Abstract

Introduction

The abuse of licit and illicit drugs is a world concern. Alcohol and tobacco are the drugs that kill the most worldwide.¹1. Ministério da Saúde (BR). Instituto Nacional de Câncer. Relatório de OMS sobre a epidemia Global de Tabagismo, 2008: Pacote MPOWE [Internet]. Instituto Nacional de Câncer; 1996 [citado 2011 jul 10]. Disponível em: http://www.inca.gov.br/tabagismo/publicacoes/OMS_Relatorio.pdf
http://www.inca.gov.br/tabagismo/publica... Their frequent use causes social, psychological and biological harms, not to mention the consequences for the users' future lives.²2. Primo NLNP, Stein AT. Prevalência do abuso e da dependência de álcool em Rio Grande (RS): um estudo transversal de base populacional. Rev Psiquiatr Rio Gd Sul. 2004 set-dez;26(3):280-6.

3. Costa COM, Alves MVQM, Santos CAST, Carvalho RC, Souza KEP, Sousa HL. Experimentação e uso regular de bebidas alcoólicas, cigarros e outras substâncias psicoativas/SPA na adolescência. Cienc Saude Coletiva [Internet]. 2007 set-out [citado 2009 ago 12];12(5):1143-54. Disponível em: http://www.scielo.br/pdf/csc/v12n5/05.pdf
http://www.scielo.br/pdf/csc/v12n5/05.pd... ^-44. Tavares BF, Béria JU, Lima MS. Fatores associados ao uso de drogas entre adolescentes escolares. Rev Saude Publica. 2004 dez;38(6):787-96. Adolescents are the most vulnerable age group when it comes to experimentation and abusive drug consumption, and the reasons that lead to the increasing use of such substances are varied and complex. Some factors might be related to the life stages, such as juvenile omnipotence sensation, challenging the family and social structures and the search for new experiences.⁴4. Tavares BF, Béria JU, Lima MS. Fatores associados ao uso de drogas entre adolescentes escolares. Rev Saude Publica. 2004 dez;38(6):787-96.

In Brazil, the Child and Adolescent Statute (ECA)⁵5. Brasil. Casa Civil. Lei no 8.069, de 13 de julho de 1990. Dispõe sobre o Estatuto da Criança e do Adolescente e dá outras providências. Diário Oficial da República Federativa do Brasil [Internet], Brasília (DF), 1990 jul 16 [citado 2011 jul 10]; Seção 1:13563. Disponível em: http://www.planalto.gov.br/ccivil_03/leis/l8069.htm
http://www.planalto.gov.br/ccivil_03/lei... understands as criminal the behavior of those who sell, provide, administer and give alcoholic drinks and other products that can cause physical or psychological addiction to children or adolescents. However, such practices are still under observation. The lack of supervision in the fulfillment of the Law and the permissiveness of families and society are factors that contribute to drugs consumption.⁴4. Tavares BF, Béria JU, Lima MS. Fatores associados ao uso de drogas entre adolescentes escolares. Rev Saude Publica. 2004 dez;38(6):787-96. As a consequence, Brazilian adolescents present high prevalence on alcohol use, substance of higher life-time consumption (60.5%), and in the 30 days prior to the interview (21.1%), among students.⁶6. Carlini ELA, Noto AR, van der Meer Sanchez Z, Carlini CMA, Locatelli DP, Abeid LR, et al. VI Levantamento nacional sobre o consumo de drogas psicotrópicas entre estudantes do ensino fundamental e médio das redes pública e privada de ensino nas 27 capitais brasileiras - 2010 [Internet]. Brasília: SENAD; 2010 [citado 2014 nov 18]. 503 p. Disponível em: http://www.obid.senad.gov.br/portais/OBID/biblioteca/documentos/Publicacoes/328890.pdf
http://www.obid.senad.gov.br/portais/OBI... These frequencies may vary according to the methods adopted for measurement, the location where the survey was conducted and the studied population. In other national studies, prevalences of 86.8%⁷7. Baus J, Kupek E, Pires M. Prevalência e fatores de risco relacionados ao uso de drogas entre escolares. Rev Saude Publica. 2002 fev;36(1):40-6., 68.9%⁸8. Guimarães JL, Godinho PH, Cruz R, Kappann JI, Tosta Junior LA. Consumo de drogas psicoativas por adolescentes escolares de Assis, SP. Rev Saude Publica. 2004 fev;38(1):130-2. and 51.0%,⁹9. Vieria PC, Aerts DRGC, 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 nov;24(11):2487-9. to alcoholic beverage consumption were found. Similar results were presented in studies conducted in other countries. In Canada, the use of alcoholic beverage was of 59.1%,¹⁰10. Leatherdale ST, Ahmed R. Alcohol, marijuana and tobacco use among Canadian youth: do we need more multi-substance prevention programming? J Prim Prev. 2010 Jun;31(3):99-108. and in Spain, 84% of the adolescent students interviewed had already tried one or more types of alcoholic beverages.¹¹11. Mendoza Berjano R, Batista Foguet JM, Sánchez Garcia M, Carrasco González AM. El consumo de tabaco, alcohol y otras drogas enlos adolescentes escolarizados españoles. Gac Sanit. 1998 nov-dic;12(6):263-71. Specifically in Madrid, the results showed that 85% of the adolescents had already tried alcohol.¹²12. Hidalgo I, Garrido G, Hernandez M. Health status and risk behavior of adolescents in the north of Madrid, Spain. J Adoles Health. 2000 Nov;27(5):351-60. Such data reflect the magnitude of the problem to global health.

