(in English): The topic of the thesis is Leisure time and its influence on risk behavior of adolescents. The aim of the study was to characterize the relation between manners of leisure time spending and risk behavior in adolescent age. The first part is dedicated to a theoretical basis for research. There are definitions of the terms leisure time and its specifics of adolescent, particular attention is paid to leisure activities. Following is characterized the period of adolescence. The conclusion of theoretical part deals with risk behavior, its various forms and factors that affects it. The second part is dedicated to research, which took place on the Semily district. Based on the analysis of scientific literature and researches was prepared a research tool - the questionnaire. By obtained data analyze I was able to fill the objective of the work and thus characterize the relation between manners of leisure time spending and risk behavior in adolescent age. The effect of the regular participation in leisure activities was proofed as one of the protective factors in risk behavior. Further, the relation between place and manner of leisure time spending and risk behavior was statistically confirmed. Powered by TCPDF (www.tcpdf.org)

Diploma thesis "The course and long-term effects of animation as a method of working with adolescents" deals with the methods of working with endangered youth in the field and in the low-threshold facility for children and youth. It represents the reflection of the development of the methodology of the work of a particular organization in the Vltava housing estate in České Budějovice in the perspective of six years, when the author also worked here with a break. This time perspective makes it possible to help assess whether and to what extent the chosen approach appears to be effective. Above all, it allows to monitor the development of clients' life paths during a sensitive period from adolescence to adulthood. The potential of animation over other guiding and prevention systems can be to focus on activation, respect for life situations and the needs of clients, which are largely developmental, but also reflects social and psychological deficits in specific individual cases as well as in group life. Phenomenologically and ethnographically oriented research follows the previous author's qualification work and monitors the development of the contact center client community in the context of workers' suggestions and spontaneous life events. It is also complemented by a trio of individual case studies...

Sexualiteten är en naturlig del av livet som varje individ utforskar och lär sig att förhålla sig till. Det sexuella utforskandet kan även innebära en risk både för den fysiska och/eller psykiska hälsan. Riskerna kan till exempel vara sökande efter bekräftelse, närhet eller status, men kan även vara att visa upp sig, dela utmanande bilder eller utbytande av sexuella tjänster mot ersättning. Sexualiteten kan även bli ett verktyg för att dominera, förtrycka eller kränka andra människor. Socialiseringsprocessen, alltså det sociala samspel som sker mellan barnet och deras familj beskrivs som grunden för hur barnet själv utvecklar sina egenskaper samt hur hen i sin tur integrerar med sin omgivning. I studien undersöks kommunikationen mellan föräldrar och barnet upplevs och huruvida det finns samband med att barnet utsätter sig själv eller andra för sexuella riskbeteenden. Studien uppmärksammar även på skillnaderna mellan könen i hur kommunikationen upplevs och vad som korrelerar med sexuellt riskbeteende. Studien är en kvantitativ analys där urvalet består av ungdomar som går i årskurs 9 (N=1357). Data är insamlad av det pågående longitudinella programmet LoRDIA (Longitudinal Research on Development In Adolescence). Studiens resultat indikerar att det finns statistiska signifikanta samband mellan ungdomar som pratar med sina föräldrar och inte uppvisar sexuella riskbeteenden. Resultaten visade även att tjejer uppvisade högre frekvens av sexuella riskbeteende.  Det föreligger även en signifikant skillnad mellan hur tjejer och killar upplever kommunikationen till vårdnadshavare och att tjejer har en högre tendens av att påverkas av vårdnadshavarnas regler och överkontroll till skillnad från killar. / Sexuality is a natural part of life which every individual explores and must learn how relate to. The sexual exploration may also cause a risk both to physical but also to the mental health. The risks may, for example, be unfavourable searching for confirmation, proximity or status, but may also be to share intimate images or exchange sexual favours for economical compensations. Sexuality can become a tool to dominate, oppress and/or offend other people. The socialization process, that is, the social interaction that takes place between the child and their family is described as the base for how the child develops his/her own characteristic and how they integrate with their surroundings. This study examines at how communication between parents and child looks and is experienced, whether there is any connection with how the child exposes themselves and/or others to sexual risk behaviours and if there is any difference between the sexes. The study is a quantitative analysis in which the sample consists of young people who are in 9th grade (N=1357). The data is collected by the ongoing longitudinal program LoRDIA (Longitudinal Research on Development In Adolescence). This study indicates that there is a statistically significant relationship between youths who communicate with their parents and shows less sexual risk behaviours. The results also demonstrate that girls show a higher frequency of sexual risk behaviour. There is also a significant difference between how girls and boys experience the communication to custodians and that girls have a higher tendency to be affected by the custodians' rules and control than what boys do. / LoRDIA

