Efetividade de uma intervenção digital na diminuição da prática de binge drinking entre frequentadores de baladas

OBJECTIVE: To evaluate the effectiveness of a web-based intervention in reducing binge drinking among nightclub patrons after six months. METHODS: We carried out a website survey with probabilistic sample in 31 nightclubs in the city of São Paulo, Brazil, which originated a randomized controlled trial with 1,057 participants. Those classified as problem drinkers (n = 465) using the Alcohol Use Disorders Identification Test were randomized into two study groups – intervention and control. The web-based intervention consisted of exposing the participants to a normative feedback screen about their alcohol consumption, characterizing the risks associated with amount consumed, money spent on drinks, drinking and driving, risk classification of Alcohol Use Disorders Identification Test, and tips to reduce damage. RESULTS: There was a significant reduction in the practice of binge drinking in the week estimated at 38% among participants in the intervention group after six months (p < 0.05). However, there was no significant reduction in the outcomes when we analyzed the intervention and control groups and at baseline and after sixth months, simultaneously. CONCLUSIONS: We cannot conclude that digital tools reduce the pattern of binge drinking among party goers in São Paulo. More studies are needed with this methodology because of its attractiveness to this type of group, given the privacy and speed that personalized information is transmitted.OBJETIVO: Avaliar, após seis meses, a efetividade de uma intervenção digital na diminuição da prática de binge drinking entre frequentadores de baladas. MÉTODOS: Foi realizado um inquérito de portal através de uma amostra probabilística em 31 baladas da cidade de São Paulo, a qual originou um ensaio controlado randomizado com 1.057 participantes. Aqueles classificados como uso problemático do álcool (n = 465) através do Alcohol Use Disorders Identification Test foram randomizados em dois grupos de estudo – intervenção e controle. A intervenção digital consistiu em expor os participantes a uma tela de feedback normativo sobre seu consumo de álcool, caracterizando os riscos associados à quantidade consumida, valores gastos com bebidas, beber e dirigir, classificação do risco do Alcohol Use Disorders Identification Test e dicas de redução de danos. RESULTADOS:Houve uma redução significativa da prática de binge drinking na semana estimada em 38% entre os participantes do grupo intervenção após seis meses (p < 0,05). Porém, não houve redução significativa nos desfechos quando se analisam os grupos intervenção e controle e os tempos início e seis meses após, simultaneamente. CONCLUSÕES: Não se pode concluir que as ferramentas digitais reduzem o padrão de binge drinking nos frequentadores de baladas paulistanas. São necessários mais estudos com esta metodologia devido ao caráter atrativo para esse grupo, tendo em vista a privacidade e a rapidez que as informações personalizadas são transmitidas

The use of ketamine to cope with depression and post-traumatic stress disorder:A qualitative analysis of the discourses posted on a popular online forum

Background Because of the shortcomings of traditional pharmacotherapy for major depressive disorder and post-traumatic stress disorder (PTSD), there has been growing interest in the rapid mood-enhancing effect of ketamine. Objectives To analyze what has been posted about ketamine use for dealing with self-reported depression and/or PTSD on one of the biggest international message boards on the internet. Methods Qualitative study with online observation of threaded discussions on Bluelight. In-depth online searches were conducted in 2018. Twenty-nine threads, with a total of 708 units of analysis, were selected and subjected to content analysis, where, via a coding process, the units of analysis were organized into nodes. Results Despite having several negative effects (e.g. dizziness, nausea and inability to talk), the examined discourses suggested that the use of ketamine to elevate mood was both efficient and worthwhile. Intranasal use was the most common route of administration mentioned. We traced how the mood enhancement caused by ketamine is perceived: the loss of pleasure disappears, as well as the depressed mood; the markedly diminished interest in activities vanishes and motivation comes back. From all the posts analyzed, only two reported negative outcomes (i.e. no mood-enhancing effect). The most mentioned adverse event was damage to the urinary bladder and the kidneys in cases of misuse. Conclusion Although online research of user-generated content has its limitations in terms of reliability and validity, the present study adds relevant information on the use of ketamine for managing depression and PTSD, whether this use is done legally or not

Fatores associados à implantação de programas de prevenção ao uso de drogas nas escolas

