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

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

Violência na infância, exposição a violência parental e abuso e/ou dependência de álcool na idade adulta* / Childhood violence, exposure to parental violence and alcohol dependence/abuse in adulthood / La violencia infantil, exposición a la violencia de los padres y el abuso y/o dependencia del alcohol en la edad adulta

Este artigo examina a associação entre o histórico de violência na infância e a dependência e uso nocivo de álcool na idade adulta. Uma amostra probabilística multiestagio foi usada para selecionar 3.007 indivíduos de 14 anos de idade ou mais, dos lares brasileiros, entre novembro de 2005 e abril de 2006. As análises mostraram a existência de associação entre o histórico de abuso físico e exposição à violência parental (p<0,001). O modelo de regressão multinomial mostrou uma associação entre o histórico de violência na infância e a dependência de álcool na idade adulta. As variáveis de maior impacto na chance para dependência do álcool foram sexo masculino, exposição à violência parental e histórico de abuso físico. Desta forma, observou-se que quanto maior o grau de exposição, maior a porcentagem de violência severa sofrida na infância. Os resultados corroboram com prévios achados que sugerem que um histórico positivo de violência na infância é um componente importante na etiologia dos transtornos decorrentes do consumo de álcool.

This article analyses the association between the history of violence in childhood and alcohol abuse and dependence in adulthood. A multistage probabilistic sample was used to select 3,007 individuals aged 14 years or older, living in Brazil, between November 2005 and April 2006. Analyses showed an association between history of physical abuse and exposure to parental violence (p<0.001). A multinomial regression model showed a significant association between history of physical abuse in childhood and alcohol dependence in adulthood. The following variables have greater impact on the probability of alcohol dependence: male sex, exposure to parental violence and history of physical abuse. Thus, the higher the level of exposure, the greater the percentage of severe violence suffered in childhood. Results corroborate previous findings, which suggest the importance of a childhood history of violence in the etiology of disorders resulting from alcohol consumption.

En este artículo se estudia la relación entre la historia de la violencia en la infancia y la dependencia y el uso nocivo de alcohol en la edad adulta. Una muestra de probabilidad de varias etapas fue utilizada para seleccionar 3.007 individuos de 14 años de edad o más de los hogares brasileños entre noviembre de 2005 y abril de 2006. El análisis mostró que hay una asociación entre la historia de abuso físico y la exposición a la violencia de los padres (p<0,001). El modelo de regresión multinomial mostró una asociación entre la historia de violencia en la infancia y la dependencia del alcohol en la edad adulta. Las variables con mayor impacto en la probabilidad de dependencia del alcohol fueran el sexo masculino, la exposición a la violencia de los padres y la historia de abuso físico. Cuanto mayor sea el grado de exposición, mayor es el porcentaje de violencia grave sufrido en la infancia. Los resultados corroboran hallazgos previos que sugieren que una historia positiva de violencia en la infancia es un componente importante en la etiología de los trastornos derivados del consumo de alcohol.

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

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

Depressive symptoms and alcohol correlates among Brazilians aged 14 years and older: a cross-sectional study.

BACKGROUND: The associations between depressive symptoms and alcohol-related disorders, drinking patterns and other characteristics of alcohol use are important public health issues worldwide. This study aims to study these associations in an upper middle-income country, Brazil, and search for related socio-demographic correlations in men and women. METHODS: A cross-sectional study was conducted between November 2005 and April 2006. The sample of 3,007 participants, selected using a multistage probabilistic sampling method, represents the Brazilian population aged 14 and older. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale and alcohol dependence was assessed using the Composite International Diagnostic Interview. Associations assessed using bi-variate analysis were tested using Rao-Scott measures. Gender specific multinomial logistic regression models were developed. RESULTS: Among the participants with alcohol dependence, 46% had depressive symptoms (17.2% mild/moderate and 28.8% major/severe; p < 0.01); 35.8% (p = 0.08) of those with alcohol abuse and 23.9% (p < 0.01) of those with a binge-drinking pattern also had depressive symptoms. Alcohol abstainers and infrequent drinkers had the highest prevalence of major/severe depressive symptoms, whereas frequent heavy drinkers had the lowest prevalence of major/severe depressive symptoms. In women, alcohol dependence and the presence of one or more problems related to alcohol consumption were associated with higher risks of major/severe depressive symptoms. Among men, alcohol dependence and being ≥45 years old were associated with higher risks of major/severe depressive symptoms. CONCLUSIONS: In Brazil, the prevalence of depressive symptoms is strongly related to alcohol dependence; the strongest association was between major/severe depressive symptoms and alcohol dependence in women. This survey supports the possible association of biopsychosocial distress, alcohol consumption and the prevalence of depressive symptoms in Brazil. Investing in education, social programs, and care for those with alcohol dependence and major/severe depressive symptoms, especially for such women, and the development of alcohol prevention policies may be components of a strategic plan to reduce the prevalence of depression and alcohol problems in Brazil. Such a plan may also promote the socio-economic development of Brazil and other middle-income countries.

