Abstract

Associated with positive impacts on health, religiosity has presented itself as a possible protection factor against alcohol consumption by teenagers. This study evaluated the prevalence of binge drinking and its association with religiosity among 12-year-old students, from Diamantina, State of Minas Gerais. Statistical analyses involved chi-square Pearson (p < 0,05) and Poisson regression with robust variance. The sample included a census of 588 students. Participation in religious activities was associated with no binge drinking (PR = 0,823; 95% CI: 0,717 – 0,945); and consumption of alcoholic beverages by the best friend was associated with binge drinking (PR = 1.554; 95% CI: 1,411-1,711). It was concluded that religiosity was associated with no consumption of alcoholic beverages in binge drinking sessions.

Key words
Binge drinking; Religiosity; Adolescents

Introduction

Over the centuries in different cultures, alcohol has been a psychoactive substance that could lead addiction¹1. Galduróz JCF, Sanchez ZVM, Opaleye ES, Noto AR, Fonseca AM, Gomes PLS. Fatores associados ao uso pesado de álcool entre estudantes das capitais brasileiras. Rev Saude Publica 2010; 44(2):267-273.^,22. Galduróz JFC, Noto AR, Fonseca AM, Carlini EA. Levantamento nacional sobre o consumo de drogas psicotrópicas entre estudantes do ensino fundamental e médio da rede pública de ensino nas 27 capitais brasileiras. Unifesp 2004; 17(1):1-503.. In 2012, its consumption was responsible for approximately 3.3 million deaths worldwide. In addition to deaths, the Disability-Adjusted Life Years (DALYs) arrived at 139 million, or 5% of the total attributed to all diseases³3. World Health Organization (WHO). Global status report on alcohol and health-2014. Geneva: WHO; 2004..

The consumption of five doses of alcoholic beverages on a single occasion is defined as “binge drinking”⁴4. Carlini EA, Galduróz JC, Noto AR, Carlini CM, Oliveira LG, Nappo SA. I Levantamento domiciliar sobre o uso de drogas psicotrópicas no Brasil: estudo envolvendo as 107 maiores cidades do país. São Paulo: Cebrid/Unifesp; 2002.. High rates of binge drinking in late adolescence and the early onset during this period of life may confer greater vulnerability to intoxication, leading to decreased motor coordination, awareness and cognition, as well as other consequences such as dependence, depression and eating disorders⁵5. Silveira CM, Silveira CC, Silva JG, Silveira LM, Andrade AG, Andrade LHSG. Epidemiologia do beber pesado e beber pesado episódico no Brasil: uma revisão sistemática da literatura. Rev Psiq Clin 2008; 35(1):31-38.

6. Pitkänen T, Lyyara AL, Pulkkinen L. Age of onset of drinking and the use of alcohol in adulthood: a follow up study from age 8-42 for females and males. Addiction 2005; 100(5):652-661.^-77. Spear LP. Adolescent alcohol exposure: are there separable vulnerable periods within adolescence? Physiology e behavior 2015; 148:122-130..

Alcohol has been the main substance consumed abusively among adolescents¹1. Galduróz JCF, Sanchez ZVM, Opaleye ES, Noto AR, Fonseca AM, Gomes PLS. Fatores associados ao uso pesado de álcool entre estudantes das capitais brasileiras. Rev Saude Publica 2010; 44(2):267-273.^,22. Galduróz JFC, Noto AR, Fonseca AM, Carlini EA. Levantamento nacional sobre o consumo de drogas psicotrópicas entre estudantes do ensino fundamental e médio da rede pública de ensino nas 27 capitais brasileiras. Unifesp 2004; 17(1):1-503.^,88. Malta DC, Mascarenhas MDM, Porto DL, Duarte EA, Sardinha LM, Barreto SM. Prevalência do consumo de álcool e drogas entre adolescentes: análise dos dados da Pesquisa Nacional de Saúde Escolar. Rev Bras Epidemio 2011; 14(1):136-146.^,99. Madruga CS, Laranjeira R, Caetano R, Pinsky I, Zaleski M, Ferri CP. Use of licit and illicit substances among adolescents in Brazil — A national survey. Addictive Behaviors 2012; 37(10):1171-1175.. While consumption of such beverages in Brazil is legally permitted only after the age of 18 (Law no. 9294, July 15, 1996)¹⁰10. Brasil. Lei 9.294, de 15 de julho de 1996. Dispõe sobre as restrições ao uso e propaganda de produtos fumígeros, bebidas alcoólicas, medicamentos, terapias e defensivos agrícolas, nos termos do Par. 4° do Art. 220 da Constituição Federal. Diário Oficial da União 1996; 16 jul., approximately 41.3% of Brazilian adolescents aged 13-15 reported alcohol consumption, according to the Household Survey on the Use of Psychotropic Drugs carried out in 2010¹¹11. Pinsky I, Sanchez M, Zaleski M, Laranjeira R, Caetano R. Patterns of alcohol use among Brazilian adolescents. Rev Bras Psiquiatria 2010; 32(3):242-249..

