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Aims: This paper presents updated prevalence estimates of awareness, ever‐use, and current use of nicotine vaping products (NVPs) from 14 International Tobacco Control Policy Evaluation Project (ITC Project) countries that have varying regulations governing NVP sales and marketing. Design, Setting, Participants and Measurements: A cross‐sectional analysis of adult (≥ 18 years) current smokers and ex‐smokers from 14 countries participating in the ITC Project. Data from the most recent survey questionnaire for each country were included, which spanned the period 2013–17. Countries were categorized into four groups based on regulations governing NVP sales and marketing (allowable or not), and level of enforcement (strict or weak where NVPs are not permitted to be sold): (1) most restrictive policies (MRPs), not legal to be sold or marketed with strict enforcement: Australia, Brazil, Uruguay; (2) restrictive policies (RPs), not approved for sale or marketing with weak enforcement: Canada, Malaysia, Mexico, New Zealand; (3) less restrictive policies (LRPs), legal to be sold and marketed with regulations: England, the Netherlands, Republic of Korea, United States; and (4) no regulatory policies (NRPs), Bangladesh, China, Zambia. Countries were also grouped by World Bank Income Classifications. Country‐specific weighted logistic regression models estimated adjusted NVP prevalence estimates for: awareness, ever/current use, and frequency of use (daily versus non‐daily). Findings NVP awareness and use were lowest in NRP countries. Generally, ever‐ and current use of NVPs were lower in MRP countries (ever‐use = 7.1–48.9%; current use = 0.3–3.5%) relative to LRP countries (ever‐use = 38.9–66.6%; current use = 5.5–17.2%) and RP countries (ever‐use = 10.0–62.4%; current use = 1.4–15.5%). NVP use was highest among high‐income countries, followed by upper–middle‐income countries, and then by lower–middle‐income countries. Conclusions: With a few exceptions, awareness and use of nicotine vaping products varied by the strength of national regulations governing nicotine vaping product sales/marketing, and by country income. In countries with no regulatory policies, use rates were very low, suggesting that there was little availability, marketing and/or interest in nicotine vaping products in these countries where smoking populations are predominantly poorer. The higher awareness and use of nicotine vaping products in high income countries with moderately (e.g. Canada, New Zealand) and less (e.g. England, United States) restrictive policies, is likely due to the greater availability and affordability of nicotine vaping products. [ABSTRACT FROM AUTHOR]

Aims and design The historical and economic involvement of Brazil with tobacco, as a major producer and exporter, was considered an insurmountable obstacle to controlling the consumption of this product. Nevertheless, the country was able to achieve significant progress in implementing public policies and to take an international leadership position, meeting its constitutional commitment to protect public health. In this paper we provide a brief historical overview of tobacco control ( TC) in Brazil, and analyse the factors that contributed to the major decline in tobacco consumption in the country over the last 20 years, as well as identify the challenges that had to be overcome and those still at play. Findings The Brazilian case demonstrates how cross-sectorial collaborations among health-related groups that capitalize on their respective strengths and capacities can help to influence public policy and overcome industry and population resistance to change. Although Brazil still lags behind some leading TC nations, the country has an extensive collaborative TC network that was built over time and continues to focus upon this issue. Conclusions The tobacco experience can serve as an example for other fields, such as alcoholic beverages, of how networks can be formed to influence the legislative process and the development of public policies. Brazilian statistics show that problems related to non-communicable diseases are a pressing public health issue, and advocacy groups, policy-makers and government departments can benefit from tobacco control history to fashion their own strategies. [ABSTRACT FROM AUTHOR]

