Use of alcohol and other drugs among Brazilian college students: effects of gender and age

Prevalence of alcohol consumption and the associated factors among students at a Brazilian public university: a cross-sectional study

BACKGROUND

The World Health Organization estimated that approximately 43% of the global population consumes alcohol, with an average annual consumption of 4.6 L per person. However, little is known about the factors influencing alcohol intake among students.

OBJECTIVES

This study aimed to determine the factors that influence alcohol intake in students at a Brazilian public institution.

DESIGN AND SETTING

This cross-sectional study was conducted at a public university in the Brazilian Midwest.

METHODS

In total, 348 Brazilian university students (124 men and 224 women; convenience sample) were recruited. The alcohol use disorder identification test (AUDIT) was used to examine alcohol use, the habitual physical activity questionnaire (Baecke) was used to assess physical activity levels, and the Brazil Economic Classification Standard Criterion was used to assess socioeconomic status. A generalized linear model (GLM) with a 95% confidence interval (CI) and odds ratio (OR) estimation was constructed using the Tweedie probability distribution and log link function, with AUDIT questionnaire scores as the dependent variable.

RESULTS

The prevalence of excessive alcohol consumption was 18.7% (9.8% in men and 8.9% in women). The GLM analysis indicated that being single and attending an agricultural science course increased the likelihood of excessive alcohol intake; however, living with family or alone had a protective effect. Being single and pursuing a course in agricultural science increased the likelihood of binge drinking.

CONCLUSION

Universities and families can use the study findings to develop initiatives aimed at enhancing students' understanding of the harmful effects of alcohol, particularly among agricultural science students.

Situational assessment and epidemiology of HIV, HBV and HCV among people who use and inject drugs in Ghana

INTRODUCTION

People who inject drugs (PWID) and people who use drugs (PWUD) are an important population group that remain under-served in Ghana. Though PWID and PWUD are among the key populations most-at-risk to acquire sexually transmitted or blood-borne diseases, they are among those with the least access to human immunodeficiency (HIV), hepatitis B (HBV) and hepatitis C (HCV) viruses' prevention, care and treatment services in Ghana due to lack of data on them. We provide a rapid assessment of the PWUD and PWID situation in Ghana.

METHODS

This rapid cross-sectional design undertook consultative meetings between the study team and relevant stakeholders, including Civil Society Organizations (CSO) working with PWUD/PWID. The assessment considered a representative sample of PWID and PWUD. It was conducted in four (4) selected regions of Ghana (Greater Accra, Ashanti, Western, and Northern). Overall, 323 participants were interviewed using respondent-driven sampling (RDS) approach. Information obtained from participants were demographics, HIV risk behaviors, human immunodeficiency (HIV) and sexually transmitted infections (STI)-related knowledge HIV/HCV/HBV screening, attitude, and practices among others. Analyses were conducted using Stata version 17 and RDSAT version 7.1.46 software.

FINDINGS

Drug use was found to be more prevalent among the youth with a median age of 37 years. Majority of the respondents were males (86%). About 28% of the female respondents identified themselves as sex workers, while about 74% have been involved in transactional sex. The median age at which respondents started using and injecting drugs was 20 and 22 years respectively. Majority (68%) of the respondents consume drugs through smoking, with 20% through snorting, inhaling or swallowing and 12% through injection. The drug mostly used among the respondents was heroin (52%). The most commonly injected drug was cocaine (55%). About 64.7% of respondents reported mixing two or more drugs. HIV prevalence among respondents was 2.5%, 12.3% among women and 17.7% among women engaged in sex work, highlighting the overlap vulnerability. The prevalence of hepatitis C was 6.0%, and Hepatitis B was 4.5%. Access to care is limited, with 63% of the respondents never been tested for HIV.

CONCLUSION

These rapid assessment findings reveal the challenging conditions for people who use and inject drugs coupled with a relatively high prevalence of HIV and Hepatitis C compared to the general population. However, it also reveals that Ghana has a window of opportunity to prevent an exponential spread of HIV and Hepatitis in this population. Therefore, there is the need to implement prevention and treatment programs for HIV and hepatitis among people who use and inject drugs including essential strategies for an enabling environment in Ghana.

Abusive Consumption of Alcoholic Beverages and Associated Factors in Brazilian University Students

The university is considered an environment that favors the initiation and use of substances, especially those that are legal, such as alcohol. This consumption can be differentiated in university students, which makes it necessary to better understand this behavior. Taking into account these aspects, we analyzed the abusive consumption of alcoholic beverages in university students and its association with socioeconomic and behavioral factors. We conducted a cross-sectional study with regularly enrolled students. We assessed the abusive consumption of alcoholic beverages using the binge drinking pattern. We collected socioeconomic and behavioral data using a questionnaire. The association between the variables was verified using logistic regression. Abusive consumption of alcoholic beverages was high, with a high weekly frequency. The association with sociodemographic and behavioral factors can increase the health risk. Education campaigns within institutions with students in the classroom and with all those who can influence these students are important. As there are few studies that consider other health risk factors that have not been analyzed yet, such as those treated in our study, with the abusive consumption of alcoholic beverages, this study seeks to contribute to the knowledge of the relationships between these variables and in the elaboration of actions aimed at improving the lifestyle and health of university students.

