El impacto de la prueba de VPH en los programas de tamizaje en América Latina: el caso de Argentina / The impact of the HPV test in screening programs in Latin America: The case of Argentina

Resumen: Objetivo: Evaluar el impacto de la prueba de VPH (prueba de VPH) en los problemas que históricamente afectaron al tamizaje de cáncer cervical en América Latina, tomando como caso al Proyecto Demostración para la Introducción de la prueba de VPH en Jujuy (PDJ), Argentina. Material y métodos: Se sintetizó la evidencia sobre los problemas del tamizaje cervical en la región. Se analizó el impacto en los problemas a partir de la introducción de la prueba de VPH. El impacto se clasificó en directo/indirecto y positivo/negativo. Resultados: El impacto directo-positivo se dio en los problemas de adherencia a la edad/frecuencia de tamizaje, laboratorios de citología, baja/moderada sensibilidad de la citología y baja cobertura. El impacto directo-negativo se vinculó con el triaje de autotoma y el envío/etiquetado de muestras. El impacto indirecto-positivo se relacionó con la reorganización programática realizada para introducir la prueba de VPH. Conclusiones: La prueba de VPH representa una ventana de oportunidad para el mejoramiento del tamizaje pero no resuelve los problemas programáticos.

Abstract: Objective: To assess the impact of HPV testing on longstanding problems faced by screening programs in Latin America, using the case of the Jujuy Demonstration Project (JDP) in Argentina. Materials and methods: The study measured the level of impact produced by the introduction of HPV-testing on problems faced by cytology programs by analyzing modifications on specific problems produced during the JDP. Impact was classified as direct/indirect, and positive/ negative. Results: Direct/positive impact was found in issues concerning age and screening frequency, cytology laboratories and screening sensitivity, and low coverage. Direct/negative impact was mainly related to the adherence to triage cytology by HPV+ women with self-collected-tests, and the delivery and labelling of samples. Indirect impact of HPV-Test was mostly positive, and related to the programmatic reorganization which was facilitated by the introduction of HPV testing. Conclusions: HPV testing provides an opportunity window for improving primary screening, but does not solve programmatic problems.

Adopción e implementación del ofrecimiento de la autotoma VPH por agentes sanitarios en Jujuy, Argentina / Adoption and implementation of HPV self-collection sampling by CHWs in Jujuy, Argentina

Resumen: Objetivo: Evaluar la adopción e implementación en escala de la estrategia orientada a ofrecer puerta a puerta la autotoma de la prueba del virus del papiloma humano (AT-VPH), por parte de agentes sanitarios (AS), en Jujuy, Argentina. Material y métodos: Se aplicó una encuesta autoadministrada a 478 AS. Las dimensiones de adopción e implementación fueron evaluadas con el modelo RE-AIM. Resultados: Adopción: 81.8% de los AS ofreció la AT-VPH y 86.4% expresó gratificación con la estrategia. Implementación: los problemas encontrados fueron la demora en la entrega de tubos (61.3%) y resultados (70.0%); falta de recursos humanos (28.3%), y dificultades al obtener turnos para realizar el triage (26.1%). El principal obstáculo fue la sobrecarga de trabajo (50.2%), mientras que la capacitación (38.0%) y el listado de mujeres a contactar (28.7%) fueron los elementos facilitadores. Conclusiones: La adopción de la AT-VPH fue alta entre los AS. Deben reforzarse las estrategias programáticas para motivar a los AS y reducir su carga de trabajo al implementar la AT-VPH.

Abstract: Objective: To evaluate adoption and implementation of scaling up of HPV self-collection (SC) strategy offered door-to-door by Community Health Workers (CHWs) in Jujuy, Argentina. Materials and methods: A self-administered questionnaire was applied to 478 CHWs. RE-AIM model was used to evaluate adoption and implementation dimensions. Results: Adoption: 81.8% offered SC and 86.4% were satisfied with the strategy. Implementation: main problems were delays in the delivery of tubes (61.3%) and results (70.0%), lack of human resources (28.3%) and difficulties in obtaining an appointment for triage (26.1%). The main obstacle was the excessive workload of CHWs (50.2%). Training (38.0%) and the list of women to be offered the test (28.7%) were identified as facilitators. Conclusions: The adoption of SC strategy was high among CHWs. Program strategies should be strengthened to motivate and reduce the excessive workload of CHWs when implementing SC strategy.