The average age at which Brazilian adolescents start to drink is 10 years¹²12. Paiva PC, Paiva HN, Oliveira Filho PM, Lamounier JA, Ferreira RC, Ferreira EF, Zarzar PM. Prevalence of traumatic dental injuries and its association with binge drinking among 12-year-olds: a population-based study. Int J Paediatr Dent 2015; 25(4):239-247.^,1313. Reis TG, Oliveira LCM. Padrão de consumo de álcool e fatores associados entre adolescentes estudantes de escolas públicas em município do interior brasileiro. Rev. bras. Epidemiol 2015; 18(1):13-24.. The very early habit has been pointed out in several studies as an important predictor for abusive consumption and dependence in adulthood¹⁴14. Ehlers CL, Slutske WS, Gilder DA, Lau P, Wilhelmsen KC. Age at first intoxication and alcohol use disorders in Southwest California Indians. Alcohol Clin Exp Res 2006; 30(11):1856-1865.

15. Dawson DA, Goldstein RB, Patricia CS, June RW, Grant BF. Age at first drink and the first incidence of adult-onset DSM-IV alcohol use disorders. Alcohol Clin Exp Res 2008; 32(12):2149-2160.

16. Helms CM, Rau A, Shaw J, Stull C, Gonzales SW, Grant KA. The effects of age at the onset of drinking to intoxication and chronic ethanol self-administration in male rhesus macaques. Psychopharmacology 2014; 231(8):1853-1861.^-1717. Morean ME, Kong G, Camenga DR, Cavallo DA, Connell C, Krishnan-arin S. First drink to first drunk: age of onset and delay to intoxication are associated with adolescent alcohol use and binge drinking. Alcohol Clin Exp Res 2014; 38(10):2615-2621.. Hingson et al.¹⁸18. Hingson RW, Heeren T, Winter MR. Age at drinking onset and alcohol dependence: age at onset, duration, and severity. Arch Pediatr Adolesc Med 2006; 160(7):739-746. reported that adolescents who had started drinking at the age of 14 were 1.78 times more likely to develop dependence compared to those who had started drinking at 21. Thirteen-year-olds who reported having consumed alcoholic beverages until the stage of intoxication were three times more likely to develop addiction when compared to those who were intoxicated at the age of 19 or over, according to the same authors. Alcohol consumption by parents and friends, as well as sociodemographic factors related to maternal schooling and sociodemographic status would also be positively associated with adolescent binge drinking¹⁹19. Campos JADB, Almeida JC, Garcia PPNS, Faria JB. Consumo de álcool entre estudantes do ensino médio do município de Passos - MG. Cien Saude Colet 2011; 16(12):4745-4754.

20. Zarzar PM, Jorge KO, Oksanen T, Vale MP, Ferreira EF, Kawachi I. Association between binge drinking, type of friends and gender: a cross-sectional study among Brazilian adolescents. BMC Public Health 2012; 12(1):257-268.

21. Sanchez ZM, Santos MG, Pereira AP, Nappo SA, Carlini EA, Carlini CM, Martins SS. Childhood alcohol use may predict adolescent binge drinking: A multivariate analysis among adolescents in Brazil. J Pediatr 2013; 163(2):363-368.^-2222. Sanchez ZM, Locatelli DP, Noto AR, Martins SS. Binge drinking among brazilian students: A gradient of association with socioeconomic status in five geo-economic regions. Drug and Alcohol Dependence 2014; 127(3):87-93..

In view of this situation, some research has been developed with a view to identifying factors that may be associated with the protection of the individual against the consumption of alcohol and other drugs²³23. Foster DW, Quist MC, Young CM, Bryan JL, Nguyen ML, Neighbors C. Benefit finding as a moderator of the relationship between spirituality/religiosity and drinking. Addictive behaviors 2013; 38(11):2647-2652.

24. Hanson GR. New vistas in Drug Abuse Prevention. Nida Notes 2002, 16(6):3-7.

25. Sanchez ZM, Opaleye ES, Chaves TV, Noto AR, Nappo SA. God forbids or mom disapproves? Religious beliefs that prevent drug use among youth. Journal of Adolescent Research 2011; 26(5):591-616.^-2626. Wallace JMJR, Delva J, O'malley PM, Bachman JG, Schulenberg JE, Johnston LD, Stewart C. Race/ethnicity, religiosity and adolescent alcohol, cigarette and marijuana use. Soc work in public health 2007; 23(2-3):193-213.. Among these, religiosity has been indicated as one of the main factors²⁶26. Wallace JMJR, Delva J, O'malley PM, Bachman JG, Schulenberg JE, Johnston LD, Stewart C. Race/ethnicity, religiosity and adolescent alcohol, cigarette and marijuana use. Soc work in public health 2007; 23(2-3):193-213.

