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BACKGROUND: To evaluate the effects of booster and no booster versions of web-based alcohol Personalised Normative Feedback (PNF) and whether descriptive norms mediated and/or participant motivation moderated the effectiveness of the intervention in real world conditions (i.e. no financial incentives). METHODS: Pragmatic randomised controlled trial with 1-, 3-, and 6-month assessments. Brazilian college students reporting alcohol use in the last 12 months (N=931) were recruited from May/2020 to December/2022 and allocated to 1) No booster/single PNF(S-PNF); 2) Booster/multiple PNF(M-PNF); or 3) Assessment-only control. We applied Helmert coding [1: Any intervention (S-PNF or M-PNF) vs. Control; and 2: S-PNF vs. M-PNF]. PRIMARY OUTCOMES: typical number of drinks/week and maximum number of drinks/week; secondary outcomes: drinking frequency and number of consequences. Three-months assessment was the primary interval. Descriptive norms were tested as mediator. Interest, importance, and readiness to change were examined as moderators. RESULTS: Compared to control, any intervention did not influence primary outcomes at 3-months or 6-months, but did at 1-month, when reduced typical drinking (IRR:0.77, 95%CI:0.66;0.90) and maximum number of drinks (IRR:0.69, 95%CI:0.58;0.82). There was an intervention effect on the consequences at 3-months. No differences were observed between S-PNF and M-PNF. No mediation effects were found at 3-months. At 6-months, there was an indirect effect on typical drinking through norms at 3-months (b=-0.82, 95%CI:-2.03;-0.12) and effects on maximum drinks through norms at 1-month (b=-0.54, 95%CI:-1.65;-0.02). No support for moderation was found. CONCLUSIONS: Intervention reduced alcohol drinking at 1 month only and was not effective thereafter. Mechanisms of effect remain unclear.

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BACKGROUND: To develop prevention programs or early interventions to reduce alcohol consumption and related problems among college students, it is essential to understand their motivations for drinking and the spontaneous (effective and non-effective) strategies they employ to control, considering the social and cultural contexts influence. This study aimed to explore these factors and the student's application of selfcare in different situations and environments, as well as to identify their reasons for not drinking. METHODS: The students were invited to participate using a snowball sampling, up to the theoretical saturation point. Qualitative individual semi-structured interviews were carried out and the interviews contents were analyzed using the NVivo software. The participants were 23 college students between 18 and 24 years old, with diverse patterns of alcohol use (low-risk to suggestive of dependence). RESULTS: Data analysis highlighted three main themes: (a) Contexts (such as bars, "open bar" parties and others) and consumption patterns; (b) Protective Strategies (such as stop-drinking intervals, eating before or during drinking, returning home in the company of a friend); (c) Motivations to control drinking (such as sense of responsibility, bad previous experiences, family and religious issues). Protective strategies and motivation to control drinking were perceived to be less prominent in specific contexts that favor high alcohol consumption, as open bar parties. CONCLUSIONS: Motivations and protective strategies varied according to the drinkers' profile, social situations and settings in which they consumed alcohol. The results highlight the need for preventive interventions planned for specific drinking patterns and contexts.

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This study aimed to investigate the effects of Mindfulness-Based Relapse Prevention (MBRP) in decision-making, inhibitory control and impulsivity compared to Treatment as Usual (TAU) for individuals with Substance Use Disorders (SUD's) in Brazil. A randomized clinical trial was conducted with participants from a therapeutic community (n = 122). Decision-making (Iowa Gambling Task), impulsivity dimensions (UPPS-P Scale), and inhibitory control (Stroop Color-Word Test) were assessed before and after the MBRP 8-week intervention. GLM Multivariate analysis was used to evaluate the effects of MBRP on different impulsivity measures. The results showed that MBRP+TAU improved the general decision-making score (p = 0,008) compared to TAU. However, no significant effects were found in impulsivity dimensions and inhibitory control in individuals with SUDs in the therapeutic community. This study found improvement in decision-making in the total IGT score; however, no effect for self-reported impulsivity and inhibitory control among middle-aged patients after an 8-weeks intervention of MBRP protocol in an inpatient setting. It adds information to the subject, with implications and possible directions to be followed by the next clinical trials with patients with SUDs in treatment. Trial registration: EnsaiosClinicos.gov.br: RBR-6c9njc.

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Although several trainings have been offered to improve professional expertise on alcohol and other drugs, few have used an interdisciplinary approach and evaluated long-term improvements in the professional's work routine. This study aimed to evaluate the outcomes of an interprofessional training program on alcohol and other drugs offered by a Regional Reference Center for Drugs of the Federal University of São Paulo, Brazil. METHODS: the evaluation was carried out longitudinally using mixed methods (questionnaires (n = 29-177) and semistructured interviews (n = 28)). The participants were current workers from public institutions of health, education, social assistance, justice, and security system who attended the training. Data were collected at the beginning, the end, and one year after the end of the training. Descriptive statistical analyses were performed for quantitative data and thematic content analyses for qualitative data. RESULTS: professionals who attended the training enhanced their understanding of substance-related issues, reduced stigma, changed their attitude, and improved their networking among the different services providing care to users. The main characteristics related to these outcomes were the interprofessional and biopsychosocial approach, and the experiential activities developed during the training. Most participants reported difficulties in implementing changes in their work routine, but those in managerial roles have reported having more autonomy to carry out such changes. CONCLUSIONS: the mixed methods converged in terms of their results. The training promoted a better understanding of issues related to substance use disorders, reduced stigma and expanded the repertoire of skills. The interprofessional and biopsychosocial approach and field activities seem to be related to these outcomes. The potential for implementing changes in daily practice was prominent among those occupying a managerial role.

