Parenting practices and interventions during the COVID-19 pandemic lockdown: an exploratory cross-sectional study of caregivers in Brazil, Mexico, and the United States.

INTRODUCTION: The COVID-19 pandemic led countries' governments to rapidly establish lockdowns and social distancing, which altered family routines and the quality of family relationships worldwide. OBJECTIVES: This exploratory cross-sectional study aimed to identify the impacts of the social distancing and lockdown in parenting practices of caregivers from Brazil, Mexico, and the USA, and to analyze the continuity of parenting intervention support for children and their families at the beginning of the pandemic in these countries. METHODS: The sample consisted of 704 caregivers of children (286 from Brazil, 225 from Mexico, and 193 from the USA) who answered an online survey about parenting practices before/after quarantine, caregiver/child routines, feelings related to quarantine, changes in everyday life since the beginning of the COVID-19 pandemic, contact with health professionals, and sources of parenting information. RESULTS: Data indicate that caregivers from the three countries experienced similar parenting practices during this time, and did not report significant changes before and after the lockdown. They sought information about parenting predominantly via social media. Those receiving previous mental health care perceived the transition from in-person to telehealth services during the pandemic as feasible and acceptable. CONCLUSION: This study will be helpful for clinicians and parents to contextualize their practices amid long-standing effects that the COVID-19 pandemic can have on children and their families during and post-pandemic from multiple cultural backgrounds.

Associated factors to non-medical and medical use of psychoactive medication among Mexican adolescents and adults in a national household survey.

BACKGROUND: Non-medical use of psychoactive medication is a public health problem. Studies in other contexts indicate that individual sociodemographic characteristics are associated with non-medical use, but these associations have not been assessed in the Mexican context. OBJECTIVES: To estimate the prevalence non-medical and medical use of psychoactive medication among Mexican adolescents and adults' medication users and to estimate the associations between sociodemographic characteristics and non-medical use of psychoactive medication, using data from a nationally representative sample. METHODS: Secondary analysis of data collected from the National Survey of Drug, Alcohol, and Tobacco Consumption (ENCODAT) 2016 to 2017. The analytical sample included people aged 12 to 65 years. The sample was stratified into two age categories: adolescents (12-17 years) and adults (18-65 years). Sub-analyses were performed to describe prevalence of use and non-medical use of psychoactive medication at the state-level. Descriptive statistics and multinomial logistic regression models were used to estimate associations between sociodemographic characteristics and medical, non-medical, and non-use of psychoactive medication in adolescents and adults. RESULTS: Among Mexican medication users in 2016, the national prevalence of non-medical use of psychoactive drugs was 19.6%; 22.2% among adolescents and 19.4% among adults. States adjacent to the US-Mexico border reported the highest levels of non-medical use of psychoactive medication. Illicit drug consumption was associated with non-medical use. Sociodemographic characteristics associated with non-medical use varied between adolescents and adults. CONCLUSIONS: There is a high proportion of non-medical use of psychoactive drugs among Mexican medication users, especially among young people. Understanding factors associated with the misuse of psychoactive medications in Mexico can inform policy for prevention and treatment.

Culturally adapting an evidence-based parenting intervention for the Chilean context: Balancing fidelity, context, and cultural relevance.

The dissemination of evidence-based parent training (PT) interventions remains extremely limited in Latin American countries. This is concerning when considering the high prevalence of child maltreatment associated with punitive parenting practices across countries in the region. Furthermore, efforts to disseminate PT interventions must be conducted by adhering to the core parenting components that have established effectiveness for such interventions, while ensuring contextual and cultural relevance for focus populations. In this manuscript, we describe the cultural adaptation of an evidence-based PT intervention in the context of Chile. This initial phase of adaptation was informed by the theoretical tenets of the Ecological Validity Model of cultural adaptation (Bernal et al., J. Abnorm. Child Psychol., 23, 1995, 67). According to findings from a qualitative thematic analysis conducted with five interventionists in training, therapists perceived that the intervention's core components were relevant to Chilean caregivers who participated in the parenting program. Interventionists also provided specific suggestions to enhance the intervention's contextual and cultural relevance. This investigation illustrates the importance of culturally adapting evidence-based interventions according to comprehensive cultural adaptation frameworks, prior to engaging in large-scale dissemination of adapted interventions in Latin American contexts.

