ABSTRACT
Resumen El incremento en el consumo de alcohol y la disminución en la edad de inicio requieren del desarrollo de propuestas preventivas dirigidas a población en edad más temprana, sustentadas teórica y empíricamente, como la Teoría de la Conducta Planeada (TCP). Para ello se debe conocer la intención que tiene el sujeto de consumir esta sustancia, por lo que se vuelve necesario evaluar sus creencias de comportamiento, normativas y de control sobre la conducta de interés. Un medio para evaluar dichas creencias lo constituyen las escalas de medición. El objetivo de este trabajo fue describir el proceso que se siguió para construir un instrumento, válido y confiable, que mide la intención de los niños de consumir bebidas con alcohol desde la Teoría de la Conducta Planeada. A diferencia de los estudios reportados desde esta teoría con adultos, no se encontró diferencia entre las creencias normativas y la importancia que se les da. En cuanto al control conductual percibido, los niños no identifican barreras para el consumo en el cuestionario, solo facilitadores. Esto puede estar relacionado con que en esta edad, es una conducta experimental. Por lo tanto la forma de calificar el instrumento para obtener la puntación en intención tuvo que modificarse.
Abstract The increase in alcohol consumption and the decrease in the age of onset requires the development of preventive proposals aimed at younger age population, theoretically and empirically supported. Theory of Planned Behavior (TCP) has this base, for it must know the intention of the subject of doing, being necessary to assess their behavioral beliefs, normative and control on the behavior of interest. A means of assessing such beliefs is constituted by the measurement scales. The aim of this study was to describe the process followed to build a valid and reliable instrument, which measures the intention of children to consume alcoholic beverages from the The-ory of Planned Behavior. Unlike the reported studies from this theory with adults, there were no differences between normative beliefs and the importance they are given. In terms of perceived behavioral control, children did not identify barriers to consumption in the questionnaire, only facilitators. This may be related to the fact that at this age, this is an experimental behaviour, so the way to qualify the instrument to get a score in intention had to be modified.
Subject(s)
Humans , Alcohol Drinking , Behavior , Child , MexicoABSTRACT
Resumen Con el objetivo de identificar, entre 317 municipios y delegaciones del país, aquellos que requieren con mayor prioridad servicios de tratamiento y prevención del consumo de drogas, se llevó a cabo un estudio transversal con base en el método Delphi, el cual constituye una metodología estructurada para recolectar sistemáticamente juicios de expertos sobre un problema, de manera que las apreciaciones individuales se transforman para elaborar un juicio colectivo sobre el tema, lo que sirve para aplicar un peso ponderado a las variables en estudio. En este caso se contó con un panel de 55 expertos que valoró el nivel de riesgo de 33 indicadores demográficos, de salud, económicos, de educación, vivienda, geográficos, turísticos, sociofamiliares, del tráfico de estupefacientes y del consumo de drogas ilegales que se encontraban vigentes. Las variables estudiadas fueron: proporción de concentración urbana, tasa media de crecimiento, edad promedio, proporción de población masculina, tasa de migración internacional, proporción de servicios de salud, viviendas con agua y energía eléctrica, viviendas con servicio de drenaje, viviendas con Internet, nivel de hacinamiento, nivel de ingreso, pobreza alimentaria, pobreza de capacidades, pobreza de patrimonio, personas de 3 años y más que no asisten a la escuela, personas de 12 años y más que no asisten a la escuela, nivel de escolaridad, ubicación en la frontera norte, formar parte de grandes metrópolis, afluencia de turismo nacional e internacional, proporción de embarazos tempranos, proporción de personas que profesan alguna religión, encontrarse ubicado en rutas de tráfico de marihuana, cocaína, metanfetaminas y/o heroína, la prevalencia del consumo de drogas en los jóvenes, las prevalencias del consumo de cocaína y de marihuana, la percepción de incremento del consumo de drogas y la proporción de la población a la que le han ofrecido drogas regaladas. Los resultados mostraron que de los 371 municipios y delegaciones con 50,000 habitantes o más considerados para este estudio, 85 de ellos formaron parte de grandes metrópolis, con más de un millón de personas; 73 fueron puntos turísticos y 73.5% de las localidades conformaron concentraciones urbanas. Se identificaron 59 municipios y delegaciones con nivel de riesgo macrosocial alto o muy alto y 105 municipios y delegaciones con un nivel de riesgo macrosocial mediano-alto, que requieren con mayor prioridad de servicios de prevención, tratamiento y rehabilitación del consumo de drogas.