Evaluación de un programa de detección temprana de cáncer cervicouterino en Colombia / Evaluation of A Cervical Cancer Early Detection Program In Colombia

Resumen Objetivo: Evaluar el proceso de atención del programa de detección temprana de cáncer cervicouterino enfocado en cobertura de tamización, oportunidad de atención y adherencia en el direccionamiento del diagnóstico y tratamiento en seis municipios de Colombia. Métodos: Estudio observacional descriptivo de corte transversal a partir del análisis de fuentes secundarias de información del programa de detección temprana de cáncer cervicouterino de una aseguradora en salud de personas afiliadas con vinculación laboral y capacidad de pago. El procesamiento y análisis de los datos fueron realizados mediante el programa estadístico SPSS® versión 22 con la identificación de frecuencias absolutas, relativas, medidas de tendencia central y variabilidad. Resultados: Para el 2014, se tomaron 28.442 citologías cervicales, el 2,3% fueron resultados con algún tipo de anormalidad. Se evidenció cobertura anual de tamización del 28,2% (0,0% -280,6%), oportunidad de atención; entre toma y entrega de resultado: 15 días (4 -118), entre el resultado y el diagnóstico: 18 días (2 - 294) y entre el diagnóstico y tratamiento: 49,5 días (2 -240). Para adherencia, el 81,6% evidencia cumplimiento del direccionamiento al diagnóstico a partir del resultado citológico y el 62,6% evidencia cumplimiento en el direccionamiento del diagnóstico al tratamiento. Conclusiones: El programa de detección temprana de cáncer cervicouterino presenta coberturas bajas de tamización, falencias en el cumplimiento de la oportunidad en la atención y de la adherencia en el direccionamiento del diagnóstico y del tratamiento.

Abstract Objective: To evaluate the care process of the Cervical Cancer Early Detection program focused on screening coverage, access to care, and adherence when addressing the diagnosis and treatment, in six towns of Colombia. Methods: A cross-sectional, descriptive, observational study conducted using the analysis of secondary information sources from the Cervical Cancer Early Detection program of an occupational health insurer of persons employed, and with the ability to pay. Data processing and analysis were performed using the statistical program SPSS® version 22 with the identification of absolute and relative frequencies, central tendency, and variability measurements. Results: In the year 2014, of the 28,442 PAP smear tests taken, 2.3% were found to have some kind of anomaly. An annual screening coverage of 28.2% (0.0% - 280.6%) was observed. The access to care between the date of the sample and the delivery of the result was 15 days (4 - 118), between the result of the test and the diagnosis: 18 days (2 - 294), and 49.5 days (2 - 240) between the diagnosis and treatment. For adherence, 81.6% showed adherence to the diagnosis based on the cytological result, and 62.6% showed compliance in the diagnosis-treatment approach. Conclusions: The cervical cancer early detection program has a low screening coverage, with failures in complying with timely care and adherence in addressing diagnosis and treatment.

Programa de detección del cáncer cervicouterino: políticas públicas y experiencias de los actores que implementan el programa en el estado de Veracruz, México / Screening program for cervical cancer: public policies and experiences of actors who implement the program in the state of Veracruz, Mexico

RESUMEN El propósito fue analizar cómo se desarrolla el Programa de Detección del Cáncer Cervicouterino en una clínica de displasias y algunos centros de salud en el estado de Veracruz, a través de las representaciones y prácticas de los actores sociales que implementan el programa. Para ello, se realizaron entrevistas en profundidad y observación de la práctica de estos prestadores de servicios durante varios periodos a lo largo de 3 años entre 2009 y 2011. A partir de la información obtenida pretendemos dar cuenta de las dificultades, aciertos y resultados que dicho programa tiene como parte de una política pública, sobre la base de que las políticas en salud tienen como prioridad que toda la población se vea beneficiada por los servicios de atención preventiva y curativa, y si bien la evidencia nos muestra que las poblaciones marginadas no se ven beneficiadas por dichos programas, pareciera que esta información no permea los saberes populares y médicos.

