Alcohol use by university students of South Brazil and its changes during the early COVID-19 pandemic

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The COVID-19 pandemic triggered significant behavioral shifts across the general population, with students particularly vulnerable to its psychosocial impacts. In this context, the present study aimed to assess alcohol consumption patterns among university students and to examine the influence of the early stages of the COVID-19 pandemic on these behaviors. Materials and Methods: A cross-sectional study was conducted between July and November 2020 using an online questionnaire. The instrument collected data on students’ lifestyle habits, health status, and substance use, both prior to and during the early phase of the COVID-19 pandemic. Results: A total of 1,553 valid responses were analyzed, of which 99.93% reported alcohol consumption. The most frequently reported pattern of use was weekly consumption. During the pandemic, 248 students indicated an increase in their alcohol intake. Students who perceived a decline in their overall health status during the early pandemic period were less likely to report increased alcohol consumption, whereas those with a confirmed COVID-19 diagnosis demonstrated a higher likelihood of increased use. Conclusion: The findings reveal a high prevalence of alcohol consumption among university students and suggest that periods marked by abrupt behavioral and routine changes, such as the COVID-19 pandemic, may significantly influence substance use patterns within this population. alcohol use university students alcoholic beverages COVID-19 pandemic psychoactive substances Figures Figure 1 Figure 2 Introduction Declared a pandemic in March 2020, COVID-19 brought significant changes to daily life [ 1 ]. To control the spread of the disease, measures such as hand and object sanitization, the use of face masks, and the implementation of social distancing protocols were required [ 2 ]. These public health interventions significantly impacted social, professional, and educational contexts for a substantial portion of the population [ 3 , 4 ]. Young adults were particularly affected during this period due to the closure of schools and universities, reduced contact with family and friends, and the suspension of collective leisure activities such as movie theaters, concerts, and parties [ 5 ]. According to Zysset et al., “The daily structure of young adults changed drastically,” which may have influenced their personal lives and behaviors [ 3 ]. The university years are often particularly challenging for students, as this period typically involves the development of independence and a growing sense of responsibility for one’s actions. In many cases, it also coincides with leaving the parental home and becoming physically distant from family support systems [ 6 , 7 ]. The COVID-19 pandemic may have intensified these challenges, potentially leading to changes with long-lasting impacts on students' lives. Several studies have reported alterations in physical activity patterns, nutritional habits, and overall health status during this period [ 8 , 9 ]. Moreover, the emergence of mental health symptoms—such as loneliness, anxiety, and depression—has been associated with pandemic-related restrictions, some of which have also been linked to increased consumption of psychoactive substances [ 5 , 10 – 13 ]. Among young people, alcohol—primarily through alcoholic beverages—is one of the most commonly consumed substances [ 14 ]. Alcohol is a psychoactive and toxic agent with a high potential for dependence [ 14 ]. Its widespread use is evident in Brazil, where it ranks as the most frequently consumed substance among youth, followed by tobacco, marijuana, and stimulants [ 15 ]. Due to its well-documented central nervous system depressant effects, many individuals resort to alcohol and other psychoactive substances as a coping mechanism for negative emotions, stress, anxiety, or depression [ 16 , 17 ]. However, this seemingly "common" use poses significant risks for children and adolescents, whose neurodevelopmental processes are still ongoing. Early exposure can result in brain damage, impaired personality development, and the onset of various mental disorders or diseases [ 18 , 19 ]. It is important to note that even low levels of alcohol consumption can pose health risks, although chronic use and heavy episodic drinking are more strongly associated with adverse health outcomes [ 14 ]. Additionally, alcohol use is implicated in more than 200 diseases, injuries, and other health-related conditions, highlighting its significant burden on public health [ 14 ]. Recent data have shown a 13% increase in alcohol-attributable deaths among individuals aged 20–39 years compared to 2019, a period during which the COVID-19 pandemic also contributed to notable lifestyle changes [ 14 ]. Accordingly, the COVID-19 pandemic has been associated with an overall rise in mortality from various causes, including alcohol-related deaths—such as those due to alcoholism and alcoholic liver disease—primarily due to the heightened health risks associated with alcohol consumption [ 20 ]. Furthermore, alcohol use is linked to negative social, economic, and cognitive outcomes, which may hinder academic performance among students [ 21 ]. It has also been consistently associated with engagement in high-risk behaviors, including unprotected sexual activity and interpersonal violence within romantic or dating contexts. These behaviors substantially elevate the risk of exposure to sexually transmitted infections (STIs), a particularly concerning issue given their already high prevalence among adolescents and young adults—the predominant demographic in university settings [ 16 , 22 ]. Moreover, alcohol consumption has been linked to increased rates of criminal activity and domestic violence or abuse, patterns that were further exacerbated during the COVID-19 pandemic [ 19 , 23 ]. Despite being aware of the harmful and potentially dangerous consequences of alcohol use, many young people continue to drink, driven by social pressures, the pursuit of relief, pleasure, and the perceived positive effects of intoxication [ 24 , 25 ]. Based on this context, the aim of this study was to analyze alcohol consumption among university students in southern Brazil and to assess its increase during the lockdown period in the early stages of the COVID-19 pandemic. Materials and Methods Study Design This is a cross-sectional study conducted between July and November 2020 with undergraduate students from Southern Brazil, using an online, self-administered questionnaire. Ethical Approval and Compliance The study was approved by the Research Ethics Committee of the Federal University of Rio Grande (CEPAS-FURG), under approval number 34030720.8.0000.5324, issued in 2020. The study adhered to the principles of the Declaration of Helsinki throughout its experimental approach involving human participants. All participants were volunteers and did not receive any form of compensation. On the first page of the questionnaire, participants were presented with an informed consent form outlining the objectives of the study, as well as the associated risks and their rights. Only individuals who provided informed consent were granted access to complete the questionnaire. Sample Size and Eligibility Criteria The sample size was determined based on the total number of students enrolled in undergraduate programs at higher education institutions in the Southern region of Brazil (comprising the states of Paraná, Rio Grande do Sul, and Santa Catarina). This information was obtained from the most recent census conducted in 2018 by the Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira (National Institute of Educational Studies and Research Anísio Teixeira), available at http://portal.inep.gov.br/basica-censo-escolar-sinopse-sinopse. The sample size was calculated using the online platform https://comentto.com/calculadora-amostral/, considering a 5% margin of error, a 95% confidence interval, and assuming a heterogeneous population. According to the census, a total of 1,428,267 undergraduate students were enrolled in the region, resulting in a minimum sample size of 1,152 participants. To account for potential losses, an additional 10% was added, raising the required sample size to 1,268 students. To be eligible for participation, individuals had to meet the following inclusion criteria: be at least 18 years old, reside exclusively in one of the Southern states of Brazil (Paraná, Rio Grande do Sul, or Santa Catarina), be enrolled in an undergraduate program, and provide informed consent by agreeing to participate and completing the questionnaire. Individuals enrolled in high school, technical, or postgraduate programs, as well as those residing outside the Southern region or who did not complete the questionnaire in full, were excluded from the study. Data Collection The authors developed a digital questionnaire designed to collect information on sociodemographic characteristics, self-perceived health, and lifestyle behaviors across two distinct time points: the period prior to the COVID-19 pandemic (referring specifically to the time before March 2020, using past-tense phrasing) and the initial phase of the pandemic (data collection concluded in November 2020) [26]. The decision to create a customized instrument was based on the fact that, at the onset of the pandemic, there were no validated or standardized questionnaires addressing the specific context under investigation. The questionnaire was hosted on the free online platform Google Forms® to ensure broad accessibility while adhering to public health guidelines regarding social distancing during the pandemic period. Participant recruitment was carried out through social media campaigns and emails sent