As práticas educativas parentais são consideradas determinantes primários no desenvolvimento de comportamentos socialmente competentes, problemas de comportamento e comportamentos relacionados à saúde na infância. Na adolescência, a influência parental sobre esses comportamentos tem literatura divergente, visto que diversos autores acreditam que a influência parental continua central, enquanto outros defendem a idéia de que a principal determinação vem do grupo de pares. Diante desse contexto, o objetivo geral dessa pesquisa foi o de relacionar as práticas educativas maternas e paternas aos comportamentos de proteção e risco à saúde na adolescência, bem como as variáveis de competência social (CS), problemas de comportamento (PC) e dificuldades com os pares, avaliando o grau de predição das práticas parentais sobre os comportamentos do adolescente. Para atingir tais objetivos, participaram deste estudo 485 adolescentes, divididos em três faixas etárias (11 a 13 anos, 14 e 15 anos, 16 e 17 anos). Todos responderam ao Inventário de Estilos Parentais materno e paterno, Inventário de auto-relato para jovens (YSR) e questionário de estilo de vida (HBSC). Os dados foram analisados através estatística descritiva, análises de correlação, de inferência estatística e análises multivariadas. Os principais resultados foram: 1) práticas educativas maternas e paternas não variaram em função do sexo dos adolescentes, porém foram diferentes entre as três faixas etárias (considerando p ≤ 0,05); 2) não houve diferença quanto à CS entre meninos e meninas, porém estas alcançaram maiores PC; 3) CS se relacionou às práticas positivas maternas (PPM) entre os mais jovens, e às PPM e às práticas positivas paternas (PPP) entre os mais velhos; 4) a partir da categorização dos índices de estilo parental em famílias com estilo parental de risco, intermediária e de proteção, observou-se que aquelas consideradas de proteção tiveram filhos com escores mais positivos de CS e menores escores nas escalas de PC, sendo que as famílias intermediárias tiveram seus filhos mais próximos das famílias de proteção na CS e mais próximo das famílias de risco nas escalas de PC nas três faixas etárias; 5) em relação aos comportamentos de proteção, os adolescentes mais jovens relataram maior freqüência desses, enquanto que os mais velhos alcançaram maiores escores nos comportamentos de risco; 6) as correlações entre estilo parental e comportamentos de proteção e risco foram significativos nas três faixas etárias, porém decaíram com o aumento da idade; 7) a partir da categorização de estilo parental, observouse que entre os adolescentes mais jovens, os de famílias de proteção tiveram filhos com escores significativamente melhores nos comportamentos de saúde e de risco; o que se manteve nas outras faixas etária, porém, em geral, não de forma significativa.; 8) os modelos de análise multivariada (modelo de regressões múltiplas e modelagem de equações estruturais) indicaram que as práticas parentais são preditoras de CS e PC nas três faixas etárias. Diante desses resultados, a pesquisa indica que a influência parental na adolescência ocorre de forma distinta em função da idade, sendo direta na fase inicial e esvanece gradualmente com o aumento da idade, porém ainda mostrando-se significativa, em especial no que concerne às práticas parentais negativas e aos comportamentos de risco. / The parental educational practices are considered primary determining in the development of socially competent behaviors, behavioral problems and behavior related to childhood health. At adolescence, the parental influence over those behaviors has divergent literature, given that several authors believe that the parental influence continues central, while others defend the idea that the main determination comes from the pair groups. In that context, the overall objective of this research was to relate the maternal and paternal educational practices to the behaviors of protection and risk to the health at adolescence, as well as the social competence (SC) variables, behavioral problems (BP) and difficulties with the pairs, evaluating the degree of prediction of the parental practices over the adolescent\'s behaviors. In order to achieve such objectives, 485 teenagers participated in this study, divided into three age groups (11 to 13; 14 and 15; 16 and 17 year-olds). They all answered the Maternal and Paternal Parental Style Inventory; the Young Self Relate (YSR) and the questionnaire of lifestyle (QLS). The data have been analyzed through descriptive statistics, correlation analysis, of statistics inferring and multi varied analysis. The main results were: 1) maternal and paternal practices did not vary according to the adolescents\' gender, on the other hand, were different according to the age groups (considering p ≤ 0,05); 2) there was no difference in SC between boys and girls, however these reached higher PC; 3) SC related to the Maternal