27. Wray-Lake L, Maggs JL, Johnston LD, Bachman JG, O'Malley PM, Schulenberg JE. Associations between community attachments and adolescent substance use in nationally representative samples. Journal of Adolescent Health 2012; 51(4):325-331.^-2828. Sanchez ZM, De Oliveira LG, Nappo SA. Religiosity as a protective factor against the use of drugs. Subst Use Misuse 2008; 43(10):1476-1486.. Epidemiological studies have shown that a high level of religiosity is associated with a lower prevalence of binge drinking²³23. Foster DW, Quist MC, Young CM, Bryan JL, Nguyen ML, Neighbors C. Benefit finding as a moderator of the relationship between spirituality/religiosity and drinking. Addictive behaviors 2013; 38(11):2647-2652.^,2929. Sanchez ZM, Oliveira LG, Nappo SA. Fatores protetores de adolescentes contra o uso de drogas com ênfase na religiosidade. Cien Saude Colet 2004; 9(1):43-55.. However, these studies are still incipient and require further studies to seek a better sedimentation and elucidation of these associations. Therefore, this study seeks to investigate the prevalence of binge drinking among 12-year-olds in the city of Diamantina (MG) and their association with religiosity, as well as sociodemographic factors and alcohol consumption by parents and best friends.

Methods

This cross-sectional epidemiological study was carried out between February and April 2013, in Diamantina, a municipality with approximately 46,372 inhabitants located in the north of the state of Minas Gerais, southeastern Brazil. The study was a census of 633 12-year-olds enrolled in eleven public and two private schools. A list of the names, school addresses and the total number of students elected for the research was obtained from the Municipal Education Secretariat. Data was collected in schools on a previously scheduled day.

Ethical considerations

This study was submitted for analysis and approval by the Human Research Ethics Committee of the Federal University of Minas Gerais (Brazil), according to recommendations of the Declaration of Helsinki. After school management's consent, participants and their parents/guardians signed an informed consent form, assuring confidentiality and anonymity of their answers.

Pilot Study

The pilot study was conducted in a region near the city of Diamantina to test the methodology of the research. Schools were selected by convenience. One hundred and one 12-year-olds from two public and one private school participated in the study. The pilot was conducted one year prior to the main study, so students who participated in it were not part of the main study. No changes in methodology were required after the results of the pilot study.

Variables

Assessment of binge drinking

The dependent variable analyzed was binge drinking. We used the short version of the tool to identify alcohol use-related problems (AUDIT-C). The AUDIT-C test was validated in Brazil³⁰30. Meneses-Gaya C1, Zuardi AW, Loureiro SR, Hallak JE, Trzesniak C, de Azevedo Marques JM, Machado-de-Sousa JP, Chagas MH, Souza RM, Crippa JA. Is the full version of the AUDIT really necessary? Study of the validity and internal construct of its abbreviated versions. Alcohol Clin Exp Res 2010; 34(8):1417-1424. in order to identify the frequency of alcohol consumption and “binge” consumption³¹31. Martins M, Santos MA, Pillon SC. Low-income families’ perceptions on the use of drugs by one of their members. Rev Latino-Am Enfermagem 2008; 16(2):293-298.. The AUDIT-C applied consisted of three questions about alcohol “binge” frequency and consumption: 1- How often did you drink alcohol in the last year? (response options: never, once a month or less, 2-4 times a month, 2-3 times a week, 4 or more times a week); 2- How many doses of alcohol do you consume on a normal day? (response options: 1, 2 or 3, 4 or 5, 6 or 7, 8 or more times) and 3- How often do you consume five or more doses on a single occasion? (response options: Never, less than once a month, once a month, once a week, daily or almost every day). Alcohol consumption was obtained from Question 1 and dichotomized as 0 (never) or 1 (for monthly to 4 or more times per week). Binge drinking was obtained from question 3 and defined as consumption of five doses on a single occasion³²32. Wechsler H, Nelson TF. Binge drinking and the American college student: what's five drinks? Psychol Addict Behav 2001; 15(4):287-291.. To identify the onset of alcohol consumption, the following question was added: How old were you when you first tried alcoholic beverages?³³33. Sanchez ZM, Martins SS, Opaleye ES, Moura YG, Locatelli DP, Noto AR. Social factors associated to binge drinking: a cross-sectional survey among Brazilian students in private high schools. BMC Public Health 2011; 11(1):201-211. The frequency of alcohol consumption by parents and friends was also included in the study from the questions: 1-Does your father drink alcoholic beverages? (answer options: 0-No or 1-yes) Does your mother drink alcoholic beverages? (answer options: 0-no or 1-yes); Does your best friend drink alcoholic beverages? (answer options: 0-no or 1-yes)³⁴34. Chung T, Colby SM, Barnett NP, Monti PM. Alcohol Use Disorders Identification Test: Factor structure in an adolescent emergency department sample. Alcohol Clin Exp Res 2002; 26(2):223-231.^,3535. Reinert DF, Allen JP. The Alcohol Use Disorders Identification Test: An update of research findings. Alcohol Clin Exp Res 2007; 31(2):185-189..