Protective strategies and motivations to control drinking among Brazilian college students: a qualitative study

BACKGROUND

To develop prevention programs or early interventions to reduce alcohol consumption and related problems among college students, it is essential to understand their motivations for drinking and the spontaneous (effective and non-effective) strategies they employ to control, considering the social and cultural contexts influence. This study aimed to explore these factors and the student's application of selfcare in different situations and environments, as well as to identify their reasons for not drinking.

METHODS

The students were invited to participate using a snowball sampling, up to the theoretical saturation point. Qualitative individual semi-structured interviews were carried out and the interviews contents were analyzed using the NVivo software. The participants were 23 college students between 18 and 24 years old, with diverse patterns of alcohol use (low-risk to suggestive of dependence).

RESULTS

Data analysis highlighted three main themes: (a) Contexts (such as bars, "open bar" parties and others) and consumption patterns; (b) Protective Strategies (such as stop-drinking intervals, eating before or during drinking, returning home in the company of a friend); (c) Motivations to control drinking (such as sense of responsibility, bad previous experiences, family and religious issues). Protective strategies and motivation to control drinking were perceived to be less prominent in specific contexts that favor high alcohol consumption, as open bar parties.

CONCLUSIONS

Motivations and protective strategies varied according to the drinkers' profile, social situations and settings in which they consumed alcohol. The results highlight the need for preventive interventions planned for specific drinking patterns and contexts.

Profile of Brazilian Undergraduates Who Use Electronic Cigarettes: a Cross-Sectional Study on Forbidden Use

The use of electronic cigarettes (e-cigarettes) persists in Brazil, despite restrictions on sales, imports, and advertising. This study aimed to identify the prevalence of e-cigarette use and user profiles among university students. This cross-sectional study used a convenience sample of 3083 university students (female = 2253, male = 830; M=26.1; SD =8.43) who completed an online survey. We employed logistic regression models and network analysis to determine the profile of e-cigarette users. The prevalence of e-cigarette use in the past year was 12.2% (n =377). Men, single individuals, Caucasians, secular individuals, and non-heterosexual individuals were more likely to engage in e-cigarette use. Intense use of alcohol, tobacco products, and illicit drugs increased the likelihood of e-cigarette use. Brazilian college students continue to use electronic cigarettes despite the prohibition. The pattern of alcohol abuse and tobacco product use among e-cigarette users is concerning. These risky behaviors render young and highly educated individuals targets for public policies to control and regulate electronic cigarettes in the country.

Prescription opioid misuse among university students: A systematic review

Misuse of prescription opioids has substantially increased in the past decade among the general population, including among university students. Relative to the literature concerning opioid misuse among the general population, little information is available regarding the college student population. Objective: The purpose of the present study was to conduct a systematic review of the literature concerning the prevalence of prescription opioid misuse among the university student population. Results: The lifetime estimate for prescription opioid misuse among general populations of students ranged from 4% to 19.7%, with higher estimates for special student populations. Students most at risk for misuse of prescription opioids are those who report higher rates of psychological distress, depression, and suicidal thoughts and behaviors, and white, male students who use alcohol and illicit drugs. Conclusions: Findings from this study underscore the need for opioid prevention and intervention programs on university campuses.

Mental health and quality of life in a population of recreative cannabis users in Brazil

Cannabis is the third most used recreational drug worldwide. Despite the popularity of cannabis use among Brazilians, information about frequent cannabis users outside clinical contexts remains scarce. This is a cross-sectional study of a non-probabilistic sample of 7405 Brazilian adults (6620 [89.4%] cannabis users and 785 [10.6%] non-users) who answered an online survey that collected demographic data, cannabis and other substance use information (initial substance use, lifetime and past-month use), and standardized scales to assess quality of life, subjective well-being, anxiety, and depression scores. Among cannabis users, 17.1% of the participants self-classified themselves as occasional users, 64.6% as habitual users, and 7.7% as dysfunctional users. Participants were mostly young male adults, with at least high-school education, employed, without children. The highest scores for quality of life were observed among habitual cannabis users, followed by occasional users, while both non-users and dysfunctional users presented less favorable scores. Subjective measures of well-being were higher among habitual and occasional users than among non-users, whereas dysfunctional users were the most affected. Poor quality of life, depression or anxiety were more prevalent among dysfunctional users, but non-users of cannabis reported more depression or anxiety symptoms and less quality of life than both occasional and habitual users. The results obtained in this study are particularly relevant because they refer to a sample predominantly composed of habitual cannabis users from the general population, a rarely represented group in other surveys. The fact that cannabis use is generally associated with increased risk of adverse health outcomes was not observed in this study.