Positive Practices (MPP) among the youngest, and to the Paternal Positive Practices (PPP) among the oldest; 4) with the categorization of the families\' parental style as risky, intermediate and protective, it has been observed that those considered protective had children with the highest SC scores and lower BP scores, being that the intermediate families had their children closer to the protective families\' SC scores and closer to the risky families in the BP scores for all three age groups; 5) concerning the protective behaviors, the youngest teenagers stated more frequency of those, while the oldest reached higher risky behavior scores; 6) the correlations between parental style and risk and protection behaviors were significant at all three age groups, however, decreased at higher ages; 7) from the categorization of parental style, it has been observed that among the younger teenagers, the ones from the protective families had kids with significantly higher scores at health and risk behaviors; which was maintained at the other age groups, although in general, not significantly; 8) the models with multi varied analysis ( multiple regression model and structural equations modeling) indicated that the parental practices are predictor of SC and BP at the three age groups. With those results, the research indicates that the parental influence in adolescents occurs in different ways according to the age, being more direct in the initial phase and vanishing gradually as age increases, although still significant, especially concerning the negative parental practices and the risk behaviors.

The purpose of the present study was to utilize a statewide, representative sample of students in grades 6-8 in Tennessee to determine the co-occurrence of health risk behaviors such as smoking, substance use and eating disorders, among adolescents by determining the impact gender, age, race, and geographic region have on the association of these behaviors with the prevalence of adolescent obesity. We also explored the role that district, school, and class level health risk behavior variables play in adolescent obesity. Among adolescent females in the sample, 17.25% were obese, whereas 27.27% of males were obese. Stratified Hierarchical Logistic Regression Analysis demonstrated that several variables such as having ever tried smoking, having a weight misperception, and eating disorder, watching TV for more than 3 hours a day, and not engaging on a sports team remained consistent in their significant association with adolescent obesity across all groups. The findings from this study suggest that certain risk behaviors play an important role in adolescent obesity. Perhaps the most significant finding of our study that requires more investigation is the effect of education on adolescent obesity.

Objectives: Asthma is a genetic disease that requires an environmental trigger to manifest in predisposed individuals. This study aims to assess the prevalence of asthma among U.S. adolescents and possible environmental triggers to asthma. Methods: This is a secondary analysis of the Youth Risk Behavioral Survey 2015 (YRBS 2015). A total of 15,624 high school students in the U.S. were included in this analysis. The YRBS was established by Center for disease control and prevention (CDC) in 1991 to monitor six priority health risk behaviors among youths and young adults. Data were collected via self-administered questionnaire which was validated by CDC through a two test reliability studies. The Data was analyzed using SAS v 9.4. Results: The overall prevalence of asthma was 23.08% with no significant difference between male (22.84%) and female (23.31%). Simple logistic regression analysis showed that the estimated odds of having asthma among individuals that initiated cigarette smoking before the age of 13 years was about 40% higher than those who did not (Odds Ratio (OR): 1.40, 95% CI: 1.22-1.62, p<0.0001). The odds of having asthma was also significantly higher among individuals who used marijuana before the age of 13 years (OR: 1.25, 95% CI: 1.11-1.46, p<0.001) than those who did not. Furthermore, the estimated odds of having asthma was 25% higher in individuals currently using marijuana (OR: 1.25, 95%CI: 1.14-1.37, p<0.0001) than those who do not and 44% higher among obese individuals (OR: 1.44, 95%CI: 1.29-1.60, p<0.0001) compared to non-obese individuals. Sleeping eight or more hours per day was protective against asthma (OR: 0.81, 95% CI: 0.74-0.88, P<0.0001). After adjusting for age and other factors, multiple logistic regression showed that the odds of having asthma was approximately 26% higher among individuals who initiated cigarette smoking before the age of 13 years (adjusted OR (aOR): 1.26, 95% CI: 1.01- 1.57, P=0.037) than those who did not. Moreover, the odds of having asthma was 18% higher among those who initiated alcohol drinking before the age of 13 years (aOR: 1.18, 95%CI: 1.04-1.35, P=0.014), compared to those who did not. There was no association found between asthma and physical activity, the use of marijuana after adjusting for age and other potential risk factors. Conclusion: While sleeping more than eight hours per day was protective against asthma, early initiation of cigarette smoking, marijuana, and alcohol drinking was positively associated with asthma. Encouraging children to sleep minimum of eight hours per day will potentially decrease asthma prevalence.