Religiosity and socioeconomic condition

The main independent variable analyzed was religiosity. Thus, the following questions used in the literature were asked: Did you participate in religious activities in the last six months? (response options: never, less than once, once a month, once a week, daily or almost every day); Did you pray in the last six months? (response options: never, less than once a month, once a week, daily or almost every day); and How important is religion in your life? (response options: not important, a little, neither little nor very important or very important)³⁶36. Spears GV. Latent growth trajectories of substance use among pregnant and parenting adolescents. Psychol Addict Behav 2010; 24(2):322-332.

37. Arria AM, Vincent KMA, Caldeira K. Measuring liability for substance use disorder among college students: Implications for screening and early intervention. J. Drug Alcohol Abuse 2009; 35(4):233-241.^-3838. Parsai MKS, Marsiglia FF. Parental monitoring, religious involvement and drug use among latino and non-latino youth in the southwestern United States. Br J Soc Work 2010; 40(1):100-114.. The socioeconomic condition was evaluated through the following variables: household income (number of minimum wages), school type (public or private) and maternal schooling (years of study)²⁰20. Zarzar PM, Jorge KO, Oksanen T, Vale MP, Ferreira EF, Kawachi I. Association between binge drinking, type of friends and gender: a cross-sectional study among Brazilian adolescents. BMC Public Health 2012; 12(1):257-268.

21. Sanchez ZM, Santos MG, Pereira AP, Nappo SA, Carlini EA, Carlini CM, Martins SS. Childhood alcohol use may predict adolescent binge drinking: A multivariate analysis among adolescents in Brazil. J Pediatr 2013; 163(2):363-368.^-2222. Sanchez ZM, Locatelli DP, Noto AR, Martins SS. Binge drinking among brazilian students: A gradient of association with socioeconomic status in five geo-economic regions. Drug and Alcohol Dependence 2014; 127(3):87-93.. Household income was determined based on the sum of all salaries received by the economically active residents of the household and classified based on the minimum wage in force in Brazil; the threshold was the mean response. Maternal schooling was defined as the number of years of study, and seven years of study was used as the cutoff point; the threshold was the mean response. The family's monthly income and maternal schooling were considered as indicators of the individual's socioeconomic status due to their association with binge drinking by adolescents, reported in several studies¹¹11. Pinsky I, Sanchez M, Zaleski M, Laranjeira R, Caetano R. Patterns of alcohol use among Brazilian adolescents. Rev Bras Psiquiatria 2010; 32(3):242-249.^,2020. Zarzar PM, Jorge KO, Oksanen T, Vale MP, Ferreira EF, Kawachi I. Association between binge drinking, type of friends and gender: a cross-sectional study among Brazilian adolescents. BMC Public Health 2012; 12(1):257-268.’³⁹39. Pratta EMM, Santos MA. Levantamento dos motivos e dos responsáveis pelo primeiro contato dos adolescentes do ensino médio com substâncias psicoativas. Rev Eletrônica Álcool e drogas 2006; 2(2):0.. The socioeconomic variables were collected through a form completed by parents/guardians, along with the informed consent form. The type of school was also used as a socioeconomic indicator, although this variable only allows a superficial evaluation; most Brazilian public schools are known to have smaller educational resources when compared to private schools. Thus, the richest adolescents in Brazil are enrolled in private schools⁴⁰40. Bendo CB, Scarpelli AC, Vale MP, Araújo ZPM. Correlation between socioeconomic indicators and traumatic dental injuries: a qualitative critical literature review. Dent Traumatol 2009; 25(4):420-425.. The students completed the questionnaire in the classroom, with teacher's prior consent. In each classroom, all questions were read aloud, which was justified by the age of subjects who, while literate, could evidence difficulties of interpretation or understanding. The advantage of all filling out the questionnaire simultaneously, preventing responses from being influenced and, at the end of the reading, all students completing the questionnaire together was also associated. Privacy and confidentiality were assured to the participants⁴¹41. Oliveira FPM, Jorge KO, Ferreira EF, Ramos-Jorge ML, Tataounoff J, Zarzar PM. Association between dental trauma and alcohol use among adolescents. Dent Traumatol 2013; 29(5):372-377..

Statistical analysis

Data was analyzed with Statistical Package for Social Sciences (SPSS) version 19.0, for Windows, which included frequency distribution and association tests. The statistical significance for the association between binge drinking and independent variables (gender, household income, maternal schooling, school type, alcohol consumption by parents and best friends, importance of religion, participation in religious activities and prayers in the last 6 months) in the bivariate analysis was determined using the chisquare test with p < 0.05.

The dependent variable (binge drinking) and the independent variables (religiosity, alcohol consumption by responsible and friends, and sociodemographic condition) were first incorporated in the model of Poisson regression with robust variance. The criterion for including other independent variables in the multiple analysis model was the statistical significance with p < 0.20 in the bivariate analysis.