Uso de club drugs entre estudantes de graduação: prevalência, características associadas e a influência dos pares

RESUMO Objetivo Medir a prevalência do uso na vida, no último ano e no último mês de duas club drugs – o ecstasy e o LSD –, bem como as características associadas ao uso dessas substâncias, no último mês, entre estudantes de graduação de uma universidade no Sul do Brasil. Métodos Trata-se de um estudo transversal conduzido no ano de 2015 com amostragem aleatória sistemática por conglomerados. Participaram 1.423 estudantes de graduação. Foi utilizado um modelo de análise multivariável em três níveis hierárquicos por meio da regressão de Poisson com ajuste robusto da variância. Resultados As prevalências de uso na vida, no último ano e no último mês de club drugs foram de 12,7%, 7,8% e 3,8%, respectivamente. Indivíduos do sexo masculino, com orientação sexual homossexual ou bissexual, mais jovens, que moravam com seus pares, solteiros, e que relataram uso no último mês de tabaco e maconha apresentaram maior probabilidade de ter feito uso no último mês de alguma club drug. Entretanto, a variável mais fortemente associada a esse desfecho foi ter algum amigo que já fez uso de alguma droga ilícita na vida (RP = 19,54). Conclusões O ambiente universitário parece ser um terreno fértil para a difusão do uso de club drugs. O fortalecimento de uma rede de apoio institucional da universidade, capaz de propor atividades de prevenção, bem como de identificar, acolher e encaminhar casos em que haja abuso e dependência dessas substâncias, pode ser uma estratégia importante para lidar com essa problemática.

Opioid use, regulation, and harms in Brazil: a comprehensive narrative overview of available data and indicators

BACKGROUND

Global opioid consumption increased multifold post-2000, disproportionately in high-income countries, with severe mortality/morbidity consequences. Latin America features comparatively low opioid availability; Brazil, the region's most populous country, makes an interesting case study concerning opioid use/harms. In this comprehensive overview, we aimed to identify and summarize medical and non-medical data and indicators of opioid availability and use, regulation/control, and harm outcomes in Brazil since 2000.

METHODS

We searched multiple scientific databases to identify relevant publications and conducted additional 'grey' literature searches to identify other pertinent information.

RESULTS

Despite some essential indicators, opioid-related data are limited for Brazil. Data indicate that population-level availability of prescription opioids represents only a small fraction of use in comparison to high-income countries. However, within Latin America, Brazil ranks mid-level for opioid consumption, indicating relatively moderate consumption compared to neighboring jurisdictions. Brazil has implemented restrictive regulations to opioid prescribing and is considered 'highly restricted' for opioid access. Codeine remains the major opioid analgesic utilized, but stronger opioids such as oxycodone are becoming more common. Professional knowledge regarding medical opioid use and effects appears limited. National surveys indicate increases in non-medical use of prescription opioids, albeit lower than observed in North America, while illicit opioids (e.g., heroin) are highly uncommon.

CONCLUSIONS

Overall population-level opioid availability and corresponding levels of opioid-related harms in Brazil remain substantially lower than rates reported for North America. However, the available surveillance and analytical data on opioid use, policy/practice, and harms in Brazil are limited and insufficient. Since existing and acute (e.g., pain-related) needs for improved opioid utilization and practice appear to be substantiated, improved indicators for and understanding of opioid use, practice, and harms in Brazil are required.

Prevalence, Incidence, and Factors Associated With Substance Use Among Medical Students: A 2-Year Longitudinal Study

OBJECTIVES

Although there are a number of studies about substance use by medical students, the majority are still cross-sectional. We aimed to investigate prevalence, 2-year incidence, and factors associated with substance use during medical training.

METHODS

This longitudinal study included medical students in 4 different waves (with each wave equaling 1 semester). Socio-demographic data, Duke Religion Index (DUREL), DASS-21, and the "Alcohol, Smoking and Substance Involvement Screening Test" (ASSIST) were used.

RESULTS

A total of 327 (56.2%) medical students were followed for 2 years. Prevalence of lifetime substance use was 89.9% for alcohol, 34.5% for cannabis, and 17.1% for sedatives. Tobacco had the greatest incidence of use over the 2 years (16.4%), followed by alcohol (13.8%) and cannabis (13.8%). At least 24% of the students would need an intervention for alcohol use, 11.4% for tobacco, and 6.5% for cannabis. Alcohol use during wave 4 was associated with organizational religiosity, and alcohol and tobacco use at the baseline; tobacco use during wave 4 was associated with age, non-organizational religiosity, and cannabis and tobacco use at the baseline; and cannabis use during wave 4 was associated with cannabis and tobacco use at the baseline.

CONCLUSIONS

Our results indicate an increase in the incidence of lifetime substance use during medical training. Prior use of substance was associated with a higher chance of use after 2 years, while age and religiousness seem to reduce the chance of use.

Illicit drug use among students of a university in Southern Brazil

OBJECTIVE

To describe drug consumption and the co-occurrence use of more than one illegal drug as well as associated factors in freshmen at a public university in Southern Brazil.

METHODS

Cross-sectional study with census of students entering undergraduate courses in 2017. A total of 1,788 university students answered questions about illicit drug use. For analysis, ordinal logistic regression was used.