ABSTRACT While individual studies from several South American countries have shown driving while intoxicated to be a problem, there are no objective systematically collected alcohol-associated driving data obtained in most South American countries. This limits their ability to implement and enforce targeted prevention strategies, evaluate whether proven prevention efforts from North America (particularly the United States and Canada) can be transferred to the South, and to sustain momentum for the improvement of road safety by demonstrating that previously implemented legal and policy changes are effective. The aim of this paper is to discuss the abysmal differences that exist between northern and southern American countries regarding the current status of driving while intoxicated prevention strategies-their implementation, impacts and effects-using Brazil as a case example. We propose a three-pronged approach to close this northern-southern American gap in driving while intoxicated prevention and intervention: (a) systematic collection on road traffic crash/injury/death as well as risk factor data, (b) passage of laws without loopholes requiring compliance with blood alcohol concentration testing and (c) provision of appropriate training and equipment to the police in concomitance with vigilant enforcement. Resources and energies must be put towards data collection, implementation of prevention strategies and enforcement in order to decrease the unacceptably high rates of these preventable driving while intoxicated deaths. [ABSTRACT FROM AUTHOR]

ABSTRACT The National Institute of Public Policy for Alcohol and Other Drugs (INPAD) is based at the Federal University of São Paulo, Brazil, and was created to collect scientific evidence regarding epidemiology, develop new therapeutic approaches, study health economics and provide education to subsidize the proper measures to change the Brazilian scenario of alcohol and drug consumption. Policies directed towards the control of alcohol and drugs in Brazil are fragmented, poorly enforced and therefore ineffective. The unregulated market of alcohol in Brazil has contributed to the worsening health of the Brazilian population. Since 1994, INPAD has participated actively in academic debates and discussions about alcohol and drug policies and their effects on the political welfare of the country. Many scientific papers and books have been published on this subject, and the internet and other media have provided excellent opportunities for the dissemination of specialized information to the general population. [ABSTRACT FROM AUTHOR]

Background and aims: The World Health Organization's (WHO's) proposed International Classification of Diseases, 11th edition (ICD‐11) includes several major revisions to substance use disorder (SUD) diagnoses. It is essential to ensure the consistency of within‐subject diagnostic findings throughout countries, languages and cultures. To date, agreement analyses between different SUD diagnostic systems have largely been based in high‐income countries and clinical samples rather than general population samples. We aimed to evaluate the prevalence of, and concordance between diagnoses using the ICD‐11, The WHO's ICD 10th edition (ICD‐10) and the Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th editions (DSM‐IV, DSM‐5); the prevalence of disaggregated ICD‐10 and ICD‐11 symptoms; and variation in clinical features across diagnostic groups. Design Cross‐sectional household surveys. Setting: Representative surveys of the general population in 10 countries (Argentina, Australia, Brazil, Colombia, Iraq, Northern Ireland, Poland, Portugal, Romania and Spain) of the World Mental Health Survey Initiative. Participants: Questions about SUDs were asked of 12 182 regular alcohol users and 1788 cannabis users. Measurements Each survey used the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview version 3.0 (WMH‐CIDI). Findings Among regular alcohol users, prevalence (95% confidence interval) of life‐time ICD‐11 alcohol harmful use and dependence were 21.6% (20.5–22.6%) and 7.0% (6.4–7.7%), respectively. Among cannabis users, 9.3% (7.4–11.1%) met criteria for ICD‐11 harmful use and 3.2% (2.3–4.0%) for dependence. For both substances, all comparisons of ICD‐11 with ICD‐10 and DSM‐IV showed excellent concordance (all κ ≥ 0.9). Concordance between ICD‐11 and DSM‐5 ranged from good (for SUD and comparisons of dependence and severe SUD) to poor (for comparisons of harmful use and mild SUD). Very low endorsement rates were observed for new ICD‐11 feature for harmful use ('harm to others'). Minimal variation in clinical features was observed across diagnostic systems. Conclusions: The World Health Organization's proposed International Classification of Diseases, 11th edition (ICD‐11) classifications for substance use disorder diagnoses are highly consistent with the ICD 10th edition and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM‐IV). Concordance between ICD‐11 and the DSM 5th edition (DSM‐5) varies, due largely to low levels of agreement for the ICD harmful use and DSM‐5 mild use disorder. Diagnostic validity of self‐reported 'harm to others' is questionable. [ABSTRACT FROM AUTHOR]