African American men who have sex with men (AAMSM) are at a greater risk of contracting HIV than any other ethnic group, subpopulation, or race. Personal, environmental, and social variables can affect risk behavior. Driven by Beck's cognitive theory of depression, this quantitative study examined the relationship between depression and HIV risk behaviors in a sample of AAMSM (n = 108). Data was gathered via the Beck Depression Inventory and the HIV Risk Behavior Questionnaire. Simple and multiple linear regression analysis were conducted to analyze the data to determine the correlation between HIV risk behavior and depression. According to study findings, there was no significant relationship found between depression and HIV risk behavior in this sample of AAMSM after accounting for the variance associated with the covariates: age, alcohol and substance use, condom attitudes, HIV knowledge, and income. While the study findings do not indicate depressive symptoms were associated with HIV sexual risk behavior, age, alcohol or drug use, and condom attitudes were significantly and positively related to HIV sexual risk behavior. Future research is recommended to identify factors specific to AAMSM for use in devising African American MSM-centric interventions. The results could inform the development of interventions targeting older AAMSM to alter behaviors associated with alcohol and drug use to impact sexual risk behaviors and reduce HIV transmission in AAMSM, thus resulting in positive social change in their lives and the lives of their families and communities.

Understanding the development of adolescent sexual risk behavior is complicated by the co-occurrence of sexual risk with substance use and delinquency, conceptualized as “problem behavior syndrome,” with common causes and influences underlying all three problem behaviors (Jessor & Jessor, 1977). Explaining the development of sexual risk becomes even more complex given the changing patterns of adaptation and maladaptation over the course of adolescence (Sroufe & Rutter, 1984). Research also suggests that multiple pathways may forecast adolescent engagement in sexual risk behavior, underscoring the ideas of equifinality and multifinality in developmental psychopathology (Cicchetti & Rogosh, 1996). To understand the diverse nature of sexual risk taking, researchers must identify these pathways and disentangle co-occurring problem behaviors from sexual risk. Revealing the course of sexual risk taking and the early risk and protective processes through which problem behavior develops allows researchers to identify the developmental periods that would be most amenable to intervention efforts (Rolf et al., 1990). Using data from the National Longitudinal Survey of Youth (NLSY79), this study aimed to disentangle problem behavior syndrome by identifying the unique developmental pathways of adolescent sexual risk, alcohol use and delinquency. This study also investigated how early adolescent processes of risk and protection were associated with the growth of these risk behaviors during adolescence. Using a developmental psychopathology and resilience framework, risk trajectories were measured with adolescents aged 15 to 24, and antecedents were measured with early adolescents ages 10 to 14 (N= 1778). Using Latent Class Growth Analyses (LCGA), joint trajectory analyses revealed five distinct adolescent risk taking groups: high sex and alcohol, moderate problem behavior, problem behavior, alcohol-only, and alcohol and delinquency experimentation. Early adolescent externalizing problems were particularly important in understanding adolescent risk group membership. The co-occurrence between sexual risk and alcohol use, the diversity of problem behavior syndrome, and potential intervention and prevention efforts are discussed.