Heavy drinking is one of the responsible factors for the increase of deaths in traffic, mainly among adolescents.¹³13. Priotto EP, Bonetti LW. Violência escolar: na escola, da escola e contra a escola. Rev Dialogo Educ [Internet]. 2009 jan-abr [citado 2011 mar 29];9(26):161-79. Disponível em: www2.pucpr.br/reol/index.php/DIALOGO?dd1=2589&dd99=pdf
www2.pucpr.br/reol/index.php/DIALOGO?dd1... The first experimentation usually happens very early in life, below the age of 12.¹⁴14. Silva LVER, Malbergier A, Stempliuk VA, Andrade AG. Fatores associados ao consumo de álcool e drogas entre estudantes universitários. Rev Saude Publica. 2006 abr;40(2):280-8. In many cases, the consumption takes place near the family, at home and with friends,⁹9. Vieria PC, Aerts DRGC, 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 nov;24(11):2487-9. in parties, bars and shopping malls.¹⁵15. Malta DC, Mascarenhas MDM, Porto DL, Duarte EA, Sardinha LM, Barreto SM, et al. Prevalência do consumo de álcool e drogas entre adolescentes: análise dos dados da pesquisa nacional de saúde escolar. Rev Bras Epidemiol [Internet]. 2011 set [citado 2011 abr 20];14 supl 1:136-46. Disponível em: http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1415-790X2011000500014&lng=en&nrm=iso
http://www.scielosp.org/scielo.php?scrip... Moreover, the use of psychoactive substances is commonly known to produce a multiplier effect, in which the consumption of a certain substance raises the risk of consumption of other substances.¹⁶16. Horta RL, Horta BL, Pinheiro RT, Morales B, Strey MN. Tabaco, álcool e outras drogas entre adolescentes de Pelotas, Rio Grande do Sul, Brasil: uma perspectiva de gênero. Cad Saude Publica. 2007 abr;23(4):775-83.

In Brazil and in many other countries, tobacco use by adolescents is highly prevalent. A national survey revealed a consumption of this substance in the prior 30 days of 5.1% among students.¹⁵15. Malta DC, Mascarenhas MDM, Porto DL, Duarte EA, Sardinha LM, Barreto SM, et al. Prevalência do consumo de álcool e drogas entre adolescentes: análise dos dados da pesquisa nacional de saúde escolar. Rev Bras Epidemiol [Internet]. 2011 set [citado 2011 abr 20];14 supl 1:136-46. Disponível em: http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1415-790X2011000500014&lng=en&nrm=iso
http://www.scielosp.org/scielo.php?scrip... Even this number being particularly lower when compared to other Latin American countries, such as Argentina (25.5%), Uruguay (17.7%) and Peru (17.3%),¹⁷17. World Health Organization. Global school-base student health survey [Internet]. Geneva: World Health Organization; 2015 [cited 2011 Apr 29]. Available from: http://www.who.int/chp/gshs/en
http://www.who.int/chp/gshs/en... these results show the need of paying closer attention to this important Public Health issue.