ABSTRACT The aim of this article is to analyze the way in which the Screening Program for Cervical Cancer is carried out in a dysplasia clinic and related health centers in the state of Veracruz, through the representations and practices of the social actors who implement the program. In order to do so, in-depth interviews and observations of the practices of health service providers were carried out during different periods over the course of three years, from 2009 to 2011. Through the information obtained, the article explores the difficulties, achievements and results of this program as part of a public policy. Although a priority of public health policy is to see the whole population benefit from preventive and curative health care services, evidence shows that marginalized populations are not benefitted by such programs; such information does not however seem to permeate popular and medical knowledge.

Tertiary Prevention of Ischemic Heart Disease: Post Coronary Artery Bypass Surgery.

Coronary heart disease is more prevalent in Indian urban populations and there is a clear declining gradient in its prevalence from semi-urban to rural populations. Epidemiological studies show a sizeable burden of coronary heart disease in adult rural (3-5%) and urban (7-10%) populations. Thus, of the 30 million patients with coronary heart disease in India, there would be 14 million who are in urban and 16 million in rural areas. In India, about 50% of coronary heart disease-related deaths occur in people younger than 70 years compared with only 22% in the West. Extrapolation of these numbers estimates the burden of coronary heart disease in India to be more than 32 million patients. In India, there are large spectrums of patients who present at tertiary stage when first examined. These patients are left with very little margin of safety. Heart disease is one of the commonest causes of mortality and morbidity worldwide. Coronary artery bypass graft (CABG) surgery is a frequently used cardiothoracic revascularization to treat coronary artery disease (CAD). In addition to physical impairments and activity restrictions in the immediate postoperative period, patients encounter some obstacles to exhibit improvements in quality of life in the long run. Cardiac tertiary prevention programs generally consist of the prevention of disease progression and patient suffering. Aim of these interventions is to reduce the negative impact of disease by restoring function and reducing disease-related complications and therefore, include the rehabilitation of disabling conditions. Cardiac rehabilitation programs are interventions aimed to reduce mortality and morbidity of patients with ischemic heart diseases through promoting a healthier lifestyle among patients. These programs are used to restore, maintain, or improve both physiologic and psychosocial outcomes and finally the quality of life in patients through a combination of exercise, education and psychological support.

Análise de programas direcionados a comportamentos exteriorizados na infância e adolescência / Analysis of programs aimed at externalized behaviors in childhood and adolescence

Diversos autores apontam a importância da intervenção precoce como estratégia eficaz para a prevenção ou interrupção da trajetória de problemas de comportamento. Esse trabalho buscou realizar uma revisão de literatura acerca de estudos sobre programas direcionados a problemas de comportamentos exteriorizados em crianças e adolescentes. Os critérios para a seleção dos artigos foram: textos completos; publicados no período de 2000 a 2011; nas bases de dados on-line Scielo, Lilacs e Pepsic; sendo excluídos artigos médicos relacionados a outras temáticas e os repetidos. Várias palavras-chave foram utilizadas para a seleção de artigos. Foram realizadas a leitura e a análise dos 23 artigos completos selecionados que se referiam a estudos teóricos e empíricos específicos acerca de programas direcionados a comportamentos exteriorizados em crianças e adolescentes. Os resultados foram agrupados para análise de suas características referentes a: 1) público-alvo; 2) comportamento-alvo abordado; 3) formas de intervenções (individual ou em grupo); 4) foco quanto ao tipo de intervenção (prevenção ou tratamento); 5) resultados e conclusões encontrados e 6) análise dos estudos acerca de teorias, delineamento e funcionamento dos programas em si. Conclui-se que diversas formas de intervenção se mostraram efetivas, sendo que cada uma foi delineada e implementada a partir de contextos e problemas específicos. Também se observa a importância da avaliação de tais propostas, no sentido da eficácia e dos resultados para a população-alvo, e da avaliação da metodologia e implementação de tais ações.

