Ilana Pinsky

The Effect of Restricting Opening Hours on Alcohol-Related Violence

OBJECTIVE We investigated whether limiting the hours of alcoholic beverage sales in bars had an effect on homicides and violence against women in the Brazilian city of Diadema. The policy to restrict alcohol sales was introduced in July 2002 and prohibited on-premises alcohol sales after 11 pm. METHODS We analyzed data on homicides (1995 to 2005) and violence against women (2000 to 2005) from the Diadema (population 360,000) police archives using log-linear regression analyses. RESULTS The new restriction on drinking hours led to a decrease of almost 9 murders a month. Assaults against women also decreased, but this effect was not significant in models in which we controlled for underlying trends. CONCLUSIONS Introducing restrictions on opening hours resulted in a significant decrease in murders, which confirmed what we know from the literature: restricting access to alcohol can reduce alcohol-related problems. Our results give no support to the converse view, that increasing availability will somehow reduce problems.

Envolvimento religioso e fatores sociodemográficos: resultados de um levantamento nacional no Brasil

CONTEXTO: As relacoes entre envolvimento religioso e saude tem sido objeto de crescente interesse, mas ha carencia de estudos fora dos Estados Unidos e da Europa. OBJETIVOS: O presente estudo descreve o envolvimento religioso na populacao brasileira e sua relacao com variaveis sociodemograficas. METODOS: Numa amostra probabilistica da populacao brasileira (n = 3.007), variaveis sociodemograficas e de envolvimento religioso foram avaliadas. RESULTADOS: Cinco por cento dos brasileiros declararam nao ter religiao, 83% consideraram religiao muito importante para sua vida e 37% frequentavam um servico religioso pelo menos uma vez por semana. As filiacoes religiosas mais frequentes foram Catolicismo (68%), Protestante/Evangelica (23%) e Espiritismo Kardecista (2,5%). Dez por cento referiram frequentar mais de uma religiao. De modo semelhante a estudos em outros paises, maior idade e sexo feminino se associaram a maiores niveis de religiosidade subjetiva e organizacional, mesmo apos o controle para outras variaveis sociodemograficas. Entretanto, nivel educacional, renda e raca negra nao se associaram de modo independente a indicadores de religiosidade. CONCLUSAO: Este estudo mostra altos niveis de religiosidade entre os brasileiros e sugere que religiosidade, em diferentes culturas, pode relacionar-se de modo diferente com outras variaveis. Para uma melhor compreensao da influencia da religiosidade na saude, e necessario expandir esse tipo de estudo para outras culturas.

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.

Pesquisa de compra de bebidas alcoólicas por adolescentes em duas cidades do Estado de São Paulo

OBJECTIVE Alcohol use is a public health problem. Commercial availability is an important factor that encourages the use of alcohol by young people. The aim of the study was to assess how often young people under 18 could buy alcohol in shops METHODS Adolescents from 13 to 17 attempted to purchase alcoholic beverages at a random sample of shops in the cities of Paulinia (n=108) and Diadema (n=426), Southeastern Brazil. The study was conducted from November to December 2003 in Paulínia, and July 2004 to August 2005 in Diadema. They were told not to lie about their ages when asked and to say that the beverage was for themselves. Statistical tests performed were two-tailed and the significance level considered was p<0.05. RESULTS Adolescents, under the minimum legal age, were successful in purchasing alcoholic beverages in the first attempt in 85.2% of the surveyed outlets in Paulinia, and 82.4% in Diadema. The adolescents bought alcoholic beverages just as easy in all shops researched. CONCLUSIONS The data showed almost unanimous easiness of teenagers to obtain alcoholic beverages, suggesting the relevance of this problem in these cities (and probably in Brazil). The urge to adopt specific alcohol policies to this age group is highlighted, in order to reduce alcohol consumption.OBJETIVO: O consumo de alcool e um problema de saude publica. A disponibilidade comercial e um importante fator no estimulo ao consumo de alcool por adolescentes. O objetivo do estudo foi verificar com que frequencia menores de 18 anos conseguem comprar bebidas alcoolicas em estabelecimentos comerciais. METODOS: Adolescentes com idades entre 13 e 17 anos tentaram comprar bebidas alcoolicas em uma amostra aleatoria de estabelecimentos comerciais em Paulinia (N=108) e Diadema (N=426), no Estado de Sao Paulo. O estudo foi realizado em novembro e dezembro de 2003 em Paulinia e de julho de 2004 a agosto de 2005 em Diadema. Eles foram orientados a nao mentir sobre sua idade quando questionados e a dizer que a bebida era para consumo proprio. Os testes estatisticos realizados foram bi-caudais e o nivel de significância considerado foi de p<0,05. RESULTADOS: Adolescentes abaixo da idade minima legal conseguiram comprar bebidas alcoolicas em uma primeira tentativa em 85,2% dos locais testados em Paulinia e em 82,4% em Diadema. Os adolescentes compraram bebidas alcoolicas com a mesma facilidade em todos os estabelecimentos pesquisados. CONCLUSOES: Os dados mostraram uma quase unânime facilidade de obtencao de bebidas alcoolicas, sugerindo a relevância do problema nestas cidades (e provavelmente no Brasil). Ressalta-se a importância da adocao de politicas especificas para esta faixa etaria, no sentido de reduzir o consumo de alcool.

