Images of alcohol in the adolescents ’ life of one quilombola community

Rev Bras Enferm [Internet]. 2019;72(2):468-75. http://dx.doi.org/10.1590/0034-7167-2018-0264 ABSTRACT Objective: To analyze the images of alcohol in the rite of passage of adolescents of a quilombola community. Method: Qualitative and participatory study was developed by Creative and Sensitive Method, and guided by generated questions: “In my house, alcohol is...”; “Near my house, I see alcohol in...” Ten adolescents who live in a quilombola community in the north of the state of Espírito Santo, Brazil, participated in the group dynamics. The material was submitted to a thematic analysis. Results: Images of alcohol are common in the daily life of adolescents and can be seen in bars drinks, in their homes or in soccer fields; in different moments within the community (weekend barbecues, church celebrations, after soccer); and also in rites of passage, where adolescents first sipped or tasted alcohol with friends or socially with adults. Final Consideration: Alcohol in quilombola communities is cultural, and socially accepted, which turns it into a challenge for health professionals to promote health education with these adolescents. Descriptors: Adolescent Behavior; African Continental Ancestry Group; Pediatric Nursing; Public Health; Ethanol.


Images of alcohol in the adolescents' life of one quilombola community
Imagens do álcool na vida de adolescentes de uma comunidade quilombola Imágenes del alcohol en la vida de adolescentes de una comunidad "quilombola"

INTRODUCTION
Alcohol is the most widely used licit drug in the world.Its sale is permitted by law to people aged over 18 years old and with self-determination (1) .However, the age at which young people taste it and its regular consumption are taking place increasingly earlier.According to data from the National Adolescent Health School Survey of 2015 (PeNSE, as per its acronym in Portuguese), 55.5% of 9th-grade students in elementary schools, aged between 13 and 15, reported that they had sipped or tasted alcohol and 21.4% have already been in a state of drunkenness (2) .In Brazil, the consumption and sale of alcohol to adolescents is forbidden by law (1) ; however, data from this survey show that it is widely consumed and its continued use can lead to chemical or psychological addiction.
In addition, alcohol can cause violent deaths, poor school performance, learning difficulties and impaired development.Within all cultural groups, the usual amount of alcohol consumed varies according to gender, income, school background, type of family, religion and sociodemographic characteristics of the place where adolescents live (2)(3)(4)7) .
These surveys focused on the use/intake of alcohol in the adolescence, but they were carried out in large cities and excluded adolescents from rural areas, especially those who claim to be black and live in a quilombola communities.In that sense, ethnic and racial issues are not properly addressed (5) .
According to the demographic census of 2010, 47.7% of Brazilians declare themselves as white, 51% as black or brown, and 1.3% as indigenous or Asian descendant.It was also observed that the percentage of people who declared themselves as black exceeded the estimates that were based on the 2000 census (6) .
Alcohol consumption in adolescence is a current issue and it has been the object of study in several areas of expertise, but the available studies do not analyze race and color in their results.Consequently, they can hide racial inequalities (2)(3)(4)7) related to first sip or taste and continued use of alcohol in the adolescence among the social and health factors that are the object of the implementation of public policies aimed at the actual needs of the population. Eve the National Adolescent Health School Survey (8) , carried out in the country in 2015, which surveyed students who reported that they had sipped or tasted alcohol at least once or in the last 30 days before the survey, included race and color in the aspects to be analyzed.

OBJECTIVE
To analyze the images of alcohol in the rite of passage of adolescents from a quilombola community.

Ethical aspects
The study was approved by the Research Ethics Committee of Escola de Enfermagem Anna Nery/Hospital Escola São Francisco de Assis, a teaching hospital of the Universidade Federal do Rio de Janeiro.All participants signed an Informed Assent, whereas their families or legal guardians signed a Free and Informed Consent.To ensure anonymity of participants, the registration units were identified by the letter A, as in 'adolescent' , followed by the letter M, as in 'male' , and F, as in 'female' , to indicate gender, a number sequence (1, 2, 3, etc.), and their age.For instance, A.M1, 13 years, A.M4, 10 years, or A.M2, 12 years, for male adolescents, and A.F1, 11 years, A.F2, 13 years, or A.F5, 13 years, for female adolescents.