Several authors point out the importance of precocious intervention as an effective strategy for the prevention or interruption of the trajectory of behavioral problems. This work intended to carry out a literature review of studies about programs aimed at externalized behavior problems in children and adolescents. The criteria for articles selection were: concluded texts; published between 2000 and 2011; in online databases Scielo, Lilacs e Pepsic; being excluded medical articles related to other themes and repeated ones. Various keywords were used for the articles selection. We carried out the reading and analysis of 23 select concluded articles that referred to specific theoretical and empirical studies about programs aimed at externalized behaviors in children and adolescents. The results were grouped for analysis of its characteristics related to: 1) target audience; 2) target behavior; 3) intervention forms (individual or in group); 4) focus on the intervention (prevention or treatment); 5) results and found conclusions and 6) analysis of studies about theories, outlining and programs operation. It was concluded that different forms of intervention were effective, and each one was outlined and implemented based on specific contexts and problems. It was also observed the importance of evaluation of these proposals in the sense of effectiveness and results for the target population and of the evaluation of methodology and implementation of these actions.

Diseño y evaluación de un programa de prevención de consumo de alcohol en una institución universitaria diseñado con los estudiantes / Alcohol consumption prevention program designed with students in a university institution

Este artículo presenta los resultados de una investigación de tipo cuasiexperimental que tuvo como objetivo diseñar, implementar y evaluar un programa de prevención al consumo de alcohol en estudiantes universitarios en la ciudad de Bogotá. El programa se diseñó con la participación de 101 estudiantes a través de grupos focales. Los estudiantes expresaron estar de acuerdo con la utilidad del programa para la comunidad universitaria y la posibilidad de generar actitudes de control hacia el consumo de alcohol. La evaluación que se realizó a los estudiantes sobre el consumo de alcohol antes y después de la implementación del programa no mostró diferencias significativas.

This article presents the results of a quasi-experimental research that aimed to design, implement and evaluate a program of prevention of alcohol consumption in college students in the Bogota city, Colombia. The program was designed with the participation of 101 students through focus groups. Students expressed agreement with the utility of the program for the university community and the possibility of generating control attitudes towards the consumption of alcohol. Student's evaluation was performed on alcohol consumption before and after implementation of the program showed no significant differences.

Programa de Prevenção ao Suicídio: estudo de caso em um município do sul do Brasil / Suicide Prevention Program: case study in a municipality in the south of Brazil

Este artigo está focado no tema da prevenção do suicídio a partir da análise de um trabalho em desenvolvimento. Foi realizado um estudo de caso do Programa de Promoção à Vida e Prevenção ao Suicídio de Candelária (RS), um município brasileiro que apresenta altos coeficientes de mortalidade por suicídio na população geral e de idosos. O objetivo deste texto é analisar uma experiência que vem obtendo êxito e tem a base numa iniciativa local. Os dados aqui apresentados resultam de observação participante, de entrevistas com a equipe que conduz o trabalho, dos grupos de discussão e da análise documental. Foram utilizadas as seguintes categorias: linha de cuidado, gestão e processo avaliativo. Os resultados da intervenção mostram que as taxas de suicídio decresceram de 5 óbitos/ano (21/100 mil habitantes) no período 1996-2000 para 3,6 óbitos/ano (12/100 mil) em 2007-2009. O estudo estabelece um diálogo com experiências de outros locais e traz contribuições para programas de prevenção que possam ser organizados no país.

This article focuses on the theme of suicide prevention based on analysis of a work in progress. A case study of the Program for Promotion of Life and Suicide Prevention of Candelária in the State of Rio Grande do Sul was conducted. It is a Brazilian municipality that has high suicide mortality rates in the general population and among the elderly. The scope of this paper is to present a experience that has proved successful and is based on a local initiative. The data presented here result from participant observation, interviews with the team carrying out the work, discussion groups and document analysis. The following categories were used: line of care, management and evaluation process. The results of intervention show that suicide rates declined from 5 deaths per year (21/100,000 inhabitants) between 1996 and 2000 to 3.6 deaths per year (12/100,000 inhabitants) between 2007 and 2009. The study establishes a dialogue with the experiences of others locations and provides contributions to prevention programs that can be set up in Brazil.

