,6); gênero feminino (OR = 0,8). Todas essas variáveis apresentaram p < 0,05. Os achados sugerem que ser mais jovem, ficar menos tempo na rua e manter vínculos com escola e família são importantes fatores de proteção para essa população quanto ao uso frequente e pesado de drogas. Esses são fatores importantes na formulação de políticas públicas para essa população.