RESULTS

Marijuana was the most consumed drug (lifetime: 42.1%; 30-day use: 22.7%), followed by hallucinogens (lifetime: 13.1%, 30-day use: 2.8%). Rates for lifetime use of 0, 1 and 2 or more drugs were 56.2%, 23.3% and 20.4%, respectively, and were associated with men (OR = 2.2; 95%CI:1.4–3.5), being at least 23 years old (OR = 2.7; 95%CI: 1.4–5.1), under 18 years old first experimentation with drugs (OR = 2.3; 95%CI: 1.3–3.9) and living with friends (OR = 2.0; 95%CI: 1.2–3.4). Rates for 30-day use of 0, 1 and 2 or more drugs were 76.8%; 18.1% and 5.1%, respectively, and were associated with being single, separated or widowed (OR = 3.2; 95%CI: 1.4–7.0), lower socioeconomic classes (OR = 0.3; 95%CI: 0.1–1.1; p = 0.001), under 18 years old first experimentation with drugs (OR = 1.8; 95%CI: 1.1–2.9) and living with friends (OR = 1.8 95%CI: 1.2–2.8).

CONCLUSION

Results indicate that students are at greater risk of illicit drug-related health problems. Thus, a better understanding of this consumption should be pursued, as well as the development of a prevention plan.

Introducing the evidence-based population health tool of the Lower-Risk Cannabis Use Guidelines to Brazil

Cannabis is the most commonly used illegal drug, and is associated with well-documented adverse health outcomes, both acute and chronic. Cannabis use prevalence in Brazil is lower than in high-use regions in the Americas (e.g., North America), but concentrated among young people. Frameworks for cannabis control are increasingly shifting towards public health-oriented principles, with some countries undertaking respective policy reforms. These frameworks require a continuum of population-level interventions (e.g., prevention and treatment) including targeted prevention of adverse health outcomes among users. In this context, and based on examples from other health fields, an international expert group developed the evidence-based Lower-Risk Cannabis Use Guidelines (LRCUG), originally for Canada, including a set of 10 recommendations based on systematic data reviews and expert consensus methods. The LRCUG form a scientific population-health prevention tool to reduce adverse public health impacts for broad application among cannabis users. In Canada, the LRCUG have been formally endorsed and are supported by leading national health organizations and government authorities within the continuum of cannabis interventions. As the LRCUG are being internationalized, this paper introduces the LRCUG's concept and content - including their original recommendations translated into Portuguese - to the Brazilian context as an evidence-based population-level intervention tool for uptake, dissemination, and discussion. Sociocultural adaptation may be required for meaningful implementation.

Anabolic steroids among resistance training practitioners

OBJECTIVE

To compare the use of anabolic steroids (AS), the motivation to use them, their side effects, the source of information and the form in which AS were obtained, the medical follow-up, and the periodic examinations in resistance training practitioners who are either current or former users of AS.

METHODS

A prevalence survey was performed in the gyms of the city of Curitiba, including 719 current and former AS users who self-administered a questionnaire. The chi-square and z of proportions (p <0.05) statistical tests were conducted.

RESULTS

Esthetics was the main motivation associated with AS intake, leading to satisfactory results. The information about the form in which to use AS was provided by doctors and AS were either purchased at the pharmacy with a prescription or illegally. Current users reported a higher number of cycles and doses, a longer duration of use, as well as larger economical investments into AS. This shows a higher consumption of such drugs, regardless of the medical follow-up and post-cycle therapy.

CONCLUSION

Given that a change in the usage pattern was observed when increasing the AS consumption, this should be considered in the elaboration of public policies to inhibit such a trend.

ACADEMIC PERFORMANCE AND CONSUMPTION OF ALCOHOL, MARIJUANA, AND COCAINE AMONG UNDERGRADUATE STUDENTS FROM RIBEIRÃO PRETO - BRAZIL

ABSTRACT Objective: to determine alcohol, marijuana, and cocaine use, abuse, and dependence, and to identify the association between the use of these substances and the academic performance of undergraduate students. Method: a cross-sectional study with 275 undergraduate students from health and humanities courses at a university in Ribeirão Preto, Brazil. The instruments used were the Questionnaire for Screening the Use of Alcohol, Tobacco and Other Substances and the student’s self-report on their performance considering a scale from zero to 10. For analysis, Fisher’s Exact Test and Pearson’s Chi-square test were used. Results: the pattern of alcohol and cocaine use in the sample studied was similar to the national average; however the prevalence of marijuana abuse was higher than the average. The use of marijuana was associated with the students’ academic performance in this study. Conclusion: the same association between abuse of and dependence on marijuana was not identified in the sample studied.

THE ASSOCIATION BETWEEN THE USE OF ALCOHOL, MARIJUANA AND COCAINE AND THE SOCIODEMOGRAPHIC CHARACTERISTICS OF UNIVERSITY STUDENTS OF RIBEIRÃO PRETO, BRAZIL

ABSTRACT Objective: to determine the prevalence of use in life and in the last three months of alcohol, marijuana and cocaine among university students from the social and health Sciences areas of Ribeirão Preto, Brazil and to evaluate the association between use in life and in the last three months of alcohol, marijuana and cocaine and the variables gender, area of the course, with whom the student lives, importance of religion, age and year of study. Method: a cross-sectional study, carried out with a convenience sample of 275 students from a public university in Ribeirão Preto-SP. For data collection, two instruments were used, containing sociodemographic, training and psychoactive substances. For the analysis, the following tests were used: Fisher's exact test, Chi-square test of Person and Mann-Whitney test. Results: As for sociodemographic factors, there was a significant association between the gender of the participants among the use of marijuana and cocaine in life (p=0.024 and p=0.005, respectively) and the last three months (p=0.013 and p=0.009, respectively), among the importance of religion and the lifetime use of alcohol, marijuana and cocaine (p <0.001, p <0.001 and p = 0.024, respectively) and the use of only marijuana in the last three months (p <0.001) and among the use of marijuana in the last three months and the year of graduation (p=0.003). Regarding age, the results showed a significant difference only between the groups that reported not to use alcohol in life (p=0.037). Conclusion: the investigated university students presented a prevalence of use in their lifetime and in the last three months of marijuana and cocaine greater among men, but not for alcohol. The importance of religion was negatively associated with the use of investigated drugs. The results can provide important subsidies for the structuring of preventive measures for abuse of psychoactive substances between university students and the need for new investigations that cover the subject.

