Uso de drogas lícitas entre estudantes de escolas de

 TITLE
Uso de drogas lícitas entre estudantes de escolas de ensino médio do município de Bragança,
norte do Brasil
Licit drug use among students in high schools in the municipality of Bragança, northern
Brazil.
AUTHORS
Lizabete A. Castor1, Clemenes P. Araújo1, Valcirene G. Guimarães1, Aldemir B. OliveiraFilho1, Gláucia C. Silva-Oliveira1,2.
AFFILIATIONS
Faculdade de Ciências Naturais, Campus do Marajó - Breves, Universidade Federal do Pará,
Breves, PA, Brasil1.
Programa de Pós-Graduação em Biologia Ambiental, Campus de Bragança, Universidade
Federal do Pará, Bragança, PA, Brasil2.
RESUMO
Este estudo determinou a prevalência e os fatores associados ao uso de drogas lícitas (álcool e
tabaco - DL) entre estudantes de escolas de ensino médio do município de Bragança, Pará,
norte do Brasil. Estudo transversal de base escolar, totalizando cinco escolas públicas e 1.632
estudantes do município de Bragança. O instrumento auto-aplicável foi adaptado de outros
estudos epidemiológicos adequados ao grupo populacional, com rigoroso procedimento,
garantindo anonimato e sigilo. A prevalência de uso de álcool e tabaco entre estudantes foi
30,18% e 8,16%, respectivamente. Diversos fatores de risco ao uso de DL foram detectados,
dos quais destacam-se: idade superior a 17 anos, ausência de participação dos pais na vida
escolar dos estudantes, estudar no período noturno, pais, amigos e familiares que usam DL e a
falta de incentivo para não usar DL. Em suma, este estudo identificou que o uso regular de DL
está associada a fatores sociais e econômicos, os quais deverão ser considerados na
elaboração de medidas para controle e prevenção ao uso de DL no município de Bragança.
Palavras-chave: Estudantes, drogas lícitas, epidemiologia, Bragança, Brasil.
ABSTRACT
This study determined the prevalence and factors associated with the use of legal drugs
(alcohol and tobacco - LD) among students from high schools in the municipality of
Bragança, Pará, northern Brazil. School-based cross-sectional study, a total of five public
schools and 1,632 students in the municipality of Bragança. The self-applicable instrument
was adapted from other epidemiological studies appropriate to the population group, with a
strict procedure, ensuring anonymity and confidentiality. The prevalence of alcohol and
tobacco among students was 30.18% and 8.16%, respectively. Several risk factors to the use
of LD were detected of which include: age over 17 years, lack of parental involvement in
school life of students, studying at night, parents, friends and family who use LD and lack of
incentive not to use LD. In summary, this study found that regular use of DL is associated
with social and economic factors, which should be considered in the preparation of measures
to control and prevent the use of LD in the municipality of Bragança.
Key-words: Students, legal drugs, epidemiology, Bragança, Brazil.
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INTRODUCTION
Adolescence is a stage of human life characterized by biological changes, cognitive,
emotional and social, which makes it an important moment for the adoption of new practices1.
In this phase, stimulated by intense changes, the adolescent becomes more vulnerable to
behaviors that can undermine their health as poor diet, sedentary lifestyle, the use of alcohol,
cigarettes and other drugs2. Currently, the use of alcohol, tobacco and illicit drugs is an
important public health problem, considering the magnitude and diversity of aspects
involved3. The use of alcohol, tobacco and other drugs travels different countries,
geographical and cultural contexts, social classes and age groups, causes damage personal,
family and social, economic cost, as well as fuels urban violence, family and interpersonal4,5.
In Brazil, several epidemiological studies of psychotropic drug use among adolescents
have shown a progressive increase in consumption6,7,8,9,10. In these studies, alcohol and
tobacco were the main drugs used, and approximately 25% of adolescents reported using
other drugs such as inhalants, marijuana, tranquilizers, amphetamines and cocaine. In
addition, there was higher consumption of cocaine in Southeast and high consumption of
alcohol and tobacco in all Brazilian regions. It was also more frequent hospitalizations due to
alcoholic addiction, traffic accidents associated with alcohol abuse and increased police
incidents for cocaine use6,7,8,9,10. In a sample of 10,030 students from elementary and high
school in northern Brazil was found that alcohol and tobacco are the drugs most consumed.
