Teens in trouble: cigarette use and risky behaviors among private, high school students in La Paz, Bolivia

OBJECTIVE: To describe the prevalence of cigarette smoking and to identify risky behaviors associated with smoking among adolescents attending high schools in a district of La Paz, Bolivia. METHODS: The Youth Risk Behavior Survey was administered to a sample of 394 males and 182 females, from 13-18 years of age, at six, randomly-selected schools in District II of La Paz. Frequencies, chi-square tests, and logistic regression were employed to identify factors associated with cigarette use during the 30 days prior to the survey. RESULTS: Approximately 40 percent of the sample (39.4 percent of males and 33.7 percent of females) had smoked cigarettes in the 30 days prior to interview. For both males and females, consumption of alcohol was the single greatest risk factor associated with cigarette use. The males and females who reported consuming at least one alcoholic beverage on three or more occasions in the previous 30 days were 22.3 and 58.5 times (95 percent CIs: 6.7, 74.1 and 6.8, 502.6, respectively) more likely to smoke tobacco than those who reported no alcohol consumption. Additional risk factors included having participated in a physical fight, having carried a weapon, having had sexual intercourse, and having used illicit drugs during the previous 30 days. CONCLUSIONS: Because teenagers who smoke are also likely to engage in a variety of other risky behaviors, parents, school administrators, and health educators may wish to use smoking to identify at-risk individuals. Among Bolivian teenagers, interventions should focus on preventing cigarette use and associated risk behaviors.

OBJETIVO: Describir la prevalencia del consumo de cigarrillos e identificar las conductas de riesgo asociadas con el hábito de fumar en adolescentes de enseñanza media superior de un distrito de La Paz, Bolivia. MÉTODOS: Se aplicó la Encuesta sobre Conductas de Riesgo en los Jóvenes a una muestra de 394 varones y 182 mujeres de 13-18 años de edad de seis escuelas del Distrito II de La Paz seleccionadas al azar. Se identificaron los factores asociados con el consumo de cigarrillos durante los 30 días previos a la encuesta, mediante el análisis de frecuencias, la prueba de la ji al cuadrado y la regresión logística. RESULTADOS: Aproximadamente 40 por ciento de la muestra (39,4 por ciento de los varones y 33,7 por ciento de las mujeres) había fumado cigarrillos en los 30 días previos a la encuesta. Tanto para ellos como para ellas, el consumo de alcohol fue el mayor factor de riesgo asociado con el consumo de cigarrillos. Los varones y las mujeres que informaron haber consumido al menos una bebida alcohólica en tres ocasiones o más durante los 30 días previos presentaron 22,3 y 58,5 veces (IC95 por ciento: 6,7 a 74,1 y 6,8 a 502,6, respectivamente) mayor probabilidad de fumar que los que informaron no haber consumido alcohol. Otros factores de riesgo adicionales fueron haber participado en una pelea física, haber portado un arma, haber tenido relaciones sexuales y haber tomado alguna droga ilícita durante los 30 días anteriores. CONCLUSIONES: Debido a que los adolescentes que fuman tienden también a incurrir en otras conductas de riesgo, los padres, los responsables escolares y los educadores sanitarios podrían utilizar el hábito de fumar para identificar a los adolescentes en riesgo. Las intervenciones dirigidas a adolescentes bolivianos deben enfocarse en la prevención del consumo de cigarrillos y de las conductas de riesgo asociadas.

Determinants of optimal breast-feeding in peri-urban Guatemala City, Guatemala

Objective. This survey was conducted to identify factors affecting early initiation of breast-feeding and exclusive breast-feeding among mothers in peri-urban Guatemala City, Guatemala. Materials and Methods. In early November 1999 a census was begun in four communities of peri-urban Guatemala City, Guatemala, to identify all children < 6 months old as well as all pregnant women who were expected to deliver during the two-month data-gathering period. After the census was completed, a survey of breast-feeding practices was administered to all mothers of infants < 6 months of age. Results. The most important determinant of early initiation of breast-feeding was place of delivery. Children born at home (odds ratio (OR) = 4.1, 95 percent confidence interval (CI): 1.2- 13.3) and at Ministry of Health health centers (OR = 4.9, 95 percent CI: 1.6-15.0) were significantly more likely than children born at private hospitals to initiate breast-feeding early. The most important determinant of exclusive breast-feeding was whether or not the mother worked outside the home. After controlling for infant's age and sex and mother's ethnicity, women who did not work outside the home were 3.2 times as likely (95 percent CI: 1.6-6.4) to exclusively breast-feed as were women who worked outside the home. Lack of exclusive breast-feeding was often associated with giving a bottle. Conclusions. Our findings suggest that global efforts must be continued to improve breast-feeding practices in delivery hospitals. In addition, community-based support of breast-feeding is needed well after delivery. Mothers who work outside the home should be provided with options to maintain exclusive breast-feeding when they are physically separated from their infants due to the demands of work

The impact of mother-to-mother support on optimal breast-feeding: a controlled community intervention trial in peri-urban Guatemala City, Guatemala

Objective. To assess the impact that a mother-to-mother support program operated by La Leche League Guatemala had on early initiation of breast-feeding and on exclusive breast-feeding in peri-urban Guatemala City, Guatemala. Materials and Methods. A population census was conducted to identify all mothers of infants < 6 months of age, and the mothers were then surveyed on their breast-feeding practices, in two program communities and two control communities. Data collection for this follow-up census and survey was carried out between November 2000 and January 2001, one year after a baseline census and survey had been conducted. Results. At follow-up, 31 percent of mothers in the program communities indicated that counselors had advised them about breast-feeding, 21 percent said they had received a home visit, and 16 percent reported attending a support group. Communitywide rates of early initiation of breast-feeding were significantly higher in program areas than in the control communities, at both baseline and follow-up. However, the change over time in early initiation in program communities was not significantly different from the change in control communities. Communitywide rates of exclusive breast-feeding were similar in program and control sites and did not change significantly from baseline to follow-up. However, of the mothers in the program communities who both received home visits and attended support groups, 45 percent of them exclusively breast-fed, compared to 14 percent of women in program communities who did not participate in those two activities. In addition, women who were exposed to mother-to-mother support activities during the year following the baseline census and survey were more likely than mothers exposed before that period to exclusively breast-feed. This suggests that the program interventions became more effective over time. Conclusions. This study does not provide evidence of population impact of La Leche League's intervention after one year of implementation. In peri-urban Guatemala, long-term community-based interventions, in partnership with existing health care systems, may be needed to improve communitywide exclusive breast-feeding rates