Response pattern of depressive symptoms among college students: What lies behind items of the Beck Depression Inventory-II?

BACKGROUND

This study examines the response pattern of depressive symptoms in a nationwide student sample, through item analyses of a rating scale by both classical test theory (CTT) and item response theory (IRT).

METHODS

The 21-item Beck Depression Inventory-II (BDI-II) was administered to 12,711 college students. First, the psychometric properties of the scale were described. Thereafter, the endorsement probability of depressive symptom in each scale item was analyzed through CTT and IRT. Graphical plots depicted the endorsement probability of scale items and intensity of depression. Three items of different difficulty level were compared through CTT and IRT approach.

RESULTS

Four in five students reported the presence of depressive symptoms. The BDI-II items presented good reliability and were distributed along the symptomatic continuum of depression. Similarly, in both CTT and IRT approaches, the item 'changes in sleep' was easily endorsed, 'loss of interest' moderately and 'suicidal thoughts' hardly. Graphical representation of BDI-II of both methods showed much equivalence in terms of item discrimination and item difficulty. The item characteristic curve of the IRT method provided informative evaluation of item performance.

LIMITATION

The inventory was applied only in college students.

CONCLUSION

Depressive symptoms were frequent psychopathological manifestations among college students. The performance of the BDI-II items indicated convergent results from both methods of analysis. While the CTT was easy to understand and to apply, the IRT was more complex to understand and to implement. Comprehensive assessment of the functioning of each BDI-II item might be helpful in efficient detection of depressive conditions in college students.

Testing bidirectional associations among emotion regulation strategies and substance use: a daily diary study

BACKGROUND AND AIMS

Alcohol and marijuana are widely used among college students. Emotion regulation strategies have been linked to alcohol and marijuana use, but little attention has been devoted to modeling the directionality of these associations. The aims of the current study were to test whether (a) daytime use of emotion regulation strategies influences the likelihood of evening substance use and (b) evening substance use influences the likelihood of next-day use of emotion regulation strategies.

DESIGN

Longitudinal daily diary data were collected for 30 days via on-line surveys.

SETTING

Northeastern United States.

PARTICIPANTS

A total of 1640 college students (mean age = 19.2 years, 54% female, 80% European American) were recruited each semester between Spring 2008 and Spring 2012.

MEASUREMENTS

Daily diaries assessed emotion regulation strategies (distraction, reappraisal, problem-solving, avoidance) and substance use (any drinking, heavy drinking, marijuana use, co-use of any drinking/heavy drinking and marijuana). Covariates included gender, age, race/ethnicity, fraternity/sorority involvement and baseline depression.

FINDINGS

Daytime distraction [odds ratio (OR) = 0.95], reappraisal (OR = 0.95) and problem-solving (OR = 0.94) predicted lower odds of evening marijuana use (P-values < 0.02). Evening heavy drinking (OR = 0.90) and marijuana use (OR = 0.89) predicted lower odds of next-day problem-solving, with heavy drinking also predicting higher odds (OR = 1.08) of next-day avoidance and marijuana use also predicting higher odds (OR = 1.08) of next-day reappraisal (P-values < 0.03).

CONCLUSIONS

There appear to be reciprocal relations among emotion regulation strategies and substance use: greater daytime use of distraction, reappraisal, and problem solving predicts lower evening substance use, while higher evening substance use predicts higher next-day avoidance and reappraisal but lower next-day problem-solving.

Association between the number of sexual partners and alcohol consumption among schoolchildren

OBJECTIVE

To determine the association between the number of sexual partners and alcohol consumption in adolescents and young schoolchildren.

METHODS

The sample consisted of students from public schools aged 12-24 years who answered the Brazilian version of the Youth Risk Behavior Survey questionnaire. The analysis was performed by multinomial logistic regression model.

RESULTS

1275 students were analyzed. For females, having two to five partners was associated with age ≥15 years (OR 14.58) and maternal education up to incomplete high school or lower educational level (OR 3.37). No consumption of alcohol decreased the chances of having more partners by 96%. For males, the associated variables were: age ≥15 years (OR 18.15); having no religion (OR 3.55); age at first dose ≤14 years (OR 3.48). Binge drinking increases the chances of having a higher number of sexual partners.

CONCLUSION

Regardless of the number of partners, binge drinking and age of alcohol consumption onset are risk factors for vulnerable sexual behavior.

