Abstracts

Introduction

Binge drinking - or heavy episodic drinking - is an important health and social problem characterized by the consumption of five or more doses of alcohol in a drinking event ¹1. Chung T, Creswell KG, Bachrach R, Clark DB, Martin CS. Adolescent binge drinking. Alcohol Res 2018; 39:5-15.. It is associated with harmful health and social outcomes, such as higher risk of violence, school absenteeism, unsafe sexual intercourse, and severe intoxication ²2. ESPAD Group. ESPAD Report 2019: results from the European School Survey Project on Alcohol and Other Drugs. Luxembourg: EMCDDA Joint Publications, Publications Office of the European Union; 2020.. The prevalence of binge drinking among adolescents aged 15 to 19 years worldwide was 13.6% in 2016 ³3. World Health Organization. Global status report on alcohol and health 2018. Geneva: World Health Organization; 2018. (Global Status Report on Alcohol, 65)..

In this study, we estimated the prevalence of binge drinking and other patterns of alcohol consumption among Brazilian adolescents using data from a large, nationally representative household survey, the 2019 Brazilian National Health Survey (PNS).

Considering the increasing number of publications on binge drinking among Brazilian adolescents, this study adds knowledge on the prevalence of binge drinking and its distribution according to sociodemographic characteristics in a nationally representative sample of Brazilian adolescents. Our findings may be useful for the implementation of more effective public policies to prevent alcohol consumption by adolescents.

Methods

The PNS aimed to understand the determinants, conditions, and health needs of the Brazilian population. The 2019 PNS was approved by the Brazilian National Ethics Research Committee (CONEP; n. 3,529,376). PNS complex multistage sampling strategy included three stages: (1) selection of census sectors (primary sample units - PSUs); (2) selection of households; (3) and individuals aged ≥ 15 years based on the list of residents. A total of 8,036 PSUs and 108,525 households were selected. Considering a 13.2% non-response rate, 94,114 households with individuals aged ≥ 15 years were interviewed. Details on the sampling and weighting process are available elsewhere ⁴4. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional de Saúde 2019. Percepção do estado de saúde, estilos de vida, doenças crônicas e saúde bucal: Brasil e grandes regiões. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2019.. In this study, 2,315 adolescents aged 15 to 17 years were included.

Assessment of alcohol consumption

Adolescents answered a questionnaire on their frequency of alcohol consumption, average frequency of consumption per week, average amount consumed in a drinking day, binge drinking in the past month, average amount consumed when binge drinking, drink-driving, alcohol consumption and abandonment of daily activities, number of times that they could not remember what happened after drinking, excessive alcohol consumption reported by close people. This study considered binge drinking as the consumption of five or more doses of alcohol in a drinking event in the past 30 days.

Sociodemographic characteristics

Data on age (15 to 17 years), sex (boys or girls), race/skin color (white, black/mixed-race, or other), school attendance (yes or no), and socioeconomic status (wealth score quintiles) were collected via the questionnaire. The wealth score was estimated by principal component analysis (PCA), according to Barros & Victoria ⁵5. Barros AJD, Victora CG. A nationwide wealth score based on the 2000 Brazilian demographic census. Rev Saúde Pública 2005; 39:523-9.. PCA included in its model the number of rooms, restrooms, televisions, microwaves, cars, motorcycles, computers, landlines, refrigerators, washing machines, and the household income. The wealth index was categorized as quintiles: the first quintile (Q1) referred to the poorest 20% and the fifth quintile (Q5) the wealthiest 20%.

Statistical analysis

Sociodemographic data and alcohol consumption among adolescents were summarized using prevalence and 95% confidence intervals (95%CI), mean, and standard deviation (SD). Simple and multivariable logistic regression models were used to estimate unadjusted and adjusted odds ratios (OR) for the association between sociodemographic factors and binge drinking. All analyses were performed using the Stata 17.0 software (https://www.stata.com).

Results

Table 1 shows the characteristics of adolescents according to binge drinking. About 51% of adolescents were boys and 37% were 17 years old. About 60% were black/mixed-race and 87% attended school. The proportion of black/mixed-race boys who did not attend school was higher and the wealth score of adolescents who practiced binge drinking was lower compared with adolescents who did not practice binge drinking.