directly to higher education institutions across the Southern region of Brazil. Prior to launching the main survey, a pilot study was conducted with a convenience sample of students (n = 15) who were not included in the final analysis. This step was undertaken to evaluate the clarity and applicability of the questionnaire. To ensure confidentiality, all responses were collected anonymously. Variables Dependent variables – Alcohol consumption Alcohol consumption was assessed through the question “Do you consume drugs legally or illegally?” in the section of the questionnaire related to regular life (before the pandemic period), with response options “yes” (with a blank space to specify the drug) or “no”. The increase in alcohol consumption was evaluated in a binary manner using the question “Did you increase this drug consumption during the pandemic?” with “yes” or “no” as response options. The frequency of alcohol consumption was measured for both periods—before and during the pandemic—using the question “How often do you consume?” with the following answer choices: “daily”, “two or more times per week”, “once a week”, “two or more times per month”, and “once a month”. Independent Variables The independent variables were collected as follows: nominal variables (gender, age, ethnicity, state of residence, type of residence, college course, type of university, and occupation) and ordinal variables (family income and health status). Additional independent variables related to participants' health and habits were collected as dichotomous variables using yes/no questions (e.g., “Do you have a chronic disease?”, “Did you practice social distancing during the pandemic?”, among others). Statistical Analysis Statistical analyses were conducted using SPSS version 20. Frequencies (absolute and relative) of the sample characteristics were calculated, and associations between increased alcohol consumption and demographic, health, and lifestyle variables before and during the pandemic were analyzed using Chi-square and Fisher’s exact tests. Statistical significance was defined as p < 0.05. To identify variables potentially associated with increased alcohol consumption during the pandemic, bivariate and multivariate analyses were performed using Poisson regression. The analysis was structured in two hierarchical levels to control for confounding factors. The first level included sociodemographic variables (age, gender, ethnicity, academic course, type of university, student occupation, and income), while the second level comprised health-related variables (presence of chronic disease, presence of psychiatric disorders, social distancing during the pandemic, household composition during the pandemic, perceived decline in health, onset of new symptoms or illnesses, self-medication during the pandemic, and confirmed COVID-19 diagnosis). Initially, crude analyses were conducted for each independent variable in relation to the dependent variable (increased alcohol consumption). Variables with associations at p < 0.200 were retained for the adjusted model [27]. Final associations were considered statistically significant at p < 0.05 and are reported with their corresponding prevalence ratios (PR) and 95% confidence intervals (95% CI). Results A total of 1,553 valid responses were included in this study. Most participants were female, white, and aged between 18 and 29 years. Among the students who reported an increase in alcohol consumption, the majority were aged 18–29 years (85.9%), female (72.2%), white (80.2%), enrolled in non-health and non-biological science degree programs (61.7%), attending public universities (71.0%), employed or engaged in internships (54.0%), and reported a monthly family income of up to BRL 2,100 (37.9%) (Table 1 ). A statistically significant association was observed between increased alcohol consumption and student income ( p < 0.046). Table 1 Sociodemographic factors associated with the increase of alcohol consumption during the COVID-19 pandemic (n/%) Increase in alcohol’s consumption p value Variables Yes No Age 18–29 years 213 (85.9) 1153 (88.4) 0.287 30 or more 35 (14.1) 152 (11.6) Gender Female 179 (72.2) 928 (71.1) 0.760 Male 69 (27.8) 377 (28.9) Race White 199 (80.2) 1071 (82.1) 0.530 Non-white 49 (19.8) 234 (17.9) Graduation course Health and biological sciences 95 (38.3) 559 (42.8) 0.207 Other 153 (61.7) 746 (57.2) University Public 176 (71.0) 914 (70.0) 0.820 Private 72 (29.0) 391 (30.0) Occupation Job or internship 134 (54.0) 627 (48.0) 0.096 Just study 114 (46.0) 678 (52.0) Income (BRL)* Up to 2,100 94 (37.9) 428 (33.6) 0.046 2,101-5,250 84 (33.9) 544 (41.7) 5,251 − 10,450 36 (14.5) 199 (15.2) More than 10,451 34 (13.7) 124 (9.5) Statistical test used Chi-square *Fischer’s exact test Among all participants, 1,552 students (99.93%) reported consuming alcohol regularly prior to the COVID-19 pandemic. The most frequently reported pattern was alcohol consumption once a week (41.0%), followed by two to three times per month (24.7%) and two or more times per week (22.5%). During the pandemic, of these 1,552 students, 247 reported an increase in their alcohol consumption. The most frequently reported consumption patterns during this period were daily use (8.5%) and two or more times per week (29.9%), both of which were statistically significant ( p < 0.001 and p < 0.003, respectively). These findings indicate that students began consuming alcohol more frequently during the pandemic (Fig. 1 ). Furthermore, during the pandemic the increase in the consumption of substances identify alcohol as the most consumed, followed by marijuana (17.8%), cigarette (15.4%) and other drugs (Fig. 2 ). Most students did not report having a chronic disease (58.1%) or a psychiatric disorder (68.5%). During the early period of the pandemic, the majority left home only for essential activities (58.9%) and were living with family or friends (90.7%). Additionally, most students perceived a decline in their own health status (60.5%), did not report the onset of new symptoms or diseases (91.1%), and did not receive a confirmed COVID-19 diagnosis (99.2%). However, a significant proportion reported practicing self-medication (62.5%) (Table 2 ). Table 2 Clinic and COVID-19 related variables associated with the increase of alcohol consumption Increase of alcohol’s consumption p value Variables Yes No Chronic disease Yes 104 (41.9) 460 (35.2) 0.052 No 144 (58.1) 845 (64.8) Psychiatric disease Yes 78 (31.5) 337 (25.8) 0.072 No 170 (68.5) 968 (74.2) Social distancing practice* No measure of social distancing 11 (4.4) 42 (3.2) 0.114 Go out for work but avoid crowds 75 (30.2) 341 (26.1) Go out only for essential activities 146 (58.9) 783 (60.0) Doing total isolation 16 (6.5) 139 (10.7) Living Alone 23 (9.3) 99 (7.6) 0.368 With family or friends 225 (90.7) 1206 (92.4) Realize a decrease in health status Yes 150 (60.5) 641 (49.1) 0.001 No 98 (39.5) 664 (50.9) New symptoms or disease during COVID-19 pandemic Yes 22 (8.9) 183 (14.0) 0.031 No 226 (91.1) 1122 (86.0) Practice self-medication during COVID-19 pandemic# Yes 155 (62.5) 733 (56.2) 0.069 No 93 (37.5) 572 (43.8) COVID-19 infection diagnosticated Yes 2 (0.8) 36 (2.8) 0.073 No 246 (99.2) 1269 (97.2) Statistical test used Chi-square *Fischer’s exact test #Self-medication is the use of medication without a doctor's or dentist's prescription or without the supervision of a health professional. In the association analysis, the students who reported a decrease in their own health status during the early period of COVID-19 pandemic presented a lower probability of increasing the alcohol consumption (Exp B = 0.927, CI 0.887–0.969; p = 0.001) but those who had a diagnosticated COVID-19 infection presented a higher probability of it (Exp B = 1.146, CI 1.053–1.247; p = 0.002). No more associations were significant (Table 3 ). Table 3 Association between sociodemographic, clinical and COVID-19 related characteristics with the increase of alcohol consumption during pandemic Level Variables Crude analysis (Exp B, 95% CI) p value Adjusted analysis (Exp B, 95% CI) p value 1 Age 18–29 years 1.03 (0.96–1.11) 0.308 30 or more 1 1 Gender Female 0.99 (0.94–1.04) 0.731 Male 1 1 Race White 1.02 (0.96–1.08) 0.508 Non-white 1 1 Graduation course Health and biological sciences 1.03 (0.98–1.07) 0.180 1.02 (0.97–1.07) 0.346 Other 1 1 1 University Public 0.99 (0.94–1.04) 0.768 Private 1 1 Occupation Job or internship 0.96 (0.92-1.00) 0.085 0.96 (0.91-1.00) 0.064 Just study 1 1 1 Income (BRL) Up to 2,100 1.04 (0.95–1.14) 0.062 1.05 (0.96–1.16) 0.056 2,101-5,250 1.10 (1.01–1.20) 1.11 (1.01–1.21) 5,251 − 10,450 1.07 (0.97–1.19) 1.08 (0.98–1.19) More than 10,451 1 1 2 Chronical disease Yes 0.95 (0.91-1.00) 0.052 0.97 (0.92–1.01) No 1 1 0.216 2 Psychiatric disease Yes 0.95 (0.90-1.00) 0.082 1.00 (0.92–1.09) 0.907 No 1 1 2 Social distancing practice No measure of social distancing 0.88 (0.76–1.02) 0.061 0.87 (0.75–1.01) 0.071 Go out for work but avoid crowds 0.91 (0.85–0.98) 0.91 (0.84–0.98) Go out only for essential activities 0.94 (0.88–0.99) 0.93 (0.88–0.99) Doing total isolation 1 1 2 Living Alone 0.96 (0.88–1.05) 0.402 With family or friends 1 2 Realize a decrease in health status Yes 0.93 (0.89–0.97) 0.001 0.92 (0.88–0.96) 0.001 No 1 1 2 New symptoms or disease during COVID-19 pandemic Yes 1.07 (1.01–1.13) 0.010 1.02 (0.96–1.08) 0.375 No 1 1 2 Practice self-medication during COVID-19 pandemic Yes 0.96 (0.91-1.00) 0.061 0.97(0.92–1.01) 0.165 No 1 1 2 COVID-19 infection diagnosticated Yes 1.13 (1.04–1.22) 0.002 1.14 (1.05–1.24) 0.002 No 1 1 Discussion Our study revealed an extremely high and alarming prevalence of alcohol consumption among university students. This population is recognized as one of the largest consumers of alcoholic beverages worldwide, partly due to increased independence and physical distance from parental supervision during this