Study type
Participatory study (9)(10) with a qualitative approach developed in the group dynamic of Creative and Sensitive Method (CSM), a type of inquiry based on art (11) .In participatory studies, knowledge is produced in the collective space, experiences are shared, and participants work actively from the perspective of their social reality.Researchers and participants get close to and away from the setting where the research is being carried out so as to develop strategies of social change (10)(11) .Developed in the CSM, artistic expression served as a pathway to human experience, providing more freedom to think and act through art (11) .

Participants and setting
In order to form the group, the following inclusion criteria were adopted: adolescents attending public elementary and/ or secondary school in a rural area; being of any gender; being aged between 10 and 19 years, according to the World Health Organization classification; and having normal cognitive and motor skills.People with acute and chronic diseases, who were not in a school located in a rural area, and who did not live in that community were excluded.
In order to recruit participants, leaders of the community and a community health agent distributed invitations to families of adolescents for a scheduled meeting on the first Sunday of February 2015.In that meeting, the first author presented the study, read and explained the Informed Consent to parents/ guardians, and the Informed Assent to adolescents.
The study setting was the rural area of a quilombola community (44 km away from São Matheus municipality), located in the north of the state of Espírito Santo.

Sources
To depict the images of alcohol that illustrate the experiences of participants where they live, three dynamics of creativity and sensitivity (DCSs) were carried out (from CSM) (11) .
Data were obtained from groups in which adolescents had signed the Informed Assent and were legally authorized by their legal guardians, who signed the Informed Consent.
The dynamics were carried out by the first author, after a training session with the second author, and implemented at five different times.At the first, participants introduced themselves and were explaine dabout the study objectives, materials to be used and the expected results.At the second, the discussion of Generated Questions (GQ) was introduced so the individual

Images of alcohol in the adolescents' life of one quilombola community
Moraes-Partelli AN, Cabral IE.
production of artistic-type could be achieved.At the third time, the production was presented individually for a collective analysis followed by a thematic codification facilitated by an intense group discussion.At this time, converging and unique topics were recorded so the generating topics could be encoded.Since there were a variety of encoded topics, at the fourth time it was discussed with participants which topics would be addressed in the group, and topics were decoded into sub-topics.This process took place as long as discussions went from intrapersonal to interpersonal, and back to intrapersonal again.At the fifth time, there was a thematic recoding with a summary and validation of the research data produced in the meeting.

Data production and organization
Data production took place in March 2015 at four meetings, with an average duration of one hour each.All meetings were filmed, recorded and photographed, with written texts and images being made.
The implemented dynamics -"My house...my world..." and "Building my world... " -were constructed, respectively, by the GQ "In my house, alcohol is... " and "Near my house, I see alcohol in... " In addition, a form for the characterization of participants was applied, which contained personal and family information, and their socioeconomic status.

Data analysis
To classify, organize and systematize the empirical material, (written texts and images), a thematic analysis was adopted (12) .Successive readings were done to assimilate the material, words, expressions, text excerpts from experiences with alcohol were coded and divided into the following topics: Alcohol with the family; Alcohol in social life (bars drinks, parties, and celebrations in the community) and Alcohol by myself.To complete the field work, two data saturation principles were adopted: repetition and relevance of participants' reports (12) .

RESULTS
Five boys and five girls were aged between 10 and 14 years.Eight were Catholics, one Protestant, and one had no religion.Six studied in the community school and four in a rural school.Six belonged to families with incomes between one and three times the minimum wage, three with less than the minimum wage and one was not able to inform it.Livelihood of families comes from work in rural areas, from allowances of the Brazilian Cash Transfer Program from the Federal Government (Bolsa Família), Continuous Cash Benefit, Unified Social Care System, and rural retirement.They were adolescents who lived with their families and whose structures varied from extended biparental (five), nuclear traditional (two), extended monoparental (two) and single parents (one).This quilombola community is intergenerational, since siblings, cousins, grandparents, uncles, and aunts were mentioned by adolescents.
For the topic "alcohol in the family", the images captured in the group dynamics "My house...my world" revealed that alcohol cannot be found in some homes but can be found in others.Four adolescents reported that these images are not present in their lives, and three reported the storage of alcoholic soft drinks at home.Three did not include images related to a continuous presence of alcohol at home in their artistic productions (Figure 1.A to C).
Inside the house, there are images of bottles of soft drinks and food, alcohol in the refrigerator with food and soft drinks.Out of their homes, we can mention the images of a woman holding a glass and drinks (bottle of sparkling wine and beer cans).In both environments, alcohol consumption is a common practice among men and women.The adolescents raised the issue of the effects of excessive alcohol consumption (intoxication) after they saw a picture of a man who was apparently sad (Figure 1.A to C).The registration units were defined as to having or not fermented drinks in the refrigerator and in the pantry, with pictures of alcohol inside and outside the house.