Introdução: Estudos destacam a prevalência crescente do crack (forma fumada de apresentação da cocaína, com ação psicoestimulante, com impacto nos neurônios e neurotransmissores cerebrais dopaminérgicos) no Brasil, em contraponto aos limitados resultados terapêuticos. Dados recentes apontam que cerca de 1% dos jovens já fizeram uso na vida de crack. A expressão clínica de um funcionamento piorado pode se dar através de marcadores de externalização social, como violência, impulsividade e comportamentos autodestrutivos. A literatura demonstra associação do crack com comportamentos sexuais de risco, violência e contravenções. Para além dos indicadores de impacto na sociedade, os sujeitos com histórico de uso de crack, podem apresentar prejuízo nos múltiplos domínios vitais, como: qualidade de vida, capacidade para o trabalho, estudo e manutenção satisfatória dos vínculos sociais. Além de tratarem-se usualmente de usuários de múltiplas substâncias e com importantes índices de associação com comorbidades psiquiátricas. É por isso que a literatura tem ampliado os estudos no que se refere à qualidade de vida dos usuários, apoio social e comorbidades associadas, tratando-se de indicadores de resultados terapêuticos que impactam no ingresso do uso, manutenção, abstinência posterior e prognóstico. No entanto, ainda são escassos os estudos no campo do abuso de substâncias, sobretudo em relação à usuários de crack. Ademais, um crescente corpo de evidências sugere que o uso de crack tem consequências sistêmicas generalizadas, mas pouca atenção tem sido dada à sua fisiopatologia. Neste sentido, o entendimento do funcionamento social e biológico dos usuários pode contribuir para alavancar terapêuticas mais efetivas e direcionadas as distintas etapas e características dos usuários. Neste sentido, esta tese objetiva: Avaliar a funcionalidade social, exposição à risco, comorbidades e biomarcadores em usuários de crack, culminando na proposição de um modelo de estadiamento. Apresentamos aqui três modelos metodológicos: O primeiro, de base populacional que avaliou aspectos sobre a funcionalidade social (qualidade de vida, produtividade, estrutura e apoio parental, adesão à prática religiosa, acesso e adesão ao tratamento), exposição à risco (práticas sexuais, episódios de agressão e porte de armas), além de comorbidades (psiquiátricas e com demais substâncias) em sujeitos de 18 a 24 anos com histórico de uso de crack em relação à população em geral. O segundo estudo diz respeito à avaliação de biomarcadores, se deu através de estudo de comparação de grupos com cinquenta e três pacientes ambulatoriais usuários de crack, combinados com cinquenta controles. O terceiro estudo pressupõe uma revisão da literatura para proposição de um modelo de estadiamento incluindo as variáveis verificadas nos demais estudos. Os resultados do estudo de base populacional indicam que os sujeitos com histórico de uso de crack demonstram prejuízo, em relação à população geral, nas múltiplas dimensões da funcionalidade social e qualidade de vida, em destaque a saúde geral, física, significativas mesmo controlando para uso na vida de cocaína, além da saúde emocional, mental e da percepção de dor. Do ponto de vista relacional evidenciam diferenças no que se refere estrutura da família nuclear no lar, na qual mães se mostram mais presentes e pais mais ausentes em relação à população em geral. Há indícios de impacto expresso na produtividade funcional em termos de escolaridade e na relação com instituições sociais, como o sistema de saúde. O histórico de uso de crack está associado com prejuízos no que tange a gestão de autocuidado e de exposição à risco, demonstrando maiores índices, em relação à população geral, de comportamento agressivo, uso de armas e práticas sexuais de risco. No que se refere aos biomarcadores e marcadores inflamatórios, evidenciou-se um aumento significativo no BDNF, IL- 1V, TNF- W e IL- 10 em usuários, sendo que não há diferenças no dano oxidativo, em relação aos controles. O estudo destes aspectos serviu de base para proposição de um modelo de estadiamento do uso do crack tendo como base a funcionalidade social dos usuários. Como considerações finais, ao que tudo indica, usuários de crack apresentam especificidades desde a constituição parental no lar à maior vulnerabilidade psicossocial. Revela-se um caráter de descontinuidade e irregularidade na adaptação à demanda funcional inicial, que se reedita na circularidade do sujeito pelas diferentes instâncias sociais, em códigos de autopreservação, e em comportamentos de externalização, estando eles mais expostos a condutas de risco e comorbidades associadas, além do prejuízo expresso também em termos de biomarcadores. O discernimento de tal aspecto pode ter impacto clínico e na elaboração de políticas públicas