However, the prevalence of frequent use of psychotropic drugs in general was 2.4%, and the
most widely used drugs in order were: solvents, marijuana, and cocaine. In addition, this
sample there was a significant predominance of use of marijuana, cocaine, opiates, tobacco
and alcohol among male students and higher education gap between students who had made
lifetime use of drugs8. In the city of Belém, the prevalence of students who tried tobacco and
consume regularly was 44% and 11%, respectively. Since the frequency of students who
experienced or regular tobacco consumed was higher in public schools, which have as factors
associated with smoking: curiosity, presence of smokers in the social environment (family
and friends) and poor school performance11.
In general, the epidemiological situation regarding the use of alcoholic beverages,
cigarettes and other drugs in the Northern Brazil is still unknown. Studies to identify the
variables associated with drug use enable a better understanding of the evolution of habit and
hence help in the development of control measures and prevention of addiction. Thus, this
study determined the prevalence and factors associated with the use of alcohol and cigarettes
among high school students in the municipality of Bragança, Pará, Northern Brazil.
MATERIAL E METHODS
Bragança and high school students
The municipality of Bragança (01 ° 03 '46 "S 46 ° 46' 22" W) is located in the
northeastern state of Para, northern Brazil. Bragança has about 113,863 inhabitants, is one of
the largest fishing pole on the north coast of Brazil. The town is noted for activity in tourism
and livestock farming and harvesting of crabs12.
Size sample
The calculation of the minimum number of participants in this study was conducted
using the proportion of test samples followed by two-tailed test. To perform these calculations
were used as parameters: the power of test = 0.95, at alpha = 0.05, minimum ratio of the
number of students for alcohol and tobacco users and nonusers of alcohol and tobacco 1:3 and
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1:10, respectively. Furthermore, the tests for determining the minimum sample size employed
prevalence of students who used alcohol and 40.6% of their respective complementary
prevalence of students non-alcohol users (59.4%)7, students and the prevalence of tobacco
users 10.5% and their respective complementary prevalence of students non-tobacco users
(89.5%)7.
Epidemiological data
Data collection was performed by standardized self-report questionnaire, in which high
school students responded to demographic and social questions, and specific questions about
your habits, your family and friends regarding the use of alcohol and tobacco. These data
were collected during class time through brief statement by the authors to explain the
objectives of the study and invite students to participate. Initially, the students were
characterized by sex and age. The variables used to indicate socioeconomic conditions were:
parents' marital status, parental education, parental involvement in school life of the student,
family income (a minimum salary/month = R$545.00 around U$320.00) and study and work
in parallel. Since, to express the student's school situation we selected the variables: series,
shift, and delay studies. To characterize the factors related to the use of alcoholic beverages
and cigarettes were used the following variables: use by parents (father, mother or both), use
by friends and family, many friends and relatives use, parents talk about the use and praised
by parents and friends do not use. Since, information regarding age, age at first use, drugs
consumed, amount used in the last 30 days, and total time of use of drugs were obtained
through open-ended questions. For quantification of drug use, this study considered the terms:
regular use (once a week) and frequent use (six or more times a month). In addition, three
questions regarding frequency of use of a fictitious drug were included in the questionnaire to
increase the reliability of data. Any affirmative response to one of these three questions led to
the exclusion of the information provided by the student.
Statistic analysis
Wilson confidence intervals were constructed for the prevalence of drug use estimates13.
Associations between use of drugs (alcoholic beverages and, cigarettes), and possible risk
factors were assessed using Chi-square Test (χ2) and Odds ratio (OR). In all tests, p values
less than 0.05 were considered statistically significant.
Ethics
Before the application of epidemiological surveys in student population, several
meetings were held with parents of students and with the direction, counselors and teachers to
request and obtain the authorization of the execution of the study in high schools in the
municipality of Bragança. In addition, all students were informed of the objectives of the
study and invited to participate. This study is linked to the research project "Aspectos
epidemiológicos do uso de drogas lícitas e ilícitas por estudantes de escolas públicas no
estado do Pará, norte do Brasil" which was approved by the Ethics Committee on Human
Research of the Institute of Sciences Health, Federal University of Pará (Accession Number:
147/2010-CEP/ICS-UFPA).
