It was verified, in this study, that the majority of outsourced workers have high self-esteem, while some presented medium and low self-esteem. It is well known that high levels of self-esteem may reflect adequate psychic conditions for work, however, lower levels may limit individual inspirations and achievements¹⁴.

This data corroborates other investigations already carried out. In a study developed with Nursing workers in the State of Minas Gerais, Brazil, it was found that 70.2% of them had high self-esteem; 29.3%, mean self-esteem and 0.5%, low self-esteem¹⁴. Another survey conducted in Mongolia, with workers from various companies, found that most had high self-esteem and felt confident and with a high level of engagement at work. However, workers with low self-esteem were more likely to feel emotionally destabilized and with a low engagement level¹⁵. Thus, with these results, it can be seen that, although the professional categories are different, the results of both investigations are similar to those of this study. In this sense, it should be mentioned that, faced with the various events of daily life, the impact of negative situations on the lives of people with high self-esteem is much lower when compared to those who have low self-esteem¹⁵.

It was also verified in this investigation that the substances most used by outsourced workers were licit ones, such as alcohol and tobacco. In addition, the illicit substances most used by them were marijuana and inhalants. These data are confirmed in other studies, as demonstrated below^16-17.

In a study carried out with 403 penitentiary agents with the objective of investigating patterns of alcohol and other drug use in a state in the Northeast of Brazil, it was observed that most of them consumed alcohol, tobacco, marijuana and inhalants¹⁶. In a study conducted with 185 nurses from three public hospitals in a region of southern Brazil, in order to analyze the relationship between the work environment and the consumption of psychoactive substances among hospital nurses, it was found that these same substances were used at some time in their lives, with alcohol being the most consumed, followed by tobacco products, marijuana, inhalants and sedatives¹⁷.

In view of the above, tobacco is a strong risk factor for the development of non-communicable diseases such as cancers, Diabetes Mellitus (DM), cardiovascular diseases and lung diseases. Still, the premature deaths due to the consumption of tobacco products occur mainly in middle- and low-income countries, being a common practice among the population of workers¹⁸. In this way, the importance of the multidisciplinary team for the diagnosis of a smoker and the appropriate guidelines on the negative consequences of its use is realized. In addition, it is up to the nurse to perform the active search of these users, develop educational actions and minimize the risks of complications arising from this use¹⁹.

Concerning the consumption of alcoholic beverages, several factors occurred at work influence their consumption among workers. Among them are dissatisfaction with work, feelings of sadness at the end of the workday, and poor quality of life. This implies the consumption of alcohol by the worker, which can have consequences, such as behavioral changes, irritability, intolerance, delays in work, absences and withdrawals, and may also lead to a decrease in productivity and dismissal²⁰.

Faced with this, the need for greater assistance to individuals who consume alcohol, by health teams, through immediate therapeutic interventions and, when necessary, referral to specialized services⁸.

When verifying the association of self-esteem with the independent variables, it was found that the outsourced workers were more likely to present low / medium self-esteem, as well as workers aged up to 39 years and those who worked during the daytime period.

The fact that women are more likely to develop low / medium self-esteem can be explained by their overwork. Generally, women perform both domestic duties and paid work activities, which contributes to high work hours and reduced self-esteem. Exercising long hours or having more than one employment relationship exposes women to the factors of suffering, insecurity and instability due to overwork and wear. Thus, there is a predisposition to develop low self-esteem, which can lead to physical and mental exhaustion²¹.

With respect to age, older workers have higher self-esteem, compared to younger workers, due to the fact that a higher requirement in the new generation ²². Moreover, it is believed that the more mature age group has a more stable self-concept and the changes faced are viewed in a positive way, besides having a greater self-knowledge, self-confidence, self-control capacity and more resilience, factors that favor high levels self-estee²³.

Regarding the work shift, when analyzing the results of this study, it is inferred that the workers who perform their functions during the day shift have a chance of presenting changes in self-esteem due to the workload associated with the presence of another job, which can generate fatigue and lack of time to perform leisure activities. Added to these factors, excessive work hours can also lead to insecurity and high pressure at work ²¹.

It was also found in this study that being a male, up to 39 years of age, not having a partner, being Catholic and having no children are more likely to have the risk of developing problems associated with consumption of alcohol.

Regarding sex, as shown in the results presented, the highest consumption of alcoholic beverages is among men, which can be explained by the social constructions that interfere in their behaviors. The masculine characteristics are associated to the high consumption of alcoholic beverages, in the same way that this consumption is also related to the brutality of this sex, poor quality of life and health neglect when compared to women²⁴.

Regarding the age group, the literature points out that young people are consuming alcoholic substances at an earlier and more intense time. The inclusion of alcoholic beverages in Brazilian society is due to the fact that these substances are legally allowed to be marketed to persons aged 18 or over, as well as the cultural and social acceptance by the population. In this context, it is emphasized that the largest consumers of alcoholic beverages are in the average age between 16 and 34 years^25-26.