Binge drinking among Brazilians: Higher drinking frequency increases related problems.

Abstract Aims: To correlate binge drinking (BD) with alcohol-related problems (ARP) in the Brazilian population. Methods: A representative cross-sectional survey was conducted in 143 Brazilian cities. Associations between the frequencies of BD and ARP were gathered using an ordered logit regression model. Results: Higher BD frequencies significantly increased the chance of injury in accidents, job loss, and involvement in intense arguments and assaults over the year. High frequency in BD increases the odds of all ARP. Conclusion: There is a dose-response association between the frequency BD and ARP and is therefore a possible target for public prevention policies.

Gambling onset and progression in a sample of at-risk gamblers from the general population.

The goal of this study was to investigate gambling-related behavior, onset and progression in a sample of at-risk gamblers from the community. A national household survey was conducted in Brazil, covering individuals 14 years old or older. Subjects were screened for at-risk gambling, those testing positive answered a questionnaire about gambling progression, preferred games and DSM-IV pathological gambling criteria. Out of 3007 respondents, 118 were considered at-risk gamblers according to the Lie/Bet Questionnaire. According to the DSM-IV, 32.7% and 24.9% of those were considered problem and pathological gamblers, respectively. Early at-risk gamblers (onset prior to 20 years of age), were more likely to be male, to prefer non-commercially structured games, and to chase losses while gambling. Young pathological gamblers (under 35 years of age) progressed faster from regular to problem gambling (roughly 2 years) than mature pathological gamblers (12 years). Such findings had not been described before because previous reports focused mostly on clinical samples that lack young, male, early-onset gamblers. Gambling programs have not satisfactorily covered this segment of gamblers. Outreach strategies and early interventions should be provided to prevent these individuals from rapidly evolving into pathological gambling.

Higher prevalence of major depressive symptoms in Brazilians aged 14 and older.

OBJECTIVE: Depression is a highly prevalent condition and is considered a major public health issue. The aim of the present study was to estimate the prevalence of depressive symptoms in the Brazilian population and establish their sociodemographic correlates. METHOD: A cross-sectional study was conducted between November 2005 and April 2006. Data were collected in face-to-face interviews using a standardized questionnaire. The sample consisted of 3,007 interviews with individuals aged 14 years and older and followed a probabilistic design covering the Brazilian national territory. Depressive symptoms were assessed according to the Center for Epidemiologic Studies Depression Scale. RESULTS: The observed prevalence of depressive symptoms was 28.3% (13% mild/moderate; 15.3% major/severe; p < 0.01). Increased depressive symptom rates were associated with being a female, being 45 years of age and older, having lower educational attainment, being single, having family income of up to 2.5 times minimum wage, and living in the northern region of Brazil (p < 0.05). CONCLUSIONS: The prevalence of depressive symptoms in Brazil is high, with major depressive symptoms being the most frequent form of this symptomatology. Considering the biopsychosocial model of mental disorders, this survey points to the involvement of psychosocial factors in the prevalence of depressive symptoms in Brazil.

Higher prevalence of major depressive symptoms in Brazilians aged 14 and older

Objective: Depression is a highly prevalent condition and is considered a major public health issue. The aim of the present study was to estimate the prevalence of depressive symptoms in the Brazilian population and establish their sociodemographic correlates. Method: A cross-sectional study was conducted between November 2005 and April 2006. Data were collected in face-to-face interviews using a standardized questionnaire. The sample consisted of 3,007 interviews with individuals aged 14 years and older and followed a probabilistic design covering the Brazilian national territory. Depressive symptoms were assessed according to the Center for Epidemiologic Studies Depression Scale. Results: The observed prevalence of depressive symptoms was 28.3% (13% mild/moderate; 15.3% major/severe; p < 0.01). Increased depressive symptom rates were associated with being a female, being 45 years of age and older, having lower educational attainment, being single, having family income of up to 2.5 times minimum wage, and living in the northern region of Brazil (p < 0.05). Conclusions: The prevalence of depressive symptoms in Brazil is high, with major depressive symptoms being the most frequent form of this symptomatology. Considering the biopsychosocial model of mental disorders, this survey points to the involvement of psychosocial factors in the prevalence of depressive symptoms in Brazil. .