Results

Among the 633 invited students, 588 (92.9%) participated. The loss of 4.6% (28) was due to the refusal to participate by parents/guardians or the students themselves and 2.5% (n = 17) due to incomplete or incoherent data.

Among all students, we found that 51.4% (302) were female. Most (92.2%) were enrolled in public schools; 75.2% (n = 442) had a monthly family income of up to three times the national minimum wage; and most mothers had more than seven years of schooling (n = 376, 63.9%).

The prevalence rates of alcohol consumption in the last year and binge drinking were 45.6% (n = 268) and 23.1% (n = 136), respectively. The mean age at which students reported having consumed their first alcoholic beverage was 10.76 years, whereas for other 12-year-old students (n = 31; 7.6%) the first consumption of alcoholic beverages occurred between the age of 8 and 9.

When questioned about participation in religious activities in the last 6 months, the study showed that 90 (15.3%) students had not participated in such activities, while 498 (88.7%) reported having participated. When considering the importance of religion in life, 68 (11.6%) students reported that religion was not important, while 520 (88.4%) said it was little important to very important. Regarding prayer frequency in the last 6 months, 173 (29.4%) students said they had not prayed, while another 415 (70.6%) prayed once a month or daily.

Bivariate analysis showed that binge drinking was associated with males (p = 0.012) and those with mothers with higher education (p = 0.017). Students who reported not engaging in binge drinking were associated with reports of greater participation in religious activities (p < 0.001) as well as praying in the last 6 months (p = 0.002). When considering the use of drinks by parents and friends, it was verified that best friend drinking was associated with consumption and binge drinking by students (p < 0.001) (Table 1)

In the Poisson regression model with robust variance, participation in religious activities was associated with students’ binge drinking (PR = 0,823; 95% CI: 0,717 – 0,945); and best friend alcohol consumption was associated with the binge drinking by these students (PR = 1.554; 95% CI: 1,411-1,711) (Table 2).

Discussion

Alcoholic beverages are the psychotropic substances most commonly used by adolescents⁴²42. Galduróz JFC, Noto AR, Fonseca AM, Carlini EA. Levantamento Nacional sobre o Consumo de Drogas Psicotrópicas entre estudantes do ensino fundamental e médio da rede pública de ensino nas 27 capitais brasileiras. Unifesp 2004; 17(1):1-503.. Adolescent drinking is an important ritual of sociability, as well as a pleasant moment, so that this period is usually one in which one drinks more in quantity and frequency⁴³43. Franch M. Um brinde à vida: reflexões sobre violência, juventude e redução de danos no Brasil. Álcool e redução de danos: uma abordagem inovadora para países em transição. Brasília: Ministério da Saúde; 2004.. In this study, the prevalence rate of alcohol consumption (45.6%) was similar to that found in multicenter studies conducted in Brazil in 2001 (48.5%)⁴⁴44. Galduróz JCF, Noto AR, Fonseca AM, Carlini CM, Oliveira LG. II Levantamento domiciliar sobre o uso de drogas psicotrópicas no Brasil: estudo envolvendo as 108 maiores cidades do País-2005. São Paulo: Página e Letras Unifesp; 2007; p. 1-472.. When we analyzed binge drinking (23.1%), we observed a lower prevalence when compared to studies in Belo Horizonte, Minas Gerais (36.0%)²⁰20. Zarzar PM, Jorge KO, Oksanen T, Vale MP, Ferreira EF, Kawachi I. Association between binge drinking, type of friends and gender: a cross-sectional study among Brazilian adolescents. BMC Public Health 2012; 12(1):257-268. and in Brazil (35.0%)²⁵25. Sanchez ZM, Opaleye ES, Chaves TV, Noto AR, Nappo SA. God forbids or mom disapproves? Religious beliefs that prevent drug use among youth. Journal of Adolescent Research 2011; 26(5):591-616.. However, these studies had broader age groups. In Brazil, while selling alcoholic beverages to individuals under 18 years of age is forbidden by law (Law No. 9.294, 15 July 1996)¹⁰10. Brasil. Lei 9.294, de 15 de julho de 1996. Dispõe sobre as restrições ao uso e propaganda de produtos fumígeros, bebidas alcoólicas, medicamentos, terapias e defensivos agrícolas, nos termos do Par. 4° do Art. 220 da Constituição Federal. Diário Oficial da União 1996; 16 jul., their consumption seems somewhat trivialized in society and is culturally associated with leisure. However, several studies show that binge drinking is a risk behavior not only due to the possibility of intoxication and death, but also because of its association with higher rates of traffic accidents⁴⁵45. Zhao G, Wu C, Houston RJ, Creager W. The effects of binge drinking and socio-economic status on sober driving behavior. Traffic Inj. Prev 2010; 11(4):342-352., poor school performance and greater possibility of dependence⁴⁶46. Pitkänen T, Lyyra A, Pulkkinen L. Age of onset of drinking and the use of alcohol in adulthood: a follow-up study from age 8-42 for females and males. Addiction 2005; 100(5):652-666..