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RESULTS
In 2011, 19,386 students were enrolled in high schools in the municipality of
Bragança14. In the period from August to December 2011, 6,556 high school students from
the five largest schools in the municipality of Bragança were invited to participate in this
study, of whom 1,638 accepted students filling out questionnaires about epidemiological use
of illicit drugs. However, data provided by six students were excluded because they reported
having used a fictitious drug. In summary, this study analyzed information provided by 1,632
high school students in the municipality of Bragança (according to the test sample size, this
study should be composed of at least 586 students to investigate the use of alcohol, and 54
students to investigate the use of tobacco).
The sample population of students from schools in the municipality of Bragança
presented aged 13-54 years, mean 19 years (SD: ±7.1yrs). Of the 1,632 students, 61.89% were
female. Regarding the marital status of parents, most students (50.37%) reported having
parents married or living together. While the educational level of parents (father and mother),
it was found that a large number, or illiterate parents with limited study time (up to 6 years).
Regarding the participation of parents in school life, 49.45% of students reported that their
parents do not participate or just part of their school lives. In addition, most students 90.01%
integrate families with monthly income from 1 to 3 minimum salaries (R$ 545.00 to 1635.00
≅ US$ 320.00 to 961.00). Finally, we found that 55.82% of the students worked and studied,
40.69% of studying the night shift, 57.48% of students reported having repeated once or
several times a school year, 42.83% receive praise for not using alcohol, tobacco and illicit
drugs and 16.48% said their parents never talked about drug use.
The prevalence of high school students who regularly use alcohol was 30.18% (95% CI:
26.82% - 35.94%). Since, 64.82% of students reported having used alcohol at least once
during their lifetime. Among the students experimented with alcohol, the alcohol distribution
was: 64.18% beer, 21.09% wine, 9.25% alcohol and 5, 48% other beverages. The average age
of students who regularly use alcohol was 20.26 years (minimum = 13yrs, maximum = 48yrs,
SD: ± 8.3yrs) with a mean age of first drink of 14.09 years (minimum = 7 yrs; maximum =
27yrs, SD = ± 3.52yrs). Among the students who regularly use alcohol, the distribution of
alcoholic beverages was: 69.47% beer, 20.42% wine and 10.11% others. After statistical
analysis, several risk factors associated with regular use of alcohol by students were
identified: male sex, older than 17 years, lack of parental involvement in school life of
students studying and working, studying at night, the gap studies, parents, friends and family
who consume alcohol and lack of incentive not to drink alcoholic beverages (Table 1).
The prevalence of high school students who regularly use tobacco was 8.16% (95% CI:
5.43% - 11.72%). Since, 25.37% of students said they had smoked tobacco at least once
during their lifetime. The average age of students tobacco users was 20.18 years (minimum =
15yrs, maximum = 50yrs, SD = ± 9.74yrs). The average age of first smoking was 12.71 years
(minimum = 7yrs; maximum = 32yrs, SD = ± 4.60yrs). After statistical analysis, several risk
factors associated with regular use of tobacco among students were identified: age over 17
years, lack of parental involvement in school life of students, studying at night, lag studies,
parents, friends and family who smoke and lack of incentive not to smoke (Table 2).