Strengthening a Culture of Prevention in Low- and Middle-Income Countries: Balancing Scientific Expectations and Contextual Realities.

Relevant initiatives are being implemented in low- and middle-income countries (LMICs) aimed at strengthening a culture of prevention. However, cumulative contextual factors constitute significant barriers for implementing rigorous prevention science in these contexts, as defined by guidelines from high-income countries (HICs). Specifically, disseminating a culture of prevention in LMICs can be impacted by political instability, limited health coverage, insecurity, limited rule of law, and scarcity of specialized professionals. This manuscript offers a contribution focused on strengthening a culture of prevention in LMICs. Specifically, four case studies are presented illustrating the gradual development of contrasting prevention initiatives in northern and central Mexico, Panamá, and Sub-Saharan Africa. The initiatives share the common goal of strengthening a culture of prevention in LMICs through the dissemination of efficacious parenting programs, aimed at reducing child maltreatment and improving parental and child mental health. Together, these initiatives illustrate the following: (a) the relevance of adopting a definition of culture of prevention characterized by national commitments with expected shared contributions by governments and civil society, (b) the need to carefully consider the impact of context when promoting prevention initiatives in LMICs, (c) the iterative, non-linear, and multi-faceted nature of promoting a culture of prevention in LMICs, and (d) the importance of committing to cultural competence and shared leadership with local communities for the advancement of prevention science in LMICs. Implications for expanding a culture of prevention in LMICs are discussed.

Innovative Identification of Substance Use Predictors: Machine Learning in a National Sample of Mexican Children.

Machine learning provides a method of identifying factors that discriminate between substance users and non-users potentially improving our ability to match need with available prevention services within context with limited resources. Our aim was to utilize machine learning to identify high impact factors that best discriminate between substance users and non-users among a national sample (N = 52,171) of Mexican children (i.e., 5th, 6th grade; Mage = 10.40, SDage = 0.82). Participants reported information on individual factors (e.g., gender, grade, religiosity, sensation seeking, self-esteem, perceived risk of substance use), socioecological factors (e.g., neighborhood quality, community type, peer influences, parenting), and lifetime substance use (i.e., alcohol, tobacco, marijuana, inhalant). Findings suggest that best friend and father illicit substance use (i.e., drugs other than tobacco or alcohol) and respondent sex (i.e., boys) were consistent and important discriminators between children who tried substances and those that did not. Friend cigarette use was a strong predictor of lifetime use of alcohol, tobacco, and marijuana. Friend alcohol use was specifically predictive of lifetime alcohol and tobacco use. Perceived danger of engaging in frequent alcohol and inhalant use predicted lifetime alcohol and inhalant use. Overall, findings suggest that best friend and father illicit substance use and respondent's sex appear to be high impact screening questions associated with substance initiation during childhood for Mexican youths. These data help practitioners narrow prevention efforts by helping identify youth at highest risk.

The influence of perceived parenting on substance initiation among Mexican children.

Parents shape their children's behaviors and impact their developmental trajectories. Despite this, few studies have examined the potential relationship between child reported parenting factors and lifetime substance use and use intentions. The current study examined the potential impact of parenting factors (i.e., positive parenting, supervision, parental illicit substance use, substance-specific communication) on early substance use and intentions among Latinx children. Data for the present study utilized a representative sample of Mexican children (n = 52,171; 5th and 6th grades) who participated in a national survey on substance use. Children reported their demographics, lifetime substance use/intentions, and perceived parenting characteristic and practices. Child reported parental (i.e., individual or both parents) illicit substance use was associated with the largest increases in risk for reporting lifetime use of all substances examined. Higher levels of positive parenting were consistently associated with reductions in risk for reporting intentions for and use of all substances examined. Parent-child substance specific communication was not significantly related to child reported lifetime use or use intentions, with the exception of a minor decrease in the odds of reporting lifetime inhalant use. Supervision was associated with small to modest increase in risk. Substance use prevention efforts targeting Latinx populations may benefit from promoting positive parenting and direct supervision during childhood. Targeted prevention efforts may be needed for Latinx children exposed to parental illicit substance use, as they may be especially at risk for early substance initiation.