About 77.6% (95%CI: 74.2-80.0) of adolescents did not drink. The prevalence of binge drinking in the past 30 days was 8.1% (95%CI: 6.2-10.3). Almost all adolescents (98.6%; 95%CI: 97.7-99.2) who consumed alcohol did not stop performing their daily activities. Only 2.6% (95%CI: 1.7-3.9) of adolescents reported not remembering what happened after drinking once a month or less. About 3.4% (95%CI: 2.0-5.4) drank so much that close people asked them to stop drinking more than once (Table 2).

Girls had odds of binge drinking 50% lower than boys (OR = 0.5; 95%CI: 0.2-0.8). The odds of adolescents who did not attend school was 2.8 times greater compared with adolescents who attended school (OR = 2.8; 95%CI: 1.6-5.0). Adolescents with higher socioeconomic status had higher odds of binge drinking. Compared with adolescents in the first wealth score quintile, the OR of binge drinking was 2.1 (95%CI: 1.4-4.1) for adolescents in the second quintile, 3.9 (95%CI: 2.0-7.8) for adolescents in the third quintile, 1.5 (95%CI: 0.7-3.3) for adolescents in the fourth quintile, and 2.9 (95%CI: 1.1-7.7) for adolescents in the fifth quintile (Table 3).

Discussion

In this study, the prevalence of binge drinking was 8.1% among Brazilian adolescents. Adolescents with higher wealth score and who did not attend school were more likely to practice binge drinking. Girls had lower odds of binge drinking than boys. These results are important for the prevention of alcohol consumption among adolescents, considering that few studies evaluated factors associated with binge drinking based on a Brazilian national household survey.

In a recent school-based survey in Brazil, the prevalence of binge drinking in the past 30 days was 6.9% among adolescents aged 13 to 17 years ⁶6. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional de Saúde do Escolar 2019. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2021.. The 2019 European School Survey Project on Alcohol and Other Drugs (ESPAD; http://www.espad.org/) showed that the prevalence of binge drinking in the past 30 days was 13% among adolescents aged 15 to 16 years from 35 European countries ²2. ESPAD Group. ESPAD Report 2019: results from the European School Survey Project on Alcohol and Other Drugs. Luxembourg: EMCDDA Joint Publications, Publications Office of the European Union; 2020.. Alcohol consumption, especially binge drinking, by adolescents is an important global health problem and several studies have already reported its consequences, such as risky sexual behavior, violence, and blackout ⁷7. Hall WD, Patton G, Stockings E, Weier M, Lynskey M, Morley KI, et al. Why young people's substance use matters for global health. Lancet Psychiatry 2016; 3:265-79..

In our study, the odds of binge drinking for girls was 50% lower compared with boys. Other studies found similar results ⁸8. Johnston LD, O'Malley PM, Miech R, Bachman JG, Schulenberg JE. Monitoring the future results on drug use, 1975-2013: overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, University of Michigan; 2015.. Boys are at increased risk of practicing binge drinking compared with girls ⁹9. Chen CM, Yi H, Faden VB. Trends in underage drinking in the United States, 1991-2011. Bethesda: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health; 2015. (Surveillance Report, 96).. This difference can be related to social and cultural norms and historical conditions that built the concepts of man and woman ¹⁰10. Freitas ES, Ribeiro KCS, Saldanha AAW. O uso de álcool por adolescentes: uma comparação por gênero. Psicol Argum 2012; 30:287-95.. The discriminatory idea of the role of man frequently presumes that alcohol consumption/binge drinking is an expression of masculinity ¹¹11. Dir AL, Bell RL, Adams ZW, Hulvershorn LA. Gender differences in risk factors for adolescent binge drinking and implications for intervention and prevention. Front Psychiatry 2017; 8:289.. In-depth studies are important to evaluate the risks for each sex and enable the development of interventions and preventive actions to reduce alcohol consumption more effectively.

Wealthier adolescents had greater odds of binge drinking compared with adolescents with lower wealth scores. Some studies showed a similar relationship between higher socioeconomic status and higher alcohol consumption among adolescents ¹²12. 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 Alcohol Depend 2013; 127:87-93.. Other studies, however, showed a positive and inverse association between socioeconomic status and binge drinking ¹³13. Jorge KO, Ferreira RC, Ferreira EF, Vale MP, Kawachi I, Zarzar PM. Binge drinking and associated factors among adolescents in a city in southeastern Brazil: a longitudinal study. Cad Saúde Pública 2017; 33:e00183115.. Adolescents with higher socioeconomic status have more financial resources to purchase alcohol and attend parties that may favor binge drinking ¹²12. 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 Alcohol Depend 2013; 127:87-93.. For adolescents with higher socioeconomic status, the “permissions” of parents that do not monitor and talk about alcohol consumption probably influence adolescents to spend more money in social activities, including buying more alcohol, which reinforces the need to invest more in public policies aimed at the taxation of alcohol, as convincing evidence have show that this action plays a central role in the prevention of alcohol consumption and abuse ¹⁴14. World Health Organization. Reducing the harm from alcohol by regulating cross-border alcohol marketing, advertising and promotion: a technical report. Geneva: World Health Organization; 2022..