life stage [ 15 , 28 – 30 ]. Consequently, the college period may represent a critical phase for the initiation or establishment of alcohol consumption patterns. Supporting this, a French study identified alcohol consumption between 18 and 25 years of age as a potential predictor of alcohol dependence in later adulthood, indicating that drinking behaviors in young adults may contribute to health problems later in life [ 7 ]. Although most participants did not consume alcohol daily before the pandemic, the World Health Organization (WHO) emphasizes that no level of alcohol consumption is risk-free—the quantity and frequency of alcohol intake determines the extent of harm to the human body [ 14 ]. Excessive consumption—whether by volume or frequency—is associated with an increased risk of various diseases, including those affecting the digestive and cardiovascular systems, multiple cancer types, immune system impairment, and mental health and behavioral disorders such as depression and anxiety [ 14 , 30 , 31 ]. Among the substances analyzed, alcohol was the most frequently consumed during the early pandemic period. Nearly the entire sample reported monthly alcohol use, and the reported increase in consumption during the early pandemic is cause for concern. In our study, alcohol consumption increased in both daily frequency and frequency multiple times per week, reflecting a more sustained pattern of use that is known to be detrimental to health and linked to disease development. Similar findings were reported in an Argentinian study, which documented a 20% increase in alcohol consumption among young adults aged 18 to 24 years and a 45% increase among adults aged 35 to 45 years [ 32 ]. Furthermore, an increase in alcohol consumption among college students as a coping mechanism for depression and depressive symptoms was observed following the onset of the COVID-19 pandemic, persisting into later phases of the pandemic in 2021. This suggests that prolonged exposure to stringent social restrictions may influence increased alcohol use [ 33 , 34 ]. An Australian study involving 4,462 participants found that 30.8% reported drinking “a lot more than normal” during the early pandemic, with depression and stress identified as significant correlates [ 35 ]. These data indicate that stressful periods, such as the COVID-19 pandemic restrictions, can modulate alcohol consumption patterns. Alcohol remains the most commonly consumed psychoactive substance worldwide due to its generally low cost and its social disinhibitory and anxiolytic effects [ 14 ]. During the pandemic, university students experienced fear regarding their future and the risk of COVID-19 infection, alongside feelings of loneliness and disrupted routines—factors contributing to a psychological burden documented in several studies. In this context, alcohol may be used as a form of escapism, consistent with research showing increased alcohol use during stressful or catastrophic events [ 35 , 36 ]. However, a comparative study of pre-drinking behaviors (consumption prior to social events) among Brazilian and British university students demonstrated that alcohol consumption was associated with missed classes and work obligations [ 21 ]. Additionally, students reported experiences of physical violence, sexual harassment, blackouts, coma, or vomiting related to alcohol use [ 21 ]. Other studies have linked alcohol consumption to higher risks of physical altercations, homicides, and traffic accidents, making it a leading cause of mortality among young people and a risk factor for subsequent use of other drugs. Thus, alcohol represents a significant hazard for students [ 37 , 38 ]. Beyond these risks, alcohol consumption is also associated with mental health disorders. Corroborating this, the COVID-19 pandemic itself was a stressful period linked to increased mental health problems. Brazilian students already exhibit high prevalence rates of depression, ranging from 28.6–50.0%, and during the pandemic, a large study found that alcohol and other drug use heightened the risk of progressing from moderate to severe depression [ 39 – 41 ]. Factors such as fear of coronavirus infection, social distancing measures, and disruption of social routines with friends and peers were cited as drivers for increased alcohol consumption aimed at alleviating sadness and depressive symptoms [ 26 , 39 – 42 ]. Moreover, a positive diagnosis of COVID-19 infection was associated with increased alcohol consumption among students. This association was also observed in a smaller study with 406 students, which reported increased alcohol use among those with confirmed COVID-19 infection [ 43 ]. It is important to note that alcohol is an immunosuppressant and may promote susceptibility to respiratory infections, including COVID-19 and other communicable diseases [ 14 , 44 , 45 ]. Additionally, alcohol consumption among young people often occurs in social settings, increasing the risk of COVID-19 transmission via respiratory droplets, regardless of symptom presentation [ 2 ]. Despite the high prevalence of alcohol consumption observed, students who reported a decline in their health status did not increase their drinking during the pandemic. This may reflect heightened health concerns among these students, especially considering the healthcare system overload and increased risk of coronavirus exposure during this period [ 2 ]. Supporting this notion, a study of first-year students found that non-drinkers exhibited greater resilience in coping with the pandemic and its associated disruptions [ 46 ]. Awareness of alcohol’s harms may therefore influence consumption behavior during exacerbating conditions such as an infectious disease pandemic. Study limitations Our study was conducted at the onset of the COVID-19 pandemic and encompassed three months of data collection. This may represent a limitation regarding students’ adaptation to the new living conditions imposed by the pandemic, potentially influencing their alcohol consumption patterns, given that the pandemic lasted approximately three years and many behavioral changes occurred throughout this extended period. Furthermore, during the data collection phase, students were still adjusting to remote learning. Additionally, we did not quantify the volume of alcohol consumed by the students and instead assessed alcohol consumption based on self-reported data. Moreover, inherent limitations of the cross-sectional study design include the inability to establish causal relationships, the inability to evaluate changes over time, and the potential for bias. Conclusion This study contributed to identifying the prevalence of alcohol consumption among college students from Southern Brazil. Given the alarming findings, it is imperative to develop new educational strategies addressing alcohol-related health and social issues, aiming to reduce the number of young individuals who initiate or increase drinking. Furthermore, our findings regarding the increase in alcohol consumption during the early period of the COVID-19 pandemic may help predict behavioral changes during stressful periods and inform preventive measures to mitigate such effects. Declarations Funding Declaration This study did not receive funding for its execution at any time. Data Availability The datasets generated during and/or analyzed during the current study are not available. Ethical approval As already mentioned in the “Ethical approvals” section, the work was approved by the University's Research Ethics Committee of the Federal University of Rio Grande (CEPAS-FURG), under approval number 34030720.8.0000.5324, issued in 2020. Consent to Participate All human rights related to research involving human beings have been respected in this work. The participants were given a Free and Informed Consent Form explaining their rights and the research itself for them to read and make the decision to take part. Only after giving their consent did the participants have access to the questionnaire. Consent to publish All the participants agreed to have their anonymous data published in articles and scientific papers, as stated in the Informed Consent Form. All the authors listed in this paper also approved its publication. References World Health Organization. (2020) Coronavirus disease (COVID-19) advice for the public. In: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public Sohrabi C, Alsafi Z, O’Neill N, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg. 2020;76:71–6. 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Brandão YST, Correia DS, De Farias MSJA, Antunes TMT, Da Silva LA. (2011) The prevalence of alcohol consumption among the students newly enrolled at a public university. In: Journal of Pharmacy and Bioallied Sciences. pp 345–349. Messina MP, Battagliese G, D’angelo A, et al. Knowledge and practice towards alcohol consumption in a sample of university students. Int J Environ Res Public Health. 2021;18(18). https://doi.org/10.3390/ijerph18189528 . Sawicki WC, Barbosa DA, Fram DS, Belasco AGS. Alcohol consumption, Quality of Life and Brief Intervention among Nursing university students. Rev Bras Enferm. 2018;71:505–12. https://doi.org/10.1590/0034-7167-2017-0692 . Fernandes TF, Monteiro BM, de Silva M JBM, et al. Uso de substâncias psicoativas entre universitários brasileiros: perfil epidemiológico, contextos de uso e limitações metodológicas dos estudos. Cad Saude Colet. 2017;25(4):498–507. https://doi.org/10.1590/1414-462x201700040181 . Alomo M, Gagliardi G, Peloche S, Somers E, Alzina P, Prokopez CR. Efectos psicológicos de la pandemia COVID-19 en la población general de Argentina. Rev Fac Cienc Med Cordoba. 