In the UK there has been growing concern about the relationship between levels of alcohol consumption and offending behaviour. The Alcohol Treatment Requirement (ATR) was introduced to the UK in 2007 and was piloted in a District in the north of England in July 2007. The ATR is a coercive form of treatment delivered jointly by the probation service and the National Health Service (NHS) and was funded by the NHS. The ATR centres on supporting offenders to cease their offending behaviour and reduce or end their alcohol misuse. Two female alcohol treatment workers have been appointed to specifically deliver the ATR. Therefore this study aimed to investigate the delivery of the ATR, and more specifically, aimed to explore what impact the ATR might have in relation to positive behaviour change and rehabilitation for offenders with alcohol problems. In order to meet the expectations of producing ¿outcome¿ data for the NHS funders, and indepth theoretical data worthy of an academic PhD, this research took a pragmatic methodological approach which enabled different social realities of the ATR to be explored. To this end, a mixed methods design was employed involving quantitative and qualitative data collection methods. The data for this research was generated in three phases with Phase One aiming to explore quantitatively the characteristics, impacts and outcomes of those sentenced to the ATR. This phase revealed that the ATR is being delivered to predominantly young, male, alcohol dependent, violent, persistent offenders. This analysis further revealed that the ATR was effective in bringing about positive treatment outcomes and in reducing reoffending. In order to explore further how this positive change was occurring, Phase Two consisted of qualitative participant observations of the treatment interaction involving the female alcohol treatment workers and the male offenders. By drawing on positioning theory, the analysis considered the complexity of the gendered interactions that occurred during these encounters. It was found that the two female alcohol treatment workers resisted positions of ¿feminine carer¿ offered up by these young men in order to occupy positions of control. Indeed this analysis provided great insight into the constant flow of negotiations and manoeuvring of positions that occurred between the alcohol treatment worker and the offender, argued to be vitally important in working towards positive behaviour change. During Phase Three ten offenders were interviewed in order to explore through a dialogical lens (Bakhtin, 1982) how they constructed and experienced treatment on the ATR. In exploring the offenders¿ stories dialogically, the analysis highlighted how the ATR was enabling, in that it offered a ¿space¿ for these offenders to engage and internalise a dialogue that draws on the authoritative voice of therapy. Therefore it was revealed that through dialogue with the ¿other¿, offenders were able to re-author a more ¿moral¿ and ¿worthy¿ self. Moreover, the ATR has been found to be successful in enabling the offenders¿ hegemonic masculine identities to be both challenged and protected as a result of the multilayered interactions that occurred during these treatment encounters. This research therefore concludes that coercive treatment, rather than being a concern, should be embraced as a way of enabling change for offenders with alcohol problems. Furthermore, this research has highlighted the value of the relational aspect of treatment in bringing about positive behaviour changes. Finally this research has shown that community sentences offer a more constructive way of engaging with offenders than those who receive a custodial sentence.

Evidence suggests that changes in alcohol consumption during the first months of the COVID-19 pandemic were unevenly distributed over consumer groups. We investigated possible inter-country differences in how changes in alcohol consumption are contingent on initial consumption (before or at the start of the pandemic), and how changes in consumption translate into possible changes in the prevalence of heavy drinking. We used data from the European Survey on Alcohol use and COVID-19 (ESAC) conducted in Czechia, Denmark, Finland, Germany, Norway, Poland, Spain, and the UK (N = 31921). Past-year alcohol consumption and changes in consumption were measured by AUDIT-C. Drinking habits were compared according to percentiles of pre-pandemic consumption levels, below versus above the 90th percentile. Across countries, drinkers in the highest 10% for pre-pandemic consumption increased their drinking during the pandemic, whereas absolute changes among those initially drinking below this level were modest. The percentage of people reporting >28 alcohol units/week increased significantly in seven of eight countries. During the first months of the COVID-19 pandemic, alcohol consumption in the upper decile of the drinkers increased as did the prevalence of heavy drinkers, in contrast with a declining consumption in other groups in the sample.