Sociodemographic characteristics associated with binge drinking among Brazilians.

BACKGROUND: Binge drinking (BD) is a harmful pattern of alcohol use. This study describes this pattern of drinking and the sociodemographic variables associated with it in a representative sample of Brazilians. METHODS: A cross-sectional survey of 3007 individuals using a multistage probabilistic sample was conducted in 143 Brazilian municipalities. The frequency of BD in the year preceding the study was assessed. BD was defined as the consumption of four drinks of alcohol within a two-hour period for women and five drinks in two hours for men. Weighted-ordered logit regression was used to assess the relationship between sociodemographic factors and BD. RESULTS: Most respondents had not engaged in binge drinking (69.7%; 95% confidence interval (CI) 67.0-72.2%). Binge drinking was more common among participants who were male (odds ratio (OR) 2.9; 95% CI 2.3-3.6) or single (OR 1.5; 95% CI 1.1-2.1) or had higher family income (OR 2.3; 95% CI 1.3-3.8). Individuals between 18 and 44 years of age were four times more likely to engage in binge drinking than adolescents (OR 4.7; 95% CI 3.3-6.8). Evangelicals/Protestants were less likely to engage in binge drinking (OR 0.7; 95% CI 0.2-0.5). CONCLUSIONS: Our study, which is the first representative survey of BD in Brazil, showed that the age range of adults who engaged in BD is wider than the age range observed in other countries. These individuals are at increased risk for the adverse consequences of binge drinking, including addiction, car accidents, involvement in crime, absenteeism, and family violence.

Use of licit and illicit substances among adolescents in Brazil--a national survey.

OBJECTIVE: We estimate the prevalence of alcohol, tobacco and illegal substance use in a national representative sample of adolescents. We also estimate how socio demographic characteristics, household environment and mental health are associated with substance misuse. METHOD: This is a cross-sectional study using data from the first Brazilian National Alcohol Survey, which gathered information on the use of psychoactive substances in 761 participants aged 14 to 19 years old. Weighted logistic regression was used to calculate adjusted odds ratios. RESULTS: More than half of the adolescents interviewed were regular alcohol users and one out of ten were abusers and/or dependents. Older male adolescents living in urban areas were more likely to present alcohol related disorders and to smoke. Age had an inverse association with illegal substance use. Smokers and those using illegal substances were more likely to report domestic violence while those with alcohol abuse/dependence were more likely to have depression. CONCLUSIONS: The high prevalence of alcohol, tobacco and illicit substance consumption among Brazilian adolescents is staggering. Young males with mood disorders from urban areas are more at risk of developing alcohol disorders while illegal drug use is highly associated to household dysfunction in early life. Brazilian growing economy will possibly lead to increased levels of substance use among adolescents if new prevention measures are not implemented. The intensification of law enforcement strategies to reduce psychotropic substances access is required.

The distribution of alcohol consumption and the prevention paradox in Brazil.

AIMS: To examine the proportion of self-reported alcohol consumed by different gender and age groups in Brazil over the past year, and to examine whether the 'prevention paradox' applies to Brazilian data on alcohol-related problems. DESIGN: A multi-stage cluster sample, representative of the Brazilian household population. SETTING: This study was conducted in Brazil between November 2005 and April 2006. PARTICIPANTS: Respondents were aged ≥ 14 years (n = 3007). MEASUREMENTS: Measures included past year estimates of (i) number of standard drinks, (ii) frequency of binge drinking, and (iii) alcohol-related problems. FINDINGS: The survey response rate was 66.4%. The top 2.5% of the drinkers by volume consume 14.9%, the top 5% consume 27.4% and the top 10% consume 44.2% of all alcohol consumed in Brazil. Men consume 77.8% of the total alcohol, and 18-29-year-olds consume 40.3%. Individuals below risky drinking guidelines for weekly volumetric intake account for 49-50% of all problem drinkers and 45-47% of all problem types reported. Individuals who do not binge or who binge infrequently (1-3 times/year) account for 50-51% of all problem drinkers and 45-46% of all reported problem types. Most binge drinkers are low-volume drinkers. CONCLUSIONS: Consistent with the prevention paradox literature, most drinking problems in Brazil are associated with low or moderate drinking. Binge drinking accounts more clearly for the distribution of alcohol problems than total volume consumed.