2020;77(3):176–81. https://doi.org/10.31053/1853.0605.v77.n3.28561 . Karadayian A, Merlo A, Czerniczyniec A, et al. Alcohol Consumption, Hangovers, and Smoking among Buenos Aires University Students during the COVID-19 Pandemic. J Clin Med. 2023;12(4). https://doi.org/10.3390/jcm12041491 . Delaney K, Dietrich MS, Corte C, Akard TF, Piano MR. Hazardous alcohol use, drinking motives and COVID-19-related anxiety in college students. J Am Coll Health. 2023. https://doi.org/10.1080/07448481.2023.2198022 . Neill E, Meyer D, Toh WL et al. (2020) Alcohol use in Australia during the early days of the COVID-19 pandemic: Initial results from the COLLATE project PCN Psychiatry and Clinical Neurosciences. https://doi.org/10.1111/pcn.13099/full Guerrero-Agenjo CM, López-Tendero J, López-González Á, et al. Alcohol Consumption in Nursing Students after the COVID-19 Lockdown. Healthc (Switzerland). 2023;11(8). https://doi.org/10.3390/healthcare11081185 . Silveira MS, Cruz JM, de O, Barreto ID, de Sarasqueta C LMMN. O consumo de bebida alcoólica em estudantes universitários. Res Soc Dev. 2021;10(1):e6410111250. https://doi.org/10.33448/rsd-v10i1.11250 . Delmondes DI, de Araujo S, de Santos EA et al. FG dos, (2022) O abuso de álcool entre estudantes universitários: uma revisão da literatura. Research, Society and Development 11(16):e39111637769. https://doi.org/10.33448/rsd-v11i16.37769 Camargo Júnior EB, Noivo IS, Gouvea TCC, Fernandes MN, de F, Gherardi-Donato EC. S (2023) Depression and Substance Use Among Brazilian University Students During the COVID-19 Pandemic. J Psychoactive Drugs. https://doi.org/10.1080/02791072.2023.2244499 Gallegos MI, Zaring-Hinkle B, Bray JH. COVID-19 pandemic stresses and relationships in college students. Fam Relat. 2022;71(1):29–45. https://doi.org/10.1111/fare.12602 . Ahuja M, Miller-Slough R, Adebayo-Abikoye E, et al. Loneliness and Alcohol use among College Students During the COVID-19 Pandemic in Rural Appalachia. Chronic Stress. 2024;8. https://doi.org/10.1177/24705470241264909 . de Souza KB, de Lemos Wyse E, Nasser N. Self-medication practice of university students of South Brazil and its implications during the COVID-19 pandemic: a cross-sectional study. Discov Public Health. 2025;22:334. https://doi.org/10.1186/s12982-025-00708-1 . Allen HK, Cohen-Winans S, Armstrong K, Clark NC, Ford MA. COVID-19 exposure and diagnosis among college student drinkers: links to alcohol use behavior, motives, and context. Transl Behav Med. 2021;11(7):1348–53. https://doi.org/10.1093/tbm/ibab059 . Testino G. Are Patients with Alcohol Use Disorders at Increased Risk for Covid-19 Infection. Alcohol Alcohol. 2020;55:344–6. Simou E, Britton J, Leonardi-Bee J. (2018) Alcohol and the risk of pneumonia: A systematic review and meta-analysis. BMJ Open 8. Fruehwirth JC, Gorman BL, Perreira KM. The Effect of Social and Stress-Related Factors on Alcohol Use Among College Students During the Covid-19 Pandemic. J Adolesc Health. 2021;69(4):557–65. https://doi.org/10.1016/j.jadohealth.2021.06.016 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7037809","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":504575352,"identity":"e12414d1-cabe-46c7-8305-d2e3b007bc41","order_by":0,"name":"Karoline Brizola de Souza","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYBACCeYDDAcYGGwSwLyEAmK0sCWAtKQlMLCBtBgQqQUIDkO0MBCjRbKNgfFwQc35PH757sQPDwwY5PnFDuDXIg00/PCMY7eLJdt4N0sAHWY4c3YCfi1y8g0Mh3nYbiduOMa7AaQlweA2IS0gW3j+nQNp2fyDKC1gh/G2HQBp2UacLUDvA7X0JSfObMvdZpFgIEHYLxLHGJg/83yzS+xnPrv55o8KG3l+aQJaGBj4P6AYQUj5KBgFo2AUjAJiAABYCT9UFtULgQAAAABJRU5ErkJggg==","orcid":"","institution":"Universidade Federal do Rio Grande (FURG)","correspondingAuthor":true,"prefix":"","firstName":"Karoline","middleName":"Brizola","lastName":"de Souza","suffix":""},{"id":504575353,"identity":"f7b1c829-8a49-413f-be1e-b01bfcb71bf6","order_by":1,"name":"Eduarda de Lemos Wyse","email":"","orcid":"","institution":"Universidade Federal do Rio Grande (FURG)","correspondingAuthor":false,"prefix":"","firstName":"Eduarda","middleName":"de Lemos","lastName":"Wyse","suffix":""},{"id":504575354,"identity":"f060f6ce-978b-4f2e-bd8a-befdb977ad91","order_by":2,"name":"Raif Gregorio Nasre Nasser","email":"","orcid":"","institution":"Universidade Federal do Rio Grande do Sul (UFRGS)","correspondingAuthor":false,"prefix":"","firstName":"Raif","middleName":"Gregorio Nasre","lastName":"Nasser","suffix":""},{"id":504575355,"identity":"066875ab-2486-4f1a-9b07-029945fe866a","order_by":3,"name":"Ana Paula Veber","email":"","orcid":"","institution":"Universidade Estadual de Ponta Grossa (UEPG)","correspondingAuthor":false,"prefix":"","firstName":"Ana","middleName":"Paula","lastName":"Veber","suffix":""},{"id":504575356,"identity":"4ee0e22a-2fb0-4139-a12f-8b514db8658b","order_by":4,"name":"Ana Luiza Muccillo-Baisch","email":"","orcid":"","institution":"Universidade Federal do Rio Grande (FURG)","correspondingAuthor":false,"prefix":"","firstName":"Ana","middleName":"Luiza","lastName":"Muccillo-Baisch","suffix":""},{"id":504575357,"identity":"4067a01e-5937-45df-9c0d-65012871f513","order_by":5,"name":"Bruno Dutra Arbo","email":"","orcid":"","institution":"Universidade Federal do Rio Grande do Sul (UFRGS)","correspondingAuthor":false,"prefix":"","firstName":"Bruno","middleName":"Dutra","lastName":"Arbo","suffix":""},{"id":504575358,"identity":"cf05ebb0-93ed-4c03-9e62-0eb30a579cf8","order_by":6,"name":"Flávio Manoel Rodrigues da Silva Júnior","email":"","orcid":"","institution":"Universidade Federal do Rio Grande (FURG)","correspondingAuthor":false,"prefix":"","firstName":"Flávio","middleName":"Manoel Rodrigues da Silva","lastName":"Júnior","suffix":""},{"id":504575359,"identity":"9322f071-33dd-436e-aa9c-85732bed23f2","order_by":7,"name":"Mariana Appel Hort","email":"","orcid":"","institution":"Universidade Federal do Rio Grande (FURG)","correspondingAuthor":false,"prefix":"","firstName":"Mariana","middleName":"Appel","lastName":"Hort","suffix":""}],"badges":[],"createdAt":"2025-07-03 11:38:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7037809/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7037809/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90176476,"identity":"83416443-358b-439f-a888-841cf3e5cae3","added_by":"auto","created_at":"2025-08-29 12:37:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":84213,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison between alcohol consumption before the pandemic and its increase during an initial period of the pandemic\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7037809/v1/3b1a8c270b5d2fa2fac5e444.png"},{"id":90176477,"identity":"a1f610b0-1317-4f62-9fff-536ce2cb9a78","added_by":"auto","created_at":"2025-08-29 12:37:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":32266,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFrequency (%) of students that increase the substances’ consumption during COVID-19 lockdown period\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7037809/v1/61108940718159a95231a711.png"},{"id":100777761,"identity":"62c34904-00c0-49b7-b055-fc28703bafc0","added_by":"auto","created_at":"2026-01-21 11:16:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1600011,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7037809/v1/9129b6b2-af58-4399-83bc-bb524485c81a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Alcohol use by university students of South Brazil and its changes during the early COVID-19 pandemic","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDeclared a pandemic in March 2020, COVID-19 brought significant changes to daily life [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. To control the spread of the disease, measures such as hand and object sanitization, the use of face masks, and the implementation of social distancing protocols were required [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These public health interventions significantly impacted social, professional, and educational contexts for a substantial portion of the population [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eYoung adults were particularly affected during this period due to the closure of schools and universities, reduced contact with family and friends, and the suspension of collective leisure activities such as movie theaters, concerts, and parties [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. According to Zysset et al., \u0026ldquo;The daily structure of young adults changed drastically,\u0026rdquo; which may have influenced their personal lives and behaviors [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe university years are often particularly challenging for students, as this period typically involves the development of independence and a growing sense of responsibility for one\u0026rsquo;s actions. In many cases, it also coincides with leaving the parental home and becoming physically distant from family support systems [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The COVID-19 pandemic may have intensified these challenges, potentially leading to changes with long-lasting impacts on students' lives. Several studies have reported alterations in physical activity patterns, nutritional habits, and overall health status during this period [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Moreover, the emergence of mental health symptoms\u0026mdash;such as loneliness, anxiety, and depression\u0026mdash;has been associated with pandemic-related restrictions, some of which have also been linked to increased consumption of psychoactive substances [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAmong young people, alcohol\u0026mdash;primarily through alcoholic beverages\u0026mdash;is one of the most commonly consumed substances [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Alcohol is a psychoactive and toxic agent with a high potential for dependence [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Its widespread use is evident in Brazil, where it ranks as the most frequently consumed substance among youth, followed by tobacco, marijuana, and