Darbe nagrinėjama alkoholio vartojimo problemų turinčių asmenų gyvenimo kokybės kitimas atsižvelgiant į tai, kokius gydimo metodus jie pasirenka šiai problemai spręsti. Didžiausias dėmesys skiriamas AA grupių įtakai gyvenimo kokybei ir jos kitimui. Ši problematika Lietuvoje mažai tyrinėta, tačiau dėl alkoholio vartojimo masto Lietuvoje ir pasaulyje yra pakankamai aktuali. Darbe buvo iškeltas tikslas ištirti AA grupių įtaką alkoholio vartojimo problemų turinčių asmenų gyvenimo kokybės kitimui. Darbo tikslui pasiekti analizuota alkoholio vartojimo problemų turinčių asmenų lankiusių ir nelankiusių anoniminių alkoholikų grupes gyvenimo kokybė, jos kitimas ir vertybių bei gydymo metodo įtaka jai. Manoma, kad alkoholio vartojimo problemų turinčių asmenų, lankiusių anoniminių alkoholikų grupes, gyvenimo kokybė pagerėjo labiau, palyginus su tais kurie tų grupių nelankė arba buvo viena-du kartus ir daugiau nelankė. Darbo tikslui pasiekti naudota PSO gyvenimo kokybės klausimynas (WHOQOL-BREF; angl. The World Health Organization Quality of Life – Bref, 1996), gyvenimo vertybių įvertinimas pagal Goštautą A, Javtoką Z, Žagminą K. (2001) ir gydymo metodo įvertinimas sudarytas pačios darbo autorės. Tyrime dalyvavo aliejų lyčių, nuo 18 iki 69 m. amžiaus, įvairios šeiminės, užimtumo, profesinės padėties ir išsilavinimo, šiuo metu besigydantys lankydami AA grupę, Minesotos programą ir medikamentiniu gydymusi, asmenys. Tyrimas parodė, kad asmenų, nepriklausomai nuo lyties, kurie turi problemų... [toliau žr. visą tekstą] / This Paper deals with changing quality of life of the people with alcohol problems, depending on what treatment methods they choose to tackle this problem. The main focus is made on the impact of AA groups to quality of life and the changes thereof. This problem has been little researched in Lithuania; however, due to the consumed alcohol level in Lithuania and world widely this issue is sufficiently relevant. The objective of the Paper is to examine the impact of AA groups to the change of the quality of life of people who have alcohol-consuming problems. For the purpose of the Objective the quality of life and of the people with alcohol-consuming problems who attended AA groups and who not attended AA groups and the change of their quality of life were analysed, as well as the values and the impact of treatment methods on it were explored. It is estimated that the quality of life of the people with alcohol-consuming problems, who attended alcoholics anonymous groups, improved more in comparison with those who did not attend these groups or those visited them once or twice and did not attend them constantly. In order to reveal the Objective of the Paper, the WHO Quality of Life Questionnaire (WHOQOL-BREF; in Eng. The World Health Organization Quality of Life – Bref, 1996), the evaluation of the life values according to Goštautas A, Javtokas Z, Žagminas K. (2001) and the evaluation of treatment method, composed by the author herself, were used. The research included persons... [to full text]

As societies across the world are facing grim problems regarding the consumption of tobacco products and alcohol, the Governments of these societies are adapting their strategies to reduce the consumption of these harmful products. These demarketing strategies are implemented to discourage the use of these products and increase the health of consumers. These strategies include a strenuous legal limit when driving under the influence of alcohol, enforcing the placement of warning labels on both cigarette packages as well as alcoholic beverages. Also included are penalties when failing to adhere to these laws, increasing prices, limiting the availability, restricting promotion and advertising, the list goes on. It is therefore seen fit to examine the attitudes of black Generation Y students’ towards the demarketing of smoking and alcohol consumption, because of the research gap concerning black Generation Y students. The primary purpose of this research study was to conclude the attitudes towards the demarketing of smoking and alcohol consumption amongst black Generation Y students within South Africa, and more specifically the Vaal Triangle region. The target population for this study comprised black Generation Y students, aged 18 to 24. A non-probability convenience sample of 200 respondents at each of the two higher education institutions was randomly chosen to participate in this research study making the total sample size 400. A self-administered questionnaire was handed out to each of the respondents to complete. The questionnaire consisted of three sections; Section A – demographical information, Section B – tobacco questionnaire and Section C – alcohol questionnaire. It was required of the respondents to complete the three sections, indicating their agreement or disagreement towards demarketing on a five-point Likert scale. The literature review included in this study comprised marketing as an organisational philosophy and function, market segmentation, targeting and positioning, as well as demarketing. The traditional marketing mix, consumption patterns within South Africa concerning smoking and alcohol, demarketing as a form of social responsibility were also discussed. The term demarketing, the marketing mix in terms of