OBJECTIVE To analyze if characteristics of managers, schools, and curriculum are associated with the implementation of programs for drug abuse prevention in elementary and high schools. METHODS Cross-sectional study, with random sample of 263 school managers. Data were collected between 2012 and 2013 by a program that sends forms via internet. A closed self-filling questionnaire was applied online. Statistical analysis included Chi-square tests and logistic regression models. The outcome variable was the presence of program for drug abuse prevention inserted in the daily life and educational program of the school. The explanatory variables were divided into: demographic data of the manager; characteristics of the school and of the curriculum; health education; and drug use in the school. RESULTS We found that 42.5% (95%CI 36.1–49.1) of the evaluated schools had programs for drug abuse prevention. With the multiple logistic regression model, we observed that the more time the manager has worked with education, the chance of the school having a program increased at about 4.0%. Experimenting with innovative teaching techniques also increased at about six times the chance of the school developing a program for drug abuse prevention. The difficulties in the implementation of the programs were more present in state and municipal schools, when compared with private schools, due to, for instance: lack of teaching materials, lack of money, and competing demands for teaching other subjects. CONCLUSIONS The implementation of programs for drug abuse prevention in the city of Sao Paulo is associated with the experience of the manager in education and with the teaching strategies of the school.OBJETIVO Analisar se características dos dirigentes, das escolas e do currículo escolar estão associadas à implantação de programas de prevenção ao uso de drogas nas escolas do ciclo fundamental II e médio. MÉTODOS Estudo transversal, com amostra aleatória sistemática de 263 dirigentes escolares. Os dados foram coletados nos anos de 2012 e 2013 por meio de um programa de envio de formulários pela internet. Aplicou-se questionário fechado, de autopreenchimento on-line. A análise estatística incluiu testes Qui-quadrado e modelos de regressão logística. A variável desfecho foi a presença de programa de prevenção ao uso de drogas inserido no cotidiano e no programa pedagógico da escola. As variáveis explicativas foram divididas em: dados demográficos do dirigente; características da escola e do currículo; educação em saúde; e consumo de drogas na escola. RESULTADOS Constatou-se que 42,5% (IC95% 36,1–49,1) das escolas avaliadas possuíam programa de prevenção ao uso de drogas. Com o modelo de regressão logística múltipla, observou-se que, a cada ano de atuação do dirigente na educação, a chance de a escola ter um programa aumentava em aproximadamente 4,0%. O fato de experimentar técnicas de ensino inovadoras também aumentou em cerca de seis vezes a chance de a escola desenvolver um programa de prevenção ao uso de drogas. As dificuldades na implantação dos programas foram mais presentes nas redes estadual e municipal, quando comparadas à rede privada, destacando-se: a falta de material didático, a falta de dinheiro e as demandas concorrentes para ensino de outras disciplinas. CONCLUSÕES A implantação de programas de prevenção ao uso de drogas no município de São Paulo está associada à experiência do dirigente escolar na educação e nas estratégias de ensino da escola

Factors associated with the implementation of programs for drug abuse prevention in schools