Differences in drinking patterns between men and women in Brazil.

OBJECTIVE: To examine sex differences in alcohol consumption according to age groups, and to assess gender and age effects on several aspects of alcohol consumption patterns. METHOD: Based on a Brazilian nationwide representative sample (n = 3,007), we analysed the differences in drinking patterns between genders. We also assessed the effects of gender, age, and gender by age interaction for alcohol consumption dimensions (frequent drinking, usual intake, binge drinking, and frequent binge drinking), using logistic and negative binomial regression models. RESULTS: Gender, age, and gender by age interaction had significant effects on the predictive models for all studied drinking patterns, except for the 'usual' dosage. The effect of gender on drinking patterns varies with age. While gender has a greater effect in older age groups, the difference between men and women decreased in the younger age groups. CONCLUSIONS: Gender convergence regarding alcohol use is a trend that might be influenced by environmental factors and should be addressed in prevention and treatment programs, as well as in public health policies.

Differences in drinking patterns between men and women in Brazil / Diferenças nos padrões de consumo de álcool entre homens e mulheres no Brasil

OBJECTIVE: To examine sex differences in alcohol consumption according to age groups, and to assess gender and age effects on several aspects of alcohol consumption patterns. METHOD: Based on a Brazilian nationwide representative sample (n = 3,007), we analysed the differences in drinking patterns between genders. We also assessed the effects of gender, age, and gender by age interaction for alcohol consumption dimensions (frequent drinking, usual intake, binge drinking, and frequent binge drinking), using logistic and negative binomial regression models. RESULTS: Gender, age, and gender by age interaction had significant effects on the predictive models for all studied drinking patterns, except for the 'usual' dosage. The effect of gender on drinking patterns varies with age. While gender has a greater effect in older age groups, the difference between men and women decreased in the younger age groups. CONCLUSIONS: Gender convergence regarding alcohol use is a trend that might be influenced by environmental factors and should be addressed in prevention and treatment programs, as well as in public health policies.

OBJETIVO: Avaliar as diferenças nos padrões de consumo de álcool entre os gêneros de acordo com as faixas etárias e avaliar os efeitos do gênero e da idade em diversos aspectos do padrão de consumo de bebidas alcoólicas. MÉTODO: Com base em amostra representativa da população brasileira (n = 3.007), nós avaliamos as diferenças nos padrões de consumo de álcool entre os gêneros. Nós também avaliamos os efeitos do gênero, da idade e da interação entre gênero e idade nas dimensões do consumo de álcool (consumo frequente, dose usual, consumo em binge e consumo frequente em binge), com uso de modelos de regressão logística e regressão binomial negativa. RESULTADOS: O gênero, a idade e a interação entre gênero e idade tiveram efeitos significantes nos modelos preditivos para todos os padrões de consumo estudados, com exceção da dose usual. O efeito do gênero ao longo das faixas etárias varia com a idade. Enquanto o gênero teve um efeito maior nas faixas etárias mais velhas, a diferença entre homens e mulheres diminuiu nas faixas etárias mais novas. CONCLUSÕES: A convergência entre os gêneros no que se refere ao uso de álcool é uma tendência que pode ser influenciada por fatores ambientais e deveria ser focada nos programas de prevenção e tratamento assim como nas políticas públicas.

Prevalence and correlates of gambling problems among a nationally representative sample of Brazilian adolescents.

The objectives of the study are: (a) to provide the first prevalence estimates of pathological gambling among Brazilian adolescents using an age-specific instrument in a nationally representative sample; (b) to investigate the extent to which adolescents participate in gambling activities in a developing country; and (c) to correlate different levels of gambling behavior with demographic variables. Multistage cluster sampling selected 3,007 individuals over 14 years of age from Brazilian household population. A total of 661 participants were between 14 and 17 years old. The Lie/Bet Questionnaire and the DSM-IV-MR-J were used for assessing problem and pathological gambling. 2.8% scored positive on the screening questionnaire, while 1.6% were classified as problem and pathological gamblers. Factors associated with problem and pathological gambling were male sex, not currently studying and considering religion as not important. Less than 4 months elapsed between the age of regular gambling involvement and the first gambling problem. Prevalence rates were quite similar from recent studies which used nationally representative samples. The association of problem and pathological gambling with male sex, school drop-out and low religiosity supports the Problem Behavior Theory. The fast progression to problem gambling adds evidence that adolescents may be more vulnerable to the effects of gambling.