Aims This case study identifies the influence and mechanisms that the alcohol industry in Brazil has been able to bring to bear to maintain self-regulation in the marketing of beer and many wines set against a trend of increasing alcohol consumption in Brazil, particularly among young people and women. It identifies the forms of power and strategies used by the alcohol industry in Brazil that may be useful for other countries to consider in seeking to move from self-regulation to state regulation of alcohol marketing. Method A review was conducted of recent legal documents and court cases, as well as the activities of alcoholic beverage industries. Results Because of an exemption, Brazilian law had established that both beer and many wines are not alcoholic beverages for marketing purposes. These beverages are subjected to industry self-regulation codes. Research shows that beer and wine marketing often violates industry codes, with little or no enforcement of penalties for non-compliance. Attempts to include beer and wine in the legal definition of alcohol have been opposed by the alcohol industry, and the courts have delegated responsibility to the legislature. The recent legal activities surrounding alcohol sales during the 2014 World Cup games in Brazil provide evidence of the alcohol industry's influence on the legislative process. Conclusion The alcohol industry in Brazil plays a significant role in the formulation of public policies on alcohol, especially regarding the regulation of marketing. This power is exercised by strong lobbying of government officials responsible for public policies. [ABSTRACT FROM AUTHOR]

Self-regulation has been promoted by the alcohol industry as a sufficient means of regulating alcohol marketing activities. However, evidence suggests that the guidelines of self-regulated alcohol marketing codes are violated routinely, resulting in excessive alcohol marketing exposure to youth and the use of content that is potentially harmful to youth and other vulnerable populations. If the alcohol industry does not adhere to its own regulations the purpose and design of these codes should be questioned. Indeed, implementation of alcohol marketing self-regulation in Brazil, the United Kingdom and the United States was likely to delay statutory regulation rather than to promote public health. Moreover, current self-regulation codes suffer from vague language that may allow the industry to circumvent the guidelines, loopholes that may obstruct the implementation of the codes, lax exposure guidelines that can allow excessive youth exposure, even if properly followed, and a standard of review that may be inappropriate for protecting vulnerable populations. Greater public health benefits may be realized if legislative restrictions were applied to alcohol marketing, and strict statutory alcohol marketing regulations have been implemented and defended successfully in the European Union, with European courts declaring that restrictions on alcohol marketing are proportional to the benefits to public health. In contrast, attempts to restrict alcohol marketing activities in the United States have occurred through private litigation and have been unsuccessful. None the less, repeated violations of industry codes may provide legislators with sufficient justification to pass new legislation and for such legislation to withstand constitutional review in the United States and elsewhere. [ABSTRACT FROM AUTHOR]

Background and aims To identify the nature of visual alcohol references in alcohol advertisements during televised broadcasts of the 2014 FIFA World Cup Tournament matches and to evaluate cross-national differences according to alcohol marketing policy restrictiveness. Design Content analysis using the Delphi method and identification of in-game sponsorships. Setting Television broadcasts of the 2014 FIFA World Cup in Argentina, Brazil, Canada, Finland, France, Mexico, Spain and the United States. Cases Eighty-seven alcohol advertisements; 20 matches. Measurements Quantitative rating scales, combined with the Delphi rating technique, were used to determine compliance of the alcohol advertisements with the International Alliance for Responsible Drinking's (IARD) Guiding Principles. Recordings of five matches from four countries were also used to identify the number of in- and out-of-game alcohol brand appearances. Findings A total of 86.2% of all unique alcohol advertisements contained at least one violation of IARD's Guiding Principles, with violation rates ranging from 72.7% (Mexico) to 100% (Brazil). Countries with the least restrictive marketing policies had a higher prevalence of violations in guidelines designed to protect minors. There were 2.76 in-game alcohol brand appearances and 0.83 out-of-game alcohol brand appearances per minute. Brand appearances did not differ across countries or according to a country's marketing policy restrictiveness. Conclusions Self-regulation and statutory policies were ineffective at limiting alcohol advertising during the 2014 FIFA World Cup Tournament television broadcasts. Most advertisements contained content that violated the self-regulation codes, and there were high levels of within-broadcast brand appearances. [ABSTRACT FROM AUTHOR]

