Research paper
Polydrug use among nightclub patrons in a megacity: A latent class analysis

https://doi.org/10.1016/j.drugpo.2015.07.012Get rights and content

Highlights

  • Three groups of drug users were found in São Paulo nightclubs.

  • It is more likely to find high level polydrug users in electronic or hip-hop nightclubs.

  • Frequency of attendance, gender and age are associate to the two polydrug groups.

  • Binge drinking was a predominant behaviour in all groups.

Abstract

Background

Nightclubs are places with a high prevalence of binge drinking and illicit drug use. The aim of this study was to evaluate the characteristics of polydrug use, including licit and illicit drugs, among 2420 nightclub patrons in a probabilistic sample in the city of São Paulo, Brazil,

Methods

The study was conducted in 2013. A latent class analysis (LCA) of polydrug use, accounting for binge drinking (BD) and other drug use (cannabis, cocaine, ecstasy, tobacco, ketamine, inhalants and hallucinogens) in the past 12 months was performed using Mplus. Multinomial logistic regression was used to evaluate latent class associations with sociodemographic characteristics and variables that characterise type of nightclub and frequency of attendance.

Findings

A three-class LCA model best described polydrug use patterns. We found a “no polydrug use” class (55%), a “moderate polydrug use” class (35%) and a “high level polydrug use” class (10%). Compared to “no polydrug use”, patrons in the two “polydrug use classes” were more likely to be men, young adults (<34 years), have attended nightclubs three times or more per month and have attended hip-hop and rock music nightclubs. Patrons in the “high level polydrug use” class were more likely to attend electronic (aOR = 9.9, 95% CI: 5.4–8.1, p < 0.001) and hip-hop music nightclubs (aOR = 10.1, 95% CI: 6.2–16.5, p < 0.001).

Conclusion

LCA is a useful method to identify groups of polydrug users among nightclub patrons. The three groups identified represented the diversity of patrons of São Paulo nightclubs. Frequency of attendance and the nightclub's musical style were highly correlated with polydrug use.

Introduction

São Paulo is the most populous city in Brazil and in the Southern hemisphere, with more than 11 million inhabitants (IBGE, 2014). The nightlife of São Paulo is arguably one of its greatest attractions, as observed by tourists and experts worldwide. According to a CNN (Cable News Network) survey, São Paulo offers the 4th best nightlife in the world, receiving a grade of nine out of 10 for working hours, people and experience (Manson, 2014). The night-time economy is lucrative, raising US$ 770 million (R$ 2.4 billions) annually (Muniz, Silva, & Maffezzolli, 2014) for the Brazilian economy.

In “the city that never sleeps”, patrons can attend all types of nightclubs, from the regular venue with pop-dance music, to electronic music nightclubs that open at dawn and close the next afternoon. Patrons can choose nightclubs from a diverse range of musical styles, such as funk (high sexual connotation dance and lyrics), “forró” (typical Brazilian ballroom dance), electronic and flashback. Besides music preferences, venues in São Paulo are characterised by the socioeconomic class and sexual orientation of their patrons. This is often related to the neighbourhood where the club is located and the cost of entry (Silva, 2014).

Worldwide, nightclubs are generally places visited by youths and young adults who are seeking entertainment and where the use of alcohol and other drugs act as important mediators (Demant, 2013). According to Calafat et al. (2011), the recreational context of the nightclub is associated with the misuse of alcohol and other drugs, and contributes to increased risk behaviour inside these venues (Duff, 2008). Moreover, patrons of music festivals and dance events have been found to have more experience of illegal drugs use than other groups in the population (Chinet et al., 2007, Winstock et al., 2001).

In the United Kingdom, a nightlife survey demonstrated that the vast majority of club drug users were polysubstance users, with over 70% also reporting hazardous alcohol consumption (Winstock et al., 2001). One of the major concerns about polydrug use is that the effects of the individual drugs are usually boosted, and harmful physiological effects can accumulate in the body (Quek et al., 2013) and increase the likelihood of physical and physiological damage (Smith, Farrell, Bunting, Houston, & Shevlin, 2011).