Smokers have higher risks of developing many types of cancer, especially lung cancer, and higher probability of heart diseases, strokes and pulmonary emphysema.¹⁷17. World Health Organization. Global school-base student health survey [Internet]. Geneva: World Health Organization; 2015 [cited 2011 Apr 29]. Available from: http://www.who.int/chp/gshs/en
http://www.who.int/chp/gshs/en... The association between a lower educational achievement and the use of tobacco and other drugs is a concern. Social class, education level, school bonds and the occurrence of school failures are more associated to the use of tobacco and illicit drugs, low school performance and low school frequency.¹⁶16. Horta RL, Horta BL, Pinheiro RT, Morales B, Strey MN. Tabaco, álcool e outras drogas entre adolescentes de Pelotas, Rio Grande do Sul, Brasil: uma perspectiva de gênero. Cad Saude Publica. 2007 abr;23(4):775-83. Tobacco consumption is more frequent among groups with lower education level.

Schools have experienced a raise in aggressiveness and violence. The abusive use of psychotropic drugs feeds violence and is associated with bullying among boys and girls.¹⁸18. Andrade SSCA, Yokota RTC, Sá NNB, Silva MMA, Araújo WN, Mascarenhas MDM, et al. Relação entre violência física, consumo de álcool e outras drogas e bullying entre adolescentes escolares brasileiros. Cad Saude Publica. 2012 set;28(9):1725-36. Also, adolescents who consume these substances are more aggressive, less interested in studying and more inattentive.¹³13. Priotto EP, Bonetti LW. Violência escolar: na escola, da escola e contra a escola. Rev Dialogo Educ [Internet]. 2009 jan-abr [citado 2011 mar 29];9(26):161-79. Disponível em: www2.pucpr.br/reol/index.php/DIALOGO?dd1=2589&dd99=pdf
www2.pucpr.br/reol/index.php/DIALOGO?dd1... On the National Survey on Students' Health (PeNSE),¹⁵15. Malta DC, Mascarenhas MDM, Porto DL, Duarte EA, Sardinha LM, Barreto SM, et al. Prevalência do consumo de álcool e drogas entre adolescentes: análise dos dados da pesquisa nacional de saúde escolar. Rev Bras Epidemiol [Internet]. 2011 set [citado 2011 abr 20];14 supl 1:136-46. Disponível em: http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1415-790X2011000500014&lng=en&nrm=iso
http://www.scielosp.org/scielo.php?scrip... 8.7% of the students reported having already tried some illicit drug.

The course of scientific studies on the problematic alcohol, tobacco and other drugs consumption by adolescents is being prioritized by the Health Sector, due to a direct and indirect association of these behaviors with some of the main causes of morbidity and mortality in adolescence.¹⁹19. Martinez Moldonado R, Pedrão LJ, Alonso Castillo MM, López Garcia KS, Oliva Rodriguez NN. Auto-estima, auto-eficácia percebida, consumo de tabaco e álcool entre estudantes do ensino fundamental, das áreas urbana e rural, de Monterrey, Nuevo León, México. Rev LatinoAm Enfermagem [Internet]. 2008 mai-jun [citado 2011 abr 29];16(spec):614-20. Disponível em: http://www.scielo.br/pdf/rlae/v16nspe/pt_18.pdf
http://www.scielo.br/pdf/rlae/v16nspe/pt... Likewise important is the conduction of researches which can support the development of educational policies and health promotion, programs and interventions for adolescents.¹⁹19. Martinez Moldonado R, Pedrão LJ, Alonso Castillo MM, López Garcia KS, Oliva Rodriguez NN. Auto-estima, auto-eficácia percebida, consumo de tabaco e álcool entre estudantes do ensino fundamental, das áreas urbana e rural, de Monterrey, Nuevo León, México. Rev LatinoAm Enfermagem [Internet]. 2008 mai-jun [citado 2011 abr 29];16(spec):614-20. Disponível em: http://www.scielo.br/pdf/rlae/v16nspe/pt_18.pdf
http://www.scielo.br/pdf/rlae/v16nspe/pt... Such need is even higher in the North of Brazil, given the lack of published studies on the problem in the region. In Porto Velho, Rondônia State, little is known about alcohol, tobacco or illicit drugs consumption.

This work aimed at studying the prevalence and associated factors of tobacco, alcohol and other drugs use by eight-grade students of state schools in the city of Porto Velho, Rondônia State (RO), Brazil.