There is no alcohol in my house. (A.M1, 13 years)
There is no alcohol in my house, just soft drink.(A.M2, 12 years)

There is food and soft drink in the fridge. (A.M3, 10 years)
There is no alcohol beverages in the fridge at home, there is food... and wine too.In "social drinking", the pictures from "Building my world... " make it possible to understand the rural way of life of this quilombola group, defined by the presence of people (friends) drinking in a bar, adolescents drinking behind their parents' back, under a tree, sipping alcohol at an early age.Once again, drunkenness is a part of what they commonly see in their social environment.In adolescents' everyday life, they see parents offering their children alcohol, pregnant women drinking beer and cachaça, and women buying liquor to their husbands (Figure 2.A and B).
In bars drinks surrounding their homes or far away, men gather to drink.In this community, bars are a meeting point for men and boys, and they are not often attended by women.Therefore, these adolescents are exposed to situations in which social drinking shapes the identity of men in their social construction of gender.

I went to T's bar, which is near my house, with many friends. Next to a bush, there is a bottle hidden, because sometimes some teenagers drink behind their parents' back. (A.M2, 12 years)
There is a bar near my house where I see a man and a boy drinking beer.Sometimes parents give their children alcohol.We can see here pregnant women drinking cachaça and beer, which is forbidden, but not for adults.Women buying beer for their husbands.When my mom goes to the church, my father asks her to buy him some liquor.(A.M3, 10 years) There are women in the bar who drink beer, cachaça or who do drugs.(A.F4, 12 years) Images related to alcohol consumption were often selected, such as people pouring drinks into their glasses, drinking straight from the bottle, in the streets or at the steering wheel (Figure 2.C).The images were reinforced with the participants' registration units.
There are these guys in the bar.There is a man pouring drink into his glass, a man drinking from the bottle and other people drinking.Here they are leaving because they are nearly drunk.

It is not right to drink and drive, he can go to jail. (A.M4, 11 years)
There is a man drinking beer or cachaça, from the bottle.There is a kid with a bottle of beer or cachaça in his hand and a man leaving in his car and drinking beer, and this is forbidden.(A.F1, 11 years) Local bars have signs with warning messages such as: "Zero alcohol, I contribute to it", "Don't let alcohol change your life", and "Drinks have never been a good company at the wheel", which were reported in artistic productions of boys and girls; adults drinking in the five bars of the community, who go from bar to bar until they get drunk (Figure 2. D).
an intrafamily and intergenerational dimension to alcohol consumption in extended families.Among those who depicted a refrigerator without alcohol, both availability and access to alcohol at home make it difficult to consume it in the house.Generally speaking, fermented drinks or hard liquor are purchased for immediate consumption.Consumption alcoholic drinks during the week and on weekends is done mainly out of the house, regardless of having it stored in the refrigerator or not.Occasionally, they celebrate their soccer matches' victory with alcohol, during the week or on the weekend.Family celebrations are the most common, such as parties and weekend barbecues, which take place in the backyard, or at bars in the community.Alcoholic beverages, especially fermented drinks (beer) and spirit one like cachaça are always present because of their wide availability and low cost, in addition to being socially accepted.Family and community parties are held in social spaces where adolescents become adults living with alcohol in a gregarious environment, to celebrate achievements.Progressively, adolescents are introduced to the use of alcohol as a natural event which is part of their cultural group.

They drink when they make barbecues or when they go to a bar. (A.M3, 10 years)
In my house, there is alcohol only when there is a party or a barbecue going on.(AM.1, 13 years)

My father drinks two liters of beer, only on Saturdays. (A.M3, 10 years)
Among the images that draw their attention, we can mention drunkenness as the result of excessive alcohol intake by their family members.The behavior changes observed are the loss of balance, sleepiness, and sadness.We can also highlight hospitalization for treatment,and absence of a relationship between high alcohol consumption and violence within the social group.