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Objetivo Este estudo teve por objetivo avaliar a prevalência de dependência de internet, seus principais preditores e a associação com problemas emocionais em estudantes de psicologia (n = 1.916) e psicólogos (n = 4.359). Método Os indivíduos preencheram um questionário sociodemográfico e outros instrumentos específicos. Observou-se que 9,3% dos estudantes e 4,0% dos psicólogos foram detectados com uso excessivo de internet. Resultados Todos os participantes com uso excessivo de internet apresentaram uma frequência significativamente maior de sintomas de depressão, ansiedade e estresse, e estes problemas foram preditores para a dependência de internet somente entre os psicólogos. Conclusão Compreender o padrão de dependência de internet pode ajudar no desenvolvimento de políticas públicas específicas para esses indivíduos.

Objective This study aimed to investigate the prevalence of Internet Addiction, its main predictors, and associations with psychological problems in psychology students (n = 1,916) and psychologists (n = 4,359). Method Participants completed a sociodemographic questionnaire and measures of interest. It was observed that 9.3% of the students and 4.0% of the psychologists screened positive for internet addiction. Results All participants with internet addiction presented a significantly higher frequency of depression, anxiety, and stress symptoms, however, these problems were predictors for internet addiction only among the professionals. Conclusion Understanding the pattern of internet addiction can help to support the development of specific public policies for these individuals.

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This study aimed to evaluate the association between student characteristics and recruitment strategies in the adherence of college students to a web-based alcohol intervention. Participants were 46,329 Brazilian students aged from 18 to 30, who consumed alcohol during the past three months. Three recruitment strategies were implemented: open invitations, and personally-addressed invitations with or without non-monetary incentives. We evaluated the educational, sociodemographic, motivational, and alcohol consumption effects on adherence using logistic regression models. Women (aOR = 1.09 [1.04; 1.14]), students with higher income (aOR = 1.32 [1.21; 1.45]), and more motivated students (aOR = 1.04 [1.03; 1.05]) were more adherent to the intervention, as well as those reporting binge drinking (aOR = 1.26 [1.19; 1.33]) and alcohol hazardous use (aOR = 1.11 [1.05; 1.18]). The use of incentives was the main factor associated with adherence (aOR = 3.69 [2.46; 5.55]). Our results may help the development of future web-based interventions related to alcohol use.

O presente estudo teve como objetivo avaliar a influência do perfil dos estudantes e das estratégias de recrutamento na adesão de universitários a uma intervenção via web sobre o uso de álcool. Participaram da pesquisa 46.329 estudantes brasileiros com idade entre 18 e 30 anos e relatando consumo de álcool nos últimos três meses. Utilizaram-se três estratégias de recrutamento: convite aberto e convite pessoalmente dirigido com e sem incentivo não monetário. Avaliouse o efeito de características educacionais, sociodemográficas, motivacionais e de uso de álcool sobre a adesão por meio de modelos de regressão logística. Mulheres (aOR = 1,09 [1,04; 1,14]), estudantes com maior renda (aOR = 1,32 [1,21; 1,45]) e mais motivados (aOR = 1,04 [1,03; 1,05]) foram mais aderentes, bem como universitários que relataram binge (aOR = 1,26 [1,19; 1,33]) e uso de risco (aOR = 1,11 [1,05; 1,18]). O emprego de incentivos foi o principal fator associado à adesão (aOR = 3,69 [2,46; 5,55]). Os resultados podem auxiliar no desenvolvimento de futuras intervenções sobre o uso de álcool via internet.

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BACKGROUND: Homelessness is one of the most severe forms of social exclusion and is an important public health issue. It is characterized by processes of weakening of interpersonal bonds. The objective of this study was, therefore, to elucidate how interpersonal relationships change over the life cycle of homeless drug and alcohol users. METHOD: We used a qualitative methodology. The participants were adults who had a history of homelessness and use of alcohol and other drugs. The interviews were semi structured and used a timeline instrument. All interview were audio recorded, transcribed, and submitted to thematic analysis. RESULTS: Twenty individuals participated in the study. Reports on social exclusion over time stood out in respect of four main themes and their respective subthemes: Theme 1 - Childhood: instability upbringing, abuse, violence, and an absent or not very present father figure; Theme 2 - Adolescence: school dropout and failure; acceptance of gender and sexual orientation; birth of first child, living with a partner or getting married: Theme 3 - Adulthood: estrangement or conflicting relationship with family; health problems; drug trafficking and prostitution; Theme 4 - Cross-cutting factors: death of relatives and substance use. CONCLUSION: The results suggest that interpersonal relationships are permeated by successive breakups, conflicts and other events that start in childhood and can have a cumulative effect in later stages of life, and cross the subsequent phases. Substance abuse and dependence are mentioned as cross-cutting factors that intensify social exclusion in all stages of life.

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This study evaluated the prevalence of Internet addiction (IA) and its association with negative psychological symptoms in Brazilian adults. A network analysis was conducted to estimate specific variables and their expected influence on IA. In this cross-sectional study, 15,476 adults (Mage  = 37.5, SD = 9.59) completed an open web-based survey. Three questionnaires were used: the Internet Addiction Test (IAT), Depression Anxiety and Stress Scale (DASS-21) and Satisfaction With Life Scale (SWLS). Based on IAT scores, participants were classified as No-Risk user (NRU), Low-Risk user (LRU) or High-Risk user (HRU). We observed that 4.8% of the participants were classified in the HRU group. In addition, their risk for severe symptoms of depression was 10 times higher and, for anxiety, seven times higher than that in the NRU group (p < .001). Time spent using smartphones was also significantly higher in the HRU group (Mhours  = 5.1, p < .001). The main factors associated with IA were depression, gender and anxiety, but the variable "having children" was the most influential in the IA network. These findings suggest that psychiatric symptoms are the main factors associated with IA among the adult population.