demarketing and the Generation Y cohort were also included within the literature review. The main finding obtained from the main survey questionnaire was that black Generation Y students’ had a positive attitude towards the demarketing of smoking and alcohol consumption. The remaining findings obtained are discussed in order to enhance the understanding of the black Generation Y students’ cohort attitudes. The recommendations for this study are given to guide the successful implementation of demarketing of cigarettes and alcohol. It is concluded from the research, that black Generation Y students’ attitudes towards the demarketing of smoking and alcohol consumption is positive, and that they are in favour of persuading consumers to reduce consumption and ultimately quit the consumption of these products. Therefore, organisations and the Government should continue to implement these demarketing strategies towards smoking and alcohol, especially amongst the black Generation Y students. / Thesis (MCom (Marketing management))--North-West University, Vaal Triangle Campus, 2013

Background: Russia has undergone tremendous socioeconomic transformations. Particularly detrimental was the period of 1990-s that evidenced hazardous trends in public health. Alcohol consumption was suggested to be responsible for the negative health trends in the society. Male alcohol consumption attracted disproportional attention leaving female alcohol consumption, its predictors and influence on women’s health disregarded and uninvestigated. Aim: To describe the practices of female alcohol consumption and socio-demographic predictors of drinking, to explore the impact that drinking might have on the self-rated health of Russian women. Method: Cross-sectional analysis of data drawn from the Russia Longitudinal Monitoring Survey, round 20th. The association tests between the measures of alcohol consumption and covariates were run. Ordinal regression model tested the predictors of self-rated health.      Results: A Russian female drinker is middle-aged, high-educated, married/ cohabiting or divorced, resides from the urban area and is infrequent drinker. The frequency of drinking increases when she is young, high-educated, married/ cohabiting, resides from urban area. U-shaped relation between drinking and self-rated health was demonstrated: never drinkers and regular drinkers report poorer health than seldom-drinkers.  Conclusion: Predictors of female drinking in Russia are poorly investigated due to overrepresentation of research focused on men’s drinking. More studies are needed in order to explore the impact of drinking on self-rated health of  Russian women.

Objectives: Violence victimization is common in youth, and the association between victimization and ill-health is well established. Youth is also the period when alcohol risk drinking is most prevalent. At youth clinics in Västernorrland, Sweden, a randomized controlled intervention was conducted examining health outcomes and risk drinking after implementing routine inquiry about violence victimization and alcohol consumption. Methods: Participants in the intervention group underwent routine inquiry about violence victimization and alcohol consumption. Victimized participants received empowering strategies and were offered further counseling. Risk drinkers received motivational interviewing (MI). All participants answered questionnaires about sociodemography and health at baseline, at 3 months and at 12 months. Of 1,445 eligible young women, 1,051 (73%) participated, with 54% of them completing the 12-month follow-up. Males were excluded from the quantitative analysis owing to the low number of male participants. Fifteen research interviews examining the experience of routine inquiry were conducted. Results: Violence-victimized young women reported more ill health than non-victimized women did. This was especially evident for those who had been multiply victimized. There were no differences in health outcomes between the baseline and the 12-month follow-up for the intervention group and for the control group. Of the victimized women in the intervention group, 14% wanted and received further counseling. There was a significant decrease in risk drinking from baseline to follow-up, but no differences between the MI group and the controls. There was a large intra-individual mobility in the young women’s drinking behavior. In interviews, the participants described how questions about violence had helped them to process prior victimization. For some, this initiated changes such as leaving a destructive relationship or starting therapy. The participants considered risk drinking in terms of consequences and did not find unit-based guidelines useful. Conclusion: Violence victimization, especially multiple victimization, was strongly associated with ill health in young women. Routine inquiry about violence and subsequent follow-up led to a high degree of disclosure but did not improve self-reported health. However, victimized participants described talking about prior victimization as very helpful. Participants viewed risk drinking in terms of consequences rather than in quantity or frequency of alcohol, which may render unit-based drinking guidelines less useful when addressing risk drinking in youth.

