Encuesta de estudiantes de la Ciudad de México 2006: Prevalencias y evolución del consumo de drogas / Student survey of Mexico City 2006: Prevalence and trends of drug use

Introduction Since three years from now, in Mexico there has been several surveys and specific research regarding drug use. Over these years the national surveillance systems databases (SISVEA, CIJ) have shown that cocaine use has stabilized and marijuana use is still increasing, although there are some regional differences. Also, the results of the 2003 Mexico City Students' Survey revealed a similar inclination: an increase on marijuana use, a slight diminish on cocaine use and as a new stage: a rebound on inhalant use. However, these changes and trends on drug use are not the same all over the country. The results found in these databases suggest that the northern border behaves differently from the rest of the country, even all along the northern border itself. While drug use in Matamoros is lower than in other border cities, Nuevo Laredo, Reynosa and Ciudad Juarez registered high cocaine and heroin use. On the other hand, even though the border cities of Sonora and Baja California have these same drug use problems, they also show high rates of methamphetamine use. Another important issue on border cities is that Ciudad Juarez has reached Tijuana's use levels, mainly among teens between 12 and 1 7 years old. These two cities have the highest substance use levels in the country, even above Mexico City. On the central region of the country, the drug use rates are halfway between. Even though Mexico City's drug use levels are among the central region and the two border cities mentioned before, in all the states that have been studied, there's been a general significant increase in drug use. In southern states, especially Yucatan (where there's a household and a students' survey), the drug rates are the lowest in the country. However, the women's drug use rates keeps increasing. Specifically the 2003 students' survey showed that in some Mexico City's counties women have higher alcohol and tobacco prevalence, and their illegal drug use trends begin to be alike to men's illegal drug use trends. Objective To present drug use prevalence results from the 2006 Mexico City Students Survey. Material and methods This survey used a 10523 Mexico City students random sample. The sample design was stratified (by county), with two stages (by school) and clustered (by groups). This data is representative by State County and by educational level. The design is comparable with previous student's surveys made by the National Psychiatric Institute (INP) and the Mexican Board of Education (SEP). The marijuana, cocaine and inhalants variation coefficients (VC) were determined according to the 2003 survey. The variable with the highest VC, a non-response rate and a design effect of two were considered as in previous surveys. With all these parameters, it was considered a 15% non-response rate, the same found in previous studies. The sample's accuracy level was 95%, with an absolute error average of 0.004. The questionnaire was made with drug use indicators that the World Health Organization used in their own surveys. Besides, some youth behaviors were explored: suicide attempt, depression, eating risk behaviors, sexual behavior, etc. Results From this sample 49.9% were women and 50.5% male. As for Tobacco <>, it affected the same both men and women, and remained similar in comparison to 2003. Also, 68.8% of the adolescents have consumed alcohol at least once in their life and 41.3% has drunk it in the previous month, being women and men equally behaved. The total drug use prevalence was 1 7.8%, statistically higher than in the 2003 survey, with a 2.6% difference. Men use more drugs compared to women. Of the total sample, 12.9% is an experimental user and 4.9% is a regular user (have used drugs five or more times). As for medical drugs (tranquillizers and amphetamines), their use is higher in women, while illegal drugs use (marijuana, cocaine, hallucinogens, inhalants, methamphetamine and heroin) is higher in men. In general terms, illegal drug use is higher than medical drugs use. Substance use percentage was nearly twice for tenth to twelfth grade students, compared to seventh to ninth grade students. Women have experimented less with illegal drugs in the 'previous year of use' than men, yet women have shown an important increase on inhalant and marijuana use over the past three years, and cocaine use has remained similar. Marijuana is the first choice drug among adolescents, followed by inhalants, tranquillizers in third place and cocaine in fourth place of choice. Also, the results show that drug use is highly related with other problematic behaviors like suicidal attempt, depressive sintomatology, antisocial behavior, and sexual risk behaviors. Conclusions The study points out an important increase in drug use over the past three years, going from 15.2% to 17.8%. Different trends can be seen on each substance. On the one hand, marijuana and inhalants use has increased widely, on the other hand tranquillizers use remains stable and cocaine use has decreased. These results showed that the illegal drugs use among both men and women has increased (marijuana and inhalants mostly), women's cocaine use has remained steady, but men's has been reduced. Legal drugs use behavior hasn't changed: the use of alcohol has enhanced, while tobacco use is similar to the 2003 survey. It has also been reported that the use rate of both substances is practically the same among men and women. Also, the situation of México City has changed slightly. The counties that are more damaged by drug use are: Azcapotzalco, Cuauhtémoc, Benito Juárez, Coyoacán and Tlalpan. In order to improve drug use prevention programs to consider the relationship between several problematic behaviors like suicidal attempt or antisocial behavior, because users showed prevalence at least twice more than non users. Likewise, there still exist a low risk perception and a high tolerance towards tobacco and alcohol use, which are important risk factors for using other drugs. Additionally, if we also take into account that the first use takes place a younger age, the probabilities of using medical and illegal drugs increase significantly.