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AIMS: To evaluate the effects of the two main components of a personalized normative feedback (PNF) [normative feedback only (NFO); and consequences feedback only (CFO)] compared with the full intervention (PNF) in reducing alcohol use and consequences. DESIGN: Three-arm pragmatic randomized controlled trial with dismantling design and 1-, 3- and 6-month follow-ups. SETTING: Web-based among Brazilian college students. PARTICIPANTS: College students (aged 18-30 years) who reported alcohol use in the last 3 months (n = 5476). INTERVENTIONS: (1) Full PNF (a) drinking profile; (b) normative comparisons; (c) practical costs; (d) alcohol consequences; (e) strategies to decrease risks; (2) NFO components (a), (b) and (e); or (3) CFO components (c), (d) and (e). MEASUREMENTS: The primary outcome was change in Alcohol Use Disorders Identification Test (AUDIT) score; secondary outcomes were the number of alcohol consequences, drinking frequency and typical/maximum number of drinks. We used mixed models with multiple imputation and a pattern-mixture model to account for attrition. Subgroup analyses considered participant motivation to know more about their drinking (less motivated versus motivated). FINDINGS: Dismantled components reduced rather than increased AUDIT score compared to full PNF, with significant effects for NFO at 1 month [b = -0.23, 95% confidence interval (CI) = -0.46; -0.002] and for CFO at 3 months (b = -0.33, 95% CI = -0.62; -0.03). Compared with PNF, NFO reduced the number of alcohol consequences at 1 month (b = -0.16, 95% CI = -0.25; -0.06) and drinking frequency at 3 months (b = -0.42, 95% CI = -0.79; -0.05), but increased the number of typical drinks at 6 months (b = 0.38, 95% CI = 0.04; 0.72). CFO reduced drinking frequency at 3 months (b = -0.37, 95% CI = -0.73; -0.01). Attrition models confirmed all results, except for the NFO effect on typical drinks and drinking frequency. Subgroup analyses indicated superiority of dismantled components among the students less motivated in knowing more about their drinking. CONCLUSIONS: There was no evidence that either the normative or the consequences components of a web-based personalized normative feedback intervention to reduce alcohol use and its consequences contributed to intervention effects. There was some evidence of adverse effects of personalized normative feedback, and these results were driven by 20% of participants who were less motivated in knowing more about their drinking.

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BACKGROUND: Web-based personalized normative feedback (PNF) interventions are less effective than their laboratory versions. Participant motivation may account for this reduced effect, but there is only a limited amount of research into the influence of motivation on PNF effectiveness. We evaluated the effectiveness of a web-based PNF in reducing alcohol use and consequences among college students with different motivation levels. METHODS: Pragmatic randomized controlled trial among Brazilian college drinkers aged 18-30 years (N = 4460). Participants were randomized to a Control or PNF group and followed-up after one (T1), three (T2) and six (T3) months. Outcomes were: AUDIT score (primary outcome), the number of consequences, and the typical number of drinks. Motivation for receiving the intervention was assessed with a visual analog scale (range: 0-10). Generalized mixed models assessed intervention effects via two paradigms: observed cases and attrition models. RESULTS: PNF reduced the number of typical drinks at T1 (OR = 0.71, p = 0.002), T2 (OR = 0.60, p < 0.001) and T3 (OR = 0.68, p = 0.016), compared to the control. Motivated students (score ≥3) receiving PNF also reduced the number of typical drinks at T1 (OR = 0.60, p < 0.001), T2 (OR = 0.55, p < 0.001) and T3 (OR = 0.56, p = 0.001), compared to the control. However, the attrition models were more robust at T1 and T2. In contrast, low-motivated students receiving the PNF increased AUDIT score at T3 (b = 1.49, p < 0.001). CONCLUSIONS: The intervention reduced alcohol use, and motivation for receiving the intervention moderated the intervention effects. Motivated students reduced their typical alcohol use, whereas low-motivated students increased their AUDIT score.

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The scope of this article is to describe and estimate the odds of problems among adolescents who reported binge drinking compared to those who reported alcohol consumption without binge drinking. The sample included 10,666 fourteen to eighteen-year-old public and private high school students in the 27 Brazilian state capitals who reported alcohol consumption at least once in the 12 months prior to the survey The odds of problems arising were estimated by ordinal logistic regression. Half of the students reported binge drinking and 33.1% admitted to at least one problem as a result. Binge drinking in the year (aOR = 4.7; CI: 3.9-5.7) and month (aOR = 4.4; CI:3.6-5.4) was associated with greater odds of reported problems. The most likely problems were: going to school or work drunk (aOR:6.5; CI:3.6-11.9); having sex without a condom (aOR:5.0; CI:3.7-6.8); and getting into a fight (aOR:4.5; CI:3.2-6.3). Adolescents who go binge drinking are more exposed to alcohol-related problems than those who report lower alcohol consumption. It is suggested that alcohol education/prevention programs should consider the most prevalent problems and risk behaviors, thereby broadening the discussion on consumption of alcohol versus non-consumption of alcohol.