Early life exposure to violence and substance misuse in adulthood-The first Brazilian national survey.

BACKGROUND: Substance misuse has been a major source of health and social problems in developing societies as it has been elsewhere. There is a growing body of evidence from developed nations linking early exposure to violence in childhood with substance misuse in adulthood. The role of depression on this association is not clear. This study estimates the association between early life exposure to violence, alcohol disorders and illegal substance use in adulthood and the role of depression on these associations using a national Brazilian sample. METHODS: The first Brazilian National Alcohol Survey gathered information on early exposure to violence and use of psychoactive substances in 1880 participants aged 20 to 60 years old selected at random from the Brazilian household population. We used weighted logistic regression to calculate adjusted odds ratios for the associations between early exposure to violence and substance misuse. To assess the mediating effect of depression on these associations we used the Sobel-Goodman Mediation Test. RESULTS: Witnessing violence during childhood or adolescence was reported by nearly 20% of the participants whilst over 8% reported having been victims of at least one form of violence. There was a statistically significant association between early exposure to violence and alcohol abuse and/or dependence and use of illegal substances in adulthood with a dose-response relationship. Depression partially explained the association between early exposure to violence with alcohol dependence (18.77% p<0.001) and did not have a statistically significant mediating effect on the association with illegal substance use (5.83% p=0.220). CONCLUSIONS: Adverse early life events may affect individual's susceptibility to substance misuse which can be partially mediated by depression. Prevalence of substance misuse in adulthood may be in part attributed to the prevalence of adverse childhood experience. While prevention is the ideal goal, detection and intervention with children exposed to violence must be prioritised.

Patterns of alcohol use among Brazilian adolescents / Padrões de uso de álcool entre adolescentes brasileiros

OBJECTIVE: To describe patterns of alcohol consumption by adolescents in Brazil. METHOD: From November 2005 to April 2006, a sample composed of 661 subjects aged between 14 to 17 years was rigorously selected in Brazil using a multistage probabilistic method to represent the profile of the adolescent Brazilian population. RESULTS: 34 percent of Brazilian adolescents drink alcoholic beverages. The mean age of drinking initiation was 14 years of age. Older adolescents, as well as those living in the southern part of Brazil, those who are not attending school and those who are working, and black individuals and those with personal income reported a higher frequency of drinking. Socio-demographic factors such as gender, income bracket, family income and student status do increase the amount of alcohol consumed. Males report a higher frequency of binge drinking than females. Moreover, more than half of the males that had drunk in the previous year reported having engaged in binge drinking on at least one occasion. Beer represents approximately half of all the drinks consumed by adolescents. There was no significant difference between genders in the kind of alcohol consumed. DISCUSSION: Among adolescents who drink, the consumption of several drinks is frequent. Alcohol consumption varies from region to region, social economic status (including self-generated income) and age. These findings are discussed in light of their importance for the development of alcohol prevention policies in Brazil.

OBJETIVO: Apresentar um panorama nacional sobre o padrão de consumo de bebidas alcoólicas entre adolescentes no Brasil. MÉTODO: Amostra rigorosamente selecionada em procedimento probabilístico em múltiplos estágios em todo o território brasileiro, de novembro de 2005 a abril de 2006, representando um perfil da população adolescente brasileira, composta por 661 sujeitos entre 14-17 anos. RESULTADOS: 34 por cento dos adolescentes brasileiros bebem. A idade média de início da experimentação de bebidas alcoólicas foi de 14 anos. Adolescentes mais velhos, habitando a região Sul, que não estudam, que trabalham, de cor negra e que têm rendimento próprio apresentaram maior frequência de consumo. A quantidade usual consumida varia de acordo com sexo, classe social, renda familiar e o fato de estudar ou não. Os jovens do sexo masculino se destacam por apresentarem um percentual bem maior do beber em binge quando comparados com as jovens e mais da metade dos adolescentes do sexo masculino que bebem o fizeram em binge em pelo menos em uma ocasião. Aproximadamente metade das doses consumidas por adolescentes é de cerveja ou chope. Com relação aos gêneros, não foi detectada diferença significativa entre tipos de bebida. DISCUSSÃO: O consumo de altas doses é frequente entre os adolescentes. Os padrões de consumo dos adolescentes apresentam variações em relação a região, estrato social, rendimentos próprios e idade. Os achados têm importância para o estabelecimento de políticas nacionais.

