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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]

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.

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.

Brazilian bioethanol is one of the most prominent biofuels produced on a large scale, representing 30% of the global fuel ethanol production share. Around 8.6 billion gallons were produced in 2019, second only to the US fuel ethanol production in the same period (15.8 billion gallons). Obtained from sugarcane in a highly energy‐efficient process, the biofuel, which can be used in Brazil as 100% ethanol (hydrated, minimum mass content of 92.5%) or in a volume proportion of 27% (anhydrous ethanol) in common gasoline, has contributed to the reduction of oil dependency and CO2 emissions, as well as to the development of an important economic sector. Pioneer biofuel policies and important advances in science and technology led to the establishment of a 46% renewable energy matrix. In this manuscript, an overview of the impacts of ethanol production and utilization will be given, with respect to environmental and socio‐economic concerns. The public policies and some technical aspects of sugarcane and ethanol production and energy cogeneration will be reviewed and discussed. © 2021 Society of Chemical Industry and John Wiley & Sons, Ltd [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]

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.

Background and Objectives: Studies have highlighted psychosocial factors associated with drug use among adolescents. Association of specific psychiatric comorbidity with substance use has not been properly established in Brazil. This study aimed to investigate alcohol, tobacco, and marijuana use by 15-18-year-old high school Brazilian students and to estimate associations with psychiatric symptoms.Methods: A cross-sectional survey of 4,034 students from 128 public and private schools in São Paulo State was carried out using a two-step probability sample. Data were collected through self-report standardized questionnaires including questions on substance use patterns and the Strengths and Difficulties Questionnaire (SDQ). Key outcome variables were past-month use and past-month frequent use of alcohol, tobacco and marijuana. Questionnaires with missing information were excluded, resulting in a final sample of 2,532 adolescents. Weighted data was analyzed through logistic regressions, adjusted by gender and by socio-economic status (SES).Results: Regarding SDQ total score, 43.6% of students had no psychiatric symptoms, 7.9% had subclinical symptoms and 48.5% presented clinically significant symptoms. Respondents with a clinically significant SDQ score were more likely to be past month alcohol (aOR = 1.51; 95%CI 1.22-1.88), tobacco (aOR = 1.82; 95%CI 1.25-2.66), and marijuana (aOR = 1.79; 95%CI 1.21-2.64) users as compared to those with no symptomatology.Discussion and Conclusions: Psychopathological symptoms were associated with alcohol, tobacco and marijuana use by 15-18-year-old adolescents. These associations should also be considered when planning public policies of mental health promotion.Scientific Significance: This study discusses the importance of the association between psychopathological symptoms and substance use in a middle-income country, with high level of social inequalities, in a state representative sample. (Am J Addict 2016;25:416-425). [ABSTRACT FROM AUTHOR]

Introduction and Aims. Screening and brief intervention (SBI) are considered good prevention strategies for alcohol-related problems in Primary Health Care (PHC). The aim of this study was to evaluate the process of an SBI implementation program for alcohol risk use and evaluate the factors that facilitated or impeded this implementation, in two PHC settings at the Brazilian city of Juiz de Fora. Design and Methods. Case 1 public PHC services and case 2 the PHC service of the Military Police. Participants were trained on SBI strategies and supervised during 6 months. The qualitative methodology of action research was used. Data were analysed using thematic analysis. Results. Case 1: 70 participants; facilitating factors: good expectations about the project; simplicity of SBI technique; collaborative way the project was planned. Barriers: lack of time; discomfort in dealing with alcohol issues; focus on alcohol-dependence; unstable political environment; other priorities; difficulties in patients' referral. Case 2: nine participants. Facilitating factors: simplicity of SBI technique; collaborative way the project was planned; importance of alcohol issues; data confidentiality and the voluntary work to do SBI. Barriers: only one health professional in the group; the variability of the institutional support; organisational culture about alcohol use. Discussion and Conclusions. The barriers and facilitators were related to two main factors: organisational culture and personal attitudes. The action research provided the opportunity to bridge the gap between research and practice, but it also showed that SBI faces significant challenges before it can be implemented as a routine procedure in PHC settings in Brazil. [Amaral MB, Ronzani TM, Souza-Formigoni MLO. Process evaluation of the implementation of a screening and brief intervention program for alcohol risk in primary health care: An experience in Brazil. Drug Alcohol Rev 2009] [ABSTRACT FROM AUTHOR]

Nonlinear adjustment toward long-run price equilibrium relationships in the sugar-ethanol-oil nexus in Brazil is examined. We develop generalized bivariate error correction models that allow for cointegration between sugar, ethanol, and oil prices, where dynamic adjustments are potentially nonlinear functions of the disequilibrium errors. A range of models are estimated using Bayesian Monte Carlo Markov Chain algorithms and compared using Bayesian model selection methods. The results suggest that the long-run drivers of Brazilian sugar prices are oil prices and that there are nonlinearities in the adjustment processes of sugar and ethanol prices to oil price but linear adjustment between ethanol and sugar prices. [ABSTRACT FROM AUTHOR]

An indicator of competitive position, the cost difference between ethanol import from Brazil with sugar processing and domestic production with corn in the United States under ideal conditions without tariffs in the ethanol market, is developed conceptually. An ex ante version of the indicator that is based on historical prices and today's technology is calculated for the last 30 years and subjected to time series analysis. Results suggest that there are no trends, but there are cyclical periods of advantage for both industries. Further, long-term averages suggest that profits would be similar in both countries under ideal trade conditions. However, the corn wet-milling industry may have slightly higher profits than other processes and locations. Finally, the U.S. dry-milling industry could improve its competitive position using modified corn varieties with high starch content, and using corn residues for biomass generation of electrical and heat energy. [ABSTRACT FROM AUTHOR]

To provide an overview of the extent of drug and alcohol misuse in Brazil and the policies and approaches in tackling substance misuse. An examination of the challenges facing the nursing profession in working with substance misusers is presented.Alcohol, cocaine, and cannabis are the most commonly misused psychoactive substances in Brazil. One of the biggest public health problems is the interface between the misuse of psychoactive substances and HIV prevalence and other sexually transmitted diseases. Findings from a recent study suggest that undergraduate nurses in Brazil are not adequately prepared in the care and management of substance misuse problems. The nursing profession in Brazil faces numerous challenges in the development of professional competence of nurses in this field.A strategy proposed is the creation of regional centres in Brazil to study the integration of substance use and misuse in the nursing undergraduate curriculum and the giving of specific support in teaching and research to nurse teachers. Nurses have a key role to play in the early recognition, assessment, prevention, and treatment of substance misuse. [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]