O objetivo deste artigo é descrever e estimar a chance de problemas entre adolescentes que referiram consumo binge drinking comparados aos que referiram ter consumido álcool sem essa característica. Participaram 10.666 estudantes de ensino médio de escolas públicas e privadas das 27 capitais brasileiras (14 a 18 anos) que declararam uso de álcool ao menos uma vez nos 12 meses anteriores à pesquisa. A chance de ocorrerem problemas devido ao consumo foi estimada por regressão logística ordinal. Metade dos estudantes relatou binge drinking e 33,1% relatou ter vivido pelo menos um problema em decorrência do seu uso. O binge drinking no ano (aOR = 4,7; IC:3,9-5,7) e mês (aOR = 4,4; IC: 3,6-5,4) foi associado à maior chance de relato de problemas. Os problemas com maior chance de ocorrer foram: ir para a escola ou trabalho embriagado (aOR = 6,5; IC:3,6-11,9); prática de relação sexual sem preservativo (aOR = 5,0; IC:3,7-6,8); e entrar em brigas (aOR = 4,5; IC:3,2-6,3). Adolescentes que praticam binge drinking estão mais expostos a problemas decorrentes de seu consumo do que aqueles que beberam em menor quantidade. Sugere-se que programas preventivos sobre álcool considerem os problemas mais prevalentes e padrões de uso mais arriscados, ampliando a dicotomia consumo versus não consumo.

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Resumo O objetivo deste artigo é descrever e estimar a chance de problemas entre adolescentes que referiram consumo binge drinking comparados aos que referiram ter consumido álcool sem essa característica. Participaram 10.666 estudantes de ensino médio de escolas públicas e privadas das 27 capitais brasileiras (14 a 18 anos) que declararam uso de álcool ao menos uma vez nos 12 meses anteriores à pesquisa. A chance de ocorrerem problemas devido ao consumo foi estimada por regressão logística ordinal. Metade dos estudantes relatou binge drinking e 33,1% relatou ter vivido pelo menos um problema em decorrência do seu uso. O binge drinking no ano (aOR = 4,7; IC:3,9-5,7) e mês (aOR = 4,4; IC: 3,6-5,4) foi associado à maior chance de relato de problemas. Os problemas com maior chance de ocorrer foram: ir para a escola ou trabalho embriagado (aOR = 6,5; IC:3,6-11,9); prática de relação sexual sem preservativo (aOR = 5,0; IC:3,7-6,8); e entrar em brigas (aOR = 4,5; IC:3,2-6,3). Adolescentes que praticam binge drinking estão mais expostos a problemas decorrentes de seu consumo do que aqueles que beberam em menor quantidade. Sugere-se que programas preventivos sobre álcool considerem os problemas mais prevalentes e padrões de uso mais arriscados, ampliando a dicotomia consumo versus não consumo.

Abstract The scope of this article is to describe and estimate the odds of problems among adolescents who reported binge drinking compared to those who reported alcohol consumption without binge drinking. The sample included 10,666 fourteen to eighteen-year-old public and private high school students in the 27 Brazilian state capitals who reported alcohol consumption at least once in the 12 months prior to the survey The odds of problems arising were estimated by ordinal logistic regression. Half of the students reported binge drinking and 33.1% admitted to at least one problem as a result. Binge drinking in the year (aOR = 4.7; CI: 3.9-5.7) and month (aOR = 4.4; CI:3.6-5.4) was associated with greater odds of reported problems. The most likely problems were: going to school or work drunk (aOR:6.5; CI:3.6-11.9); having sex without a condom (aOR:5.0; CI:3.7-6.8); and getting into a fight (aOR:4.5; CI:3.2-6.3). Adolescents who go binge drinking are more exposed to alcohol-related problems than those who report lower alcohol consumption. It is suggested that alcohol education/prevention programs should consider the most prevalent problems and risk behaviors, thereby broadening the discussion on consumption of alcohol versus non-consumption of alcohol.

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[RESUMO]. Objetivo. Identificar as principais modalidades de intervenções via Internet para limitar o uso de álcool por estudantes universitários e descrever os efeitos dessas intervenções sobre o consumo e as consequências do uso de álcool. Método. Esta é uma revisão sistemática com artigos disponíveis nas bases PubMed, PsycINFO e SciELO. Foram utilizados os termos de busca alcohol drinking AND Internet, sem restrição de data ou idioma. Foram critérios de inclusão: ser estudo randomizado controlado com amostra de estudantes universitários, enfocar intervenções via Internet e avaliar os efeitos dessas intervenções sobre o consumo ou as consequências do uso de álcool. Resultados. Foram analisados 36 artigos e identificadas duas modalidades principais de intervenção via Internet: feedbacks normativos personalizados (FNP, n=28) e intervenções multicomponentes (n=8). Doze estudos com FNP observaram redução no uso de álcool 3 meses após a intervenção. Intervenções multicomponentes reduziram o consumo e as consequências do uso. A intervenção mais avaliada foi o site AlcoholEdu, que reduziu o uso de álcool e as consequências do uso 6 meses após a intervenção. Conclusões. FNP e o site AlcoholEdu foram as intervenções mais avaliadas entre os estudos selecionados e se mostraram eficazes na redução do consumo de álcool entre estudantes universitários. Essas estratégias são uma alternativa para ampliar o acesso de universitarios a intervenções para limitar o uso de álcool.