The early use of alcohol has been pointed out as an important predictor for problematic consumption in adulthood¹⁴14. Ehlers CL, Slutske WS, Gilder DA, Lau P, Wilhelmsen KC. Age at first intoxication and alcohol use disorders in Southwest California Indians. Alcohol Clin Exp Res 2006; 30(11):1856-1865.^,1616. Helms CM, Rau A, Shaw J, Stull C, Gonzales SW, Grant KA. The effects of age at the onset of drinking to intoxication and chronic ethanol self-administration in male rhesus macaques. Psychopharmacology 2014; 231(8):1853-1861.^,1717. Morean ME, Kong G, Camenga DR, Cavallo DA, Connell C, Krishnan-arin S. First drink to first drunk: age of onset and delay to intoxication are associated with adolescent alcohol use and binge drinking. Alcohol Clin Exp Res 2014; 38(10):2615-2621.. In their longitudinal study in the U.S., Dawson et al.¹⁵15. Dawson DA, Goldstein RB, Patricia CS, June RW, Grant BF. Age at first drink and the first incidence of adult-onset DSM-IV alcohol use disorders. Alcohol Clin Exp Res 2008; 32(12):2149-2160. found that adolescents who started drinking before the age of 15 were significantly more likely to become addicted in adult life, compared to those who had a late first consumption at the age of 18 (PR = 1.38, p = 0.047). In this sample, 7.6% of students reported first consumption between 8 and 9 years of age. In addition, 29.7% of those who reported binge drinking said it was done at the age of 10. The earlier the contact with alcohol, the more vulnerable individuals become to dependence, which can alter the normal development of the brain and hamper the ability to perform specific tasks for their age³⁶36. Spears GV. Latent growth trajectories of substance use among pregnant and parenting adolescents. Psychol Addict Behav 2010; 24(2):322-332..

In this study, binge drinking by participating adolescents was not statistically associated with gender. Studies indicate that drunkenness⁸8. Malta DC, Mascarenhas MDM, Porto DL, Duarte EA, Sardinha LM, Barreto SM. Prevalência do consumo de álcool e drogas entre adolescentes: análise dos dados da Pesquisa Nacional de Saúde Escolar. Rev Bras Epidemio 2011; 14(1):136-146., increased risk of alcohol consumption¹⁹19. Campos JADB, Almeida JC, Garcia PPNS, Faria JB. Consumo de álcool entre estudantes do ensino médio do município de Passos - MG. Cien Saude Colet 2011; 16(12):4745-4754. and regular consumption of beverages⁴⁷47. Fraga S, Sousa S, Ramos E, Dias S, Barros H. Alcohol use among 13-year-old adolescents: associated factors and perceptions. Public Health 2011; 125(7):448-456. are more frequent among boys. However, several studies have shown a corresponding consumption for both genders or higher in females⁸8. Malta DC, Mascarenhas MDM, Porto DL, Duarte EA, Sardinha LM, Barreto SM. Prevalência do consumo de álcool e drogas entre adolescentes: análise dos dados da Pesquisa Nacional de Saúde Escolar. Rev Bras Epidemio 2011; 14(1):136-146.^,1313. Reis TG, Oliveira LCM. Padrão de consumo de álcool e fatores associados entre adolescentes estudantes de escolas públicas em município do interior brasileiro. Rev. bras. Epidemiol 2015; 18(1):13-24.^,4848. Vieira PC, De Castro ADRG, Freddo SL, Bittencourt A, Monteiro L. Uso de álcool, tabaco e outras drogas por adolescentes escolares em município do Sul do Brasil. Cad Saude Publica 2008; 4(11):2487-2498.. Currently, female behavior has been shown to be very similar to male behavior, especially in risk behavior, mainly in adolescence. This is justified by the aspiration for acceptance as an integral part of a group of equals, and may lead adolescents to adopt modes concerning that group⁴⁸48. Vieira PC, De Castro ADRG, Freddo SL, Bittencourt A, Monteiro L. Uso de álcool, tabaco e outras drogas por adolescentes escolares em município do Sul do Brasil. Cad Saude Publica 2008; 4(11):2487-2498.. Historically, it has been known that, since the end of the eighteenth century, equal rights and opportunities claimed by women have revolutionized society⁴⁹49. Bezerra TCE. Mulheres e Políticas Públicas: uma análise sob a ótica das lutas pela construção da cidadania. O público e o privado 2012; (8):149-161.. Believing that the use of beverages is affected by cultural definitions⁵⁰50. Neves DP. Alcoholism: indictment or diagnosis? Cad Saude Publica 2004; 20(1):7-14., it is observed that the contemporary female conduct of equating men even in the act of drinking has reflected a currently experienced cultural change between genders⁵¹51. Moreno RS, Ventura RN, Bretas JRS. O uso de Álcool e Tabaco por Adolescentes do Município de Embu, São Paulo, Brasil. Revista da Escola de Enfermagem da USP 2010; 44(4):969-977.^,5252. Strauch ES, Pinheiro RT, Silva RA, Horta BL. Uso de álcool por adolescentes: estudo de base populacional. Rev Saude Publica 2009; 43(4):647-655.. Although this consumption is not a “typically male” behavior according to the results obtained in this study, we can note that society believes that alcohol abuse by men causes physical and moral deterioration of self-care and family care, while for women this consumption reveals women that “dishonestly” fail to fulfill their role of wives, workers and mothers who take care of their children and watch over home order, showing the demarcation of genders⁵³53. Campos EA, Reis JG. Representations on the use of alcohol among women undergoing treatment at a reference center in the city of São Paulo, Brazil. Interface (Botucatu) 2010; 14(34):539-550..