stimulants [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Due to its well-documented central nervous system depressant effects, many individuals resort to alcohol and other psychoactive substances as a coping mechanism for negative emotions, stress, anxiety, or depression [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, this seemingly \"common\" use poses significant risks for children and adolescents, whose neurodevelopmental processes are still ongoing. Early exposure can result in brain damage, impaired personality development, and the onset of various mental disorders or diseases [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIt is important to note that even low levels of alcohol consumption can pose health risks, although chronic use and heavy episodic drinking are more strongly associated with adverse health outcomes [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Additionally, alcohol use is implicated in more than 200 diseases, injuries, and other health-related conditions, highlighting its significant burden on public health [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Recent data have shown a 13% increase in alcohol-attributable deaths among individuals aged 20\u0026ndash;39 years compared to 2019, a period during which the COVID-19 pandemic also contributed to notable lifestyle changes [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Accordingly, the COVID-19 pandemic has been associated with an overall rise in mortality from various causes, including alcohol-related deaths\u0026mdash;such as those due to alcoholism and alcoholic liver disease\u0026mdash;primarily due to the heightened health risks associated with alcohol consumption [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFurthermore, alcohol use is linked to negative social, economic, and cognitive outcomes, which may hinder academic performance among students [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. It has also been consistently associated with engagement in high-risk behaviors, including unprotected sexual activity and interpersonal violence within romantic or dating contexts. These behaviors substantially elevate the risk of exposure to sexually transmitted infections (STIs), a particularly concerning issue given their already high prevalence among adolescents and young adults\u0026mdash;the predominant demographic in university settings [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Moreover, alcohol consumption has been linked to increased rates of criminal activity and domestic violence or abuse, patterns that were further exacerbated during the COVID-19 pandemic [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite being aware of the harmful and potentially dangerous consequences of alcohol use, many young people continue to drink, driven by social pressures, the pursuit of relief, pleasure, and the perceived positive effects of intoxication [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Based on this context, the aim of this study was to analyze alcohol consumption among university students in southern Brazil and to assess its increase during the lockdown period in the early stages of the COVID-19 pandemic.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a cross-sectional study conducted between July and November 2020 with undergraduate students from Southern Brazil, using an online, self-administered questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval and Compliance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Research Ethics Committee of the Federal University of Rio Grande (CEPAS-FURG), under approval number 34030720.8.0000.5324, issued in 2020. The study adhered to the principles of the Declaration of Helsinki throughout its experimental approach involving human participants.\u003c/p\u003e\n\u003cp\u003eAll participants were volunteers and did not receive any form of compensation. On the first page of the questionnaire, participants were presented with an informed consent form outlining the objectives of the study, as well as the associated risks and their rights. Only individuals who provided informed consent were granted access to complete the questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size and Eligibility Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was determined based on the total number of students enrolled in undergraduate programs at higher education institutions in the Southern region of Brazil (comprising the states of Paraná, Rio Grande do Sul, and Santa Catarina). This information was obtained from the most recent census conducted in 2018 by the \u003cem\u003eInstituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira\u003c/em\u003e (National Institute of Educational Studies and Research Anísio Teixeira), available at http://portal.inep.gov.br/basica-censo-escolar-sinopse-sinopse. The sample size was calculated using the online platform https://comentto.com/calculadora-amostral/, considering a 5% margin of error, a 95% confidence interval, and assuming a heterogeneous population. According to the census, a total of 1,428,267 undergraduate students were enrolled in the region, resulting in a minimum sample size of 1,152 participants. To account for potential losses, an additional 10% was added, raising the required sample size to 1,268 students.\u003c/p\u003e\n\u003cp\u003eTo be eligible for participation, individuals had to meet the following inclusion criteria: be at least 18 years old, reside exclusively in one of the Southern states of Brazil (Paraná, Rio Grande do Sul, or Santa Catarina), be enrolled in an undergraduate program, and provide informed consent by agreeing to participate and completing the questionnaire. Individuals enrolled in high school, technical, or postgraduate programs, as well as those residing outside the Southern region or who did not complete the questionnaire in full, were excluded from the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors developed a digital questionnaire designed to collect information on sociodemographic characteristics, self-perceived health, and lifestyle behaviors across two distinct time points: the period prior to the COVID-19 pandemic (referring specifically to the time before March 2020, using past-tense phrasing) and the initial phase of the pandemic (data collection concluded in November 2020) [26]. The decision to create a customized instrument was based on the fact that, at the onset of the pandemic, there were no validated or standardized questionnaires addressing the specific context under investigation.\u003c/p\u003e\n\u003cp\u003eThe questionnaire was hosted on the free online platform Google Forms® to ensure broad accessibility while adhering to public health guidelines regarding social distancing during the pandemic period. Participant recruitment was carried out through social media campaigns and emails sent directly to higher education institutions across the Southern region of Brazil.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePrior to launching the main survey, a pilot study was conducted with a convenience sample of students (n = 15) who were not included in the final analysis. This step was undertaken to evaluate the clarity and applicability of the questionnaire. To ensure confidentiality, all responses were collected anonymously.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDependent variables – Alcohol consumption\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlcohol consumption was assessed through the question “Do you consume drugs legally or illegally?” in the section of the questionnaire related to regular life (before the pandemic period), with response options “yes” (with a blank space to specify the drug) or “no”. The increase in alcohol consumption was evaluated in a binary manner using the question “Did you increase this drug consumption during the pandemic?” with “yes” or “no” as response options. The frequency of alcohol consumption was measured for both periods—before and during the pandemic—using the question “How often do you consume?” with the following answer choices: “daily”, “two or more times per week”, “once a week”, “two or more times per month”, and “once a month”.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIndependent Variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe independent variables were collected as follows: nominal variables (gender, age, ethnicity, state of residence, type of residence, college course, type of university, and occupation) and ordinal variables (family income and health status). Additional independent variables related to participants' health and habits were collected as dichotomous variables using yes/no questions (e.g., “Do you have a chronic disease?”, “Did you practice social distancing during the pandemic?”, among others).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analyses were conducted using SPSS version 20. Frequencies (absolute and relative) of the sample characteristics were calculated, and associations between increased alcohol consumption and demographic, health, and lifestyle variables before and during the pandemic were analyzed using Chi-square and Fisher’s exact tests. Statistical significance was defined as \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003eTo identify variables potentially associated with increased alcohol consumption during the pandemic, bivariate and multivariate analyses were performed using Poisson regression. The analysis was structured in two hierarchical levels to control for confounding factors. The first level included sociodemographic variables (age, gender, ethnicity, academic course, type of university, student occupation, and income), while the second level comprised health-related variables (presence of chronic disease, presence of psychiatric disorders, social distancing during the pandemic, household composition during the pandemic, perceived decline in health, onset of new symptoms or illnesses, self-medication during the pandemic, and confirmed COVID-19 diagnosis).