Methods

This is a cross-sectional study conducted in Porto Velho-RO. This work is part of a greater project, called Students' Health in the Brazilian Northern Region, developed in the cities of Porto Velho, Ji-Paraná (Rondônia State, RO) and Santarém (Pará State, PA).

In Porto Velho, the state school system had about 57,107 students aged between 5 and 18 years old, distributed in nine units, located in the urban area. This study target population was composed by eighth-grade students of sate schools in the city of Porto Velho, in 2009 (N=4,667).

To define the sample calculation, the different outcomes prevalences were estimated in 50%, in order to produce the highest number of sample possible; considering 4% as the maximum error and a 95% confidence interval.

To avoid a possible design bias, since a process of sampling by cluster was used, the sample calculation was multiplied by 1.5; 20% was added up to this product, to compensate for eventual losses, totalizing 996 students.

The sampling was conducted by clusters, stratified by units. Initially, the total number of schools and 8^th grade classes was identified. With this information, the sample was proportionally distributed according to the number of students enrolled in each one of the units. After that, the 8^th grade classes of all schools were numbered for the selection of students. According to the average amount of students by shift (morning or afternoon), 34 classes were randomly chosen. All students of the chosen classes were invited to participate in the study.

The data collection was conducted in the classroom. The students answered to a self-report questionnaire composed by closed questions. After the students were done answering, the questionnaires were collected by the researchers. The instrument adopted was the same used in a study conducted with students from Rio Grande do Sul State, for the project The Students' Health in the Municipal Schools of Gravataí-RS, which was based on the Global School-Based Student Health Survey, of the World Health Organization - WHO.¹⁷17. World Health Organization. Global school-base student health survey [Internet]. Geneva: World Health Organization; 2015 [cited 2011 Apr 29]. Available from: http://www.who.int/chp/gshs/en
http://www.who.int/chp/gshs/en...

The instrument used to measure the students' economical classification or status came from the Brazilian Association of Survey Companies (ABEP).²⁰20. Associação Brasileira das Empresas de Pesquisa. Critério Classificação Econômica - Brasil - ABEP [Internet] 2010. [citado 2011 fev 5]. Disponível em: http://www.abep.org/Servicos/Download.aspx?id=03
http://www.abep.org/Servicos/Download.as... Due to the lack of class E families and to the small number belonging to classes A and D, the economical status was categorized as A+B and C+D.

The outcomes studied were the consumption of alcohol, tobacco and other drugs in the 30 days prior to the interview. The independent variables were:

For data quality control, the questionnaire answers were double typed on Epi Data software, and there was consistency and coherency analysis. The inconsistencies detected were checked in the original documents.

The associations between the outcomes and the variables of interest were analyzed by using the multivariable Cox regression for cross-sectional studies.²¹21. Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003 Oct;3:21. The multiple regression was conducted for each one of the outcomes, including the variables of interest, regardless of the level of significance in the univariate analysis, with the associations with p<0.05 being considered significant. For the use of tobacco in the prior 30 days, the following variables were included in the model, in one single stage: sex; skin color, economical status; parental tobacco consumption (parents who smoke) and friends tobacco consumption (friends who smoke); and the use of alcohol and drugs in the prior 30 days by the adolescent. For the use of alcohol in the prior 30 days, the following variables were included in the model, simultaneously: sex, skin color, economical status; parental alcohol consumption (parents who drink); use of tobacco and drugs in the prior 30 days by the adolescent. Finally, for the use of other drugs in the prior 30 days, the following variables were included in the model: sex; skin color; economical status; use of drugs by friends; and use of alcohol and tobacco in the prior 30 days by the adolescent.

The study project was approved by the Lutheran University of Brazil Ethics Committee (Protocol No. 2009-251H) and by the Secretariat of Education of Rondônia State. The parents or guardians of each student who took part in the study signed a Term of Consent.

Results

832 students were interviewed with 16.5% of loss. Among the students who took part in the study, 56.6% were girls and 73.8% self-declared non-white. The interviewees' age varied from 12 to 19 years old: median of 14 years old; average of 14.34 years old; and standard deviation of 1.01. Class B presented the highest number of students (432: 51.9%), followed by class C (364: 43.7%) (Table 1).

With regard to the use of substances in life-time, prevalences were 49.6%, 17.5% and 5.3% for alcohol, tobacco and other drugs, respectively. In the prior 30 days, prevalences were 24.0% for the use of alcohol, 6.2% for tobacco and 2.3% for other drugs. Regarding the use of substances by parents and friends, 59.4% of the students revealed having parents who drink and 26.1%, parents who smoke, 52.0% declared having friends who smoke; 33.2% have friends who use other drugs (Table 1).