Anabolic-Androgenic Steroid use in the Nordic Countries: A Meta-Analysis and Meta-Regression Analysis

Aims

To investigate the lifetime prevalence and moderators of non-medical AAS use in the five Nordic countries.

Methods

We conducted a meta-analysis and meta-regression using studies gathered from searches in PsycINFO, PubMed, ISI Web of Science, Google Scholar, and reference checks. Included were 32 studies that provided original data on 48 lifetime prevalence rates based on a total of 233,475 inhabitants of the Nordic countries.

Results

– The overall lifetime prevalence obtained was 2.1% [95% confidence interval (CI): 1.3-3.4, I2 = 99.5, P < 0.001]. The prevalence for males, 2.9% (95% CI: 1.7-4.8, I2 = 99.2, P < 0.001), was significantly higher (Qbet = 40.5, P < 0.001) than the rate for females, 0.2% (95% CI: 0.1-0.4, I2 = 90.5, P < 0.001). Sweden has the highest prevalence of AAS use: 4.4%, followed by Norway: 2.4%, Finland: 0.8%, Iceland: 0.7%, and Denmark: 0.5%. Country, sample type, and male sample percentage significantly predicted AAS use prevalence in a meta-regression analysis. No indication of publication bias was found.

Conclusion

– Though subject to some limitations, our findings suggest that non-medical AAS use should be regarded as a serious public health problem in the Nordic countries.

Aplicação do instrumento Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): uma revisão integrativa

RESUMO Objetivo Objetivou-se sistematizar o conhecimento e a aprendizagem de como é a aplicação do instrumento Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Método Revisão integrativa, realizada entre maio e julho do ano de 2014, nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrieval System Online (Medline), PubMed e Scientific Electronic Library Online (SciELO), assim como no sistema de busca do Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES). Foram selecionados 26 artigos. Resultados: O ASSIST concentrou-se no auxílio da identificação e classificação do uso de substância psicoativa, tendo se revelado importante no rastreamento do envolvimento com o álcool e outras drogas, e efetivo no nível primário à saúde. Conclusão: Confirmou-se como instrumento a ser usado na Atenção à Saúde.

The Prevalence of Substance use and Associated Risk Factors Among University Students in the City of Jahrom, Southern Iran

Background:

Substance use among college students in Iran is a serious problem. Determining the pattern of substance use among University students is an important issue for implementing prevention and treatment programs.

Objectives:

The present survey attempts to determine the prevalence of substance usage and associated risk factors among the students of Jahrom University of Medical Sciences and Islamic Azad University of Jahrom, Jahrom, Iran.

Patients and Methods:

This cross-sectional study was carried out from December 2012 to February 2013 and included 1149 randomly selected students of two Jahrom universities. A standard questionnaire was used for data gathering. Data were analyzed using the SPSS version 15 for Windows. T-test and Chi-square T-test and Chi-square and Logestic regression tests were used for data analysis.

Results:

Tobacco (28.3%), alcohol (13.0%), and cannabis and marijuana (5.2%) were the most common substances used by the students. The prevalence of substance use among the male students was significantly higher (OR: 1.5, 95%CI: 1.42 - 2.68, P < 0.001). The risk of at least single episode of substance usage was higher among the students which were living alone (OR: 3.03, 95%CI: 1.74 - 5.28, P < 0.001) The most important motivators for beginning substance use were curiosity, in 46.4%, and seeking pleasure, in 28.8%.

Conclusions:

Substance usage is considered as a risk factor for students’ health among University students in Iran. Design of educational courses addressing the detrimental effects and dire consequences of substance usage could help to improve control programs. Universities could improve their drug abuse control programs by focusing on the high risk groups determined by relevant studies.

Prevalence and correlates of anabolic-androgenic steroid use in a nationally representative sample of 17-year-old Norwegian adolescents

BACKGROUND

Anabolic-androgenic steroid (AAS) use has been identified as a serious public health problem.

OBJECTIVES

This study investigates the prevalence and correlates of AAS use among Norwegian adolescents.

METHODS

In 2012, a nationally representative sample of 2,055 17-year-old adolescents (963 males and 1,088 females) participated in a survey. The response rate was 70.4%. In addition to questions about AAS use, participants completed the Parental Monitoring Scale, the Family Relations/Cohesion Scale, the Alcohol Use Disorders Identification Test C, the Mini-International Personality Item Pool-Five-Factor Model, the Eysenck Narrow Impulsiveness Subscale, the Arnett Inventory of Sensation Seeking, the Short-Form Buss-Perry Aggression Questionnaire, the Hospital Anxiety and Depression Scale, and the UCLA Loneliness Scale. They also answered questions about demography, gambling, smoking, snus, and narcotic use. Descriptive statistics and logistic regression were used to analyze the data.

RESULTS

The lifetime prevalence of AAS use was 0.30% (0.52% in males and 0.09% in females), while current prevalence was 0.25%. Moreover, 19.39% of the sample reported having an acquaintance who used or had used AAS. Having an acquaintance who used or had used AAS was significantly related to snus use, depression, aggression, extraversion, and conscientiousness in both univariate and multivariate logistic regression analyses. Conclusions/Importance: Our findings suggest a high prevalence of AAS use among Norwegian adolescents and denote the significance of social, personality, and health factors in adolescents' exposure to AAS milieu.