Abstract With the objective to identify, among 317 municipalities and delegations of the country, those requiring with higher priority drug abuse prevention and treatment services, it was made a cross-sectional study, based on the Delphi method, which is a structured methodology to systematically collect expert opinions on an issue, so that the individual assessments are transformed to produce a collective judgment on the subject that was carried out, and apply a weight to the variables under study. In this case we had a panel of 55 experts, whose assessed the risk level of 33 updated demographic, health, economic, education, housing, geographic, touristic, socio-familiar, drug trafficking and use of illegal drugs. The studied variables were: Proportion of urban concentration, average growth rate, average age, proportion of male population, international migration rate, Proportion of health services, Homes with water and electricity, Drawnig housing service, Internet housing service, Overcrowding level, Income level, Food poverty, Capability poverty, Patrimony poverty, Persons of 3 years and older who do not attend school, Persons aged 12 and over who do not attend school, school level, location on the northern border, are part of large metropolis, inflow of national and international tourism, proportion of early pregnancy, people who practice some religion, be located on routes of trafficking marijuana, cocaine, methamphetamine and / or heroin, prevalence of drug use among young people, prevalence of cocaine and marijuana use, the perception of increased drug use, and the proportion of the population that has been offered drugs for free. The results showed that of the 371 municipalities and delegations with 50,000 inhabitants or more considered for this study, 85 of them were part of large metropolis with more than a million people; 73 were tourist spots and 73.5% of the localities made urban concentrations. Were identified 59 municipalities and delegations with a high or very high macro-social risk level and 105 municipalities and delegations with a medium-high macro-social risk level, requiring with highest priority services of prevention, treatment and rehabilitation of drug abuse problems.
ABSTRACT
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Summary The need of cost-effective drug abuse prevention programs has derived in a growing interest to develop scientific based alternatives. On this context, this study forms part of a project for the design and evaluation of a theoretical and empirically sustained intervention for illicit drug abuse prevention among Mexican junior high school students. Starting with the revision and assessment of different theoretical models that could be adapted to the conditions of the institutional context wherein the intervention will be developed, the Azjen and Fishbein's Theory of Planned Behavior was chosen. This theory includes proximal cognitive and attitude factors directly related to the initiation of drug use. In accordance with it, the experimental use of substances is a result of the intention of consuming them, which, in turn, depends on three elements: a) the attitude toward the drug use, b) the normative beliefs on this matter (subjective norm) and c) the perceived behavioral control regarding drug use or, in turn, confronting social pressure. In a first instance, several items were developed adapting the constructs of the Theory of Planned Behavior to the target population's characteristics. On this base, the reliability and validity of a self-applied questionnaire for the measurement of the variables of the model was proved. In this work are reported the findings of the evaluation of Theory of Planned Behavior's potential to predict both behavioral intention of using illicit drugs and consumption of substances among Mexican high school students, in order to set a precedent to apply the model later on in the design and evaluation of a preventive intervention directed to such population. Method: The study was carried on with an ex post facto, correlational design, and with a non-probabilistic sample of 1,019 subjects. Sample. The sample size was estimated considering the possibility of selecting a subsample of drug users and comparison subjects for a post-stratified analysis, assuring a statistical power of 80% and adequate sensibility and stability. Therefore, this work includes the performed analyses with a sample of 75 drug users and 75 non users, paired by gender, age, school grade and occupation. Instrument. The instrument was a self-applied questionnaire specially developed for the study, according to information obtained in previous focal groups interviews with high school students. The questionnaire showed a global realiability of 0.9154 and between 0.62 and 0.94 in each one of its scales, which included: behavioral beliefs (0.9121), attributed