Among those who have consumed alcohol any moment in their lives, the first experimentation usually happened at the age of 12 to 13 years old (average of 11.59 years old; standard deviation of 2.31 years old), and 39.3% reported having drunk for the first time at home and 46.7% reported drinking with friends. In the prior 30 days, 50.0% of the students denied having drunk alcohol and 17.7% informed having drunk three or more times in this period (Table 2). 25.4% of the students reported having already drunk excessively at least once in their lives; 24 of them had problems with their parents, fights or school absence in the prior 30 days. Among all the interviewees, 52 of them said their parents would not notice if they got home drunk and 44.5% said they did not know what their parents' reaction would be in this kind of situation.

With regard to tobacco use (Table 3), the average age of experimentation was 11.87 years old (standard deviation: 2.01 years old). Among the 53 students who had smoked in the prior 30 days, 26 smoked less than one cigarette/day, 22 reported smoking mainly in parties and bars, and 11 smoked at school.

The age group in which the highest number of adolescents have tried other drugs was between 13 and 15 years old, with an average of 13.20 (standard deviation: 1.62). Cannabis was the first experimentation drug for 23 of the 44 students who have used it in life-time, followed by anabolic steroids and solvents (Table 4).

After adjusted analysis, the use of alcohol in the prior 30 days (Table 5) was higher among boys (34.0%), those who used other drugs in the prior 30 days (81.0%) and among those who reported having parents who drink (52.0%). Those who have also smoked in the prior month referred a 3.5 times higher alcohol intake.

Concerning the use of tobacco in the prior 30 days (Table 5), the adolescents who have drunk in the prior 30 days and the ones whose friends smoke presented prevalences 6.7 and 9.6 times higher than their reference pairs, respectively. The use of other drugs prevalence among those who had drunk in the prior 30 days and among those who have friends who use other drugs were, respectively, 4.3 and 8.7 times higher than their pairs.

Discussion

The scientific studies on the use of alcohol, tobacco and other drugs have revealed important findings about the situation in Brazil. However, little is known about the problem in some regions, especially in the North of the country. This study, conducted with students from Porto Velho, Rondônia State, pointed out that approximately half of the interviewees have already consumed alcohol in some moment and one fourth of them have used the substance in the prior 30 days. Nonetheless, the prevalence of alcohol consumption in the prior month was lower than those observed in other studies that used the same data collection instrument in countries such as Argentina, Peru and Uruguay, with prevalences of 56.8%, 27.1% and 59.6% respectively.¹⁷17. World Health Organization. Global school-base student health survey [Internet]. Geneva: World Health Organization; 2015 [cited 2011 Apr 29]. Available from: http://www.who.int/chp/gshs/en
http://www.who.int/chp/gshs/en...

Boys consumed more alcohol in the prior month than girls. Such finding might be related to various factors, among them, a cultural issue: it is socially more acceptable that men make use of these substances. Even so, a change on this matter may be going on. On the National Survey on Students' Health (PeNSE)¹⁵15. Malta DC, Mascarenhas MDM, Porto DL, Duarte EA, Sardinha LM, Barreto SM, et al. Prevalência do consumo de álcool e drogas entre adolescentes: análise dos dados da pesquisa nacional de saúde escolar. Rev Bras Epidemiol [Internet]. 2011 set [citado 2011 abr 20];14 supl 1:136-46. Disponível em: http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1415-790X2011000500014&lng=en&nrm=iso
http://www.scielosp.org/scielo.php?scrip... , conducted with students who consumed alcohol in the prior month, this consumption was higher among girls, but there was no statistical significance; however, among students who have tried alcohol at least once in life, the prevalence was significantly higher among the girls.

The fact that 39.2% of the students in this study have tried alcohol for the first time at home; most of them between 12 and 13 years old and reporting the habit of drinking mainly with friends and family, deserves a closer attention. Adolescence is a period when great importance is given to belonging to groups, which makes the individual more vulnerable to others' influence for risky behaviors.²²22. Jinez MLJ, Souza JRM, Pillon SC. Uso de drogas e fatores de risco entre estudantes de ensino médio. Rev Lat Am Enfermagem. 2009 mar-abr;17(2):246-52. However, the values and the attitudes adopted by the parents, who lead their children education, can offer protection or risk for them, including for alcohol consumption.¹⁸18. Andrade SSCA, Yokota RTC, Sá NNB, Silva MMA, Araújo WN, Mascarenhas MDM, et al. Relação entre violência física, consumo de álcool e outras drogas e bullying entre adolescentes escolares brasileiros. Cad Saude Publica. 2012 set;28(9):1725-36. On the studied group, a non-protective family environment was identified, based on the fact that 44.5% of the students did not know what would be their parents' reaction if they got home drunk.