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Table 1: Identification of factors associated with alcohol use in students, Bragança, Pará
Variables
Gender
Male
Female
Age
Up to 17 years
More than 17 years
Marital status of parents
Married + Live together
Single + Deceased
Educational level of father
Illiterate + studied up to six years
Studied over six years
Educational level of mother
Illiterate + studied up to six years
Studied over six years
χ2 (p-value)
OR
95%CI
23,38 (<0,01)
1,68
1,00
1,36 – 2,08
114,08 (<0,01)
1,00
3,36
2,67 – 4,22
1,60 (20,60)
1,00
1,14
0,92 – 1,41
0,59 (44,30)
1,09
1,00
0,88 – 1,34
1,15 (28,32)
1,00
1.00
0,90 – 1,42
1,00
1,98
1,60 – 2,44
1,04
1,00
0,73 - 1,48
2,03
1,00
1,64 - 2,53
1,00
3,24
2,61 – 4,02
3,32
1,00
2,63 – 4,19
1,78
1,00
1,43 – 2,20
4,26
1,00
2,42 – 7,49
1,00
4,31
3,43 – 5,40
1,00
2,42
1,93 – 3,02
1,00
1,15
0,93 – 1,42
Parent participation in school life of children
Always
40,33 (<0,01)
Sometimes + never
Family income
Up to three
0,06 (81,33)
More than three
Studies and works
Yes
41,72 (<0,01)
No
Period of study
Daytime (morning and afternoon)
118,36 (<0,01)
Nighttime (night)
Gap studies
Yes
107,83 (<0,01)
No
Parents drink (father, mother or both)
Yes
27,96 (<0.01)
No
Friends and relatives drink
Yes
29,50 (<0,01)
No
How many friends and relatives drink
No + Few
169,65 (<0,01)
Most + All
Parents and relatives praised for not drinking
Always
61,90 (<0,01)
Sometimes + never
Parents talk about alcoholism
Always
1,68 (19,51)
Sometimes + never
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Table 2: Identification of factors associated with tobacco use in students, Bragança, Pará.
Variables
Gender
Male
Female
Age
Up to 17 years
More than 17 years
Marital status of parents
Married + Live together
Single + Deceased
Educational level of father
Illiterate + studied up to six years
Studied over six years
Educational level of mother
Illiterate + studied up to six years
Studied over six years
Parent participation in school life of children
Always
Sometimes + never
Family income
Up to three
More than three
Studies and works
Yes
No
Period of study
Daytime (morning and afternoon)
Nighttime (night)
Gap studies
Yes
No
Parents smoke (father, mother or both)
Yes
No
Friends and relatives smoke
Yes
No
How many friends and relatives smoke
No + Few
Most + All
Parents and relatives praised for not smoking
Always
Sometimes + never
Parents talk about tobacco
Always
Sometimes + never
χ2 (p-value)
OR
95%CI
23,38 (<0,01)
1,68
1,00
1,36 – 2,08
114,08 (<0,01)
1,00
3,36
2,67 – 4,22
1,60 (20,60)
1,00
1,14
0,92 – 1,41
0,59 (44,30)
1,09
1,00
0,88 – 1,34
1,15 (28,32)
1,00
1,13
0,90 – 1,42
40,33 (<0,01)
1,00
1,98
1,60 – 2,44
0,06 (81,33)
1,04
1,00
0,73 - 1,48
41,72 (<0,01)
2,03
1,00
1,64 - 2,53
118,36 (<0,01)
1,00
3,24
2,61 – 4,02
107,83 (<0,01)
3,32
1,00
2,63 – 4,19
27,96 (<0.01)
1,78
1,00
1,43 – 2,20
29,50 (<0,01)
4,26
1,00
2,42 – 7,49
169,65 (<0,01)
1,00
4,31
3,43 – 5,40
61,90 (<0,01)
1,00
2,42
1,93 – 3,02
1,68 (19,51)
1,00
1,15
0,93 – 1,42
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DISCUSSION
Several authors have shown that in epidemiological research in order to identify the
prevalence of drug use by students, the most appropriate method is the self-report
questionnaire administered to a group classroom15,16,17,18. This option is justified because it is
relatively inexpensive and well accepted by the research subjects, since the refusal rate is low.
Furthermore, this procedure has been able to get information about private behavior, because
anonymity is explicitly guaranteed4,17,18. In this study, self-fulfilling questionnaire was
employee to characterize the use of drugs among students. Participants voluntarily provided
relevant information for visualization of drug use by students and their parents, relatives and
friends. However, it should be noted that the type of questionnaire used in this study
preferentially measured reporting of drug use rather than consumption itself. Therefore, one
should be cautious in interpreting the data.
Other considerations of this research are related to reliability and data loss. Being a schoolbased study, the lack of commitment of the students was considered in the design of the
survey through questions related to drug use fictitious. Some students provided information
that could cause confusion in the prevalence and associated factors related to drug use, but
they were identified and excluded from the study. In addition, students with more serious
involvement with alcohol, tobacco, and especially marijuana and cocaine may have already
been excluded from the school system or lack often, not being addressed by the study.