How do the content and writing style of people who drink alcohol beverages stand out from non-drinkers? How much information can we learn about a person's alcohol consumption behavior by reading text that they have authored? This thesis attempts to extend the methods deployed in authorship attribution and authorship profiling research into the domain of automatically identifying the human action of drinking alcohol beverages. I examine how a psycholinguistics dictionary (the Linguistics Inquiry and Word Count lexicon, developed by James Pennebaker), together with Kenneth Burke's concept of words as symbols of human action, and James Wertsch's concept of mediated action provide a framework for analyzing meaningful data patterns from the content of blogs written by consumers of alcohol beverages. The contributions of this thesis to the research field are twofold. First, I show that it is possible to automatically identify blog posts that have content related to the consumption of alcohol beverages. And second, I provide a framework and tools to model human behavior through text analysis of blog data.

Introdução: A exposição do feto a grandes quantidades de componentes tóxicos decorrente do consumo de tabaco e álcool durante a gestação pode acarretar problemas tais como prematuridade, baixo peso ao nascer, aborto e distúrbios no desenvolvimento infantil. Essa associação tem sido recentemente objeto de diversos estudos, porém os resultados são contraditórios devido aos métodos e amostras distintos. Objetivo: Estudar a associação entre o consumo de tabaco e/ou álcool pela gestante e o desenvolvimento infantil entre 13 e 30 meses de idade. Método: Estudo descritivo e analítico, prospectivo, de uma coorte de conveniência iniciada no pré-natal (2010), avaliada no nascimento e a partir do início do segundo ano de vida (2011/2013) no município de Ribeirão Preto, SP. A variável dependente foi o escore médio do desempenho dos filhos nas cinco subescalas da Bayley Scales of Infant and Toddler Development ® third edition - screening test (Bayley - III®). A variável exploratória foi o consumo de tabaco e/ou álcool na gestação, classificado como nenhum consumo, consumo isolado de tabaco ou álcool e consumo concomitante das substâncias. As diferenças entre as médias nos escores das cinco subescalas foram comparadas por meio de regressão linear, em quatro modelos: ajustado pelas faixas etárias de aplicação do teste, propostas no manual técnico da escala (modelo 1); ajustado pelas faixas etárias, por consumo de tabaco e/ou álcool na gestação e características da mãe, da gestação e do parto (modelo 2); ajustado pelas faixas etárias, por consumo de tabaco e/ou álcool na gestação e variáveis do seguimento das crianças (modelo 3); ajustado por todas as variáveis dos modelos anteriores (modelo 4). Resultados: Foram estudadas 998 mulheres, das quais 121 (12,1%) fumaram e 246 (24,6%) referiram ter consumido bebida alcoólica na gravidez. O consumo isolado de álcool foi três vezes maior (18,6%) do que o consumo apenas de tabaco (6,1%). O consumo combinado de tabaco e álcool durante a gestação foi de 6,0%, sem diferença segundo a faixa etária das crianças avaliadas (p>0.05). Não houve diferença nas médias do escore cognitivo segundo o consumo das substâncias em nenhum modelo. Consumo concomitante foi associado a menor média dos escores em ambas as subescalas de comunicação (diferença de 1,12 pontos para comunicação receptiva, IC95% 0,45 a 1,79; 1,19 pontos para comunicação expressiva, IC95% 0,31 a 2,07) e motoras (diferença de 1,20 pontos na subescala motora fina, IC95% 0,55 a 1,85; 0,70 pontos para subescala motora grossa, IC95% 0,13 a 1,28), em torno de um ponto em média, comparado com nenhum consumo de tabaco e álcool. Conclusão: Consumo concomitante de tabaco e álcool teve efeito significativo, porém pequeno, na média dos escores de comunicação e motores, mas não na subescala cognitiva. / Introduction: Fetal exposure to large amounts of toxic compounds resulting from the consumption of tobacco and alcohol during pregnancy