\u003c/p\u003e\n\u003cp\u003eInitially, crude analyses were conducted for each independent variable in relation to the dependent variable (increased alcohol consumption). Variables with associations at \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.200 were retained for the adjusted model [27]. Final associations were considered statistically significant at \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05 and are reported with their corresponding prevalence ratios (PR) and 95% confidence intervals (95% CI).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 1,553 valid responses were included in this study. Most participants were female, white, and aged between 18 and 29 years. Among the students who reported an increase in alcohol consumption, the majority were aged 18\u0026ndash;29 years (85.9%), female (72.2%), white (80.2%), enrolled in non-health and non-biological science degree programs (61.7%), attending public universities (71.0%), employed or engaged in internships (54.0%), and reported a monthly family income of up to BRL 2,100 (37.9%) (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). A statistically significant association was observed between increased alcohol consumption and student income (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.046).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSociodemographic factors associated with the increase of alcohol consumption during the COVID-19 pandemic (n/%)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eIncrease in alcohol\u0026rsquo;s consumption\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u0026ndash;29 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e213 (85.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1153 (88.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.287\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35 (14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e152 (11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e179 (72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e928 (71.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.760\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e69 (27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e377 (28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e199 (80.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1071 (82.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.530\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-white\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e49 (19.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e234 (17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGraduation course\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHealth and biological sciences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e95 (38.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e559 (42.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.207\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e153 (61.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e746 (57.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eUniversity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePublic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e176 (71.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e914 (70.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.820\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e72 (29.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e391 (30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJob or internship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e134 (54.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e627 (48.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJust study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e114 (46.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e678 (52.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncome (BRL)*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUp to 2,100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e94 (37.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e428 (33.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.046\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,101-5,250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e84 (33.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e544 (41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5,251\u0026thinsp;\u0026minus;\u0026thinsp;10,450\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36 (14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e199 (15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMore than 10,451\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34 (13.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e124 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e\u003cstrong\u003eStatistical test used Chi-square *Fischer\u0026rsquo;s exact test\u003c/strong\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAmong all participants, 1,552 students (99.93%) reported consuming alcohol regularly prior to the COVID-19 pandemic. The most frequently reported pattern was alcohol consumption once a week (41.0%), followed by two to three times per month (24.7%) and two or more times per week (22.5%). During the pandemic, of these 1,552 students, 247 reported an increase in their alcohol consumption. The most frequently reported consumption patterns during this period were daily use (8.5%) and two or more times per week (29.9%), both of which were statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.003, respectively). These findings indicate that students began consuming alcohol more frequently during the pandemic (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eFurthermore, during the pandemic the increase in the consumption of substances identify alcohol as the most consumed, followed by marijuana (17.8%), cigarette (15.4%) and other drugs (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eMost students did not report having a chronic disease (58.1%) or a psychiatric disorder (68.5%). During the early period of the pandemic, the majority left home only for essential activities (58.9%) and were living with family or friends (90.7%). Additionally, most students perceived a decline in their own health status (60.5%), did not report the onset of new symptoms or diseases (91.1%), and did not receive a confirmed COVID-19 diagnosis (99.2%). However, a significant proportion reported practicing self-medication (62.5%) (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eClinic and COVID-19 related variables associated with the increase of alcohol consumption\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eIncrease of alcohol\u0026rsquo;s consumption\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eChronic disease\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104 (41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e460 (35.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e144 (58.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e845 (64.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychiatric disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78 (31.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e337 (25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e170 (68.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e968 (74.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial distancing practice*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo measure of social distancing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGo out for work but avoid crowds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75 (30.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e341 (26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGo out only for essential activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e146 (58.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e783 (60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDoing total isolation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e139 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLiving\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e99 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.368\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith family or friends\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e225 (90.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1206 (92.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRealize a decrease in health status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e150 (60.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e641 (49.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e98 (39.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e664 (50.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eNew symptoms or disease during COVID-19 pandemic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e183 (14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.031\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e226 (91.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1122 (86.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003ePractice self-medication during COVID-19 pandemic#\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e155 (62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e733 (56.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e572 (43.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOVID-19 infection diagnosticated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e246 (99.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1269 (97.