Introduction

During adolescence, physical and psychological changes occur that mark the transition from puberty to adulthood (^{Terra Júnior et al., 2021}). The presence of protective factors influences moral and social development, since the social group can pose a risk for negative experiences (^{Zeitoune et al., 2012}). Additionally, hormonal conflicts and the search for new experiences increase vulnerability to alcohol consumption (^{Terra Júnior et al., 2021}).

Alcohol abuse is associated with millions of deaths worldwide (^{World Health Organization, 2017}). In 2017, global alcohol consumption was estimated at 6.2 liters per person aged 15 years or older, with alcohol being the most commonly used psychoactive substance among adolescents (^{World Health Organization, 2017}; ^{Benincasa et al., 2018}). In 2019, 2.6 million deaths were attributed to its consumption. According to the ^{World Health Organization (2024)}, alcohol accounted for 5.5% of all deaths in the Americas and 6.7% of all disability-adjusted life years. Additionally, 8.2% of the population over the age of 15 has an alcohol use disorder.

During the COVID-19 pandemic, alcohol consumption increased compared to previous years, despite the closure of bars and restaurants (^{Adamoli et al., 2020}). This growth has been attributed to changes in routine, social distancing, stress, emotional instability, grief, future uncertainties, and financial problems (^{Rehm et al., 2020}; ^{Willsher, 2020}; ^{Ministry of Health, 2020}).

Starting from this context of alcohol use among adolescents, the following guide question of the study emerged: What is the prevalence and factors associated with alcohol consumption among adolescents enrolled in basic education during the social isolation caused by the COVID-19 pandemic? Thus, the aim of this study was to evaluate the consumption of alcoholic beverages among high school/technological adolescents during the COVID-19 pandemic.

Method

This is an observational, cross-sectional study, developed on three campuses of the Federal Institute of Maranhão, located in Imperatriz, Barra do Corda and Coelho Neto. The study population consisted of adolescents and the sample size was determined by calculating finite populations, and a sample of 334 students was required:

Adolescents aged 14 to 18 years, attending remote or in-person classes in the morning and afternoon shifts, were included, excluding those without internet access, as the study was conducted virtually. Data collection took place from November 2021 to May 2022 via Google Forms, with the link sent through class group chats via instant messaging. On the initial page of the questionnaire, there was an Informed Assent Form (IAF), and only after both the adolescent's assent and the legal guardian's authorization could the participant proceed to the questionnaire stage. In the case of adolescents aged 18 years, after accepting to participate in the research, with the click on “accept” in the Informed Consent Form (ICF) the system granted access to the questionnaire stage.

The research was regulated by Resolution No. 466/12 of the National Health Council (CNS) and was approved by the Research Ethics Committee of the Federal University of Piauí (UFPI) (Opinion No. 4,118,472).

The survey link was sent to WhatsApp groups, institutional emails, and social media of each school. In each unit, a staff member from the student affairs coordination disseminated the link and invited the adolescents, following prior briefing about the study. The questionnaire was divided into two categories. The first contained questions developed by the researchers and addressed sociodemographic and economic aspects, including variables such as age, ethnicity, sex, education level, housing conditions, number of people living in the household, monthly income, and employment status. The second category focused on alcohol consumption.

To identify the pattern of alcohol consumption during social isolation, the AUDIT–a quick and specific instrument (81% accuracy) for detecting harmful use, validated in Brazil and other countries–was applied (^{Silva et al., 2019}).

The risk in this study was the possible identification of participants through their responses; however, anonymity was ensured by not allowing names to be provided. To avoid influence from parents or guardians, students were instructed to respond without third parties present and to submit the form immediately to block further access. External participation was also prevented, as the form required an institutional email for access.

Data were double-entered for error correction, organized in Excel, and analyzed using SPSS version 20. The sample was characterized by descriptive statistics, including means, standard deviations, and absolute and relative frequencies. Normality was assessed using the Kolmogorov-Smirnov test. Associations were evaluated by odds ratios (OR) with 95% confidence intervals. Logistic regression was used to analyze relationships between variables, with a significance level set at 0.05.

In the analysis of data on alcohol consumption, the variable “used at least once” was considered for affirmative responses, regardless of the reported frequency, and the variable “never used” was considered for negative responses.

Results

Out of 2,507 adolescents enrolled across three campuses, 344 participated; after excluding 2 incomplete questionnaires, the final sample comprised 342 participants. To describe the sample, absolute and relative frequencies were used for qualitative variables, and mean ± standard deviation (SD) for quantitative variables. The Kolmogorov-Smirnov test assessed normality. In bivariate analysis, Pearson's chi-square test, Fisher's exact test, Mann-Whitney U test for two categories, and Kruskal-Wallis test for three or more categories were applied.

To identify factors associated with alcohol consumption, binary logistic regression was performed, presenting crude odds ratios (OR) with 95% confidence intervals. Data were entered into Excel and analyzed using SPSS version 20, with a significance level set at p < 0.05.