value to behavioral beliefs (0.7964), normative beliefs (0.6480), subject's disposition to adjust to normative expectations (0.8564), descriptive norm (0.6254), drug use opportunities (0.8129) and perceived behavioral control coping with such opportunity situations (0.9442). A factorial analysis of principal components yielded 16 factors of at least three items each, with factorial weights higher than 0.4, and closely attached to Theory of Planned Behavior's variables, with an explained variance of 59%. Analysis. Previous to data analysis, normality tests (Kolmogorov- Smirnov) were performed, indicating the necessity to apply nonparametric tests of differences and to transform the data to be adapted to the requirements of later parametric analyses. A correlation analysis was carried out to prove the association between behavioral intention and drug use, as well as between the different components of the Theory of Planned Behavior. Finally, linear and logistic regression analyses were conducted to determine the explicative potential of the model and the predictive weight of each variable on the model with regard to the behavioral intention and the consumption of drugs. Findings: According to the Mann-Whitney test, compared with students who had not used drugs, subjects that used them at least once in their life showed more favorable attitudes toward consumption (median= 6.9 vs. 3.9, z=-5.22, p=0.000), perceived more social tolerance (median=3.8 vs. 3.5, z=-2.27, p=0.023), were more willing to give in to social pressure for using substances (median=2.0 vs. 1.0, z=-5.598, p=0.000), perceived a higher number of users among their significant others, and less negative consequences Salud Mental, Vol. 30, No. 1, enero-febrero 2007 69 of drug use in themselves (median=16.3 vs. 7.1, z=-4.246, p=0.000), and felt less capable of behavioral control when coping with opportunities for consumption, which, in turn, are more frequent in their case (median=5.7 vs 1.8, z=-6.76, p=0.000). The correlation between the intention and the behavior of drug use (r=0.41, p<0.000) was allocated inside the range reported in other populations. Drug use intention correlated with attitude toward drug use at r=0.45 (p=0.000), with subjective norm, including additional components at r=0.48 (p=0.000), and with perceived behavioral control at r=0.59 (p=0.000). Drug use correlated with attitude at r=0.51 (p=0.000), with subjective norm at r=0.28 (p=0.001), and with perceived behavioral control at r=0.37 (p=0.000). Linear regression analysis yielded that the model explained 34% of the variance of drug use intention, which increased to 38% when adding personal and descriptive norm elements to the subjective norm construct. Behavioral control (measured on the basis of the product of exposition to drug use facilitating situations punctuations by perceived behavioral control to cope with these situations punctuations) was identified as the best predictor of drug use intention (B=0.32, p=0.001), followed by attitude toward drug use (B=0.24, p=0.004) and subjective norm, which originally showed a non-significant effect but increased its predictive weight when additional elements were added (B=0.24, p=0.004). According to the logistic regression analysis, behavioral control is also the best predictor of illicit drug use on the model (odds ratio= 1.42, p<0.000). On the contrary, subjective norm (including personal and descriptive norm) and attitude (odds ratio=1.144, p=0.06) were not significant predictors of drug use. Discussion: In general, this findings indicate that the Theory of Planned Behavior showed an acceptable predictive capacity (similar to that found in other populations), and can be taken as a valid theoretical ground to develop a preventive intervention directed to Mexican students of high school education. As is the case with other populations, the variable in the Planned Behavior Theory with more predictive weight was perceived behavioral control, followed by attitude to drug use and, in third place, by subjective norm. Despite it could be supposed that subjective norm would have a higher predictive weight in Mexican teenagers, findings probably reflected idiocentric and individualistic tendencies reported in other studies. Results also point out to the convenience of including it in the program of intervention informative components to produce an awareness effect and an impact in the intention of using drugs. Still, they indicate above all, the need to integrate components directed to the development and reinforcement of behavioral control abilities that have an effect in the use of drugs itself. Specifically, it is considered the convenience of including components for the development of group pressure resistance abilities and assertive communication, appropriate to the contexts in which young people face drug abuse risk situations.