Consumo de drogas en adolescentes mexicanas / Drug use in mexican female adolescents

Resumen:

Estudio descriptivo y transversal, cuyo objetivo fue identificar el uso de drogas en mujeres estudiantes de bachillerato de Veracruz, México. Participaron 152 adolescentes, seleccionadas mediante muestreo aleatorio simple. Se utilizaron 14 preguntas del cuestionario para estudiantes 2006 aprobado por la Organización Mundial de la Salud (OMS) y adaptado a población mexicana. El uso en la vida fue de un 60,5% con edad de inicio de 14,3 años, el 21,1% consumió en el último mes, el 3,3% hace uso frecuente y el 4% uso. Las drogas más experimentadas fueron el alcohol (52%), el tabaco (28,9%) y la marihuana (7,2%). El 14,6% realizó el primer consumo en su propia casa, el 9,9% uso alcohol y tabaco y el 4,7% drogas ilícitas. Existe alta tolerancia familiar para el consumo de drogas lícitas e ilícitas y baja percepción del riesgo de las estudiantes. El estudio tiene contribuciones para apoyar la realización de programas preventivos en relación al consumo de drogas en estudiantes de bachillerato.

Elementos para programas de prevención en consumo de alcohol en universitarios / Elements for prevention programs in alcohol consumption by university students

El presente estudio no experimental, tuvo como objetivo proponer elementos para los programas de prevención del consumo de alcohol con universitarios, partiendo del análisis de los niveles, situaciones y características del consumo. En 10 universidades de Bogotá, 2.910 universitarios respondieron la ficha características del consumo, el CEAL y el ISCA, y 80 participaron en 15 grupos focales. El consumo es alto, se inicia tempranamente con aprobación de los padres y en él influyen las presiones académicas, la soledad y la cultura. Existen indicadores de abuso y dependencia. Las situaciones asociadas al consumo son las emociones y los momentos agradables, la urgencia por consumir y la presión social. Los programas preventivos deben ser implementados por jóvenes, orientados al consumo responsable, utilizando una variedad de actividades con responsabilidad de los actores.

The non - experimental study, aimed to propose from university's students items for prevention programs of alcohol consumption obtain by examining levels, situations and characteristics of alcohol consumption of 2910 students in ten universities of Bogotá - Colombia who answered the features tab in consumption, the CEAL and the ISCA, participating in 15 focus groups, 80 students. Consumption is high, begins at early ages, approved by parents, associated by academic pressures loneliness and culture. There are indices of abuse and dependence. The situations associated with consumption are emotions and good times, the urge to consume and social pressure. Preventive programs should be implemented by youth-oriented, responsible consumption using a variety of activities with responsibility from the actors.

Cobertura de programas preventivos en Chile / Coverage with preventive programs in Chile

Introducción: Los Programas de Medicina Preventiva para que tengan un impacto en el nivel de salud deben tener una alta cobertura poblacional. Objetivo: Estudiar la cobertura de los programas preventivos que se realizaron en el Sistema de Salud Público Chileno el año 2007. Material y Métodos: Se revisó la cobertura de los programas preventivos en las bases de datos del Departamento de Estadísticas e Información en Salud del Ministerio de Salud de Chile del año 2007. Resultados: La cobertura global de los programas preventivos medido a través del Índice de Medicina Preventiva fue de0.202. El programa de salud dirigido a los < de 6 años (infantil) fue el que registró una mayor cobertura (0.84), un nivel de cobertura intermedio se observó en los programas de la mujer (0.34) y del adulto mayor (0.29), por su parte los programas dirigidos a la población escolar, adolescente y adulto fueron los que presentaron menores coberturas (<0.1). Discusión: La alta cobertura observada en el programa preventivo dirigido a la población infantil, ha sido un factor que ha favorecido la mejoría en el nivel de salud de este grupo poblacional, particularmente ha contribuido a reducirla mortalidad infantil en Chile. El país debe crear estrategias que permitan incrementar la cobertura en programas preventivos dirigidos a la población escolar, adolescente y adulta, solo de esta forma podrá seguir avanzando en la senda de mejorar el nivel de salud poblacional.