Most participants were under 16 years old (179; 52.3%). Females predominated (223; 62.3%) over males (129; 37.7%). Regarding ethnicity, 255 (74.6%) self-identified as Brown, 56 (16.4%) as White, 28 (8.2%) as Black, 2 (0.6%) as Indigenous, and 1 (0.3%) as Yellow-skinned.

Regarding the school year, 113 (33%) were in the 1st year, 105 (30.7%) in the 2nd year, and 124 (36.3%) in the 3rd year of high school. Most participants (324; 94.7%) lived in masonry houses, 1 (0.3%) in a stilt house, 4 (1.2%) in an apartment building, and 13 (3.8%) in a wattle and daub house. Regarding the employment status of the head of household, 185 (54.1%) were employed, 61 (17.8%) held informal jobs, 72 (21.1%) were unemployed but received government assistance, and 24 (7%) were unemployed without assistance. Household income varied among participants: 116 (33.9%) reported earning up to one minimum wage, 115 (33.6%) reported earning more than one minimum wage, 97 (28.4%) stated they earned less than one minimum wage, and 14 (4.1%) reported having no income at all.

Regarding the frequency of alcohol consumption, 108 (31.6%) reported drinking at least once and 234 (68.4%) stated that they did not consume. In reference to the amount of alcoholic beverage on a normal day, 107 (31.3%) entered the variable “used at least once” and 235 (68.7%) in “never used". When asked about the frequency of consumption of six drinks or more on a single occasion, 63 (18.4%) entered the variable “used at least once” and 279 (81.6%) in “never used”.

Regarding difficulty in stopping drinking, 13 (3.8%) reported having experienced it, while 329 (96.2%) did not. Concerning failure to complete daily tasks due to alcohol, 11 (3.2%) reported difficulties, whereas 331 (96.8%) did not. Regarding drinking early in the day to “cure” a hangover, 9 (2.6%) reported having done so, and 333 (97.4%) did not. Additionally, 32 (9.4%) reported forgetting events from the previous day due to alcohol consumption, compared to 310 (90.6%) who did not.

Regarding feeling guilty about drinking, 28 (8.2%) answered yes and 314 (91.8%) no. Concerning concern from family members or professionals due to abusive alcohol behavior, 7 (2%) reported it had occurred, while 335 (98%) did not. Finally, 22 (6.4%) stated they had injured themselves or others because of alcohol consumption, whereas 320 (93.6%) denied this (Table 1).

According to the AUDIT score, 314 (91.8%) adolescents were in Zone I, indicating the need for primary intervention; 20 (5.9%) were in Zone II, requiring basic guidance; 2 (0.6%) were in Zone III, recommending brief intervention and follow-up; and 6 (1.8%) were in Zone IV, indicating referral to specialized services.

Discussions

Some studies have reported an increase in alcohol consumption among adolescents during social isolation (^{Luca et al., 2020}; ^{Grigoletto et al., 2020}; ^{Ahmed et al., 2020}), while others indicated a reduction before the pandemic (^{WHO, 2017}; ^{Pennay et al., 2018}) and during the first six months of the COVID-19 pandemic (^{Pelham et al., 2021}). ^{Dumas et al. (2020)} observed stability in the number of adolescents who consumed alcohol, but an increase in the frequency of use among girls.

The literature identifies alcohol as one of the most commonly used substances among adolescents (^{Jongenelis et al., 2019}; ^{Peltzer & Pengpid, 2021}; ^{Crane et al., 2021}; ^{Pelham, 2021}), which is consistent with the findings of this study, showing a consumption rate of 26.6%. Alcohol abuse is considered a risk factor for the use of other drugs and is associated with absenteeism, poor academic performance, school failure, and dropout (^{Soares et al., 2019}).

In this study, 108 adolescents (31.6%) consumed alcohol at least once in the past year, and 63 (18.4%) consumed six or more drinks on a single occasion. This excessive consumption, known as binge drinking, is common among individuals aged 12 to 17 (^{White, 2020}; ^{Alcover, 2021}) and is associated with polysubstance use, influenced by lack of family and peer support, weak parental bonds, school dropout (^{Rodzlan Hasani, 2021}), sociodemographic factors, low income (^{Halladay et al., 2020}), anxiety, and depression (^{Williams at al., 2021}).

The scientific literature has shown growing concern regarding alcohol consumption among adolescents, especially when related to contexts of social and emotional vulnerability. A bibliometric study analyzing publications on the topic between 1973 and 2022 highlighted a strong correlation between substance use and mental health issues such as anxiety, depression, and suicidal behavior (^{Costa & Silva-Júnior, 2024}).