can lead to problems such as preterm birth, low birth weight, miscarriage and disorders in child development. This association has recently been the subject of several studies, but the results are contradictory due to differences in methods and samples. Objective: To study the association between the consumption of tobacco and/or alcohol by pregnant women and child development between 13 and 30 months of age. Methods: This is a descriptive and analytical, prospective study of a cohort of convenience initiated prenatally (2010), assessed at birth and from the beginning of the second year of life (2011-2013) in the city of Ribeirão Preto, Brazil. The dependent variable was the mean score of the performance of children in the five subscales of the Bayley Scales of Infant and Toddler Development ® third edition - screening test (Bayley - III®). The explanatory variable was the use of tobacco and/or alcohol during pregnancy rated as no consumption, isolated consumption of tobacco and alcohol and concomitant consumption of the substances. The differences between the mean scores in the five subscales were compared using linear regression in four models: adjusted for age of test application proposed in the technical manual of the scale (model 1); adjusted by age groups, for tobacco and/or alcohol use during pregnancy and maternal characteristics of pregnancy and childbirth (model 2); adjusted by age groups, for tobacco and/or alcohol use during pregnancy and variables related to children in the follow-up (model 3); adjusted for all the variables of the previous models (model 4). Results: 998 women were studied, 121 of them (12.1%) smoked and 246 (24.6%) reported having consumed alcohol in pregnancy. The isolated alcohol consumption was three times higher (18.6%) than the consumption of tobacco only (6.1%). The combined use of tobacco and alcohol during pregnancy was 6.0%, with no difference according to the child\'s age group (p> 0.05). There was no difference in mean cognitive score based on consumption of substances in any model. Concomitant intake was associated with lower mean scores in both communication subscales (1.12 points difference for receptive communication, 95% CI 0.45 to 1.79; 1.19 points for expressive communication, 95% CI 0.31 to 2.07) and motor subscale (1.20 points difference in the fine motor subscale, 95% CI 0.55 to 1.85; 0.70 points for gross motor subscale, 95% CI 0.13 to 1.28), around a point on average compared with no consumption of tobacco and alcohol. Conclusion: concomitant consumption of tobacco and alcohol had a significant effect, however small, in the mean score of the communication and motor subscales, but not in the cognitive subscale.

O objeto deste estudo são as práticas de Atenção Básica (AB) desenvolvidas nos serviços de saúde voltadas para pessoas e grupos sociais que consomem drogas de forma prejudicial. Este objeto foi recortado a partir do referencial teórico da Saúde Coletiva e se conforma na interface entre as políticas públicas voltadas para a população que faz uso prejudicial de drogas e a realidade concreta dos serviços de saúde. O estudo tem por objetivo geral analisar as práticas voltadas para consumidores problemáticos de drogas na AB, a partir do levantamento dessas práticas junto a trabalhadores de uma UBS da região periférica do município de São Paulo. Trata-se de estudo qualitativo, de natureza descritiva e analítica, que se desenvolveu na perspectiva dialético-crítica. A coleta de dados foi realizada a partir de entrevistas semiestruturadas e individuais com 10 trabalhadores de uma UBS mista, ou seja, que atua com a Estratégia de Saúde da Família (ESF) e com o modelo tradicional de produção dos serviços de saúde. As práticas desenvolvidas pelos trabalhadores e direcionadas aos usuários de drogas são analisadas a partir da categoria analítica processo de trabalho, que permite analisar os modos e as dificuldades de operacionalização das políticas públicas nos espaços concretos de produção dos serviços de saúde. Os resultados mostram que: 1) os trabalhadores