A response from the authors of the article "Reducing the legal blood alcohol concentration limit for driving in developing countries: a time for change? Results and implications derived from a time-series analysis (2001–10) conducted in Brazil" which was published in a previous issue is presented.

The article presents the author's views on the article "Reducing intoxication among bar patrons: some lessons from prevention of drinking and driving," by K. Graham and colleagues. The paper was focused on the enforcement of the laws for restricting the intoxication among bar patrons. Role of corporate social responsibility (CSR) in the formation of laws for drinking and driving is discussed.

ABSTRACT Aims This study evaluated the effectiveness of a brief intervention (BI) for illicit drugs (cannabis, cocaine, amphetamine-type stimulants and opioids) linked to the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ASSIST screens for problem or risky use of 10 psychoactive substances, producing a score for each substance that falls into either a low-, moderate- or high-risk category. Design Prospective, randomized controlled trial in which participants were either assigned to a 3-month waiting-list control condition or received brief motivational counselling lasting an average of 13.8 minutes for the drug receiving the highest ASSIST score. Setting Primary health-care settings in four countries: Australia, Brazil, India and the United States. Participants A total of 731 males and females scoring within the moderate-risk range of the ASSIST for cannabis, cocaine, amphetamine-type stimulants or opioids. Measurements ASSIST-specific substance involvement scores for cannabis, stimulants or opioids and ASSIST total illicit substance involvement score at baseline and 3 months post-randomization. Findings Omnibus analyses indicated that those receiving the BI had significantly reduced scores for all measures, compared with control participants. Country-specific analyses showed that, with the exception of the site in the United States, BI participants had significantly lower ASSIST total illicit substance involvement scores at follow-up compared with the control participants. The sites in India and Brazil demonstrated a very strong brief intervention effect for cannabis scores ( P < 0.005 for both sites), as did the sites in Australia ( P < 0.005) and Brazil ( P < 0.01) for stimulant scores and the Indian site for opioid scores ( P < 0.01). Conclusions The Alcohol, Smoking and Substance Involvement Screening Test-linked brief intervention aimed at reducing illicit substance use and related risks is effective, at least in the short term, and the effect generalizes across countries. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To examine the proportion of self-reported alcohol consumed by different gender and age groups in Brazil over the past year, and to examine whether the 'prevention paradox' applies to Brazilian data on alcohol-related problems. Design A multi-stage cluster sample, representative of the Brazilian household population. Setting This study was conducted in Brazil between November 2005 and April 2006. Participants Respondents were aged ≥ 14 years (n = 3007). Measurements Measures included past year estimates of (i) number of standard drinks, (ii) frequency of binge drinking, and (iii) alcohol-related problems. Findings The survey response rate was 66.4%. The top 2.5% of the drinkers by volume consume 14.9%, the top 5% consume 27.4% and the top 10% consume 44.2% of all alcohol consumed in Brazil. Men consume 77.8% of the total alcohol, and 18-29-year-olds consume 40.3%. Individuals below risky drinking guidelines for weekly volumetric intake account for 49-50% of all problem drinkers and 45-47% of all problem types reported. Individuals who do not binge or who binge infrequently (1-3 times/year) account for 50-51% of all problem drinkers and 45-46% of all reported problem types. Most binge drinkers are low-volume drinkers. Conclusions Consistent with the prevention paradox literature, most drinking problems in Brazil are associated with low or moderate drinking. Binge drinking accounts more clearly for the distribution of alcohol problems than total volume consumed. [ABSTRACT FROM AUTHOR]

An interview with alcohol epidemiologist Raul Caetano is presented. When asked about the role of Brazil in his personal and professional development, he refers to the amalgam of African and European culture. He says that people of Brazil have developed their own resources for difficulties as they do not depend on the government. He believes that alcohol-related problems arise due to availability of low-cost alcohol. He comments on high rate of alcohol dependence.