Introducción Desde hace tres años se han hecho varias encuestas sobre consumo de drogas en nuestro país, además de investigaciones específicas sobre el tema. En estos últimos tres años diversos sistemas de información del país (SISVEA, CIJ) han mostrado que el consumo de cocaína se ha estabilizado y que el consumo de mariguana sigue en aumento, aunque estos aspectos presentan variaciones a nivel regional. Asimismo, en los datos de la encuesta de estudiantes de la Ciudad de México del 2003, se encontró una situación similar, hubo un incremento en el consumo de mariguana, un ligero decremento en el consumo de cocaína y, como nueva situación, un repunte en el consumo de inhalables. Por supuesto que los cambios y comportamientos no son iguales en todo el país. Por otra parte, se ha observado que las mujeres han incrementado su consumo de drogas de manera específica. Por ejemplo, el reporte de la encuesta del 2003 muestra que en los casos del alcohol y del tabaco, en algunas delegaciones de la Ciudad de México hay una mayor prevalencia de mujeres que consumen estas sustancias y hay indicios de que en el consumo de algunas drogas ilegales las prevalencias del consumo son similares a las de los hombres. Objetivo El objetivo de este estudio fue el de presentar los resultados de la Encuesta del 2006 sobre las prevalencias del uso de drogas entre la comunidad escolar en la Ciudad de México. Material y métodos El estudio se realizó con una muestra aleatoria de 10 523 estudiantes de todo el Distrito Federal. Los datos de este estudio son representativos por delegación y por nivel educativo, y el diseño es comparable al de estudios anteriores realizados en escuelas por el Instituto Nacional de Psiquiatría Ramón de la Fuentes Muñiz y la Secretaría de Educación Pública. El cuestionario se conformó con los indicadores de consumo de drogas que se han utilizado en este tipo de estudios que corresponden a los empleados por la OMS. Además, se exploraron diversas conductas de los adolescentes, como el intento suicida, su nivel de depresión y sus conductas alimentarias de riesgo, así como diversos aspectos de su conducta sexual. Resultados Del total de la muestra el 49.5% fueron mujeres y el 50.5% fueron hombres. En los resultados se encontró que el consumo de tabaco alguna vez en la vida ha afectado de modo similar tanto a hombres como a mujeres y fue similar a lo encontrado en el 2003. Por otro lado, se encontró que el 68.8% de los/as adolescentes ha usado alcohol alguna vez en su vida y un 41.3% lo ha consumido en el último mes; resultando igualmente afectados tanto los hombres como las mujeres. La prevalencia total de consumo de drogas fue del 1 7.8%, porcentaje estadísticamente mayor al del 2003 en un 2.6%. Los hombres estuvieron dentro del subgrupo más afectado por el consumo actual en comparación con las mujeres. De acuerdo al nivel educativo de los participantes, el consumo de sustancias fue casi del doble para los/as adolescentes de escuelas de bachillerato, como para los de bachillerato técnico, en comparación con los/as de secundaria. En cuanto a las drogas ilegales, en el consumo durante el último año, una proporción menor de mujeres ha experimentado con drogas -en ellas se ha observado, en los últimos tres años, un incremento importante en el consumo de inhalables y mariguana- en tanto que el consumo de cocaína se ha mantenido estable. Por lo que respecta a cada sustancia, la mariguana ocupa el primer lugar de preferencia entre los/as adolescentes, le sigue el consumo de inhalables, los tranquilizantes en tercer lugar y la cocaína en cuarto. Conclusiones El estudio mostró un incremento importante en el consumo de drogas en los últimos tres años: del 15.2% ha pasado a 17.8%. Además, dentro del uso de cada sustancia se observan situaciones distintas. Por un lado, el incremento del uso de la mariguana y de los inhalables es grande, mientras que en los tranquilizantes el consumo se mantiene estable y el de la cocaína ha disminuido. Al analizar estos resultados según el sexo, se encontró que los niveles de consumo de drogas ilegales (mariguana e inhalables principalmente), en las mujeres, han aumentado y la cocaína se ha mantenido estable: en tanto que en los hombres también se han incrementado las dos primeras sustancias, pero el consumo de cocaína ha disminuido. Por lo que respecta a las drogas legales, la dinámica se mantiene similar. Por un lado, el consumo de alcohol se ha incrementado en tanto que el consumo de tabaco se mantiene similar al del 2003. Las delegaciones más afectadas por el consumo de drogas son Azcapotzalco, Cuauhtémoc, Benito Juárez, Coyoacán y Tlalpan, las cuales han desplazado a Gustavo A. Madero, Venustiano Carranza, Iztacalco y Miguel Hidalgo. En el caso del abuso del alcohol, también han cambiado las delegaciones más afectadas, actualmente son Miguel Hidalgo, Cuauhtémoc, Benito Juárez, Cuajimalpa y Tlalpan. Al analizar la relación del consumo de drogas con otras conductas problemáticas se observa que los y las usuarias de drogas, han presentado de dos a tres veces más sintomatología depresiva, intento suicida, conductas antisociales, así como un posible trastorno por déficit de atención.