The literature shows conflicting results while considering binge drinking and family socioeconomic status. Some researchers point out that binge drinking is positively associated with higher socioeconomic status⁵⁴54. Almeida-filho N, Lessa I, Magalhães L, Araújo M, Aquino E, Kawachi I, James S. Alcohol drinking patterns by gender, ethnicity, and social class in Bahia, Brazil. Rev Saude Publica 2004; 38(1):45-54.^,5555. Humensky JL. Are adolescents with high socioeconomic status more likely to engage in alcohol and illicit drug use in early adulthood? Substance abuse treatment, prevention, and policy 2010; 5(19):5-19., while others point out a higher prevalence of consumption when the status is lower¹¹11. Pinsky I, Sanchez M, Zaleski M, Laranjeira R, Caetano R. Patterns of alcohol use among Brazilian adolescents. Rev Bras Psiquiatria 2010; 32(3):242-249.^,5656. Mendoza-Sassi RA, Béria JU. Prevalence of alcohol use disorders and associated factors: a population-based study using AUDIT in southern Brazil. Addiction 2003; 98(6):799-804.. Our results indicate that there was no statistically significant association between maternal schooling and binge drinking by her children. Factors such as culture and religiosity may be associated with variables income and schooling, influencing in a complex way the profile of alcohol consumption in a population. The evaluation of the influence of these socioeconomic factors on behaviors in developing countries such as Brazil becomes more complex, since increased years of schooling can have a minimal effect on increased income⁵⁷57. Ferreira LN, Sales ZN, Casotti CA, Júnior JPB, Júnior ACRB. Perfil do consumo de bebidas alcoólicas e fatores associados em um município do nordeste do Brasil. Cad Saude Publica 2011; 27(8):1473-1486.. The association between binge drinking and socioeconomic status is still contradictory, and it is important to point out the existence of studies that do not indicate such association⁵⁸58. Lundborg P. Social capital and substance use among swedish ado le scents-an explorative study. Social Sci Med 2005; 61(6):1151-1158.^,5959. Barros M, Botega N, Dalgalarrondo P, Marín-Léon L, Oliveira H. Prevalence of alcohol abuse and associated factors in a population-based study. Rev Saude Publica 2007; 41(4):502-509..

Although adolescence is the period associated with the onset of alcohol consumption⁸8. Malta DC, Mascarenhas MDM, Porto DL, Duarte EA, Sardinha LM, Barreto SM. Prevalência do consumo de álcool e drogas entre adolescentes: análise dos dados da Pesquisa Nacional de Saúde Escolar. Rev Bras Epidemio 2011; 14(1):136-146., several so-called “protective factors” may contribute to the non-involvement of individuals. According to a survey by Hanson²⁴24. Hanson GR. New vistas in Drug Abuse Prevention. Nida Notes 2002, 16(6):3-7., the main protective factors are: family, due to the construction of affective bonds and monitoring of friendships and activities, strong involvement with school and/ or religious activities and availability of information. Religiosity has become an object of increasing interest to research. Studies investigating the relationship between religious involvement and binge drinking indicate a positive association between greater involvement in religious activities and lower consumption²³23. Foster DW, Quist MC, Young CM, Bryan JL, Nguyen ML, Neighbors C. Benefit finding as a moderator of the relationship between spirituality/religiosity and drinking. Addictive behaviors 2013; 38(11):2647-2652.^,2929. Sanchez ZM, Oliveira LG, Nappo SA. Fatores protetores de adolescentes contra o uso de drogas com ênfase na religiosidade. Cien Saude Colet 2004; 9(1):43-55.^,6060. Lucchetti G, Koenig HG, Pinsky I, Laranjeira R, Vallada H. Religious beliefs and alcohol control policies: a Brazilian nationwide study. Revista Brasileira de Psiquiatria 2014; 36(1):4-10.. In addition, it is associated with a lower risk of depression and suicide, reduced mortality rate and a better quality of life⁶¹61. Moreira-Almeida A, Latufo Neto F, Koenig HG. Religiousness and mental health: a review. Rev Bras Psiquiatria 2006; 28(3):242-250.. Participation in religious activities is strongly connected with health care. In our study, we observed that this action was negatively associated to binge drinking. Adolescents involved in religious activities fill in their time and begin to receive teachings about conduct and moral concepts that discourage the use of alcoholic beverages and increase faith²⁵25. Sanchez ZM, Opaleye ES, Chaves TV, Noto AR, Nappo SA. God forbids or mom disapproves? Religious beliefs that prevent drug use among youth. Journal of Adolescent Research 2011; 26(5):591-616.. Some authors suggest that religious teachings work as a protective factor by exerting a direct influence on the family, individual personality or bringing values related to life sanctity²⁸28. Sanchez ZM, De Oliveira LG, Nappo SA. Religiosity as a protective factor against the use of drugs. Subst Use Misuse 2008; 43(10):1476-1486.^,6262. King MB, Koenig HG. Conceptualising spirituality for medical research and health service provision. BMC Health Services Research 2009; 13(9):1-7.^,6363. Geppert C, Bogenschutz MP, Miller WR. Development of a bibliography on religion, spirituality and addictions. Drug Alcohol Rev 2007; 26(4):389-395.. The perceived personal responsibility for the physical and mental care that religiosity brings cooperates so that practitioners implement self-control regarding the use of alcohol and other drugs²³23. Foster DW, Quist MC, Young CM, Bryan JL, Nguyen ML, Neighbors C. Benefit finding as a moderator of the relationship between spirituality/religiosity and drinking. Addictive behaviors 2013; 38(11):2647-2652.^,6464. Stylianou S. The role of religiosity in the opposition to drug use. Int J Offender Ther Comp Criminol 2004; 48(4):429-448..