In several European countries, music preference and venue choice seem to predict illegal drug use (Calafat, Fernández, Juan, & Becoña, 2008). A Danish study that focused on drug initiation at music festivals, found a higher prevalence of first cannabis and tobacco use among attendees of rock festivals (Hesse, Tutenges, & Schliewe, 2010). The same group of researchers found that patrons who prefered hip-hop or electronic music festivals were more likely to be polydrug users, while patrons who prefered pop music were less likely to have used all illicit drugs (Hesse & Tutenges, 2012).

In Brazil, a population survey has shown that nightclubs are the location of choice for young people to practise binge drinking (Sanchez et al., 2011), however, to date no epidemiological survey has identified patterns of consumption of alcohol and drugs among patrons of these venues. All major studies about the nightlife environment have been conducted in Europe (Bellis et al., 2008), North America (Carlson, Wang, Falck, & Siegal, 2005) and Oceania (McKetin, Chalmers, Sunderland, & Bright, 2014), leaving a large gap in knowledge about this behaviour in less wealthy and more unequal countries.

Diagnosis of the risks is the first step in the development of effective harm reduction policies for a given population, thus it is necessary to understand the São Paulo nightlife scene. In this sense, science can inform policy by identifying which groups are more exposed to risks and should be targeted by nightlife harm reduction initiatives, such as: providing free water; organising a “chill out” area with appropriate ventilation, regulation of temperature, and places to sit; staff training for a responsible drinking service and first-aid support during alcohol and drugs intoxication (Van Havere, Vanderplasschen, Lammertyn, Broekaert, & Bellis, 2011).

The study reported here, called “Balada com Ciência” (www.baladacomciencia.com.br) was designed to evaluate the prevalence of risk behaviours practised by nightclub patrons in the city of São Paulo, with an emphasis on alcohol and illicit drug use. We set out to evaluate how concurrent polydrug use is grouped among nightclub patrons by the use of latent class analysis (LCA) and to explore how these different patterns of drug use are associated with sociodemographic factors, frequency of attendance and the music style of the venue.

Section snippets

Methodology

Recruitment and procedures for obtaining informed consent and protecting the rights of study participants was approved by the Research Ethics Committee of the Federal University of São Paulo (Universidade Federal de São Paulo – UNIFESP) (protocol number 795276).

Findings

A total of 3063 patrons were approached at the 31 nightclubs, resulting in 2422 interviews (79.1% acceptance rate at the time of entrance). There was no significant gender difference between those who consented or did not consent to participate in the interview at nightclub entrance (p = 0.945).

Two interviews had missing data in all of the variables required for the construction of latent classes, so the final sample size was 2420 interviews.

Table 1 presents the sociodemographic characteristics

Discussion

LCA was used to classify nightclub patrons of the city of São Paulo according to their drug consumption patterns over the preceding year. A 3-class model (“no polydrug use”, “moderate polydrug use” and “high level polydrug use”) provided the best explanation of polydrug use patterns. “Moderate” or “high level polydrug use” were found in approximately half of the patrons.

Other studies have used LCA to evaluate drug consumption patterns in specific populations and usually their best model was

Conclusion

Our study shows that individual level factors and nightclub music style can be associated with different patterns of polydrug use among patrons in São Paulo. Illicit drug users are not equally distributed among the venues, since polydrug users are more likely to be found in a certain type of nightclub, such as electronic, hip-hop, pop-dance and rock. However, binge drinking is a highly prevalent behaviour among the three identified groups and alcohol harm reduction is an important need in São

Role of funding source

Funding for this study was provided by the São Paulo State Research Support Foundation (Fundação de Amparo a Pesquisa do Estado de São Paulo – FAPESP), Grant number 11/51658-0. FAPESP have no further role in study design, the collection, analysis and interpretation of data, the writing of the report or in the decision to submit the paper for publication.

Contributors

Sanudo was responsible for data analysis and the writing of the first version of the manuscript. Andreoni was responsible for sampling, dataset weighting, data analysis supervision and the revision of the manuscript. Sanchez designed the study, wrote the grant protocol and corrected the manuscript to create the final version. All authors have read and approved the final version of the manuscript and have revised it critically for important intellectual content.

Acknowledgements

We thank the FAPESP (São Paulo State Research Support Foundation – Fundação de Amparo a Pesquisa do Estado de São Paulo), Grant number 11/51658-0, for the funding and all the field researchers for the data collection and the nightclub owners and patrons to allow the study success.

Conflict of interest

The authors declare that there are no conflicts of interest.

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