Alcohol use patterns among Brazilian adults / Padrão de uso de álcool em brasileiros adultos

OBJECTIVE: To describe patterns of alcohol consumption in the adult Brazilian population. METHOD: Multicluster random sample of 2,346 subjects 18 years of age or older, selected nationwide. Interviews were conducted in respondents' homes between November 2005 and April 2006. RESULTS: About 48 percent of the sample had not drunk alcoholic beverages in the past year, with variations by gender, age, marital status, education, income and region of the country. Among drinkers, 29 percent reported drinking 5 or more drinks per occasion (men, 38 percent). Sociodemographic variables are associated with the frequency and amount of drinking, alcohol problems, and alcohol abuse and dependence. Among the whole sample (including drinkers and non drinkers), 28 percent reported binge drinking, 25 percent reported at least one kind of alcohol related problem, 3 percent were alcohol abusers and another 9 percent were alcohol dependent. DISCUSSION: Abstinence is high in the Brazilian population. However, elevated proportions of those who drink consume alcohol in a high risk pattern (binge-drinking), report a high level of alcohol problems, alcohol abuse and dependence. National public policies must consider these factors, as well as the regional Brazilian differences.

OBJETIVO: Apresentar os padrões de consumo de bebidas alcoólicas entre a população adulta brasileira. MÉTODO: Amostra de 2.346 indivíduos, cuidadosamente selecionada da população brasileira com 18 anos ou mais. Amostra selecionada em todo o território brasileiro, por meio de procedimento probabilístico em múltiplos estágios. As entrevistas, realizadas nas residências, ocorreram entre novembro de 2005 e abril de 2006. RESULTADOS: 48 por cento da amostra relataram não haver bebido no último ano e esse índice variou de acordo com sexo, idade, estado civil, nível educacional e de renda e região do país. Entre aqueles que bebiam, 29 por cento consumiam usualmente cinco ou mais doses por ocasião (38 por cento entre os homens). Fatores sociodemográficos foram relevantes em relação a todas as variáveis de consumo estudadas: frequência, quantidade, problemas, abuso e dependência. Na amostra total, incluindo os não-bebedores, 28 por cento beberam em binge, 25 por cento relataram ao menos um tipo de problema relacionado ao consumo, 3 por cento preencheram critério para abuso e 9 por cento para dependência. DISCUSSÃO: O grau de abstinência da população brasileira é alto. No entanto, os bebedores apresentam elevado nível de consumo de risco. A prevalência de problemas relacionados ao consumo, abuso e dependência de álcool também é significativa. Políticas públicas nacionais devem levar em conta esses fatores assim como as diferenças regionais.

ADHD in a representative sample of the Brazilian population: estimated prevalence and comparative adequacy of criteria between adolescents and adults according to the item response theory.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a clinically significant disorder in adulthood, but current diagnostic criteria and instruments do not seem to adequately capture the complexity of the disorder in this developmental phase. Accordingly, there are limited data on the proportion of adults affected by the disorder, specially in developing countries. METHOD: We assessed a representative household sample of the Brazilian population for ADHD with the Adult ADHD Self-report Scale (ASRS) Screener, and evaluated the instrument according to the Rasch model of item response theory. RESULTS: The sample was comprised by 3007 individuals, and the overal prevalence of positive screeners for ADHD was 5.8% [95% confidence interval (CI), 4.8-7.0]. Rasch analyses revealed the misfitt of the overall sample to expectations of the model. The evaluation of the sample stratified by age revealed that data for adolescents showed a signficant fittnes to the model expectations, while items completed by adults were not adequated. CONCLUSIONS: The lack of fitness to the model for adult respondents challenges the possibility of a linear transformation of the ordinal data into interval measures and the utilization of parametric analyses of data. This result suggests that diagnostic criteria and instruments for adult ADHD must take into account a developmental perspective. Moreover, it calls for further evaluation of currently employed research methods in light of modern theories of psychometrics.