La Encuesta de Estudiantes de Nivel Medio y Medio Superior de la Ciudad de México: noviembre 2003. Prevalencias y evolución del consumo de drogas

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Abstract: Introduction: Research focused on drug consumption in schools has been developed in México since 1976 and has allowed for a constant monitoring of this behavior in the population. The National Institute of Psychiatry Ramón de la Fuente (INP) and the Public Education Administration (SEP) have been the pionering institutions in these efforts, where other interested institutions and states add their contributions to the assessment of the problem in this social sector. Due to the need of developing local preventive programs to reduce drug consumption, several regions of the country have carried out, in a first stage, situational diagnoses of drug consumption. These data, in addition to other community information sources, have helped to enhance efforts in terms of prevention. To date, the main investigations related to students are the Fourth National Survey on Addictions, the National Survey from the National System for the Integral Family Development, regional surveys with young students from 7th to 91 grades (Queretaro; Ríoverde, San Luis Potosí; Sinaloa; Tamaulipas and Ciudad Guzmán, Jalisco.), from 101 to 12th grade (same states, except for Ciudad Guzman and the study done in Guanajuato whose results have not been published yet) and college (Ríoverde). The main findings for adolescents and youths obtained from these studies show an increase in drug consumption, specially for alcohol, cannabis and metamphetamines, although the general index of consumption remains steady since 2001, specially in the case of cocaine. There have also been changes in men and female contributions to the consumption index, giving similar prevalences for alcohol and tobacco in both. Regional variations have been observed, where drug consumption is higher in more urbanized cities. However, new generations are more affected by this phenomenon regardless of the level of urbanization of the place where they live. Also, as it has been previously established, being in a scholastic environment is a protective factor against drug consumption, beacause consumption is higher among adolescents who do not study, and it is a differential factor that protects men more than women. As a consequence, these sources and different students' surveys point out that the probability of drug consumption increases when a minor is working. Additionally, studies report that an early consumption onset for tobacco and alcohol, mainly before 13 years old, increases the possibility of consuming other drugs. This fact is important because several reports on the literature show that age of onset for consuming these drugs is becoming earlier. It is relevant to consider that drug consumption is not an isolated factor. It is known that some precursors for drug consumption are the same for other behaviors, such as sexual intercourses without protection, antisocial, delinquent behaviors or suicide attempt. In behalf of this, prevention programs must be designed in an integral way considering the global environment of adolescents, and not just focused on drug consumption. From this point of view, results from the survey on drug use carried out among students in Mexico City in autumn, 2003, are presented. This survey is the most recent diagnosis about this problem in Mexican adolescents, and keeps the methodological standards of previous surveys. Objective: The aim of the present work is to give a recent and complete view about this problem and prevention opportunities for adolescents of Mexico City and the whole country. Materials and method: The study comprised a randomized sample of 10,659 students from Mexico City, with a two-stage design (school-group), and stratified (from 71 to 9 grades, and from 10 to 123 grades, technical and normal), where the last selection unit was the scholar group. Data is representative for delegation and educational level, and the design is similar to those previously applied in schools by the INP and SEP. The reviewed sample frame was obtained from the registrations to the 2001-2002 school period of SEP A randomized sample was obtained for each county and educational level. Regarding estimations precision, calculated non-response index was 15%, with an absolute error average of 0.004, and a design effect equaling 2. The confidence intervals obtained were generated by the STATA program, version 7.0. The mean-age of the subjects was 14.6 years (12-22 years), 50.5% of the sample were men and 49.5% were women. The indicators of drug consumption included in the questionnaire are the same used in similar studies and are the same used by the WHO. In addition to drug consumption and related problems, several behaviors were assessed among adolescents, such as suicide attempt, level of depression, eating