Estudo transversal sobre o uso de risco de álcool em uma amostra de estudantes de uma universidade federal brasileira

Objetivo Avaliar o padrão de consumo de álcool entre estudantes de uma universidade federal brasileira que faz parte do Programa de Apoio a Planos de Reestruturação e Expansão das Universidades Federais (REUNI) e identificar os grupos mais expostos a problemas relacionados ao uso de álcool e fatores associados. Métodos Caracteriza-se como um estudo descritivo, quantitativo e de delineamento transversal no qual se aplicou um questionário de caracterização sociodemográfica e o The Alcohol Use Disorders Identification Test (AUDIT) em 787 estudantes universitários de uma universidade federal brasileira. Resultados Entre os estudantes, 82,9% se enquadraram no grupo que faz consumo de baixo risco e 17,1%, no grupo que faz um consumo de risco. A análise de correspondência detectou que os estudantes do gênero masculino, os que não possuíam religião, que praticavam atividade física esporadicamente e que residiam em repúblicas se caracterizaram como pertencentes ao grupo de risco em relação ao consumo de álcool. Conclusões Os resultados indicam predominância de consumo de álcool de baixo risco entre os estudantes e sugerem uma relação entre consumo de álcool de maior risco e gênero masculino, não possuir religião, praticar atividade física esporadicamente e residir em repúblicas. Essas informações devem ser consideradas em programas preventivos no ambiente universitário.

The role of first use of inhalants within sequencing pattern of first use of drugs among Brazilian university students

The present study investigated the role of first use of inhalants within a first drug sequencing pattern. In a representative sample of university students from 27 Brazilian capitals (n = 12,711), we analyzed the patterns of transition from/to first use of inhalants to/from the first use of alcohol, tobacco, cannabis, cocaine, hallucinogens, ecstasy, amphetamines, prescription opioids, and tranquilizers. Cox proportional hazards models were used to analyze data. Drugs that were not specified as the pair of drugs tested in each model were included as time-varying covariates in all models. In this sample, first use of inhalants was preceded only by the first use of alcohol and tobacco. However, first use of inhalants preceded first use of cannabis, amphetamines, cocaine, and tranquilizers. First use of inhalants preceded the first use of prescription opioids, and vice versa. This study highlights the need to intervene early with youths who are at risk of or just beginning to use inhalants, because this class of drugs seems to be the first illegal drug in Brazil to be experimented by respondents in our sample. There is also a call for attention to individuals who have already first used inhalants because of their higher chance to experiment with other drugs such as cannabis, cocaine, and prescription drugs. All these findings show an in-transition culture of drug use, which should be tracked through time, because some classical models (i.e., gateway model) might be outdated and might also not fit within different settings.

Steroids, psychosis and poly-substance abuse

OBJECTIVE

To review consequences of the changing demographic profile of anabolic-androgenic steroid (AAS) use.

METHOD

Case report and review of key papers.

RESULTS

We report here a case of a 19-year-old Irish male presenting with both medical and psychiatric side effects of methandrostenolone use. The man had a long-standing history of harmful cannabis use, but had not experienced previous psychotic symptoms. Following use of methandrostenolone, he developed rhabdomyolysis and a psychotic episode with homicidal ideation. Discussion Non-medical AAS use is a growing problem associated with medical, psychiatric and forensic risks. The population using these drugs has changed with the result of more frequent poly-substance misuse, potentially exacerbating these risks.

CONCLUSION

A higher index of suspicion is needed for AAS use. Medical personnel need to be aware of the potential side effects of their use, including the risk of violence. Research is needed to establish the magnitude of the problem in Ireland.

Use transition between illegal drugs among Brazilian university students

PURPOSE

The aim of the present study was to test whether the first use of an illicit drug increases the chance of first use of other illicit drugs.

METHOD

The transitions from the first use of a drug to the first use of another drug were analyzed. Comparisons were made between first drug users and non-users. Survival analysis methods were used to compare the cumulative probability of second drug use after adjusting for socio-demographic covariates and the intermediate use of alcohol and/or tobacco. A total of 12,721 Brazilian university students participated in this study.

RESULTS

Inhalants and marijuana were used prior to the use of several other drugs, whereas the opposite pattern was not found. Ecstasy was used before other drugs in several instances. Other well-examined drugs, such as amphetamines, cocaine and hallucinogens, were used both before and after other illicit drugs without any marked predominance for either of the two roles.

CONCLUSIONS

This study supports the role of the use of marijuana and inhalants almost exclusively before the use of other illicit drugs, whereas the use of ecstasy has an opposite role. These roles could be linked to the prevalence of lifetime use and whether individuals were at an earlier or later age during experimentation.

The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression analysis

PURPOSE

To estimate the global lifetime prevalence rate of anabolic-androgenic steroid (AAS) use and investigate moderators of the prevalence rate.

METHODS

A meta-analysis and meta-regression analysis was performed using studies gathered from searches in PsycINFO, PubMed, ISI Web of Science, and Google Scholar among others. Included were 187 studies that provided original data on 271 lifetime prevalence rates. Studies were coded for publication year, region, sample type, age range, sample size, assessment method, and sampling method. Heterogeneity was assessed by the I(2) index and the Q-statistic. Random effect-size modeling was used. Subgroup comparisons were conducted using Bonferroni correction.