Parenting Programs for Underserved Populations in Low- and Middle-Income Countries: Issues of Scientific Integrity and Social Justice.

Research suggests that parenting programs are effective for preventing behavioral and emotional difficulties in children, but a lot more attention needs to be paid to issues of context and culture during the development, testing and implementation of these interventions. The views and needs of underserved and disenfranchised communities in the US and the Global South are often not taken into account for the development and testing of interventions. The successful implementation of evidence-based interventions for vulnerable children and families in underserved and marginalized communities requires careful consideration of how existing paradigms of prevention, evaluation, and implementation science impact issues of social justice and equity. This paper will describe how a team of parenting program researchers has been collaborating with their partners globally in generating local knowledge by balancing the need for rigorous scientific methods with issues of power. Authors from the U.S., Latin America, Africa and Southeast Asia draw on their experiences regarding challenges and successes with issues regarding study design and measurement, the transferability and adaptation of interventions, and the dissemination and implementation of different parenting interventions while placing communities at the center of their efforts through participatory methods. We describe innovative approaches that span the continuum of intervention development, adaptation, optimization, evaluation, implementation, and scale up of different parenting programs for vulnerable children and families across the world. We conclude by offering specific and pragmatic recommendations to increase access of culturally relevant and effective parenting programs in these communities.

National trends in alcohol consumption in Mexico: results of the National Survey on Drug, Alcohol and Tobacco Consumption 2016-2017 / Tendencias nacionales del consumo de alcohol en México: resultados de la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2016-2017

Abstract: Introduction: Worldwide, binge drinking of alcohol has increased, especially among young people. In Mexico, various epidemiological sources allow us to account for the growth this pattern of consumption has had. Given this context, the Encuesta Nacional de Consumo de Drogas 2016-2017 (ENCODAT) shows the evolution in alcohol consumption. Objective: To determine the prevalence and national and regional trends, as well as state variations of alcohol consumption in the population aged 12 to 65. Method: The ENCODAT 2016-2017 is a random, probabilistic, and multi-stage study with national and state representation. The sample consisted of 56 877 people who answered a standardized questionnaire through ACASI (self-administered computer interviews) that collects information about the use of tobacco, alcohol, and medical and illegal drugs. Results: Binge drinking past month increased from 12.3% to 19.8% from 2011 to 2016. A similar situation occurs in daily use (from .8% to 2.9%) and weekly binge drinking (from 5.4% to 8.5%). The age of onset has remained stable since 2011 (16.6 years for men, 19.2 years for women in 2016). Meanwhile, 2.2% reported alcohol dependence. The states with the highest prevalence of binge drinking are Nuevo León (30.3%), Jalisco (27.7%) and, Coahuila (27.5%). Discussion and conclusion: The results show that alcohol use increased with respect to 2011, especially in women; data on treatment seeking indicate that women who use alcohol are also the least likely to seek help. Given this context, it is necessary to have specialized spaces that provide treatment in keeping with use-based needs and gender condition.