risk behaviors and some features of their sexual behavior. Interviewers were trained to obtain the most reliable information from the adolescents and to keep confidentiality. A total of 23 interviewers and five supervisors participated in the study. Results: First of all, a slightly increase in drug consumption was found in the last three years, from 14.7% to 15.2%, which is not significative. Nevertheless, there are significant changes in the consumption of specific drugs. There is a significant increase in cannabis consumption, while inhalants and tranquilizers remain steady and cocaine use showed a slightly decrease. By sex, it was observed that drug consumption in women has increased, while in men it remains steady or has even decreased a little. In this context, drug preferences remain very similar to those reported three years ago, where cannabis occupied the first place, followed by inhalants, tranquilizers and cocaine (with similar levels of consumption between the last three ones). The drugs of preference among women are tranquilizers. With respect to legal drugs, alcohol consumption has increased, while tobacco consumption remains similar to the reported in the survey of 2000. A significant change in these drugs, as mentioned above, is that their consumption is almost the same among men and women. Talking about alcohol abuse, a 2% increase was observed, which indicates 23.8% of the adolescents had consumed at least five drinks per occasion during the month previous to the study. In regional terms, there were also changes. The most affected delegations are Azcapotzalco, Venustiano Carranza, Miguel Hidalgo and Cuauhtemoc. In the last survey, the most affected delegations were Gustavo A. Madero and Coyoacan. This is very important information, because the SEP implemented several prevention strategies in these two delegations in order to reduce drug consumption. Considering the results of the present study, it can be concluded these efforts were successful. Even though results will be presented in a specific publication, according to the adolescents' evaluation of the brochure given to each student at the end of the application, we can say they were very positive, as 15% of the adolescents indicated they had quitted smoking and a similar percentage reported a decrease in their tobacco consumption. Another 15% mentioned they had used help telephone lines, and more than 60% shared the content of the brochure with their families. Most of them have kept the brochure for future occasions and have also lent it to friends. Discussion: The data about drug consumption is similar to the data of other national studies reporting that consumption of medical and illegal drugs and tobacco, is steadier on the whole, although there are changes in specific drugs consumption and by sex. Meanwhile, the prevalence of alcohol consumption has been increasing, even when its abuse remains stable. For prevention, it is important to consider the new location of the problem (most affected delegations), and to use crime indicators and other delinquent behaviors, to share prevention efforts in the most affected areas of the city. Another interesting result is the low level of risk perception for tobacco and alcohol consumption, which are important precursors for the consumption of other drugs, especially if there is an early consumption onset for these substances. In the context of drug consumption associated with other adolescents' problems, suicide attempt is the most frequent situation reported by the participants (16%) and it is even more frequent than drug consumption. Although this situation seems to be quite problematic, adolescent population in scholastic environments is the least affected in comparison to those that quit or stop studying. On the other hand, the information obtained about the brochure "What's up with your life?" is encouraging for prevention practices, and the presence and growth of these problems makes it important to consider that the process of obtaining information as an integral part of the diagnosis may also be used as an opportunity to reach adolescents with information or materials created for them. Finally, it is important to point out that prevention must be applied during childhood and not only during adolescence. To reach this goal, it is important to include all possible human resources. The point is simple: the possibilities to obtain better results under this conception are greater, because the interaction with children and their complete integration at home facilitate this prevention task. During childhood, the human being is more receptive to this kind of interventions and it is simpler to work with the families. So, when children grow up, it will be easier to communicate with them as adolescents and to give them all the support they require in their identity formation. Even when the work is focused on the longer term, the results will be better and we will be able to offer better options to the new generations from the construction of an adequate prevention culture.