[ABSTRACT]. Objective. To identify the main modalities of Internet-based interventions to limit alcohol use among university students, and to describe the effects of these interventions on alcohol use and related consequences. Methods. A systematic review of PubMed, PsycINFO, and SciELO was performed using as search terms “alcohol drinking AND Internet,” without date or language restrictions. Inclusion criteria were randomized controlled trial design, focus on college students and on Internet-based interventions, and evaluating the effects of the intervention on alcohol use or alcohol-related consequences. Results. Thirty-six articles were analyzed. Two main intervention modalities were identified: personalized normative feedback (PNF, n=28) and multicomponent interventions (n=8). Twelve studies with PNF reported reductions in alcohol use 3 months after the intervention. Multicomponent interventions reduced alcohol use and related consequences; most studies focused on the website AlcoholEdu, which reduced alcohol consumption and the consequences of alcohol use 6 months after the intervention. Conclusions. FNP and the AlcoholEdu website, the most frequently evaluated interventions among the selected studies, were effective in reducing alcohol use in university students. These strategies are an alternative to increase the access of university students to interventions aimed at limiting alcohol use.

[RESUMEN]. Objetivo. Determinar las principales modalidades de intervención por Internet para limitar el consumo de alcohol de los estudiantes universitarios, y describir los efectos de cada una en el consumo de alcohol y sus consecuencias. Método. Esta es una revisión sistemática hecha con artículos disponibles en las bases PubMed, PsycINFO y SciELO. Se utilizaron como términos de búsqueda alcohol drinking AND Internet, sin restricción de fecha ni de idioma. Los criterios de inclusión fueron los siguientes: estudio aleatorizado controlado con una muestra de estudiantes universitarios, enfoque en intervenciones por Internet y evaluación de los efectos de esas intervenciones en el consumo de alcohol o sus consecuencias. Resultados. El análisis de 36 artículos permitió encontrar dos modalidades principales de intervención por Internet, a saber, intervenciones basadas en retroalimentación normativa personalizada (n=28) e intervenciones multicomponentes (n=8). En doce estudios con retroalimentación normativa personalizada se observó una reducción del consumo de alcohol tres meses después de la intervención. Las intervenciones multicomponentes redujeron el consumo de alcohol y sus consecuencias. La intervención más evaluada fue el sitio AlcoholEdu, que disminuyó el consumo de alcohol y sus consecuencias seis meses después de realizarla. Conclusiones. La retroalimentación normativa personalizada y el sitio AlcoholEdu fueron las intervenciones más evaluadas en los estudios seleccionados y demostraron ser eficaces para reducir el consumo de alcohol en los estudiantes universitarios. Esas estrategias ofrecen una alternativa para ampliar el acceso de los estudiantes a intervenciones destinadas a limitar el consumo de alcohol.

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OBJECTIVE: To identify the main modalities of Internet-based interventions to limit alcohol use among university students, and to describe the effects of these interventions on alcohol use and related consequences. METHODS: A systematic review of PubMed, PsycINFO, and SciELO was performed using as search terms "alcohol drinking AND Internet," without date or language restrictions. Inclusion criteria were randomized controlled trial design, focus on college students and on Internet-based interventions, and evaluating the effects of the intervention on alcohol use or alcohol-related consequences. RESULTS: Thirty-six articles were analyzed. Two main intervention modalities were identified: personalized normative feedback (PNF, n=28) and multicomponent interventions (n=8). Twelve studies with PNF reported reductions in alcohol use 3 months after the intervention. Multicomponent interventions reduced alcohol use and related consequences; most studies focused on the website AlcoholEdu, which reduced alcohol consumption and the consequences of alcohol use 6 months after the intervention. CONCLUSIONS: FNP and the AlcoholEdu website, the most frequently evaluated interventions among the selected studies, were effective in reducing alcohol use in university students. These strategies are an alternative to increase the access of university students to interventions aimed at limiting alcohol use.

OBJETIVO: Determinar las principales modalidades de intervención por Internet para limitar el consumo de alcohol de los estudiantes universitarios, y describir los efectos de cada una en el consumo de alcohol y sus consecuencias. MÉTODO: Esta es una revisión sistemática hecha con artículos disponibles en las bases PubMed, PsycINFO y SciELO. Se utilizaron como términos de búsqueda alcohol drinking AND Internet, sin restricción de fecha ni de idioma. Los criterios de inclusión fueron los siguientes: estudio aleatorizado controlado con una muestra de estudiantes universitarios, enfoque en intervenciones por Internet y evaluación de los efectos de esas intervenciones en el consumo de alcohol o sus consecuencias. RESULTADOS: El análisis de 36 artículos permitió encontrar dos modalidades principales de intervención por Internet, a saber, intervenciones basadas en retroalimentación normativa personalizada (n=28) e intervenciones multicomponentes (n=8). En doce estudios con retroalimentación normativa personalizada se observó una reducción del consumo de alcohol tres meses después de la intervención. Las intervenciones multicomponentes redujeron el consumo de alcohol y sus consecuencias. La intervención más evaluada fue el sitio AlcoholEdu, que disminuyó el consumo de alcohol y sus consecuencias seis meses después de realizarla. CONCLUSIONES: La retroalimentación normativa personalizada y el sitio AlcoholEdu fueron las intervenciones más evaluadas en los estudios seleccionados y demostraron ser eficaces para reducir el consumo de alcohol en los estudiantes universitarios. Esas estrategias ofrecen una alternativa para ampliar el acceso de los estudiantes a intervenciones destinadas a limitar el consumo de alcohol.