Resumen: Introducción: A nivel internacional, el consumo excesivo de alcohol ha aumentado, principalmente entre la población joven. En México, diversas fuentes epidemiológicas dan cuenta del crecimiento de este patrón de consumo. Dado este contexto, la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2016-2017 (ENCODAT) muestra la evolución en el consumo de alcohol. Objetivo: Conocer las prevalencias y tendencias nacionales y regionales, así como las variaciones estatales del consumo de alcohol en la población de 12 a 65 años. Método: La ENCODAT 2016-2017 es un estudio aleatorio, probabilístico y polietápico con representatividad nacional y estatal. En la muestra participaron 56 877 personas que contestaron un cuestionario estandarizado mediante ACASI (entrevistas auto-administradas por computadoras), que recaba información sobre consumo de tabaco, alcohol y drogas médicas e ilegales. Resultados: El consumo excesivo en el último mes se incrementó de 12.3% a 19.8% de 2011 a 2016. Una situación similar ocurre en el consumo diario (de .8% a 2.9%) y consuetudinario (de 5.4% a 8.5%). La edad de inicio se ha mantenido estable desde 2011 (16.6 años hombres; 19.2 años mujeres en 2016). En tanto, el 2.2% reportó dependencia al consumo de alcohol. Las entidades con las prevalencias más altas en consumo excesivo son Nuevo León (30.3%), Jalisco (27.7%) y Coahuila (27.5%). Discusión y conclusión: Los resultados muestran que el consumo de alcohol creció con respecto a 2011, especialmente en mujeres. Datos sobre la asistencia a tratamiento, indican que éstas son también quienes menos acuden. Dado este contexto, es necesario contar con espacios especializados que brinden atención conforme a las necesidades de consumo y de condición de género.

Contextual factors associated with marijuana use in school population / Factores contextuales asociados con el consumo de marihuana en población estudiantil

Abstract Introduction Marijuana use among the student population has increased in Mexico and Latin America. There are social, interpersonal and individual factors associated with the onset and continuation of marijuana use. These include the availability of drugs in the community, opportunity for use, low perceived risk of harm from marijuana use and social tolerance by family and close friends. Moreover, these factors increase the probability of experimenting with other drugs, polysubstance use and dependence. Objective To identify the relationship between the level of urbanization, drug availability, exposure to opportunity for use, risk perception and social tolerance of the level of marijuana use among Mexican middle and high school students. Method The results are drawn from various surveys conducted in Mexico City and the National Survey of Drug Use among Students 2014. A total of 114 364 middle and high school students participated (49.8% boys and 50.2% girls). Results Of the respondent 10.6% had used marijuana at least once (12.9% boys and 8.4% girls). The variables that predicted higher marijuana use were drug use approval by family and best friend,, the level of urbanization and low risk perception. Discussion and conclusion Action must be taken on the factors mentioned to decrease the availability and use of drugs in the environment, and raise awareness of their consequences. These elements must be introduced systematically and creatively into preventive programs in this area.

Resumen Introducción El consumo de mariguana en población estudiantil se ha incrementado en México y América Latina. Existen factores sociales, interpersonales e individuales asociados con el inicio y la continuación de su consumo. Entre ellos encontramos la disponibilidad de drogas en la comunidad, la oportunidad de consumo, la baja percepción de riesgo por consumir mariguana, la tolerancia social de la familia y la de los amigos cercanos. Además, estos factores aumentan la probabilidad de experimentar con otras drogas, ser policonsumidor y producir dependencia. Objetivo Conocer la relación entre el nivel de urbanización, la disponibilidad de drogas, la exposición a la oportunidad de consumo, la percepción de riesgo y la tolerancia social con el nivel de consumo de mariguana en los estudiantes mexicanos de secundaria y bachillerato. Método Los resultados parten de diversas encuestas realizadas en la Ciudad de México y de la Encuesta Nacional de Consumo de Drogas en Estudiantes 2014. Participaron 114 364 alumnos de secundaria y bachillerato (49.8% hombres y 50.2% mujeres). Resultados El 10.6% consumieron mariguana alguna vez (12.9% hombres y 8.4% mujeres). Las variables predictoras de un mayor consumo de mariguana fueron la tolerancia ante el consumo de drogas de la familia y del mejor amigo, el nivel de urbanización y una baja percepción de riesgo. Discusión y conclusión Es necesario incidir en los factores señalados con objeto de disminuir la disponibilidad y el consumo de drogas en el entorno, así como en el conocimiento real de sus consecuencias. Estos elementos deben introducirse sistemática y creativamente en los programas preventivos del área.