Adolescents who begin drinking alcohol at an early age tend to experiment with other substances rather than reduce use over time (^{Choi et al., 2018}; ^{Merrin et al., 2018}). In this study, the consumption of six or more drinks was more frequent among those over 16 years old and 3rd-year high school students, confirming that this practice is more common in late adolescence (^{Peltzer & Pengpid, 2021}; ^{Rodzlan Hasani, 2021}; ^{Choi et al., 2018}).

Among the adolescents, 20 (5.85%) required basic guidance, 2 (0.58%) brief intervention, and 6 (1.75%) referral to specialized services. According to Campollo et al. (2018), early identification of mental health problems related to substance use is essential for appropriate referral.

This study revealed higher alcohol consumption among female adolescents, a phenomenon already observed in recent investigations on substance use patterns between genders over the past decade (^{Horta et al., 2007}; ^{Malbergier et al., 2012}; ^{Ferreira & Machado, 2013}; ^{Jackson et al., 2016}; ^{Peltier et al., 2019}; ^{Malta et al., 2021}; ^{Malta et al., 2022}; ^{Obeid et al., 2022}; ^{Freitas et al., 2023}; ^{Costa et al., 2024}; ^{Ramos et al., 2024}).

Although historically alcohol consumption has been higher among men, this difference has decreased, resulting in similar patterns between the sexes (^{Nadaleti et al., 2018}; ^{Mohale & Mokwena, 2020}). Binge drinking is more common among men but has also increased among women between 2006 and 2018 (^{Merrin et al., 2018}; ^{McKetta & Keyes, 2019}).

The change in women’s social roles may contribute to this increase due to overload, stress, reduced stigmas, and access to spaces previously dominated by men (^{Sanchez et al., 2020}; ^{Haighton et al., 2018}; ^{Andrade, 2021}). Early initiation and growth in consumption are concerning for public health and should be a focus of women’s health programs, as biologically they are more sensitive to the effects of drugs (^{Andrade, 2021}).

In this study, a higher frequency of alcohol consumption was observed among Black adolescents, a trend also identified in other epidemiological investigations. In the Brazilian context, adolescents aged 15–17 who self-identified as Black or Brown are approximately 60% more likely to engage in binge drinking (^{Medeiros et al., 2022}).

The Black population is the most affected by alcohol-attributable deaths in Brazil, according to the report Alcohol and the Health of Brazilians: Panorama 2024 by CISA. In 2022, the alcohol-attributable mortality rate was 10.4 per 100,000 inhabitants among Black individuals, compared to 7.9 among Whites, approximately 30% higher. These data highlight the unequal impact of alcohol consumption among White, Black, and Brown populations, evidencing the vulnerability of the Black population (^{Andrade, 2024}).

Structural racial inequalities in Brazil exacerbate the impacts of alcohol consumption on the Black population. Limited access to healthcare, education, and housing, combined with structural racism and socioeconomic vulnerability, hinders treatment and intensifies the harmful effects of alcohol in this group (^{Andrade, 2024}; ^{Batista & Kalckmann, 2021}).

This study found that alcohol consumption was more frequent among adolescents with family income above one minimum wage, which means that the higher socioeconomic condition contributes to drug use, due to the resources for purchasing the product (^{Reis & Oliveira, 2015}; ^{Lu et al., 2015}; ^{Jackson et al., 2016}).

The cross-sectional design limits the identification of causal relationships between substance use and the variables analyzed. Convenience sampling compromises representativeness and may introduce biases, especially due to the small sample size. Virtual data collection, necessary because of remote learning, may have hindered participation of students with limited access to electronic devices, affecting the sample composition.

Additionally, the higher number of female participants, combined with the absence of homogeneity testing between groups, may have influenced the findings related to the increase in alcohol consumption among women. These factors highlight the need for studies using probabilistic sampling, with balanced gender distribution, to allow for greater generalizability of the findings and better control of potential biases, particularly in the post-COVID-19 pandemic context.

Finally, it is important to note that the data were obtained exclusively from adolescents enrolled in school, which may limit the extrapolation of results to out-of-school youth, especially regarding patterns of polysubstance use.

Conclusion

A high rate of alcohol consumption was observed among women, a finding frequently reported in recent studies indicating that alcohol use among women is increasing and approaching or matching that of men, regardless of age group. However, the association between ethnicity and alcohol consumption in this study differs from other scientific evidence, indicating that it is not coherent to classify being Black as a risk factor for alcohol use. This highlights the need for collaborative longitudinal studies on a global scale to deepen the understanding of this issue and to inform public policies on prevention and health education. Such efforts are essential to strengthen strategies for preventing alcohol use and related diseases in adolescents, taking into account the specific patterns of psychoactive substance use in this age group.

Given the findings, significant knowledge gaps remain regarding the impact of the COVID-19 pandemic on adolescent alcohol use. The current body of evidence presents a mixed picture—some studies report a decrease in substance use, others an increase, and some suggest varied effects. In this context, the results of this study contribute to the ongoing discourse and enhance the understanding of the topic.