Images of alcohol in the adolescents' life of one quilombola community
Moraes-Partelli AN, Cabral IE.
In the house, there is a sign saying "Zero alcohol, I contribute to it".There is a bar near my house and people are drinking.Older adults go from bar to bar...until they are completely drunk.(A.M1, 13 years) The sign "Don't let alcohol change your life" mobilized the group in the problematization of the risk of violence as the result of alcohol abuse, which does not exist in the community.The image of the bar with many bottles and beer cans as well as the one with drunk people driving shows the daily life of this social group (Figure 2.C and D).

Near my house, there's M.'s and C's bars, which are quite far, with people drinking. There are bottles of liquor and soft drink as well. Drunken people in the car and driving. I made a sign here: "Don't let alcohol change your life". There is no violence. (A.M3, 10 years).
The image of a man who drinks beer, leaves the bar and drives is followed by the image of a car accident, with the headline "One more drink, one life less".This internalized social imaginary strengthens the relationship between alcohol, driving and risk of death, which was problematized by adolescents (Figure 2

.E).
I did a bar, from C., which is not very close to my house, and there are trees around and a man who reads the sign: "One more drink, one life less".There is no drinking problem related to violence.(A.F3, 11 years) Images of signs displayed in bars were the main subjects of artistic productions by girls and boys, who criticized the consumption of alcohol followed by driving a car or riding a motorbike.The criticism was better structured among those who were influenced by radio and TV campaigns than among those of the community.There are more motorbikes than cars, but the images that came up were those of cars, as the result of an assimilation process within the community.
The DCS "Building my world... " also resulted in the selection of words or expressions related to parties and celebrations in the community.The girls brought the image of parties, with people dancing, drinking and getting drunk; a party at the soccer field; adolescents who drink in parties and adults who seem to approve of this behavior as part of a rite of passage from adolescence to adulthood (Figure 3).

[...]
There are parties which take place near the Catholic church, with people dancing and having fun; there are some bottles of liquor.At the soccer field, there are always parties and lots of drinks.Some teenagers drink and the adults don't say anything.There are also kids who drink beer.The set of selected images means that the sale and consumption of alcohol is common in community parties near the church and the soccer field, with music, dance, entertainment and drunkenness.These social events are more frequent on weekends, holidays and occasionally in the evening during the week.
The topic "Alcohol and me" was built from the dynamics "My house...my world" and "Building my world... " Cousins and siblings tried alcohol in the backyard, during family celebrations and on weekends, and then made regular use of beer and wine.Images of bottles of alcoholic drinks (hard liquor or not) being poured into glasses or being drunk straight from them, and also beer cans make up the settings of artistic productions.These scenes show that adults and adolescents have easy access to alcohol and enjoy it in their daily lives (Figures 3 and 4).
Four boys tried alcohol, but one of them did not like its taste and another one is not sure whether he will carry on drinking; one girl drinks beer and wine socially and has tried sparkling wine.The disapproval of the taste made them not carry on drinking, except for one girl (A.F2, 13 years) who occasionally consumed fermented and hard liquor.Therefore, gender is a sociocultural variable which interferes and is influenced by race/ethnicities, social class, religion, and generation, that is why it must be understood as a structuring concept in which the differences between women and men are constructions that characterize the life of individuals (12) .In this way, it is understood that rural life in quilombola communities has its own aspects that define and drive the daily life of families.Representations, social and gender relationships are unique constructions that are passed down from generation to generation, defined by identity and social relations not only in this quilombola community, but which are common to other traditional communities such as indigenous, nomads, and settlements (14)(15)(16) .
Women who live in the community drink alcohol mostly in local parties, whereas men do it in the backyard, in bars and soccer fields.We can see that women have a strong influence on the community in terms of culture and customs dissemination, but generally men are the decision-makers within families.In that sense, sipping and using alcohol among adolescents are behaviors that are mainly adopted by boys in their rite of passage to adulthood, when they shape their masculinity, and living in a permissive environment becomes their reference model (17) .Some of the boys and girls of the quilombola community tried beer, wine and sparkling wine for the first time when they were children; some did it the adolescence and did not like it; and others continued to consume it secretly, with peers or under the supervision of adults in local bars, celebrations or barbecues in the backyard, with their families.
It is a common practice, although the sale and provision of liquor to people under 18 years is forbidden in Brazil, due to the negative effects on growth and development (1)(2) .Beer, which is a fermented drink, was the image that was most frequently mentioned and reproduced in artistic creations by adolescents, and this suggests that it is the most common alcoholic beverage, widely available in family environments, bars drinks, and local parties, even though it is more expensive than cachaça, a harder liquor that is more traditional in quilombola communities.
Permissiveness and availability of alcohol at home, with relatives consuming it, stimulates curiosity to taste something new, in addition to the first effects of alcohol such as pleasure and loosening up, a social joyfulness that results from its intake in backyards or bars.These are all motivating factors that encouraged boys and girls to taste and use alcohol in their rite of passage to adulthood (4)(5) .Alcohol becomes a new form of representation where adolescents who are going through a transition period (and recently came out of childhood) use it as something that shows the value of their actions and their words with regard to adults (18) .
Sipping alcohol as part of the rite of passage seems to be a phenomenon that is unique to this social group that lives in a rural area.The relationship between the use of drugs, such as alcohol and crack, by children and adolescents, is a complex phenomenon which needs to be understood, interpreted and learned more deeply.In a study carried out with different families, it was found that violence resulting from alcohol use is a great challenge (19) .
The use of alcohol in the adolescence is a public health issue, and public policies need to be implemented.Therefore, the use of alcohol by adolescents is a great challenge to be overcome by health and education professionals with the help of policies (19)(20) , Among those who tried alcohol, they did it in their childhood or adolescence, behind their families' back, or with a family member; the experience was pleasant for some and unpleasant for others because they did not like the taste.