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e\u003cstrong\u003eStatistical test used Chi-square *Fischer\u0026rsquo;s exact test\u003c/strong\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e#Self-medication is the use of medication without a doctor\u0026apos;s or dentist\u0026apos;s prescription or without the supervision of a health professional.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the association analysis, the students who reported a decrease in their own health status during the early period of COVID-19 pandemic presented a lower probability of increasing the alcohol consumption (Exp B\u0026thinsp;=\u0026thinsp;0.927, CI 0.887\u0026ndash;0.969; p\u0026thinsp;=\u0026thinsp;0.001) but those who had a diagnosticated COVID-19 infection presented a higher probability of it (Exp B\u0026thinsp;=\u0026thinsp;1.146, CI 1.053\u0026ndash;1.247; p\u0026thinsp;=\u0026thinsp;0.002). No more associations were significant (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAssociation between sociodemographic, clinical and COVID-19 related characteristics with the increase of alcohol consumption during pandemic\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLevel\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCrude analysis\u003c/p\u003e\n \u003cp\u003e(Exp B, 95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAdjusted analysis\u003c/p\u003e\n \u003cp\u003e(Exp B, 95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u0026ndash;29 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.03 (0.96\u0026ndash;1.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.99 (0.94\u0026ndash;1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.731\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.02 (0.96\u0026ndash;1.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.508\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-white\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGraduation course\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHealth and biological sciences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.03 (0.98\u0026ndash;1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.02 (0.97\u0026ndash;1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.346\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eUniversity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePublic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.99 (0.94\u0026ndash;1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.768\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJob or internship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.96 (0.92-1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.96 (0.91-1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJust study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncome (BRL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUp to 2,100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.04 (0.95\u0026ndash;1.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.05 (0.96\u0026ndash;1.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,101-5,250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.10 (1.01\u0026ndash;1.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.11 (1.01\u0026ndash;1.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5,251\u0026thinsp;\u0026minus;\u0026thinsp;10,450\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.07 (0.97\u0026ndash;1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.08 (0.98\u0026ndash;1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMore than 10,451\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eChronical disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.95 (0.91-1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.97 (0.92\u0026ndash;1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.216\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychiatric disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.95 (0.90-1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (0.92\u0026ndash;1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.907\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial distancing practice\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo measure of social distancing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.88 (0.76\u0026ndash;1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.87 (0.75\u0026ndash;1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGo out for work but avoid crowds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.91 (0.85\u0026ndash;0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.91 (0.84\u0026ndash;0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGo out only for essential activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.94 (0.88\u0026ndash;0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.93 (0.88\u0026ndash;0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDoing total isolation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLiving\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.96 (0.88\u0026ndash;1.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.402\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith family or friends\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRealize a decrease in health status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.93 (0.89\u0026ndash;0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.92 (0.88\u0026ndash;0.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNew symptoms or disease during COVID-19 pandemic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.07 (1.01\u0026ndash;1.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.02 (0.96\u0026ndash;1.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.375\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePractice self-medication during COVID-19 pandemic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.96 (0.91-1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.97(0.92\u0026ndash;1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.165\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOVID-19 infection diagnosticated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.13 (1.04\u0026ndash;1.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.14 (1.05\u0026ndash;1.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study revealed an extremely high and alarming prevalence of alcohol consumption among university students. This population is recognized as one of the largest consumers of alcoholic beverages worldwide, partly due to increased independence and physical distance from parental supervision during this life stage [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Consequently, the college period may represent a critical phase for the initiation or establishment of alcohol consumption patterns. Supporting this, a French study identified alcohol consumption between 18 and 25 years of age as a potential predictor of alcohol dependence in later adulthood, indicating that drinking behaviors in young adults may contribute to health problems later in life [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough most participants did not consume alcohol daily before the pandemic, the World Health Organization (WHO) emphasizes that no level of alcohol consumption is risk-free\u0026mdash;the quantity and frequency of alcohol intake determines the extent of harm to the human body [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Excessive consumption\u0026mdash;whether by volume or frequency\u0026mdash;is associated with an increased risk of various diseases, including those affecting the digestive and cardiovascular systems, multiple cancer types, immune system impairment, and mental health and behavioral disorders such as depression and anxiety [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAmong the substances analyzed, alcohol was the most frequently consumed during the early pandemic period. Nearly the entire sample reported monthly alcohol use, and the reported increase in consumption during the early pandemic is cause for concern. In our study, alcohol consumption increased in both daily frequency and frequency multiple times per week, reflecting a more sustained pattern of use that is known to be detrimental to health and linked to disease development. Similar findings were reported in an Argentinian study, which documented a 20% increase in alcohol consumption among young adults aged 18 to 24 years and a 45% increase among adults aged 35 to 45 years [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFurthermore, an increase in alcohol consumption among college students as a coping mechanism for depression and depressive symptoms was observed following the onset of the COVID-19 pandemic, persisting into later phases of the pandemic in 2021. This suggests that prolonged exposure to stringent social restrictions may influence increased alcohol use [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. An Australian study involving 4,462 participants found that 30.8% reported drinking \u0026ldquo;a lot more than normal\u0026rdquo; during the early pandemic, with depression and stress identified as significant correlates [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. These data indicate that stressful periods, such as the COVID-19 pandemic restrictions, can modulate alcohol consumption patterns.