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RESUMO Objetivo Identificar as principais modalidades de intervenções via Internet para limitar o uso de álcool por estudantes universitários e descrever os efeitos dessas intervenções sobre o consumo e as consequências do uso de álcool. Método Esta é uma revisão sistemática com artigos disponíveis nas bases PubMed, PsycINFO e SciELO. Foram utilizados os termos de busca alcohol drinking AND Internet, sem restrição de data ou idioma. Foram critérios de inclusão: ser estudo randomizado controlado com amostra de estudantes universitários, enfocar intervenções via Internet e avaliar os efeitos dessas intervenções sobre o consumo ou as consequências do uso de álcool. Resultados Foram analisados 36 artigos e identificadas duas modalidades principais de intervenção via Internet: feedbacks normativos personalizados (FNP, n=28) e intervenções multicomponentes (n=8). Doze estudos com FNP observaram redução no uso de álcool 3 meses após a intervenção. Intervenções multicomponentes reduziram o consumo e as consequências do uso. A intervenção mais avaliada foi o site AlcoholEdu, que reduziu o uso de álcool e as consequências do uso 6 meses após a intervenção. Conclusões FNP e o site AlcoholEdu foram as intervenções mais avaliadas entre os estudos selecionados e se mostraram eficazes na redução do consumo de álcool entre estudantes universitários. Essas estratégias são uma alternativa para ampliar o acesso de universitários a intervenções para limitar o uso de álcool.

ABSTRACT Objective To identify the main modalities of Internet-based interventions to limit alcohol use among university students, and to describe the effects of these interventions on alcohol use and related consequences. Methods A systematic review of PubMed, PsycINFO, and SciELO was performed using as search terms "alcohol drinking AND Internet," without date or language restrictions. Inclusion criteria were randomized controlled trial design, focus on college students and on Internet-based interventions, and evaluating the effects of the intervention on alcohol use or alcohol-related consequences. Results Thirty-six articles were analyzed. Two main intervention modalities were identified: personalized normative feedback (PNF, n=28) and multicomponent interventions (n=8). Twelve studies with PNF reported reductions in alcohol use 3 months after the intervention. Multicomponent interventions reduced alcohol use and related consequences; most studies focused on the website AlcoholEdu, which reduced alcohol consumption and the consequences of alcohol use 6 months after the intervention. Conclusions FNP and the AlcoholEdu website, the most frequently evaluated interventions among the selected studies, were effective in reducing alcohol use in university students. These strategies are an alternative to increase the access of university students to interventions aimed at limiting alcohol use.

RESUMEN Objetivo Determinar las principales modalidades de intervención por Internet para limitar el consumo de alcohol de los estudiantes universitarios, y describir los efectos de cada una en el consumo de alcohol y sus consecuencias. Método Esta es una revisión sistemática hecha con artículos disponibles en las bases PubMed, PsycINFO y SciELO. Se utilizaron como términos de búsqueda alcohol drinking AND Internet, sin restricción de fecha ni de idioma. Los criterios de inclusión fueron los siguientes: estudio aleatorizado controlado con una muestra de estudiantes universitarios, enfoque en intervenciones por Internet y evaluación de los efectos de esas intervenciones en el consumo de alcohol o sus consecuencias. Resultados El análisis de 36 artículos permitió encontrar dos modalidades principales de intervención por Internet, a saber, intervenciones basadas en retroalimentación normativa personalizada (n=28) e intervenciones multicomponentes (n=8). En doce estudios con retroalimentación normativa personalizada se observó una reducción del consumo de alcohol tres meses después de la intervención. Las intervenciones multicomponentes redujeron el consumo de alcohol y sus consecuencias. La intervención más evaluada fue el sitio AlcoholEdu, que disminuyó el consumo de alcohol y sus consecuencias seis meses después de realizarla. Conclusiones La retroalimentación normativa personalizada y el sitio AlcoholEdu fueron las intervenciones más evaluadas en los estudios seleccionados y demostraron ser eficaces para reducir el consumo de alcohol en los estudiantes universitarios. Esas estrategias ofrecen una alternativa para ampliar el acceso de los estudiantes a intervenciones destinadas a limitar el consumo de alcohol.