When we analyze the fundamental role that friends play in individual behavior, it is known that these are great influencers for consumption⁶⁵65. Valente T, Ritt-Olson A, Stacy A, Unger J, Okamoto J, Sussman S. Peer acceleration: effects of a social network tailored substance abuse prevention program among high-risk adolescents. Addiction 2007; 102(11): 1804-1815.. Living with friends who consume alcohol is a predisposing factor. Through multiple analysis, we observed that alcohol consumption by the best friend was statistically associated with binge drinking among students. Often, the first alcoholic consumption occurs at parties, where drinks ingested are offered by friends and used as a socializing means⁴⁸48. Vieira PC, De Castro ADRG, Freddo SL, Bittencourt A, Monteiro L. Uso de álcool, tabaco e outras drogas por adolescentes escolares em município do Sul do Brasil. Cad Saude Publica 2008; 4(11):2487-2498.. In this perspective, studies by Sanchez et al.²⁵25. Sanchez ZM, Opaleye ES, Chaves TV, Noto AR, Nappo SA. God forbids or mom disapproves? Religious beliefs that prevent drug use among youth. Journal of Adolescent Research 2011; 26(5):591-616. and Zarzar et al.²⁰20. Zarzar PM, Jorge KO, Oksanen T, Vale MP, Ferreira EF, Kawachi I. Association between binge drinking, type of friends and gender: a cross-sectional study among Brazilian adolescents. BMC Public Health 2012; 12(1):257-268. have shown that friendships developed in religious environments with people who habitually do not engage in binge drinking favor a lower risk lifestyle. Through networks of friends healthy behaviors can be shared. In schools, the environment of common rules, goals and values that aims life, can also reduce the risk of high alcohol consumption⁶⁵65. Valente T, Ritt-Olson A, Stacy A, Unger J, Okamoto J, Sussman S. Peer acceleration: effects of a social network tailored substance abuse prevention program among high-risk adolescents. Addiction 2007; 102(11): 1804-1815.. However, Zarzar et al.²⁰20. Zarzar PM, Jorge KO, Oksanen T, Vale MP, Ferreira EF, Kawachi I. Association between binge drinking, type of friends and gender: a cross-sectional study among Brazilian adolescents. BMC Public Health 2012; 12(1):257-268. emphasize that the best friendships, when developed within the church, works as a protective factor against binge drinking.

The limitations of this study include its cross-sectional design, which does not allow the establishment of a cause-and-effect direction, but facilitates the identification of associations between the analyzed variables. The use of questionnaires enables the omission of information, but since they are anonymous, they leave the participant with more freedom to answer personal questions. Students who were in the classroom and who agreed to participate in the study were evaluated. Thus, the results may not reflect what happens to those who missed or evaded school and those not enrolled.

Longitudinal works that study religiosity and other factors that may act as a protective factor for risk behaviors are extremely relevant so that new strategies are elaborated and discussed for adolescent health promotion.

Conclusion

There was a high prevalence of binge drinking among 12-year-olds participating in this study. The participation of adolescents of this study in religious activities appeared as a possible protective factor for binge drinking. The consumption of alcoholic beverages by the best friend was identified as a possible risk factor for binge drinking by adolescents.

Acknowledgments

Authors would like to thank the Minas Gerais Research Support Foundation (FAPEMIG) and the National Council for Scientific and Technological Development (CNPq) for the financial support.

References

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