\u003c/p\u003e\u003cp\u003eAlcohol remains the most commonly consumed psychoactive substance worldwide due to its generally low cost and its social disinhibitory and anxiolytic effects [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. During the pandemic, university students experienced fear regarding their future and the risk of COVID-19 infection, alongside feelings of loneliness and disrupted routines\u0026mdash;factors contributing to a psychological burden documented in several studies. In this context, alcohol may be used as a form of escapism, consistent with research showing increased alcohol use during stressful or catastrophic events [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, a comparative study of pre-drinking behaviors (consumption prior to social events) among Brazilian and British university students demonstrated that alcohol consumption was associated with missed classes and work obligations [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Additionally, students reported experiences of physical violence, sexual harassment, blackouts, coma, or vomiting related to alcohol use [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Other studies have linked alcohol consumption to higher risks of physical altercations, homicides, and traffic accidents, making it a leading cause of mortality among young people and a risk factor for subsequent use of other drugs. Thus, alcohol represents a significant hazard for students [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBeyond these risks, alcohol consumption is also associated with mental health disorders. Corroborating this, the COVID-19 pandemic itself was a stressful period linked to increased mental health problems. Brazilian students already exhibit high prevalence rates of depression, ranging from 28.6\u0026ndash;50.0%, and during the pandemic, a large study found that alcohol and other drug use heightened the risk of progressing from moderate to severe depression [\u003cspan additionalcitationids=\"CR40\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Factors such as fear of coronavirus infection, social distancing measures, and disruption of social routines with friends and peers were cited as drivers for increased alcohol consumption aimed at alleviating sadness and depressive symptoms [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan additionalcitationids=\"CR40 CR41\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMoreover, a positive diagnosis of COVID-19 infection was associated with increased alcohol consumption among students. This association was also observed in a smaller study with 406 students, which reported increased alcohol use among those with confirmed COVID-19 infection [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. It is important to note that alcohol is an immunosuppressant and may promote susceptibility to respiratory infections, including COVID-19 and other communicable diseases [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Additionally, alcohol consumption among young people often occurs in social settings, increasing the risk of COVID-19 transmission via respiratory droplets, regardless of symptom presentation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite the high prevalence of alcohol consumption observed, students who reported a decline in their health status did not increase their drinking during the pandemic. This may reflect heightened health concerns among these students, especially considering the healthcare system overload and increased risk of coronavirus exposure during this period [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Supporting this notion, a study of first-year students found that non-drinkers exhibited greater resilience in coping with the pandemic and its associated disruptions [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Awareness of alcohol\u0026rsquo;s harms may therefore influence consumption behavior during exacerbating conditions such as an infectious disease pandemic.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy limitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOur study was conducted at the onset of the COVID-19 pandemic and encompassed three months of data collection. This may represent a limitation regarding students\u0026rsquo; adaptation to the new living conditions imposed by the pandemic, potentially influencing their alcohol consumption patterns, given that the pandemic lasted approximately three years and many behavioral changes occurred throughout this extended period. Furthermore, during the data collection phase, students were still adjusting to remote learning. Additionally, we did not quantify the volume of alcohol consumed by the students and instead assessed alcohol consumption based on self-reported data.\u003c/p\u003e\u003cp\u003eMoreover, inherent limitations of the cross-sectional study design include the inability to establish causal relationships, the inability to evaluate changes over time, and the potential for bias.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study contributed to identifying the prevalence of alcohol consumption among college students from Southern Brazil. Given the alarming findings, it is imperative to develop new educational strategies addressing alcohol-related health and social issues, aiming to reduce the number of young individuals who initiate or increase drinking. Furthermore, our findings regarding the increase in alcohol consumption during the early period of the COVID-19 pandemic may help predict behavioral changes during stressful periods and inform preventive measures to mitigate such effects.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive funding for its execution at any time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analyzed during the current study are not available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs already mentioned in the \u0026ldquo;Ethical approvals\u0026rdquo; section, the work was approved by the University\u0026apos;s Research Ethics Committee of the Federal University of Rio Grande (CEPAS-FURG), under approval number 34030720.8.0000.5324, issued in 2020.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll human rights related to research involving human beings have been respected in this work. The participants were given a Free and Informed Consent Form explaining their rights and the research itself for them to read and make the decision to take part. Only after giving their consent did the participants have access to the questionnaire.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the participants agreed to have their anonymous data published in articles and scientific papers, as stated in the Informed Consent Form.\u003c/p\u003e\n\u003cp\u003eAll the authors listed in this paper also approved its publication.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. (2020) Coronavirus disease (COVID-19) advice for the public. In: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public\u003c/span\u003e\u003cspan address=\"https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSohrabi C, Alsafi Z, O\u0026rsquo;Neill N, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg. 2020;76:71\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZysset A, Volken T, Amendola S, von Wyl A, Dratva J. Change in Alcohol Consumption and Binge Drinking in University Students During the Early COVID-19 Pandemic. 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The Effect of Social and Stress-Related Factors on Alcohol Use Among College Students During the Covid-19 Pandemic. J Adolesc Health. 2021;69(4):557\u0026ndash;65. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jadohealth.2021.06.016\u003c/span\u003e\u003cspan address=\"10.1016/j.jadohealth.2021.06.016\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"alcohol use, university students, alcoholic beverages, COVID-19 pandemic, psychoactive substances","lastPublishedDoi":"10.21203/rs.3.rs-7037809/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7037809/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eAlcohol is the most commonly consumed psychoactive substance worldwide, with university students representing a subgroup characterized by elevated consumption rates. The COVID-19 pandemic triggered significant behavioral shifts across the general population, with students particularly vulnerable to its psychosocial impacts. In this context, the present study aimed to assess alcohol consumption patterns among university students and to examine the influence of the early stages of the COVID-19 pandemic on these behaviors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e A cross-sectional study was conducted between July and November 2020 using an online questionnaire. The instrument collected data on students’ lifestyle habits, health status, and substance use, both prior to and during the early phase of the COVID-19 pandemic.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 1,553 valid responses were analyzed, of which 99.93% reported alcohol consumption. The most frequently reported pattern of use was weekly consumption. During the pandemic, 248 students indicated an increase in their alcohol intake. Students who perceived a decline in their overall health status during the early pandemic period were less likely to report increased alcohol consumption, whereas those with a confirmed COVID-19 diagnosis demonstrated a higher likelihood of increased use.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The findings reveal a high prevalence of alcohol consumption among university students and suggest that periods marked by abrupt behavioral and routine changes, such as the COVID-19 pandemic, may significantly influence substance use patterns within this population.\u003c/p\u003e","manuscriptTitle":"Alcohol use by university students of South Brazil and its changes during the early COVID-19 pandemic","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-29 12:37:39","doi":"10.21203/rs.3.rs-7037809/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"96b8d670-6019-4131-a540-a6488cb15f48","owner":[],"postedDate":"August 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-21T09:54:36+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-29 12:37:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7037809","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7037809","identity":"rs-7037809","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}