Aims The aims of this study are to describe the tobacco dependence treatment systems in five countries at different stages of development of their systems, and from different income levels and regions of the world, and to draw some lessons from their experiences that might be useful to other countries. Methods and data sourses Data were drawn from an earlier survey of treatment services led by M.R. and A.M., from Party reports to the Secretariat of the Framework Convention on Tobacco Control, and from correspondents in the five countries. These data were entered onto a standard template by the authors, discussed with the correspondents to ensure they were accurate and to help us interpret them, and then the templates were used as a basis to write prose descriptions of the countries' treatment systems, with additional summary data presented in tables. Results Two of the middle-income countries have based their treatment on specialist support and both consequently have very low population coverage for treatment. Two countries have integrated broad-reach approaches, such as brief advice with intensive specialist support; these countries are focusing currently upon monitoring performance and guaranteeing quality. Cost is a significant barrier to improving treatment coverage and highlights the importance of using existing infrastucture as much as possible. Conclusions Perhaps not surprisingly the greatest challenges appear to be faced by large, lower-income countries that have prioritized more intensive but low-reach approaches to treatment, rather than developing basic infrastructure, including brief advice in primary care and quitlines. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To assess the prevalence of potential alcohol use disorders and associated factors using the Alcohol Use Disorders Identification Test (AUDIT). Design Cross-sectional study. Setting A town in southern Brazil. Participants A representative sample of 1260 people aged 15 and over. Measurements Demographic, socioeconomic, smoking habit and mental health data were collected. Logistic regression was used in the multivariate analysis, and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Findings Overall prevalence of alcohol use disorder was 7.9%, with 14.5% prevalence among men and 2.4% among women. The risk of alcohol misuse increased across social class (P linear trend = 0.03) and compared with the highest classes (A and B), groups C through E had ORs of 1.48, 1.51 and 2.36, respectively. Males had an OR of 6.89 (CI 3.61–13.16) compared with women. A linear trend was found (P = 0.001) between smoking categories, and smokers (OR 3.27; CI 1.91–5.58) and ex-smokers (OR 1.30; CI 0.56–2.98) were at higher risk than non-smokers. Those with minor psychiatric disorders had a 2.48 OR (CI 1.35–4.56) of presenting a positive test. Conclusions The AUDIT detected a high prevalence of potential alcohol use disorders in the population sampled. Those identified are potential targets for preventive measures implemented through health policies. [ABSTRACT FROM AUTHOR]

Aims. A survey of cocaine users was undertaken to study (i) the frequency of reported drug overdoses among cocaine users; and (ii) the frequency of witnessing drug overdoses in the same population. Design and setting. A cross-sectional study as part of the World Health Organization (WHO) Multi-city Study among injecting drug users (IDUs), phase II, was conducted in Santos Metropolitan Region, State of São Paulo, Brazil, in 1999. Participants. Three hundred and ninety-six exclusive users of cocaine in the Santos Metropolitan Region, São Paulo State, Brazil were surveyed concerning their past experience with drug overdoses. Findings. Eighty (20%) of the cocaine users reported having experienced one or more overdoses, and 50% reported that they knew one or more other cocaine users who had died of an overdose. On multivariate analysis, being female and having spent time in jail were associated with an increased likelihood of having had one or more overdoses. Conclusion. Cocaine overdoses are an important and under-recognized health problem in the Santos Metropolitan Region, and possibly in other areas of Brazil. [ABSTRACT FROM AUTHOR]