Highly reported prevalence of drinking and driving in Brazil: data from the first representative household study

OBJECTIVE Brazil lacks information about driving under the influence of alcohol (DUI) originated from representative samples obtained from the general population. METHOD 333 subjects with a valid drivers license and drinking in the last 12 months were drawn from a multistaged sample of 2,346 adults from the first Brazilian Household Survey of Patterns of Alcohol Use. A multivariate analysis was conducted to understand the associations between risk factors and driving after drinking three or more drinks. RESULTS the overall DUI prevalence reported in the sample was 34.7% - 42.5% among males and 9.2% among females. Being male (OR = 6.0, 95% CI 2.9-12.6), having a previous DUI accident (OR = 7.9, 95% CI 2.5-24.9), binging in the last year (OR = 2.2, 95% CI 1.03-4.5) and having an unfavorable opinion towards policies (OR = 2.9, 95% CI 1.4-6.2) remained associated with heavy drinking and driving after model adjustments. DISCUSSION This was the first study evaluating driving under the influence of alcohol in a representative sample of the Brazilian population. The prevalence of DUI found is alarming, and possibly underestimated in the sample. Results demonstrate the need for more studies on this association and show directions towards preventive strategies for the specific high-risk group of male drivers with previous problems with alcohol and unfavorable opinions about prevention policies.

Prevalência do beber e dirigir em Diadema, estado de São Paulo

Problems due to alcohol use among drivers have been assessed worldwide and studies indicate high morbidity and mortality rates related to drinking and driving. There are few national studies about this subject. Thus, this study was conducted aiming at estimating the prevalence of drinking and driving and testing the acceptability of passive and active breathalyzers. A total of 908 drivers were tested in the main streets of a city in the state of Sao Paulo, from February 2005 to March 2006. The methodology adopted was sobriety checkpoints. In 23.7% of the drivers some level of alcohol was found in the exhaled air; in 19.4% alcohol level was equal to or higher than the legal limit. The passive breathalyzer was reliable and presented results comparable to the active one. These findings were six times higher than those found in similar surveys carried out in other countries, indicating the relevance of this problem. Specific public policies to fight the problem and more national studies are needed.

Violência entre parceiros íntimos e consumo de álcool

OBJETIVO: Estimar a prevalencia de violencia por parceiros intimos e o consumo de alcool durante os eventos dessa violencia. METODOS: Estudo transversal com amostra probabilistica de multiplos estagios, representativa da populacao brasileira, composta por amostra de 1.445 homens e mulheres casados ou vivendo em uniao estavel, entrevistados entre novembro de 2005 e abril de 2006. As entrevistas foram realizadas na casa dos entrevistados, usando um questionario fechado padronizado. As taxas de prevalencia de violencia por parceiros foram estimadas e testes qui-quadrado foram empregados para avaliar as diferencas de genero nessa prevalencia. RESULTADOS: Homens apresentaram uma prevalencia geral de 10,7% de episodios de violencia por parceiros e as mulheres 14,6%. Homens consumiram alcool em 38,1% dos casos de e as mulheres em 9,2%. Com relacao a percepcao de consumo de alcool pela companheira, homens informaram que sua parceira consumia em 30,8% dos episodios de violencia e mulheres que o seu parceiro fazia ingestao de alcool em 44,6% dos episodios. CONCLUSOES: As mulheres se envolveram em mais episodios de (perpetracao, vitimizacao ou ambos) leves e graves do que os homens. A frequencia quatro vezes maior de relatos de homens alcoolizados durante os eventos permitem supor que a prevencao a violencia por parceiros possa se beneficiar de politicas publicas de reducao do consumo de alcool.

Alcohol consumption in late-life — The first Brazilian National Alcohol Survey (BNAS)

To investigate the alcohol consumption in later life in Brazil and its association with socio-demographic characteristics. This study was a cross-sectional analysis of nationally representative survey data. A multistage cluster sampling procedure was used to select 3007 individuals of 14 years of age and older from the Brazilian household population. In this study we analyzed data from all 400 participants who were over 60 years old. Alcohol Abuse and Dependence Syndrome was established according to DSM-IV and Risky Drinking was defined in two ways: heavy drinkers (>7 drinks/week) and as binge drinkers (>3 drinks/one occasion). Twelve percent of participants reported heavy drinking behavior while 10.4% and 2.9% were binge drinkers and alcohol dependent respectively. In the adjusted logistic regression only gender was associated with heavy drinking behavior. Males, the youngest and the wealthiest were more likely to report binge drinking behaviors. In conclusion, alcohol related-problems are common but under recognized among older adults. Health professionals should be aware that common definitions of alcohol abuse and dependence may not apply as readily to older people, who have had biological changes for alcohol tolerance and its effects on the Central Nervous System.

Brief motivational interview and educational brochure in emergency room settings for adolescents and young adults with alcohol related problems: a randomized single blind clinical trial

OBJECTIVE To evaluate the effectiveness of brief motivational interviewing and an educational brochure when delivered in emergency room to reduce alcohol abuse and related problems among adolescents and young adults. METHOD A randomized single-blind clinical trial with a three-month follow-up was carried out at three emergency rooms from October 2004 to November 2005; subjects assessed were 16-25 years old treated for alcohol related events up to 6 hours after consumption. Socio-demographic data, quantity, frequency and negative consequences of alcohol consumption, motivation to change habits and future risk perception were evaluated. Statistical analysis was performed on subjects who completed follow-up (completers). ANCOVA model was used to analyze the difference between the intervention groups with statistical significance level α = 5% and confidence interval (CI) of 95%. RESULTS 186 subjects formed the initial sample, being 175 included and randomized to the educational brochure group (n = 88) or motivational interviewing group (n = 87). Follow-up assessment was performed in 85.2% of the sample. No significant difference between groups was observed. However, significant reductions (p < 0.01) in related problems and alcohol abuse were found in both groups. CONCLUSION In this sample a reduction of alcohol use and related problems was observed. Preliminary data indicate that controlled clinical trials with motivational interviewing, educational brochure and nonintervention should be of future interest among Brazilian adolescent populations.

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.