With regard to the use of tobacco, the results pointed out that 17.5% have already used it, at least once, prevalence lower than the one found in other studies.¹¹11. Mendoza Berjano R, Batista Foguet JM, Sánchez Garcia M, Carrasco González AM. El consumo de tabaco, alcohol y otras drogas enlos adolescentes escolarizados españoles. Gac Sanit. 1998 nov-dic;12(6):263-71.^,1212. Hidalgo I, Garrido G, Hernandez M. Health status and risk behavior of adolescents in the north of Madrid, Spain. J Adoles Health. 2000 Nov;27(5):351-60.^,1313. Priotto EP, Bonetti LW. Violência escolar: na escola, da escola e contra a escola. Rev Dialogo Educ [Internet]. 2009 jan-abr [citado 2011 mar 29];9(26):161-79. Disponível em: www2.pucpr.br/reol/index.php/DIALOGO?dd1=2589&dd99=pdf
www2.pucpr.br/reol/index.php/DIALOGO?dd1... The use of tobacco in the prior 30 days (6.4%) was also lower when compared to studies developed in Argentina (25.5%), Uruguay (17.7%) and Peru (17.3%).¹⁷17. World Health Organization. Global school-base student health survey [Internet]. Geneva: World Health Organization; 2015 [cited 2011 Apr 29]. Available from: http://www.who.int/chp/gshs/en
http://www.who.int/chp/gshs/en... The use of tobacco was inferior to one cigarette/day (22.0%) or between two and five cigarettes/day (13.8%). These data possibly reflect the anti-tobacco campaigns, broadcasted in the country during the past twenty years, the main responsible for turning smoking into a less sociable tolerated habit. A survey conducted in 2010 with Primary and High School students, enrolled in public and private schools, from the 27 Brazilian state capitals, showed a significant decrease on tobacco consumption when comparing to the data from a study conducted in 2004.⁶6. Carlini ELA, Noto AR, van der Meer Sanchez Z, Carlini CMA, Locatelli DP, Abeid LR, et al. VI Levantamento nacional sobre o consumo de drogas psicotrópicas entre estudantes do ensino fundamental e médio das redes pública e privada de ensino nas 27 capitais brasileiras - 2010 [Internet]. Brasília: SENAD; 2010 [citado 2014 nov 18]. 503 p. Disponível em: http://www.obid.senad.gov.br/portais/OBID/biblioteca/documentos/Publicacoes/328890.pdf
http://www.obid.senad.gov.br/portais/OBI...

In most cases, tobacco experimentation happened at a very young age (between 12 and 13 years old), corroborating with other national³3. Costa COM, Alves MVQM, Santos CAST, Carvalho RC, Souza KEP, Sousa HL. Experimentação e uso regular de bebidas alcoólicas, cigarros e outras substâncias psicoativas/SPA na adolescência. Cienc Saude Coletiva [Internet]. 2007 set-out [citado 2009 ago 12];12(5):1143-54. Disponível em: http://www.scielo.br/pdf/csc/v12n5/05.pdf
http://www.scielo.br/pdf/csc/v12n5/05.pd... ^,2424. Moreno RS, Ventura RN, Brêtas JRS. O uso de álcool e tabaco por adolescentes do município de Embu, São Paulo, Brasil. Rev Esc Enferm USP. 2010 dez;44(4):969-77. and international¹⁰10. Leatherdale ST, Ahmed R. Alcohol, marijuana and tobacco use among Canadian youth: do we need more multi-substance prevention programming? J Prim Prev. 2010 Jun;31(3):99-108.^,2525. Ferreira MMSRS, Torgal MCLFPR. Consumo de tabaco e de álcool na adolescência. Rev LatAm Enfermagem. 2010 mar-abr;18(2):255-61. studies outcomes. The consume - identified in lower proportions in their own houses - took place mainly in parties and bars, with school being the third in this ranking. The use of tobacco was significantly associated with the fact that the student has smoker friends, which is similar to findings of other studies.⁹9. Vieria PC, Aerts DRGC, 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 nov;24(11):2487-9.^,2525. Ferreira MMSRS, Torgal MCLFPR. Consumo de tabaco e de álcool na adolescência. Rev LatAm Enfermagem. 2010 mar-abr;18(2):255-61.^,2626. Kristjansson AL, Sigfusdottir ID, Allegrante JP, Helgason AR. Social correlates of cigarette smoking among Icelandic adolescents: a population-based cross-sectional study. BMC Public Health. 2008 Mar;8:86. In this case, the results found might also be related to a change of social conception towards tobacco, especially in the family environment. Nevertheless, the weight of peer groups influence in adopting a behavior should be considered here, since it is a characteristic of adolescence, whence the importance of preventive actions for adolescents, especially at school.