combativas não somente ao crack, mas às vulnerabilidades sociais preliminares e associadas à droga. / Introduction: Studies highlight the rising prevalence of crack cocaine (form of cocaine that are smoked, with psychostimulant action, affect dopaminergic brain neurotransmitters and neurons) users in Brazil, in contrast to the limited therapeutic results. Recent data indicate that approximately 1% of young people have already used crack cocaine in lifetime. The clinical expression of a worsened functioning may be through outsourcing social markers such as violence, impulsivity and selfdestructive behaviors. The literature demonstrates association of crack cocaine with risky sexual behavior, and violence misdemeanors. In addition to indicators of impact on society, the subjects with a history of crack cocaine use may experience impairments in multiple vital areas such as: quality of life, ability to work, study and satisfactory maintenance of social bonds, and most often they are multiple substances users and have significant rates of psychiatric comorbidities associations. That is why the literature has extended the studies of the quality of life of users, social support and associated comorbidities, the therapeutic outcomes indicators that impact the inflow of use, maintenance, withdrawal and subsequent prognosis. However, there are still few studies in the field of substance abuse, especially in relation to crack cocaine users. Moreover, a growing body of evidence suggests that crack cocaine use has widespread systemic consequences, but little attention has been given to its pathophysiology. In this sense, an understanding of the social and biological functioning of the users can help to leverage more effective targeted therapies linked to different stages and characteristics of users. This thesis aims to evaluate the social functioning, exposure to risk, comorbidities and biomarkers in crack cocaine users, culminating in proposing a model of staging. Here are three methodological models: The first, a population-based study that assessed aspects of social functioning (quality of life, productivity, structure and parental support, adherence to religious practice, access and adherence to treatment), exposure to risk (sexual practices, episodes of aggression and possession of weapons), and comorbidity (psychiatric and other substances) in subjects between 18 to 24 yearsold with a history of crack cocaine use, compared to the general population. The second study focus on evaluation of biomarkers through a comparative study between grups with fifty-three outpatients crack cocaine users, combined with fifty controls. The third study presupposes a literature review, to propose a model of staging including variables verified in other studies. The results of the populationbased study indicate that subjects with a history of crack cocaine use (compare with the general population) show a loss in the multiple dimensions of social functioning and quality of life, highlighted the general health, physical, in significant even after controlling for use in the life of cocaine, plus the emotional, mental and perception of pain. The relational dimension revealed differences regarding the structure of the nuclear family in the home, in which mothers are more present and fathers more absent in relation to the general population. There are indications of impact, expressed in functional productivity in terms of scholarity and relationship with social institutions, such as the health system. The history of crack cocaine use is associated with damage in terms of self-care management and risk exposure, demonstrating highest rates of aggressive behavior, use of weapons and risky sexual practices, when compared with the general population. With regard to biomarkers and inflammatory markers, revealed a significant increase in BDNF, IL- 1V, TNF- W and IL- 10 in users, with no differences in oxidative damage, compared to controls. The study of these aspects formed the basis for proposing a model of staging of the use of crack cocaine, based on the social functionality of users. As conclusion, it seems that crack cocaine users have specificities from the parental constitution of the home to greater psychosocial vulnerability. There is a character discontinuity and irregularity in the initial adaptation to functional demands, which replays in the circularity of the subject by the various social environments, codes of selfpreservation, and externalizing behaviors, while they are more exposed to risk behaviors and associated comorbidities besides the loss also expressed in terms of biomarkers. The insight of that aspect may have clinical and developmental impact, not only the crack cocaine combative public policy, but also to combat social precrack cocaine vulnerabilities.

