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Although several trainings have been offered to improve professional expertise on alcohol and other drugs, few have used an interdisciplinary approach and evaluated long-term improvements in the professional's work routine. This study aimed to evaluate the outcomes of an interprofessional training program on alcohol and other drugs offered by a Regional Reference Center for Drugs of the Federal University of São Paulo, Brazil. METHODS: the evaluation was carried out longitudinally using mixed methods (questionnaires (n = 29-177) and semistructured interviews (n = 28)). The participants were current workers from public institutions of health, education, social assistance, justice, and security system who attended the training. Data were collected at the beginning, the end, and one year after the end of the training. Descriptive statistical analyses were performed for quantitative data and thematic content analyses for qualitative data. RESULTS: professionals who attended the training enhanced their understanding of substance-related issues, reduced stigma, changed their attitude, and improved their networking among the different services providing care to users. The main characteristics related to these outcomes were the interprofessional and biopsychosocial approach, and the experiential activities developed during the training. Most participants reported difficulties in implementing changes in their work routine, but those in managerial roles have reported having more autonomy to carry out such changes. CONCLUSIONS: the mixed methods converged in terms of their results. The training promoted a better understanding of issues related to substance use disorders, reduced stigma and expanded the repertoire of skills. The interprofessional and biopsychosocial approach and field activities seem to be related to these outcomes. The potential for implementing changes in daily practice was prominent among those occupying a managerial role.

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Objective: This study aimed to estimate the association between tobacco smoking and risk for dementia in seven low- and middle-income countries.Methods: Secondary analysis of the 10/66 population-based cohort study was conducted with 11,143 dementia-free individuals aged 65 years and older who were followed-up for an average of 3.8 years totalling 42,715 person-years. Cox regression with competing-risk analyses was used, controlling for age, gender, number of assets, past hazardous drinking, exercise and self-report of heart disease. Exposure was measured in packyears and smoking status. The number of packyears was calculated by multiplying the average number of packs per day by years of consumption up to 50 years old and up to age at baseline.Results: Meta-analysis of the results from each country yielded non-significant pooled relative risk ratios for all comparisons. There was no difference in risk for any dementia between 'ever smokers' compared to 'never smokers' (HR 0.96; 95% CI 0.82-1.13); 'current smokers' compared to 'never smokers' (HR 0.83; 95% CI 0.66-1.06); 'former smokers' compared to 'never smokers' (HR 1.06; 95% CI 0.88-1.27); 'current smokers' compared to 'former smokers' (HR 0.86; 95% CI 0.66-1.13). Results were similar for Alzheimer's disease (AD) and Vascular Dementia (VaD) as outcomes. Lifetime tobacco consumption (packyears) was not associated with any dementia (HR 1.00; 95% CI 0.99-1.00), nor with AD or VaD.Conclusion: Pooled results from all the countries showed no significant association between smoking and the onset of any dementia. Selective quitting in later-life might have biased the results towards no effect.

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Este artigo descreve a experiência de implementação e avaliação de cursos de capacitação sobre a temática do álcool e outras drogas para profissionais da rede pública do município de São Paulo, organizados pelo CRR-DIMESAD-UNIFESP, apoiados por edital da Secretaria Nacional de Políticas sobre Drogas. A partir de metodologia mista de pesquisa, envolvendo abordagem qualitativa e quantitativa, são descritos os desafios metodológicos enfrentados na primeira edição dos cursos e a trajetória de mudanças que culminou na reestruturação dos cursos em módulos temáticos, a partir da avaliação dos processos formativos vigentes em 2014 e do diálogo com as secretarias parceiras, acerca das demandas dos profissionais. A reestruturação, em curso desde meados de 2016, pautou-se ainda nos pressupostos ético-políticos do paradigma da Educação Permanente, enfatizando o processo ensino-aprendizagem em sua dimensão emancipatória e política.