The use of other drugs was reported by 5.3% of the students, a considerably low prevalence. According to PeNSE,¹⁵15. Malta DC, Mascarenhas MDM, Porto DL, Duarte EA, Sardinha LM, Barreto SM, et al. Prevalência do consumo de álcool e drogas entre adolescentes: análise dos dados da pesquisa nacional de saúde escolar. Rev Bras Epidemiol [Internet]. 2011 set [citado 2011 abr 20];14 supl 1:136-46. Disponível em: http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1415-790X2011000500014&lng=en&nrm=iso
http://www.scielosp.org/scielo.php?scrip... the prevalence of illicit drugs experimentation varied from 5.3% in Macapá, Amapá State to 14.2% in Curitiba, Paraná State. According to this study, the use of these drugs in the prior 30 days was reported by 2.28% of the interviewees. Recovering data from the 2010 survey, conducted with Primary and High School students, from private and public schools of the 27 Brazilian state capitals,⁶6. Carlini ELA, Noto AR, van der Meer Sanchez Z, Carlini CMA, Locatelli DP, Abeid LR, et al. VI Levantamento nacional sobre o consumo de drogas psicotrópicas entre estudantes do ensino fundamental e médio das redes pública e privada de ensino nas 27 capitais brasileiras - 2010 [Internet]. Brasília: SENAD; 2010 [citado 2014 nov 18]. 503 p. Disponível em: http://www.obid.senad.gov.br/portais/OBID/biblioteca/documentos/Publicacoes/328890.pdf
http://www.obid.senad.gov.br/portais/OBI... the use was found to be 5.5% in the prior month. It is possible that Porto Velho adolescents use fewer drugs than those who live in other cities, although many factors might explain this result, for instance, methodological differences: in the survey conducted in the 27 Brazilian state capitals, students from Primary and High Schools were included, whereas only students enrolled in the 8^th grade of primary school took part in the Porto Velho study. If the age profiles of both studies were similar, the results would probably be closer, considering the increase trend in drug consumption as people get older.⁶ Another possibility is that the outcomes here presented are the result of educational actions and public policies which have been implemented lately.

Cannabis was the first experimentation drug, similarly to other studies.⁸8. Guimarães JL, Godinho PH, Cruz R, Kappann JI, Tosta Junior LA. Consumo de drogas psicoativas por adolescentes escolares de Assis, SP. Rev Saude Publica. 2004 fev;38(1):130-2.^,99. Vieria PC, Aerts DRGC, 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 nov;24(11):2487-9. The lower price and the easy access may explain this preference, when comparing to the other illicit substances. In the media, the discussions and the distinct opinions on the possible harms caused by cannabis, its legalization and even its therapeutic use may be transmitting to adolescents the idea that this is a harmless substance.