Introdução: Estudos destacam a prevalência crescente do crack (forma fumada de apresentação da cocaína, com ação psicoestimulante, com impacto nos neurônios e neurotransmissores cerebrais dopaminérgicos) no Brasil, em contraponto aos limitados resultados terapêuticos. Dados recentes apontam que cerca de 1% dos jovens já fizeram uso na vida de crack. A expressão clínica de um funcionamento piorado pode se dar através de marcadores de externalização social, como violência, impulsividade e comportamentos autodestrutivos. A literatura demonstra associação do crack com comportamentos sexuais de risco, violência e contravenções. Para além dos indicadores de impacto na sociedade, os sujeitos com histórico de uso de crack, podem apresentar prejuízo nos múltiplos domínios vitais, como: qualidade de vida, capacidade para o trabalho, estudo e manutenção satisfatória dos vínculos sociais. Além de tratarem-se usualmente de usuários de múltiplas substâncias e com importantes índices de associação com comorbidades psiquiátricas. É por isso que a literatura tem ampliado os estudos no que se refere à qualidade de vida dos usuários, apoio social e comorbidades associadas, tratando-se de indicadores de resultados terapêuticos que impactam no ingresso do uso, manutenção, abstinência posterior e prognóstico. No entanto, ainda são escassos os estudos no campo do abuso de substâncias, sobretudo em relação à usuários de crack. Ademais, um crescente corpo de evidências sugere que o uso de crack tem consequências sistêmicas generalizadas, mas pouca atenção tem sido dada à sua fisiopatologia. Neste sentido, o entendimento do funcionamento social e biológico dos usuários pode contribuir para alavancar terapêuticas mais efetivas e direcionadas as distintas etapas e características dos usuários. Neste sentido, esta tese objetiva: Avaliar a funcionalidade social, exposição à risco, comorbidades e biomarcadores em usuários de crack, culminando na proposição de um modelo de estadiamento. Apresentamos aqui três modelos metodológicos: O primeiro, de base populacional que avaliou aspectos sobre a funcionalidade social (qualidade de vida, produtividade, estrutura e apoio parental, adesão à prática religiosa, acesso e adesão ao tratamento), exposição à risco (práticas sexuais, episódios de agressão e porte de armas), além de comorbidades (psiquiátricas e com demais substâncias) em sujeitos de 18 a 24 anos com histórico de uso de crack em relação à população em geral. O segundo estudo diz respeito à avaliação de biomarcadores, se deu através de estudo de comparação de grupos com cinquenta e três pacientes ambulatoriais usuários de crack, combinados com cinquenta controles. O terceiro estudo pressupõe uma revisão da literatura para proposição de um modelo de estadiamento incluindo as variáveis verificadas nos demais estudos. Os resultados do estudo de base populacional indicam que os sujeitos com histórico de uso de crack demonstram prejuízo, em relação à população geral, nas múltiplas dimensões da funcionalidade social e qualidade de vida, em destaque a saúde geral, física, significativas mesmo controlando para uso na vida de cocaína, além da saúde emocional, mental e da percepção de dor. Do ponto de vista relacional evidenciam diferenças no que se refere estrutura da família nuclear no lar, na qual mães se mostram mais presentes e pais mais ausentes em relação à população em geral. Há indícios de impacto expresso na produtividade funcional em termos de escolaridade e na relação com instituições sociais, como o sistema de saúde. O histórico de uso de crack está associado com prejuízos no que tange a gestão de autocuidado e de exposição à risco, demonstrando maiores índices, em relação à população geral, de comportamento agressivo, uso de armas e práticas sexuais de risco. No que se refere aos biomarcadores e marcadores inflamatórios, evidenciou-se um aumento significativo no BDNF, IL- 1V, TNF- W e IL- 10 em usuários, sendo que não há diferenças no dano oxidativo, em relação aos controles. O estudo destes aspectos serviu de base para proposição de um modelo de estadiamento do uso do crack tendo como base a funcionalidade social dos usuários. Como considerações finais, ao que tudo indica, usuários de crack apresentam especificidades desde a constituição parental no lar à maior vulnerabilidade psicossocial. Revela-se um caráter de descontinuidade e irregularidade na adaptação à demanda funcional inicial, que se reedita na circularidade do sujeito pelas diferentes instâncias sociais, em códigos de autopreservação, e em comportamentos de externalização, estando eles mais expostos a condutas de risco e comorbidades associadas, além do prejuízo expresso também em termos de biomarcadores. O discernimento de tal aspecto pode ter impacto clínico e na elaboração de políticas públicas