Características individuais e contextuais associadas ao uso de álcool entre escolares brasileiros: um estudo de base escolar

Abstract

Introduction: Alcohol is the psychoactive substance with the highest prevalence of consumption among adolescents. The use of alcoholic drinks is determined by individual and behavioral characteristics and the adolescent’s social context. Although the school offers resources to promote health and to adopt measures to prevent adolescent’s alcohol consumption, studies evaluating the association between alcohol use and school characteristics are scarce in Brazil. Objectives: To analyse the association between individual and contextual characteristics with alcohol experimentation, use in the past thirty days, and drunkenness among adolescents. Methods: Cross-sectional study using data from the 2015 National School Health Survey (PeNSE) with adolescents from public and private schools attending 9th grade of elementary school in 26 Brazilian capitals and the Federal District. Multilevel logistic regression models, stratified by type of school administration (public/private), were performed to obtain odds ratio (OR) with 95% confidence intervals (95%CI), for the outcomes: alcohol experimentation (yes/no); alcohol use in the last thirty days (yes/no); drunkenness episode (yes/no); and exposures: having friends who drank alcohol and/or used drugs and/or cigarettes, smoking parents, adoption of preventive policies at school, and knowledge of cigarette use on school premises. Results: In general, public school students reported higher prevalence of alcohol experimentation (51.9%), use in the last thirty days (20.2%) and drunkenness (22.1%) than private school students. Girls were more likely to experiment alcohol (OR = 1.09; 95% CI = 1.05; 1.12) and use in the last thirty days (OR = 1.09; 95% CI = 1.05; 1.13) and less prone to drunkenness (OR = 0.90; 95%CI = 0.87; 0.93). There was a positive association of alcohol consumption in the three outcomes with use of substances by parents and peers and also with previous consumption of other substances by the adolescents themselves. Having a policy of banning alcohol consumption at school was positively associated with alcohol experimentation (OR = 1.11; 95% CI = 1.04; 1.18). In public schools, the principal being aware that teachers and students smoke at school was associated with greater and lesser use of alcohol by adolescents, respectively. Joint actions with the Basic Family Health Unit and the School Health Program were not associated with the outcomes after adjustments. Conclusion: Exposure to legal and illegal substances by friends and in the family and school environment are factors that favor alcohol experimentation, use in the last thirty days and drunkenness episode among adolescents. Moreover, policy of banning alcohol consumption at school was related to increase in alcohol experimentation. Thus, considering the school as a favorable space for the development of prevention activities, public policies specific for alcohol prevention must be developed in this environment to minimize adolescent alcohol use.