It was found in this investigation that not having a partner is a risk factor for developing problems with alcohol. There is no consensus in the literature regarding the marital status of the individual and its possible association with the consumption of alcoholic beverages. However, there are indications for a greater risk of consumption of this substance in single, divorced or widowed persons, that is, without companion²⁷. Consumption of alcohol and other drugs can be an important source of marital problems, separations and divorces; therefore, there is a tendency of reduction or discontinuation of this consumption when one has companion²⁸.

Regarding religious belief, the fact of being a Catholic was a risk factor for alcohol consumption. This result was different from that found in another study, in which it was evidenced that the presence of religiosity was a protective factor against alcohol consumption. Going to church or religious meetings can be seen as factors that contribute to distancing the individual from the consumption of alcoholic beverages. Experiencing a religious belief and following the precepts of a religion prove to be protective factors against alcoholism²⁹.

Outsourced workers, who did not have children, were more likely to be at risk of developing problems associated with alcohol consumption, as presented previously. Having children causes profound changes in the life of the person and family, especially in their routine, since children demand care, welfare concerns and increased financial expenses. This family bond and the bond of love established with a child reduce the chances of the individual consuming alcoholic beverages^30-31.

Based on the evaluation of the risk of developing problems related to the consumption of tobacco products, it was found that workers who did not practice physical activity were more likely to have this risk.

Smoking can influence the person’s sedentary lifestyle, being a risk factor for several incapacitating diseases, associated to the reduction of physical exercise capacity due to physical exhaustion and fatigue³². Physical inactivity associated with tobacco use is strongly related to overweight and obesity, increasing the risk of developing cardiovascular problems throughout life³³. The interaction between smoking, lack of physical activity and overweight or obesity may be associated with mental health problems among young adults³⁴.

In view of the above, it is important to emphasize the importance of the health team, especially nurses, in identifying the best approach to dealing with smokers, as well as their concerns, to assist them in adherence to treatment against nicotine addiction³⁵.

When assessing the association of the self-esteem variable with the risk of developing problems related to alcohol consumption, it was verified that there was no significant association between these two variables, as well as between self-esteem and the risk of developing problems related to the consumption of tobacco derivatives . However, it is emphasized that self-esteem is associated with dependence on alcoholic beverages, because the greater the dependence of this substance, the lower the self-esteem of the person³⁶.

Thus, it can be stated, based on the results presented, that changes in self-esteem are often related to changes in the mental health of the person associated with adherence to substance abuse such as alcohol and tobacco, in addition to non-adherence to other healthy lifestyles when compared to people with good mental health³⁴.

In the context of outsourced work, it is possible to affirm that since this modality of services implies the precariousness of working conditions, workers are affected by fear of unemployment, insecurity in the work environment, psychological suffering, substance abuse, mental disorders and, consequently, incapacity for work³⁷.

Therefore, prevention of mental disorders and abuses of licit and illicit substances from psychosocial factors in the work environment is paramount since mental health care will benefit not only the worker but also the people with whom he relates^37-38.

It should be noted that the professional able to work in this area of prevention of injuries and health promotion is the nurse, since he provides extended care to the person in a critical, holistic, individual and humanized manner, considering all its dimensions³⁹, including those professionals who work in companies.

Some factors were limiting in this study, such as its transversal design, which did not allow to verify the cause-effect relationship of the results found. However, it allowed to characterize and associate the variables, observing the situation of the worker at that moment. In addition, the difficulty in finding the workers was another limitation due to the different activities performed at the university. However, this factor did not interfere in the sample size and the results found. It was also added that it was not possible to carry out the stratification of the participants by profession, since there were many functions and some of them were performed by few professionals, which made it difficult to carry out the groupings and, therefore, made impossible the realization of statistical associations.

In view of the above, it is suggested to carry out longitudinal investigations that address the theme analyzed in this study in a way that demonstrates the causal and cause-effect of the change in self-esteem with the use of substances in outsourced workers.

Although this research has been conducted in a single public university, there is scope for the data to be generalized, since outsourcing is a phenomenon that exists in the current capitalist system in which there is an abrupt increase in unemployment and, along with it, growth flexibilization and precariousness of work.

This study can contribute to the advancement of scientific knowledge, since there is a reduced amount of research that addresses outsourced workers from Higher Education Institutions and the changes in self-esteem and substance use, since outsourcing is a new configuration of the labor market. Thus, the study allowed to elucidate the occurrence and influence of these factors in the work environment and may subsidize knowledge for the elaboration of actions directed to the promotion of workers’ health, improving the social, individual and labor welfare.

In view of these results, it will be possible to contribute to the fact that nurses who work in companies have subsidies for acting in their professional practice, so that they act with greater commitment in prevention, curative and educational actions to outsourced workers, greater productivity, and reduced absenteeism due to mental illness and substance use.