combativas não somente ao crack, mas às vulnerabilidades sociais preliminares e associadas à droga. / Introduction: Studies highlight the rising prevalence of crack cocaine (form of cocaine that are smoked, with psychostimulant action, affect dopaminergic brain neurotransmitters and neurons) users in Brazil, in contrast to the limited therapeutic results. Recent data indicate that approximately 1% of young people have already used crack cocaine in lifetime. The clinical expression of a worsened functioning may be through outsourcing social markers such as violence, impulsivity and selfdestructive behaviors. The literature demonstrates association of crack cocaine with risky sexual behavior, and violence misdemeanors. In addition to indicators of impact on society, the subjects with a history of crack cocaine use may experience impairments in multiple vital areas such as: quality of life, ability to work, study and satisfactory maintenance of social bonds, and most often they are multiple substances users and have significant rates of psychiatric comorbidities associations. That is why the literature has extended the studies of the quality of life of users, social support and associated comorbidities, the therapeutic outcomes indicators that impact the inflow of use, maintenance, withdrawal and subsequent prognosis. However, there are still few studies in the field of substance abuse, especially in relation to crack cocaine users. Moreover, a growing body of evidence suggests that crack cocaine use has widespread systemic consequences, but little attention has been given to its pathophysiology. In this sense, an understanding of the social and biological functioning of the users can help to leverage more effective targeted therapies linked to different stages and characteristics of users. This thesis aims to evaluate the social functioning, exposure to risk, comorbidities and biomarkers in crack cocaine users, culminating in proposing a model of staging. Here are three methodological models: The first, a population-based study that assessed aspects of social functioning (quality of life, productivity, structure and parental support, adherence to religious practice, access and adherence to treatment), exposure to risk (sexual practices, episodes of aggression and possession of weapons), and comorbidity (psychiatric and other substances) in subjects between 18 to 24 yearsold with a history of crack cocaine use, compared to the general population. The second study focus on evaluation of biomarkers through a comparative study between grups with fifty-three outpatients crack cocaine users, combined with fifty controls. The third study presupposes a literature review, to propose a model of staging including variables verified in other studies. The results of the populationbased study indicate that subjects with a history of crack cocaine use (compare with the general population) show a loss in the multiple dimensions of social functioning and quality of life, highlighted the general health, physical, in significant even after controlling for use in the life of cocaine, plus the emotional, mental and perception of pain. The relational dimension revealed differences regarding the structure of the nuclear family in the home, in which mothers are more present and fathers more absent in relation to the general population. There are indications of impact, expressed in functional productivity in terms of scholarity and relationship with social institutions, such as the health system. The history of crack cocaine use is associated with damage in terms of self-care management and risk exposure, demonstrating highest rates of aggressive behavior, use of weapons and risky sexual practices, when compared with the general population. With regard to biomarkers and inflammatory markers, revealed a significant increase in BDNF, IL- 1V, TNF- W and IL- 10 in users, with no differences in oxidative damage, compared to controls. The study of these aspects formed the basis for proposing a model of staging of the use of crack cocaine, based on the social functionality of users. As conclusion, it seems that crack cocaine users have specificities from the parental constitution of the home to greater psychosocial vulnerability. There is a character discontinuity and irregularity in the initial adaptation to functional demands, which replays in the circularity of the subject by the various social environments, codes of selfpreservation, and externalizing behaviors, while they are more exposed to risk behaviors and associated comorbidities besides the loss also expressed in terms of biomarkers. The insight of that aspect may have clinical and developmental impact, not only the crack cocaine combative public policy, but also to combat social precrack cocaine vulnerabilities.