Aims. To describe AIDS and malaria geography in Brazil, highlighting the role of injecting drug users (IDUs) in malaria outbreaks occurring in malaria-free regions, and the potential clinical and public health implications of malaria/HIV co-infection. Design. Review of the available literature and original analyses using geoprocessing and spatial analysis techniques. Findings. Both HIV/AIDS and malaria distribution are currently undergoing profound changes in Brazil, with mutual expansion to intersecting geographical regions and social networks. Very recent reports describe the first clinical case of AIDS in a remote Amazonian ethnic group, as well as malaria cases in Rio de Janeiro state (hitherto a malaria-free area for 20 years); in addition, two outbreaks of both infections occurred at the beginning of the 1990s in the most industrialized Brazilian state (Sao Paulo), due to the sharing of needles and syringes by drug users. Spatial data point to: (a) the expansion of HIV/AIDS towards malarigenic areas located in the centre-west and north of Brazil, along the main cocaine trafficking routes, with IDU networks apparently playing a core role; and (b) the possibility of new outbreaks of secondary malaria in urban settings where HIV/AIDS is still expanding, through the sharing of needles and syringes. Conclusions. New outbreaks of cases of HIV and malaria are likely to occur among Brazilian IDUs, and might conceivably contribute to the development of treatment-resistant strains of malaria in this population. Health professionals should be alert to this possibility, which could also eventually occur in IDU networks in developed countries. [ABSTRACT FROM AUTHOR]

Studies the alcohol and drug consumption characteristics among high school students in Brazil. Relations between subjective and objective family situations and drug/alcohol consumption; Environmental conditions affecting drug/alcohol use; Parent-child relations influencing drug consumption.

The author comments on the paper "Why don't northern American solutions to drinking and driving work in southern America?" by F. Pechansky and A. Chandran, which addresses the lack of policies regarding drinking and driving. According to her, lack of data or laws is not a problem in Brazil but lapses in the enforcement of existing laws is. She refers to several studies on drunk driving and suggests acquiring a better understanding of the problem through research and monitoring.

The article presents news items related to drug addiction. Brazil's National Council for Research has announced the creation of the country's first National Institute of Policies on Alcohol and Drugs. The periodical "Drug and Alcohol Review" has elected Robin Room to the position of editor in chief following a decision from former editor in chief, John Saunders, to assume the position of founding and emeritus editor in chief at the periodical. A New Delhi, India High Court has overturned a federal ban on cigarette smoking in films and television programs.

The author comments on the article "Why don't northern American solutions to drinking and driving work in southern America?" by F. Pechansky and A. Chandran. She highlights the points addressed by the authors of the study regarding aspects lacking in Brazil and notes that the issue of advocacy and active popular support is not taken into consideration by the study. She opines that active participation as a critical factor to tackle the state of affairs of drinking and driving rates.

The article focuses on the study on morality in an unregulated alcohol market population in Brazil. The alcohol consumption and in unregulated areas continuously expand each year and drinking patterns vary all the time. The research also indicated an increasing concern in the Brazilian society over the issue of alcohol consumption and public health.

Focuses on the use of cognitive-behavioral approach for treating alcohol and drug dependence in Brazil. Basis on the Minnesota model; Participation of the Alcoholics Anonymous meetings; Cost-effectiveness of Motivational Enhancement Therapy in group-based treatment.

A letter to the editor is presented in relation to the issues surrounding the emergence and the spread of oxidation (oxi) in Brazil.

The author discusses the article on alcohol use in Brazil and its prevention paradox by R. Caetano and colleagues. He says that the article provides an anatomy of drinking patterns and related problems in the country with both high rates of alcohol consumption disorders and abstention. He states that there is no such thing as fully risk-free drinking. He mentions the use of the prevention paradox to promote public health policies limiting he physical and economic availability of alcohols.