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OBJECTIVE:: to evaluate problems associated with alcohol use among university students who reported binge drinking in comparison to students who consumed alcohol without binging. METHOD:: a cross-sectional study among university students (N=2,408) who accessed the website about alcohol use. Logistic and linear regression models were included in the statistical analyzes. RESULTS:: alcohol use in the last three months was reported by 89.2% of university students; 51.6% reported binge drinking. Compared to students who did not binge drink, university students who presented this pattern were more likely to report all evaluated problems, among them: black out (aOR: 5.4); having academic problems (aOR: 3.4); acting impulsively and having regrets (aOR: 2.9); getting involved in fights (aOR: 2.6); drinking and driving (aOR: 2.6) and accepting a ride with someone who had drunk alcohol (aOR: 1.8). Students who binged also had higher scores on the Alcohol Use Disorders Identification Test (b=4.6; p<0.001), more negative consequences (b=1.0; p<0.001) and a reduced perception of the negativity of the consequences (b=-0.5; p<0.01). CONCLUSION:: binge drinking was associated with an increase in the chances of manifesting problems related to alcohol use. The conclusions of this study cannot be generalized for all of the Brazilian population. OBJETIVO:: avaliar problemas associados ao uso de álcool entre universitários que relataram binge drinking em comparação a estudantes que consumiram álcool sem binge drinking. MÉTODO:: estudo transversal entre universitários (N=2.408) que acessaram website sobre o uso de álcool. Nas análises estatísticas incluíram-se modelos de regressão logística e linear. RESULTADOS:: o uso de álcool, nos últimos três meses, foi relatado por 89,2% dos universitários e 51,6% referiram uso binge. Comparados a estudantes que não praticaram binge, universitários que apresentaram esse padrão tiveram maior chance de relatar todos os problemas avaliados, entre eles: incapacidade de lembrar o que aconteceu (aOR:5,4); problemas acadêmicos (aOR:3,4); agir impulsivamente e se arrepender (aOR:2,9); envolver-se em brigas (aOR:2,6); dirigir após beber (aOR:2,6) e pegar carona com alguém que bebeu (aOR:1,8). Estudantes que consumiram álcool no padrão binge também apresentaram maior pontuação no Alcohol Use Disorders Identification Test (b=4,6; p<0,001), mais consequências negativas (b=1,0; p<0,001) e menos percepção da negatividade das consequências (b=-0,5; p<0,01). CONCLUSÃO:: a prática de binge drinking esteve associada ao aumento das chances de manifestação de problemas relacionados ao uso de álcool. As conclusões deste estudo não podem ser reproduzidas para toda realidade brasileira. OBJETIVO:: evaluar problemas asociados al uso de alcohol entre estudiantes universitarios que relataron binge drinking en comparación a estudiantes que consumieron alcohol sin binge drinking. MÉTODO:: estudio transversal entre estudiantes universitarios (N=2.408) que visitaron una página web sobre el uso de alcohol. En los análisis estadísticos, fueron incluidos modelos de regresión logística y linear. RESULTADOS:: el uso de alcohol, en los últimos tres meses, fue relatado por 89,2% de los estudiantes universitarios, y entre ellos 51,6% relataron uso binge. En comparación a estudiantes universitarios que no practicaron binge, los estudiantes que presentaron ese estándar tuvieron una mayor oportunidad de relatar todos los problemas evaluados, entre ellos: incapacidad de recordar lo que sucedió (aOR:5,4); problemas académicos (aOR:3,4); actuar por impulso y arrepentirse (aOR:2,9); involucrarse en peleas (aOR:2,6); manejar después de beber (aOR:2,6) y compartieron viaje con alguien que bebió (aOR:1,8). Estudiantes que consumieron alcohol dentro del estándar binge también presentaron una mayor puntuación en el Alcohol Use Disorders Identification Test (b=4,6; p<0,001), más consecuencias negativas (b=1,0; p<0,001) y menor percepción de la negatividad de las consecuencias (b=-0,5; p<0,01). CONCLUSIÓN:: la práctica de binge drinking estuvo asociada al aumento de las oportunidades de manifestación de problemas relacionados al alcohol. Las conclusiones de este estudio no pueden ser adaptadas a toda la realidad brasileña.

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ABSTRACT Objective: to evaluate problems associated with alcohol use among university students who reported binge drinking in comparison to students who consumed alcohol without binging. Method: a cross-sectional study among university students (N=2,408) who accessed the website about alcohol use. Logistic and linear regression models were included in the statistical analyzes. Results: alcohol use in the last three months was reported by 89.2% of university students; 51.6% reported binge drinking. Compared to students who did not binge drink, university students who presented this pattern were more likely to report all evaluated problems, among them: black out (aOR: 5.4); having academic problems (aOR: 3.4); acting impulsively and having regrets (aOR: 2.9); getting involved in fights (aOR: 2.6); drinking and driving (aOR: 2.6) and accepting a ride with someone who had drunk alcohol (aOR: 1.8). Students who binged also had higher scores on the Alcohol Use Disorders Identification Test (b=4.6; p<0.001), more negative consequences (b=1.0; p<0.001) and a reduced perception of the negativity of the consequences (b=-0.5; p<0.01). Conclusion: binge drinking was associated with an increase in the chances of manifesting problems related to alcohol use. The conclusions of this study cannot be generalized for all of the Brazilian population.

RESUMO Objetivo: avaliar problemas associados ao uso de álcool entre universitários que relataram binge drinking em comparação a estudantes que consumiram álcool sem binge drinking. Método: estudo transversal entre universitários (N=2.408) que acessaram website sobre o uso de álcool. Nas análises estatísticas incluíram-se modelos de regressão logística e linear. Resultados: o uso de álcool, nos últimos três meses, foi relatado por 89,2% dos universitários e 51,6% referiram uso binge. Comparados a estudantes que não praticaram binge, universitários que apresentaram esse padrão tiveram maior chance de relatar todos os problemas avaliados, entre eles: incapacidade de lembrar o que aconteceu (aOR:5,4); problemas acadêmicos (aOR:3,4); agir impulsivamente e se arrepender (aOR:2,9); envolver-se em brigas (aOR:2,6); dirigir após beber (aOR:2,6) e pegar carona com alguém que bebeu (aOR:1,8). Estudantes que consumiram álcool no padrão binge também apresentaram maior pontuação no Alcohol Use Disorders Identification Test (b=4,6; p<0,001), mais consequências negativas (b=1,0; p<0,001) e menos percepção da negatividade das consequências (b=-0,5; p<0,01). Conclusão: a prática de binge drinking esteve associada ao aumento das chances de manifestação de problemas relacionados ao uso de álcool. As conclusões deste estudo não podem ser reproduzidas para toda realidade brasileira.