Introduction: In order to have an impact on the level of health, Preventive Medicine Programs should have high population coverage. Objective: To study the coverage of preventive programs which were conducted in the Chilean Public Health System in 2007. Material and Methods: The coverage of preventive programs in the databases of the Department of Health Statistics and Information of the Chilean Ministry of Health in the year 2007 were reviewed. Results: The overall coverage of preventive programs as measured by the index of Preventive Medicine was 0.202. The health program aimed at < 6 years (children) was the one that recorded a greatest coverage (0.84). An intermediate level of coverage was observed in the women’s program (0.34) and in that of elderly (0.29). Programs conducted for school children, teenagers, and adults presented a low coverage (<0.1). Discussion: The high coverage observed in the child health preventive program, has been a factor that has led to the improvement of the health status of this population group. Particularly, it has contributed to reduce the infant mortality in Chile. The country must create strategies to increase the coverage of preventive programs aimed at schoolchildren, teenagers and adults. Only in this way we can go on improving the level of population health.

Prevalence of periodontal disease in special needs patients at APAE-PF/RS and the effect of local prevention programs

Aim: The objective of this study was to assess the prevalence and severity of periodontal disease and the efficiency of oral health programs in patients with special needs under treatment at APAE/ PF-RS (Association of Parents and Friends of Special Needs Individuals - Passo Fundo/RS). Methods: The periodontal condition of 109 patients was evaluated through clinical examination by two undergraduate students calibrated for the Periodontal Screening and Recording (PSR) index. The data collected were analyzed by SPSS 15.0 for Windows focusing on qualitative research. A descriptive analysis of data (percentile, frequency, mean and standard deviation) was performed, as well as statistical analysis by the chi-square at 5% significance level, and Pearson’s t-test to verify the correlation of the variables age, gender, handicap level and PSR index. Results: Age was a significant factor for PSR1, PSR2, PSR4 and PSR5, where younger patients showed better periodontal health than older ones; however, gender and handicap level did not show significant differences when correlated with the PSR. The patients presented prevalence of periodontal health in the majority of sextants, followed by gingivitis. Few patients showed more severe degrees of periodontal disease. Conclusions: This study demonstrated that the patients had acceptable oral hygiene, and low prevalence of gingivitis and periodontitis, suggesting that the program of prevention and dental care adopted at the facility was efficient and may represent a model for periodontal health care for patients in other institutions and towns.

Capacidad predictiva de la Teoría de la Conducta Planificada en la intención y uso de drogas ilícitas entre estudiantes mexicanos

resumen está disponible en el texto completo

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.

The Effectiveness and Satisfaction of Personal Computer Based Smoking Cessation Program for Adolescents

BACKGROUND: Although smoking hazards are acknowledged worldwide, recent study of Korean teenage smokers shows that students' first smoking experiences are occurring at younger ages. Therefore, we have developed an internet-based smoking prevention program, and assessed the effectiveness of the self-administered internet program by comparing with traditional lecture. METHODS: Between April and June of 2004, 463 female eighth-grade students at a middle school were divided into two groups. One group (n=252) received the lecture- based smoking prevention education by an expert, while the other group (n=212) learned themselves via the internet program. Prior to both smoking prevention programs, the students filled out questionnaires about their basic information. One month after their education, the students were tested on the information included in the programs without prior notice and filled out another questionnaire on the level of comprehension, satisfaction and other factors. RESULTS: According to the pre-education questionnaire, the percentage of current smoking rate was 2.8%, and the first smoking experience was largely between the sixth and seventh grades. When comparing the scores of self-administered internet education with that of the lecture, the mean scores were 56.7 and 57.8, respectively, which was not significantly different (P=.267). The survey on comprehension, satisfaction, and other factors did not show any significant difference between the two groups. CONCLUSION: There was no significant difference between the internet-based program and the lecture- based one, in terms of effectiveness as well as comprehension, satisfaction, and other factors. Considering that the internet-based program is not restricted by time or location, it will no doubt be an effective tool in teenage smoking prevention programs.