OBJECTIVE: To analyze if characteristics of managers, schools, and curriculum are associated with the implementation of programs for drug abuse prevention in elementary and high schools. METHODS: Cross-sectional study, with random sample of 263 school managers. Data were collected between 2012 and 2013 by a program that sends forms via internet. A closed self-filling questionnaire was applied online. Statistical analysis included Chi-square tests and logistic regression models. The outcome variable was the presence of program for drug abuse prevention inserted in the daily life and educational program of the school. The explanatory variables were divided into: demographic data of the manager characteristics of the school and of the curriculum health education and drug use in the school. RESULTS: We found that 42.5% (95% CI 36.1-49.1) of the evaluated schools had programs for drug abuse prevention. With the multiple logistic regression model, we observed that the more time the manager has worked with education, the chance of the school having a program increased at about 4.0%. Experimenting with innovative teaching techniques also increased at about six times the chance of the school developing a program for drug abuse prevention. The difficulties in the implementation of the programs were more present in state and municipal schools, when compared with private schools, due to, for instance: lack of teaching materials, lack of money, and competing demands for teaching other subjects. CONCLUSIONS: The implementation of programs for drug abuse prevention in the city of Sao Paulo is associated with the experience of the manager in education and with the teaching strategies of the school.OBJETIVO: Analisar se características dos dirigentes, das escolas e do currículo escolar estão associadas à implantação de programas de prevenção ao uso de drogas nas escolas do ciclo fundamental II e médio. MÉTODOS: Estudo transversal, com amostra aleatória sistemática de 263 dirigentes escolares. Os dados foram coletados nos anos de 2012 e 2013 por meio de um programa de envio de formulários pela internet. Aplicou-se questionário fechado, de autopreenchimento on-line. A análise estatística incluiu testes Qui-quadrado e modelos de regressão logística. A variável desfecho foi a presença de programa de prevenção ao uso de drogas inserido no cotidiano e no programa pedagógico da escola. As variáveis explicativas foram divididas em: dados demográficos do dirigente; características da escola e do currículo; educação em saúde; e consumo de drogas na escola. RESULTADOS: Constatou-se que 42,5% (IC95% 36,1–49,1) das escolas avaliadas possuíam programa de prevenção ao uso de drogas. Com o modelo de regressão logística múltipla, observou-se que, a cada ano de atuação do dirigente na educação, a chance de a escola ter um programa aumentava em aproximadamente 4,0%. O fato de experimentar técnicas de ensino inovadoras também aumentou em cerca de seis vezes a chance de a escola desenvolver um programa de prevenção ao uso de drogas. As dificuldades na implantação dos programas foram mais presentes nas redes estadual e municipal, quando comparadas à rede privada, destacando-se: a falta de material didático, a falta de dinheiro e as demandas concorrentes para ensino de outras disciplinas. CONCLUSÕES: A implantação de programas de prevenção ao uso de drogas no município de São Paulo está associada à experiência do dirigente escolar na educação e nas estratégias de ensino da escola.Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)Coordenacao de Aperfeicoamento Pessoal de Nivel Superior (CAPES)Programa de Pós-Graduação em Saúde Coletiva. Universidade Federal de São Paulo. São Paulo, SP, BrasilSetor de Estatística Aplicada. Pró-reitoria de Pós-Graduação e Pesquisa. Universidade Federal de São Paulo. São Paulo, SP, BrasilDepartamento de Medicina Preventiva. Centro Brasileiro de Informações Sobre Drogas Psicotrópicas. Universidade Federal de São Paulo. São Paulo, SP, BrasilPrograma de Pós-Graduação em Saúde Coletiva. Universidade Federal de São Paulo. São Paulo, SP, BrasilSetor de Estatística Aplicada. Pró-reitoria de Pós-Graduação e Pesquisa. Universidade Federal de São Paulo. São Paulo, SP, BrasilDepartamento de Medicina Preventiva. Centro Brasileiro de Informações Sobre Drogas Psicotrópicas. Universidade Federal de São Paulo, Rua Botucatu 740,4 Andar, BR-04023900 Sao Paulo, SP, BrazilCNPq: 472991/2012-4Web of Scienc

Sexual aggression in the São Paulo nightlife scenarios: a public health concern

Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo, R Botucatu,740 Vila Clementino, BR-04023062 Sao Paulo, SP, BrazilDepartamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo, R Botucatu,740 Vila Clementino, BR-04023062 Sao Paulo, SP, Brazil.Web of Scienc

Factors Associated with Pre-drinking Among Nightclub Patrons in the City of São Paulo

Aims: the aim of the study was to describe the phenomenon of pre-drinking (alcohol consumption before entering nightclubs or bars) and to identify factors associated with pre-drinking practices among patrons in the city of São Paulo, Brazil. Methods: Individual-level data were collected by a portal survey of 2422 patrons at the entrance and at the exit of 31 nightclubs. the nightclubs were selected by two-stage sampling using a probability proportional to the establishments' capacity in the first stage and a systematic sample of patrons in the second stage. Breath alcohol concentration (BrAC) was measured. Face-to-face interview identified pre-drinking characteristics and past-year risk behaviors. Analysis used sample weights to compensate for nightclubs or patrons that were possibly over- or under-represented. Results: of the study participants, 41.3% (95% confidence interval (CI) = 33.7-49.3) engaged in pre-drinking on the night of the interview. Being male (odds ratio (OR) = 1.98, 95% CI = 1.45-2.71), past-year binge drinking (OR = 2.28, 95% CI = 1.70-3.07), previous episodes of severe effects from drunkenness (OR = 1.77, 95% CI = 1.40-2.22) and sexual risk behavior (OR = 1.67, 95% CI = 1.20-2.33) were associated with recent pre-drinking. Pre-drinking predicted higher BrACs at the nightclub exit. Conclusion: Pre-drinking is prevalent among nightclub patrons and associated with risk behaviors, and is associated with alcohol intoxication at nightclub exits. Environmental prevention strategies must consider pre-drinking as a potential risk factor for alcohol intoxication in nightclubs.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Dept Prevent Med, Epidemiol Sect, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Informat Hlth, Sect Stat, São Paulo, BrazilUniversidade Federal de São Paulo, Sect Bioestat, Dept Prevent Med, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Prevent Med, Epidemiol Sect, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Informat Hlth, Sect Stat, São Paulo, BrazilUniversidade Federal de São Paulo, Sect Bioestat, Dept Prevent Med, São Paulo, BrazilFAPESP: 2011/51658-0FAPESP: 2012/03832-4Web of Scienc