desenvolvem o processo de trabalho, na perspectiva funcionalista da moderna saúde pública, que compreende o consumo de drogas como doença e considera usuários de drogas como desviantes; 2) as práticas existentes são consideradas frágeis e os trabalhadores valorizam muito a formação técnico-clínica, que em suas opiniões proporcionaria melhores respostas para as demandas relacionadas ao uso de drogas; 3) reproduz-se um ciclo infértil de explicação sobre a incapacidade e as sensações de fracasso que tomam conta do discurso de muitos trabalhadores que lidam com demandas relacionadas ao consumo prejudicial de drogas; 4) todo o processo de trabalho parece ficar centrado num único elemento, o trabalhador em si, já que os demais elementos não se encontram estruturados para atender a demanda. Pode-se concluir que as formas como se organizam os processos de trabalho na AB e como se estrutura o processo de produção dos serviços de saúde brasileiro dificulta e/ou impede o acesso da população usuária de drogas à rede de atenção à saúde. A AB carece de elementos estruturais inerentes ao processo de produção em saúde, e da dinamicidade interna aos processos de trabalho, que favoreçam a implementação de práticas voltadas aos indivíduos e grupos sociais que usam drogas de forma prejudicial. Este trabalho contribui com a finalidade do estudo de promover denúncia em relação à fragilidade das práticas desenvolvidas na AB frente às desafiadoras e crescentes demandas relacionadas ao consumo de drogas pela população. / The object of this study was the practices developed at Primary Health Care services focused on individuals and social groups who use drugs in a harmful way. The study object derived from the theoretical framework of collective health and was constructed at the interface between public policies focused on the population that uses harmful drugs and the reality of health services. The aim of the study was to analyze the practices towards drug users at Primary Health Care based on a survey of these practices with workers of a Primary Health Center (PHC) in the outskirts of São Paulo. It is a qualitative, descriptive and analytical research developed within a critical-dialectical approach. Data were collected from semi structured interviews with 10 workers of a PHC, which has two different health care models, namely: the Family Health Strategy and the traditional model of primary health services. The practices developed by workers and directed towards drug users were analyzed from the analytical category of the work process, which allows the analysis of the modes and difficulties to operationalizing public policies as practices that take place in the real spaces of the health production process. Results show that: 1) workers develop the work process within the functionalist perspective of the modern public health, which understands drug consumption as a disease and considers users as deviants; 2) the existing practices are actually considered fragile and the workers greatly value technical and clinical training that in their opinions would provide better responses to the demands related to drug use; 3) a cycle of infertile explanation about the incapacity and the feeling of failure of the workers who deal with demands related to drug use is reproduced; 4) the entire work process seems to be focused on a single element, the workers itself since the other elements seem not to be structured. It may be concluded that the ways the work process is organized in the PHC and how the process of the Brazilian primary health services is structured makes it difficult or constitute a barrier for drug users to access the health care network. The PHC lacks structural elements inherent to the health care process and internal dynamics of the work processes that favor the implementation of practices directed towards individuals and social groups who use drugs in a harmful way. The purpose of the study is to report the fragility of the practices developed at the PHC due to the challenging and increasing demands of drug consumption.