DISCUSSION
The material produced in group dynamics showed that alcohol is part of the culture and socially accepted in quilombola communities.Alcohol consumption was more frequently reported among men than women, represented by the image of the father, uncle or grandfather.In the community, there are families who buy liquor and consume it immediately without storing it in the refrigerator, and those who store them with food and soft drinks, alcohol drink like beer; they lock wine bottles in the pantry to prevent children from having access to them.
The images represented by adolescents in their artistic productions reveal that family members (father, uncle, grandfather) are used to consuming alcohol in their backyards, community bars and parties, and at soccer fields.However, there are no reports of violence in the family neither in the community as the result of alcohol abuse.Boys and girls depicted the effects of alcohol with the image of a sad man after he had some cachaça, associating it with a complication of drunkenness.Scenes of men who drink heavily are engraved in the memory of the group as a gender stereotype socially built in rural areas, for which social relationships are based on patriarchal values, which define the role played by men.
While gender role refers to a set of rules and prescriptions established by society and culture, regarding the behaviors that men and women must have, gender stereotypes are preconceptions about how men and women are and behave in social relationships (13) .

Figure 1 -
Figure 1 -Excerpts of the dynamics of creativity and sensitivity artistic production "My house...my world... ", São Mateus, Espírito Santo, Brazil, March 2015 (A.M4, 10 years) There is no alcohol beverages in my fridge.(A.F1, 11 years) In my house, there is beer and soft drink in the fridge.The wine stays locked in the pantry because there are kids around [...].(A.F2, 13 years) In my house, there is beer, soft drink, and food in the fridge.(A.F3, 11 years) [...] My father drinks beer and cachaça when he's at home.[...] (A.M2, 12 years) Parents drink alone in the backyard or with a relative (grandfather, uncle) or even with adolescents themselves, which gives Images of alcohol in the adolescents' life of one quilombola community Moraes-Partelli AN, Cabral IE.Sometimes my grandfather and my uncle get drunk and sleep upright, staggering.There is no drinking problem related to violence.(A.F3, 11 years) He [the father] was so drunk once that he fell on the floor.He drinks on the weekend, sometimes on Fridays.(A.M2, 12 years) [...] there is a sad man, because he drank cachaça... (A.M3, 10 years) My father drinks wine, my brother has beer, and sometimes I do drink [...].(A.F2, 13 years) Only my father drinks beer, he buys and drinks it immediately, without leaving any in the fridge.Sometimes my father drinks with his father [the adolescent's grandfather] at my grandmother's house.On the weekend or during the week as well.(A.F1, 11 years) My father, my uncle, and my grandfather drink beer, cachaça, and wine.(A.F3, 11 years) My father, my grandfather, and my uncle drink beer... Just my grandfather who drinks cachaça from time to time.(A.M3, 10 years) (A.F5, 14 years) [...] From time to time, they throw parties and people drink and leave drunk and fall down in the middle of the road.(A.F2, 13 years) [...] I've seen kids drinking beer.(A.M3, 10 years)