Research designed specifically to evaluate the sub-population of students who left or were
expelled from schools should be conducted in the future.
Monitoring large-scale use of psychotropic drugs among Brazilian students was initiated in
1987 by CEBRID, which conducted the last survey in 20048. In the latter study it was found
that the prevalence of Brazilian students regular alcohol users was 44.3%8. In northern Brazil,
the prevalence of regular alcohol use among students was 39.1%. Since the prevalence of
regular alcohol use among students in the city of Belém (40.6%) is relatively similar to that
observed in northern Brazil8. In this study, alcohol was the most regularly used psychoactive
drug among students, with prevalence around 30.2% (less than observed in the northern Brazil
and the municipality of Belém). Although socioeconomic and cultural differences, WHO
points out alcohol as the most consumed psychoactive drug in the world for adults, teens and
children due to low cost, easy to obtain, wide propaganda of manufacturers, low level of
awareness of health problems related to alcohol and local social issues19,20.
The use and abuse of alcohol have been major precipitating causes of situations of
vulnerability in adolescence and youth. The role of parents and the family atmosphere and
striking in adolescent development and consequently in their relationship with alcohol21.
Studies conducted among students in the municipalities of Feira de Santana (Bahia,
northeastern Brazil) and Cuiabá (Mato Grosso, Midwestern Brazil) showed that the risk
factors associated with alcohol use were similar to those detected in this study22,23. On the
other hand, some studies found no relationship between gender and alcohol use, as observed
in this study. In Cajazeiras (Paraíba, northeast Brazil) and Paulinia (São Paulo, southeastern
Brazil), alcohol use among students was also associated with alcohol use by parents, relatives
and friends, regardless of gender21,24,25. The lack of family support, drug use by parents,
permissive parental attitudes, family and friends before the use of alcohol and indiscipline are
predisposing factors for experimentation and continuation of alcohol use among
adolescents26. Preventive strategies involving community interventions through public
policies, have revealed a greater impact than individual interventions.
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Tobacco is a psychotropic drug that causes more isolation, illness and preventable death in the
world. Approximately 25% of regular smokers die prematurely due to smoking-related
diseases, losing about 20 years of life20. In Brazil, the prevalence of regular tobacco use
among students is around 9.9%. In northern Brazil, this frequency is relatively similar among
students, about 10.7%8. This study detected a prevalence of regular tobacco use among
students in around 8.2%. This value is lower than that observed in studies conducted among
students in the towns of Gravataí, Pelotas and Santa Maria (Rio Grande do Sul, southern
Brazil), Campinas, and Aracaju (Sergipe and São Paulo, southeastern Brazil), Brasília
(Federal District, Midwest of Brazil), Feira de Santana (Bahia, northeastern Brazil) and Belém
(Pará, northern Brazil)11,17,27,28,29,30,31,32,33. Thus, it is stated that among students in the city of
Bragança there is a reduced prevalence of regular tobacco use.
Furthermore, this study found an association between regular use of tobacco by students with
tobacco use by parents, family and friends and lack of incentive not to smoke. In the
literature, these variables are commonly associated with tobacco use11,31,34,35,36. This
framework is closely related to examples of parents, relatives and friends who serve as role
model for children and adolescents, thus facilitating the adoption of smoking during
adolescence or youth, and later difficulty and lack of incentive for not smoking. It also
becomes more pronounced because of tobacco directed to cause biochemical stimulation of
nicotine receptors34,37. Added to this, the risk factors associated with tobacco use among
students in the city of Bragança corroborate those observed among students in Belém11,
indicating a possible local profile of students tobacco users.
In short, smoking and a public health problem. Despite the low rate of tobacco use among
students Bragança, prevention and control should be performed in schools, especially the
evidence gap in studies associated with tobacco use, and thus the establishment of health
promotion programs should be employed.
CONCLUSION
This study found that regular use of licit drugs (alcohol and tobacco) is associated with social
and economic factors, which should be considered in the preparation of measures for control
and prevention of illicit drug use in the municipality of Bragança.
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