Introdução: A exposição do feto a grandes quantidades de componentes tóxicos decorrente do consumo de tabaco e álcool durante a gestação pode acarretar problemas tais como prematuridade, baixo peso ao nascer, aborto e distúrbios no desenvolvimento infantil. Essa associação tem sido recentemente objeto de diversos estudos, porém os resultados são contraditórios devido aos métodos e amostras distintos. Objetivo: Estudar a associação entre o consumo de tabaco e/ou álcool pela gestante e o desenvolvimento infantil entre 13 e 30 meses de idade. Método: Estudo descritivo e analítico, prospectivo, de uma coorte de conveniência iniciada no pré-natal (2010), avaliada no nascimento e a partir do início do segundo ano de vida (2011/2013) no município de Ribeirão Preto, SP. A variável dependente foi o escore médio do desempenho dos filhos nas cinco subescalas da Bayley Scales of Infant and Toddler Development ® third edition - screening test (Bayley - III®). A variável exploratória foi o consumo de tabaco e/ou álcool na gestação, classificado como nenhum consumo, consumo isolado de tabaco ou álcool e consumo concomitante das substâncias. As diferenças entre as médias nos escores das cinco subescalas foram comparadas por meio de regressão linear, em quatro modelos: ajustado pelas faixas etárias de aplicação do teste, propostas no manual técnico da escala (modelo 1); ajustado pelas faixas etárias, por consumo de tabaco e/ou álcool na gestação e características da mãe, da gestação e do parto (modelo 2); ajustado pelas faixas etárias, por consumo de tabaco e/ou álcool na gestação e variáveis do seguimento das crianças (modelo 3); ajustado por todas as variáveis dos modelos anteriores (modelo 4). Resultados: Foram estudadas 998 mulheres, das quais 121 (12,1%) fumaram e 246 (24,6%) referiram ter consumido bebida alcoólica na gravidez. O consumo isolado de álcool foi três vezes maior (18,6%) do que o consumo apenas de tabaco (6,1%). O consumo combinado de tabaco e álcool durante a gestação foi de 6,0%, sem diferença segundo a faixa etária das crianças avaliadas (p>0.05). Não houve diferença nas médias do escore cognitivo segundo o consumo das substâncias em nenhum modelo. Consumo concomitante foi associado a menor média dos escores em ambas as subescalas de comunicação (diferença de 1,12 pontos para comunicação receptiva, IC95% 0,45 a 1,79; 1,19 pontos para comunicação expressiva, IC95% 0,31 a 2,07) e motoras (diferença de 1,20 pontos na subescala motora fina, IC95% 0,55 a 1,85; 0,70 pontos para subescala motora grossa, IC95% 0,13 a 1,28), em torno de um ponto em média, comparado com nenhum consumo de tabaco e álcool. Conclusão: Consumo concomitante de tabaco e álcool teve efeito significativo, porém pequeno, na média dos escores de comunicação e motores, mas não na subescala cognitiva. / Introduction: Fetal exposure to large amounts of toxic compounds resulting from the consumption of tobacco and alcohol during pregnancy can lead to problems such as preterm birth, low birth weight, miscarriage and disorders in child development. This association has recently been the subject of several studies, but the results are contradictory due to differences in methods and samples. Objective: To study the association between the consumption of tobacco and/or alcohol by pregnant women and child development between 13 and 30 months of age. Methods: This is a descriptive and analytical, prospective study of a cohort of convenience initiated prenatally (2010), assessed at birth and from the beginning of the second year of life (2011-2013) in the city of Ribeirão Preto, Brazil. The dependent variable was the mean score of the performance of children in the five subscales of the Bayley Scales of Infant and Toddler Development ® third edition - screening test (Bayley - III®). The explanatory variable was the use of tobacco and/or alcohol during pregnancy rated as no consumption, isolated consumption of tobacco and alcohol and concomitant consumption of the substances. The differences between the mean scores in the five subscales were compared using linear regression in four models: adjusted for age of test application proposed in the technical manual of the scale (model 1); adjusted by age groups, for tobacco and/or alcohol use during pregnancy and maternal characteristics of pregnancy and childbirth (model 2); adjusted by age groups, for tobacco and/or alcohol use during pregnancy and variables related to children in the follow-up (model 3); adjusted for all the variables of the previous models (model 4). Results: 998 women were studied, 121 of them (12.1%) smoked and 246 (24.6%) reported having consumed alcohol in pregnancy. The isolated alcohol consumption was three times higher (18.6%) than the consumption of tobacco only (6.1%). The combined use of tobacco and alcohol during pregnancy was 6.0%, with no difference according to the child\'s age group (p> 0.05). There was no difference in mean cognitive score based on consumption of substances in any model. Concomitant intake was associated with lower mean scores in both communication subscales (1.12 points difference for receptive communication, 95% CI 0.45 to 1.79; 1.19 points for expressive communication, 95% CI 0.31 to 2.07) and motor subscale (1.20 points difference in the fine motor subscale, 95% CI 0.55 to 1.85; 0.70 points for gross motor subscale, 95% CI 0.13 to 1.28), around a point on average compared with no consumption of tobacco and alcohol. Conclusion: concomitant consumption of tobacco and alcohol had a significant effect, however small, in the mean score of the communication and motor subscales, but not in the cognitive subscale.