It is also important to take into consideration the similar experimentation age for alcohol, tobacco and other drugs: 12-13 years old to alcohol and tobacco, and 13-15 years old to other drugs. These findings corroborate with other studies.⁹9. Vieria PC, Aerts DRGC, 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 nov;24(11):2487-9.^,1010. Leatherdale ST, Ahmed R. Alcohol, marijuana and tobacco use among Canadian youth: do we need more multi-substance prevention programming? J Prim Prev. 2010 Jun;31(3):99-108.^,1515. Malta DC, Mascarenhas MDM, Porto DL, Duarte EA, Sardinha LM, Barreto SM, et al. Prevalência do consumo de álcool e drogas entre adolescentes: análise dos dados da pesquisa nacional de saúde escolar. Rev Bras Epidemiol [Internet]. 2011 set [citado 2011 abr 20];14 supl 1:136-46. Disponível em: http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1415-790X2011000500014&lng=en&nrm=iso
http://www.scielosp.org/scielo.php?scrip... ^,2222. Jinez MLJ, Souza JRM, Pillon SC. Uso de drogas e fatores de risco entre estudantes de ensino médio. Rev Lat Am Enfermagem. 2009 mar-abr;17(2):246-52. The early involvement with this kind of substance, even if in an experimental way, may be harmful to cognitive and physiological development, making them more likely to be influenced by friends in their involvement in high risk behaviors.²²22. Jinez MLJ, Souza JRM, Pillon SC. Uso de drogas e fatores de risco entre estudantes de ensino médio. Rev Lat Am Enfermagem. 2009 mar-abr;17(2):246-52. The use of alcohol has also shown significant association with the use of tobacco and other drugs. In fact, the use psychoactive substances usually produces a multiplying effect, in which the consume increases the probability of using other drugs.¹⁶16. Horta RL, Horta BL, Pinheiro RT, Morales B, Strey MN. Tabaco, álcool e outras drogas entre adolescentes de Pelotas, Rio Grande do Sul, Brasil: uma perspectiva de gênero. Cad Saude Publica. 2007 abr;23(4):775-83.

It is important to highlight that the use of substances by friends has been associated to the use of tobacco and other drugs, but not to the use of alcohol. The latter has been associated only to the use by their parents. Families are responsible for their children. It is in a family environment that experiences are built and shared, where the first rules and values associated to social interaction are taught. In many families, alcohol is not seen as a health risk factor, but as a cultural and assembling element. On the other hand, tobacco and other drugs are less sociable acceptable, turning its use - part of an adolescent experience - into a challenging behavior to social rules. However, studies have shown that the lack of limits and/or authority, the failure to comply rules, the need for affection, comprehension and family support may undermine adolescents, favoring harmful influences of friends and the adoption of risk behaviors to health.⁴4. Tavares BF, Béria JU, Lima MS. Fatores associados ao uso de drogas entre adolescentes escolares. Rev Saude Publica. 2004 dez;38(6):787-96.^,2222. Jinez MLJ, Souza JRM, Pillon SC. Uso de drogas e fatores de risco entre estudantes de ensino médio. Rev Lat Am Enfermagem. 2009 mar-abr;17(2):246-52.^,2424. Moreno RS, Ventura RN, Brêtas JRS. O uso de álcool e tabaco por adolescentes do município de Embu, São Paulo, Brasil. Rev Esc Enferm USP. 2010 dez;44(4):969-77. A positive family attitude is important in order to change unhealthy habits and avoid adolescents to be negatively influenced by friends and acquaintances. Therefore, the results presented, show how important is the family and school involvement in programs related to the prevention of the use of tobacco, alcohol and other drugs, mainly among adolescents.

Yet, the data collected must be carefully handled due to the inherent limitation of cross-sectional studies and to the fact that the group studied is exclusively composed by eighth-grade students of Porto Velho state schools. Students enrolled in municipal and private schools did not take part in the survey. Another limitation is that prevalences of substances use are usually underestimated when non acceptable social behaviors are investigated, although the self-report questionnaire might reduce the impact of this bias.

The information obtained in this study is relevant and point to the need of developing and implementing policies that promote the research on this issue, mainly in the North of the country. The information might also be used to support actions of the School Health Program (PSE)²⁸28. Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Saúde na escola [Internet]. Brasília: Ministério da Saúde; 2009 [citado 2015 mar 4]. 96 p. (Série B. Textos Básicos de Saúde, Cadernos de Atenção Básica, n. 24) Disponível em: http://dab.saude.gov.br/docs/publicacoes/cadernos_ab/abcad24.pdf
http://dab.saude.gov.br/docs/publicacoes... , which is a national policy implemented in 2007 and aims to join the Health and Education areas for developing actions that promote a healthier school population.

The school is seen as a changing agent. When it is incapable of developing this role, associated to the lack of a well-structured family and to the easy access to alcohol, tobacco and other harmful drugs, it results in a set of factors which can lead the student to the use of such substances.

Each adult, family member, Health or Educational professional, community representative have an important role on orientating adolescents, offering them the opportunity of knowing, contributing to make them qualified and capable of handling their lives with quality.

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