RESUMEN Objetivo: evaluar problemas asociados al uso de alcohol entre estudiantes universitarios que relataron binge drinking en comparación a estudiantes que consumieron alcohol sin binge drinking. Método: estudio transversal entre estudiantes universitarios (N=2.408) que visitaron una página web sobre el uso de alcohol. En los análisis estadísticos, fueron incluidos modelos de regresión logística y linear. Resultados: el uso de alcohol, en los últimos tres meses, fue relatado por 89,2% de los estudiantes universitarios, y entre ellos 51,6% relataron uso binge. En comparación a estudiantes universitarios que no practicaron binge, los estudiantes que presentaron ese estándar tuvieron una mayor oportunidad de relatar todos los problemas evaluados, entre ellos: incapacidad de recordar lo que sucedió (aOR:5,4); problemas académicos (aOR:3,4); actuar por impulso y arrepentirse (aOR:2,9); involucrarse en peleas (aOR:2,6); manejar después de beber (aOR:2,6) y compartieron viaje con alguien que bebió (aOR:1,8). Estudiantes que consumieron alcohol dentro del estándar binge también presentaron una mayor puntuación en el Alcohol Use Disorders Identification Test (b=4,6; p<0,001), más consecuencias negativas (b=1,0; p<0,001) y menor percepción de la negatividad de las consecuencias (b=-0,5; p<0,01). Conclusión: la práctica de binge drinking estuvo asociada al aumento de las oportunidades de manifestación de problemas relacionados al alcohol. Las conclusiones de este estudio no pueden ser adaptadas a toda la realidad brasileña.

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As part of a multicenter project supported by the World Health Organization, we developed a web-based intervention to reduce alcohol use and related problems. We evaluated the predictors of adherence to, and the outcomes of the intervention. Success was defined as a reduction in consumption to low risk levels or to <50% of the baseline levels of number of drinks. From the 32,401 people who accessed the site, 3389 registered and 929 completed the full Alcohol Use Disorders Identification Test (AUDIT), a necessary condition to be considered eligible to take part in the intervention. Based on their AUDIT scores, these participants were classified into: low risk users (LRU; n=319) harmful/hazardous users (HHU; n=298) or suggestive of dependence users (SDU; n=312). 29.1% of the registered users (LRU=42; HHU=90; SDU=82) completed the evaluation form at the end of the six-week period, and 63.5% reported low-risk drinking levels. We observed a significant reduction in alcohol consumption in the HHU (62.5%) and SDU (64.5%) groups in relation to baseline. One month after the intervention, in the follow-up, 94 users filled out the evaluation form, and their rate of success was similar to the one observed in the previous evaluation. Logistic regression analyses indicated that HHU participants presented higher adherence than LRU. Despite a relatively low adherence to the program, its good outcomes and low cost, as well as the high number of people that can be reached by a web-based intervention, suggest it has good cost-effectiveness.

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Resumo O objetivo foi analisar a associação entre o uso de tabaco (no mês e frequente) com os estilos parentais e o comportamento de fumar dos pais, em uma amostra de estudantes do Ensino Médio. Foram avaliados 17.246 estudantes do Ensino Médio de escolas públicas e privadas das 27 capitais brasileiras. A prevalência do uso de tabaco na vida foi de 25,2%, 15,3% no ano, 8,6% no mês, e 3,2% para uso frequente. Em relação aos estilos parentais, 39,2% dos pais foram classificados como negligentes, 33,3% autoritativos, 15,6% como indulgentes e 11,9% autoritários. Comparados a estudantes com pais autoritativos, filhos de pais negligentes ou indulgentes tiveram maior chance de relatar o uso no último mês ou frequente de tabaco. Observou-se uma associação entre o estilo parental e uso de cigarros por estudantes do Ensino Médio. O estilo parental autoritativo foi associado à proteção ao uso de tabaco no mês e frequente entre os adolescentes.

Resumen El objetivo fue analizar la asociación entre el consumo de tabaco (durante el mes y su frecuencia) con los estilos parentales y el hábito de fumar de los padres, en una muestra de estudiantes de secundaria. Los participantes fueron reclutados de escuelas públicas y privadas de 27 capitales estatales de Brasil (n = 17.246). La prevalencia de uso en la vida fue un 25,2%, en el último año 15,3%, en el último mes 8,6%, y 3,2% de uso frecuente. El consumo de tabaco parental fue reportado por un 28,6% de los estudiantes. 39,2% de los padres fueron clasificados como negligentes, 33,3% autoritativos, 15,6% indulgentes y 11,9% autoritarios. Comparados con los adolescentes con padres autoritativos, aquellos con padres negligentes o indulgentes reportaron más uso de tabaco durante el último mes o uso frecuente. Se encontró asociación entre estilos parentales y uso de tabaco por parte de los estudiantes. El estilo parental autoritativo se asoció con la protección para el uso del tabaco en el mes y frecuencia entre los adolescentes.

Abstract The objective was to evaluate the relationship between tobacco use (previous month and frequent use), parenting styles and parental smoking behavior in a sample of high school students. Participants were recruited from public and private high schools from 27 Brazilian state capitals (N = 17,246). The overall prevalence of tobacco use in life was 25.2%; 15.3% in the previous year; 8.6% in the previous month; and 3.2% for frequent use. Tobacco use by the parents was reported by 28.6% of the students. Regarding parenting styles, 39.2% were classified as negligent, 33.3% authoritative, 15.6% as indulgent and 11.9% authoritarian. Compared to adolescents with authoritative parents, those with negligent or indulgent parents were more prone to report tobacco use during the last month or frequent use. This study showed an association between parenting styles and tobacco use by high school students. Authoritative parents were associated with protection from frequent and previous month tobacco use among adolescents.

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