This article describes the implementation and evaluation of training courses on addiction issues to workers from the public sector in São Paulo city. It was conducted by the Regional Reference Center of the Federal University of São Paulo. The restructuring process of the courses, since their first edition, held in 2014, as well as their methodological challenges and the series of changes that led to their restructuring into thematic modules are described.. This changing process was based on the evaluation of the existing training courses in 2014 and on the dialogue, related to the worker's demands, with different public departments. The evaluation research conducted was based on qualitative and quantitative approach. Such restructuring, ongoing since mid-2016, was also marked by ethical and political assumptions of the Brazilian Permanent Education paradigm, emphasizing the teaching-learning process in its emancipatory and political dimension.

Esteartículodescribe la experiencia de implementación y evaluación de cursos de capacitación sobre la temática de alcohol y otras drogas para profesionales de la red pública del municipio de São Paulo, organizados por el Centro Regional de Referencia de la Universidad Federal de São Paulo. A partir de la metodología de investigación mixta, con enfoque cualitativo y cuantitativo, describiremos el trayecto de la reestructuración de los cursos, partiendo de la primera edición (2014) y planteada por la convocatoria de la Secretaria Nacional de Políticas sobre Drogas. Serán descritos los desafíos metodológicos enfrentados en la primera edición de los cursos y la trayectoria de los cambios que culminó en la reestructuración de los cursos en módulos temáticos, a partir de la evaluación de los procesos formativos vigentes en 2014 y del diálogo con las secretarías que trabajan en conjunto. Tal reestructuración se pautó en los supuestos ético-políticos del programa de Educación Permanente, enfatizando el proceso de enseñanza-aprendizaje en su dimensión emancipadora y política.

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Este estudo qualitativo descritivo objetivou compreender a relação entre o consumo de álcool e a expressão da violência no relacionamento de casais compostos por pelo menos um cônjuge dependente do álcool. Foram realizadas entrevistas com uso de roteiro semiestruturado com dez casais, posteriormente transcritas e submetidas à análise de conteúdo. Todos os casais relataram violência conjugal, atrelada ao uso de álcool. A violência, principalmente verbal e física, foi protagonizada por ambos os cônjuges e agravada com o tempo e com o aumento da quantidade de ingestão de álcool. Foram relatadas outras dificuldades relacionais e de trabalho, associadas ao uso contínuo do álcool, além de histórico de uso de substâncias e de violência nas famílias de origem dos participantes. Este estudo evidenciou a complexidade e a dinâmica da violência conjugal, associada à dependência de álcool, que deve ser considerada em programas de prevenção, redução de danos ou outras intervenções e encaminhamentos do casal enquanto um sistema que demanda atenção integral.

This qualitative and descriptive study aimed to understand the relation between the alcohol consumption and the violence expansion, in the relationship of couples made up by, at least, one partner with alcohol dependence. Semi-structured interviews with 10 couples were done, which were transcribed and submitted to the content analysis. All the couples reported marital violence related to alcohol use. Violence, mainly verbal and physical ones, was committed by both partners and it became worse due to increase of amount of alcohol ingestion. Other relational and professional difficulties, associated to continuous use of alcohol, were reported, in addition to the history of substance use and violence in the origin families of the participants. This study makes evident the complexity of the marital violence associated to the alcohol dependence, which must be considered for the prevention programs, interventions and the couple guiding­as a system that requires full attention.

Este estudio cualitativo descriptivo tuvo como objetivo comprender la relación entre el consumo de alcohol y la expresión de la violencia en la relación de parejas compuestas por, al menos uno de los cónyuges, dependiente de alcohol. Se realizaron entrevistas semiestructuradas con diez parejas, posteriormente transcriptas y sometidas a análisis de contenido. Todas las parejas relataron violencia conyugal relacionada al uso de alcohol. La violencia, principalmente verbal y física, fue protagonizada por ambos cónyuges y agravada con el tiempo y con el aumento de la cantidad de ingestión de alcohol. Fueron relatadas otras dificultades relacionales y de trabajo, asociadas al uso continuo de alcohol, además de antecedentes de uso de sustancias y de violencia en las familias de origen de los participantes. Este estudio, evidenció la complejidad y la dinámica de la violencia conyugal asociada a la dependencia de alcohol, que deben ser consideradas en programas de prevención, reducción de daños u otras intervenciones y derivaciones de las parejas como un sistema que demanda atención integral.

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

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

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

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

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

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

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

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

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