RESULTS

The global lifetime prevalence rate obtained was 3.3% (95% confidence interval [CI], 2.8-3.8; I(2) = 99.7, P < .001). The prevalence rate for males, 6.4% (95% CI, 5.3-7.7, I(2) = 99.2, P < .001), was significantly higher (Qbet = 100.1, P < .001) than the rate for females, 1.6% (95% CI, 1.3-1.9, I(2) = 96.8, P < .001). Sample type (athletes), assessment method (interviews only and interviews and questionnaires), sampling method, and male sample percentage were significant predictors of AAS use prevalence. There was no indication of publication bias.

CONCLUSION

Nonmedical AAS use is a serious widespread public health problem.

Comparação do uso de drogas entre universitários brasileiros, norte-americanos e jovens da população geral brasileira

OBJETIVO: Comparar o uso de drogas entre os universitários e a população geral brasileira, assim como com os universitários norte-americanos, identificando possíveis diferenças de uso pela interferência da cultura. MÉTODOS: Para comparar o uso de drogas na vida entre as populações de interesse, foram utilizados os dados públicos de levantamentos estatísticos brasileiros realizados com universitários e a população geral, assim como levantamento estatístico norte-americano, por meio da comparação de intervalos de confiança (IC 95%). RESULTADOS: O uso de drogas na vida é mais frequente entre os estudantes norte-americanos, que relatam usar mais tabaco, tranquilizantes, maconha, ecstasy, alucinógenos, cocaína, crack e heroína que os universitários brasileiros. Em contrapartida, os universitários brasileiros relatam usar quase duas vezes mais inalantes do que os universitários norte-americanos. Esse padrão se repete ao se analisarem as diferenças intragênero. A isso se soma que os universitários brasileiros parecem envolver-se com mais frequência no uso de bebidas alcoólicas, maconha, tranquilizantes, inalantes, alucinógenos e anfetamínicos que seus pares da população geral brasileira. CONCLUSÕES: Conhecer as particularidades do uso de drogas entre os universitários é de suma importância para a detecção precoce desse consumo. Investimentos nesse segmento e diferenças de sexo devem ser contempladas nas políticas preventivas, assim como na elaboração de estratégias para a redução e o controle desse consumo, como programas de triagem e intervenção breve, uma vez que possuem a melhor relação custo-benefício.

Uso de anfetaminas por motoristas de caminhão em rodovias do Estado de São Paulo: um risco à ocorrência de acidentes de trânsito?

No Brasil, é comum o uso de anfetaminas por motoristas de caminhão, o que pode culminar na ocorrência de acidentes de trânsito. O objetivo deste artigo é estimar a prevalência do uso de anfetaminas entre caminhoneiros. Motoristas (N = 134) foram abordados em duas rodovias do Estado de São Paulo e solicitados a responder um questionário, assim como a fornecer uma amostra de urina para realização de análises toxicológicas. Todos os dados foram analisados em Stata 8.0. Todos os participantes eram do sexo masculino, de idade média de 40,8 anos e de baixa escolaridade. A presença de anfetaminas foi detectada em 10,8% das amostras de urina, cujo uso foi justificado para manter a vigília durante o trabalho. O uso de anfetaminas foi detectado entre caminhoneiros em rodovias de São Paulo. Cessado o efeito estimulante, a sonolência advinda de uma possível privação de sono diminui a atenção e o bom desempenho na direção, predispondo o condutor aos acidentes de trânsito e seus custos relacionados.

The effects of alcohol mixed with energy drinks (AmED) on traffic behaviors among Brazilian college students: a national survey

OBJECTIVE

Drinking alcohol mixed with energy drinks (AmED) may be contributing to hazardous drinking practices and risk-taking behaviors among college students. In this regard, this study aimed to assess the frequency of AmED consumption in a national sample of Brazilian college students and to estimate the risk that energy drinks pose on drinking and traffic behaviors.

METHOD

A sample of 12,711 college students from across the country was asked to complete a research questionnaire on the use of drugs and other behaviors. Students who reported drinking in the previous 12 months (N = 8672) were divided into 2 groups: (a) those who reported drinking only alcohol (N = 4192) and (b) those who reported drinking AmED (N = 1119). The college students who reported the use of at least one illicit drug were excluded from data analysis. Descriptive and inferential analyses were subsequently carried out using the R library survey software 2.15.0. The null hypothesis was rejected at the level of P < .05.

RESULTS

AmED users are more likely to be hazardous drinkers. Being male, single, and involved with high-risk drinking behaviors are associated to AmED. After adjusting for demographic and drinking variables, the odds of being involved in high-risk traffic behaviors--for example, driving at high speed (odds ratio [OR] = 2.6; P < .001) and driving after binge drinking (OR = 2.8; P < .001)--were higher among AmED users than alcohol only users (AUs).

CONCLUSION

The current findings are consistent with the results of previous studies. Drinking AmED may make college students more vulnerable to the occurrence of risky drinking and traffic behaviors. Educational campaigns targeted to young people should be developed warning them about the potential risks of mixing alcohol with energy drinks.