Our findings also showed that adolescents who did not attend school were more vulnerable to binge drinking. An United Nations Children’s Fund (UNICEF) study performed in Brazil with adolescents aged 15 to 17 years found that the three main reasons for school absenteeism were: lack of interest in studying (38.2%); working or seeking employment (14.6%); and pregnancy (11.4%) ¹⁵15. Fundo das Nações Unidas para a Infância. Cenário da exclusão escolar no Brasil. Um alerta sobre os impactos da pandemia da COVID-19 na Educação. São Paulo: Fundo das Nações Unidas para a Infância; 2021.. Given the particularities of the social, economic, and cultural context in Brazil ⁴4. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional de Saúde 2019. Percepção do estado de saúde, estilos de vida, doenças crônicas e saúde bucal: Brasil e grandes regiões. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2019., regional differences, even between states of the same region, regarding alcohol consumption and binge drinking may exist. In this study, we aimed to provide the national scenario of binge drinking among adolescents, considering that each region and state require a detailed analysis and interpretation of the findings, which would not be possible in a short report. However, we encourage future studies to analyze regional differences to identify trends and local particularities of binge drinking in Brazil.

Risky behaviors in adolescence can perpetuate throughout adulthood ¹1. Chung T, Creswell KG, Bachrach R, Clark DB, Martin CS. Adolescent binge drinking. Alcohol Res 2018; 39:5-15.; thus, developing actions to prevent alcohol consumption at school age is important ¹⁶16. Pereira APD, Sanchez ZM. Characteristics of school-based drug prevention programs in Brazil. Ciênc Saúde Coletiva 2020; 25:3131-42.. Evidence shows that the association between binge drinking and school absenteeism has been mutually reinforcing effects (bidirectional). Lower school performance may lead vulnerable adolescents to binge drinking and binge drinking may promote a poor school performance and increase the probability of school dropout ¹⁷17. Patte KA, Qian W, Leatherdale ST. Binge drinking and academic performance, engagement, aspirations, and expectations: a longitudinal analysis among secondary school students in the COMPASS study. Health Promot Chronic Dis Prev Can 2017; 37:376-85.. These findings raised concern, considering the importance of school performance to adolescents’ future opportunities ¹⁷17. Patte KA, Qian W, Leatherdale ST. Binge drinking and academic performance, engagement, aspirations, and expectations: a longitudinal analysis among secondary school students in the COMPASS study. Health Promot Chronic Dis Prev Can 2017; 37:376-85.. On the other hand, for adolescents who do not attend school, promoting environmental interventions, such as strengthening the prohibition of the sale of alcohol to adolescents, regulating drinking parties, and reducing alcohol availability in the neighborhood, is essential ¹⁸18. United Nations Office on Drugs and Crimes; World Health Organizations. International standards on drug use prevention. Second update edition. Vienna: United Nations Office on Drugs and Crime/World Health Organization; 2018..

Our study has some limitations. Alcohol consumption was self-reported and, therefore, susceptible to measurement error. Participants tend to omit risk behaviors, which lead to an underestimated prevalence of binge drinking and other alcohol consumption patterns. We did not perform analyses by Brazilian region and state, considering that Brazil has a continental dimension, was another limitation. Although this was a descriptive study and associations aimed to identify groups of adolescents more exposed to binge drinking, we could not evaluate the temporal relationship between school attendance and socioeconomic status and binge drinking due to the cross-sectional data. Despite these limitations, the PNS have a great methodological rigor and generalizing its results is safe for national estimates.

Conclusion

About 8% of Brazilian adolescents reported recent binge drinking. Boys, adolescents with higher socioeconomic status, and adolescents who did not attend school were more likely to binge drinking. These findings suggest the need for interventions and public policies beyond schools to reach the adolescents at higher risk.

References

Publication Dates

History