Does #Tamojunto alter the dynamic between drug use and school violence among youth?: Secondary analysis from a large cluster-randomized trial

The present study investigated how intervention might alter the relationship between perpetrating violence and later drug use. A cluster-randomized controlled trial design involving 72 schools (38 intervention, 34 control) and 6390 students attending grades 7 and 8 was employed in Brazil. Drug use and violence were assessed at three points. A random-intercept cross-lagged panel model examined the reciprocal association between drug use and school violence domains across the three data collection waves. For both groups, we found that the cross-lagged effect of perpetration on further drug use in adolescents was stronger than the reverse, but the interrelationship was not statistically significant between #Tamojunto and control schools. The carry-over effects of drug use and violence were also not significantly different between groups. There is a lack of evidence showing that #Tamojunto can modify the dynamics between drug use and school violence across the 21-month period. The direction of the causal effect (i.e., the more perpetration behavior, the more subsequent drug use behavior) is present, but weak in both groups. The trial registration protocol at the national Brazilian Register of Clinical Trials (REBEC) is #RBR-4mnv5g.publishedVersio

Does #Tamojunto alter the dynamic between drug use and school violence among youth? Secondary analysis from a large cluster-randomized trial

The present study investigated how intervention might alter the relationship between perpetrating violence and later drug use. A cluster-randomized controlled trial design involving 72 schools (38 intervention, 34 control) and 6390 students attending grades 7 and 8 was employed in Brazil. Drug use and violence were assessed at three points. A random-intercept cross-lagged panel model examined the reciprocal association between drug use and school violence domains across the three data collection waves. For both groups, we found that the cross-lagged effect of perpetration on further drug use in adolescents was stronger than the reverse, but the interrelationship was not statistically significant between #Tamojunto and control schools. The carry-over effects of drug use and violence were also not significantly different between groups. There is a lack of evidence showing that #Tamojunto can modify the dynamics between drug use and school violence across the 21-month period. The direction of the causal effect (i.e., the more perpetration behavior, the more subsequent drug use behavior) is present, but weak in both groups. The trial registration protocol at the national Brazilian Register of Clinical Trials (REBEC) is #RBR-4mnv5g

Adolescent gender differences in the determinants of tobacco smoking: a cross sectional survey among high school students in São Paulo

Background: Diverse psychosocial factors have been associated with the use of cigarettes by adolescents. We investigated gender differences in tobacco smoking, and factors correlated with smoking among boys and girls. Methods: Data was collected on recent cigarette smoking (CS) and related factors, with a focus on religious beliefs, leisure activities, family structure, relationships and parental monitoring from 2,691 private school-attending youths from 28 schools in São Paulo, Brazil, selected via probability sampling. Estimates were derived via weighted hierarchical logistic regression models. Results: There was no difference in the prevalence of recent cigarette smoking between boys and girls (14.2%). Older age (a_OR_boys = 1.71[1.33-2.21]; a_OR_girls = 1.73[1.35-2.23]), second-hand smoke exposure at home (a_OR_boys = 1.52[1.00-2.29]; a_OR_girls = 1.74[1.13-2.68]) and not having a religion (a_OR_boys = 1.99[1.41-2.81]; a_OR_girls = 1.78[1.14-2.78]) were associated with CS in boys and girls. Adolescents who went out often at night were more likely to be tobacco smokers (a_OR_boys = 8.82[3.96-19.67]; a_OR_girls = 14.20[6.64-30.37]). For girls, data suggest that CS was also associated with a lack of parental attention and care (a_OR_girls = 4.37[1.19-16.04]) and no participation in youth religious activities (a_OR_girls = 2.76[1.49-5.12]). For boys, CS was additionally associated with the loss of one or both parents (a_OR_boys = 3.75[1.78-7.85]). Conclusions: Although older age, living with smokers at home and lack of religion were common contributing factors to cigarette smoking among all adolescents, girls were influenced to a greater degree by family relationships and religiosity than boys. The study results may be materially important to the development of prevention programs that influence determinants connected to gender and the implementation of single-core models of prevention; gender differences must be considered in order to reduce adolescent CS