El consumo de drogas en México: Resultados de la Encuesta Nacional de Adicciones, 2011 / Drug use in Mexico: Results from the 2011 National Addictions Survey

Introduction In the international context, Mexico is a country with low drug use level, in turn, it shows an increase when considering the most recent epidemiologic trends. In order to maintain an updated analysis of drug use in general population and to identify the most at risk groups, the National Survey of Addictions (ENA) was held in 2011. Objetive The aim of the study was to determine the lifetime prevalence for any drug and any illegal drug use at a national and regional level, in population aged 12 to 65 years. Also, to acknowledge drug consumption trends since 2002 in Mexico. Material and methods ENA 2011 survey is a randomized, multistage probabilistic study. It is representative at a national level and also for eight regions of the country, including rural and urban population. The sample was 3 849 adolescents and 12 400 adults who answered a computerized version of a standardized questionnaire containing sections of tobacco, alcohol, medical drugs (opiates, tranquilizers, sedatives, amphetamines) and illegal drugs (marijuana, cocaine, crack, hallucinogens, inhalants, heroin and methamphetamines). All participants read and signed an informed consent. Emphasis was made on the voluntary and confidential use of the information. Results The national lifetime prevalence of any drug grew between 2002 and 2011, increasing significantly from 5.0% to 7.8%, while consumption of any illegal drugs increased from 4.1% to 7.2%. By sex, in men, any drug use increased from 8.6% to 13%. Illegal drugs increased from 8.0% to 12.5%. In women, use of any drug increased from 2.1% to 3.0% and use of any illegal drug increased from 1.0% to 2.3%. Marijuana is the first drug of choice (6.5%) followed by cocaine (3.6%). Considering regions, any drug consumption grew significantly in the Western (5.5% to 10.3%), Northeast (5.5% to 10.3%), North Central (7.5% to 9.2%) and South Central (4.2% to 7.5%). As for illegal drugs, there is also a statistically significant increase in these regions, however, growth was proportionally bigger in South Central region, going from 3.5% to 6.8%. Conclusions Results from this study indicate a growth in the consumption of illegal drugs from 2002 to 2011, especially in marijuana. It also shows that men from 18 to 34 years are the most affected by this consumption, while increases in adolescent men have been low. Moreover, the study shows that those who have received some type of prevention, showed a smaller consumption prevalence, indicating that further work is needed in this area with young people to consolidate activities of health promotion and drug use prevention, working with infant population is needed, including a systematic evaluation of the actions mentioned above. In the international context, data from this study confirms that Mexico continues reporting low levels of drug consumption.

Introducción En el contexto internacional, México es uno de los países con bajo nivel de consumo de drogas, pero que, a su vez, reporta un incremento si se consideran las tendencias epidemiológicas más recientes. Con la finalidad de mantener un diagnóstico actualizado del consumo de drogas en la población general y de identificar los grupos en mayor riesgo, se llevó a cabo la Encuesta Nacional de Adicciones 2011 (ENA). Objetivo Conocer la prevalencia alguna vez en la vida de uso de cualquier droga y de cualquier droga ilegal a nivel nacional y regional en población de 12 a 65 años. Así como conocer las tendencias que ha seguido el consumo a partir de 2002. Material y métodos La ENA 2011 es un estudio aleatorio, probabilístico y polietápico con representatividad nacional y para ocho regiones del país. Incluye poblaciones rurales y urbanas. La muestra fue de 3 849 adolescentes y 12 400 adultos quienes contestaron un cuestionario estandarizado en versión computarizada que contiene las secciones de tabaco, alcohol, drogas médicas (opiáceos, tranquilizantes, sedantes, anfetaminas) e ilegales (mariguana, cocaína, crack, alucinógenos, inhalables, heroína y metanfetaminas). Todos los participantes leyeron y firmaron una carta de consentimiento informado. Se hizo énfasis en el carácter voluntario y confidencial de la información. Resultados La prevalencia de consumo de cualquier droga alguna vez en la vida a nivel nacional creció significativamente entre 2002 y 2011 al pasar de 5.0% a 7.8%, mientras que el consumo de cualquier droga ilegal incrementó de 4.1% a 7.2%. Por sexo, en los hombres el consumo de cualquier droga pasó de 8.6% a 13% y de drogas ilegales de 8.0% a 12.5%. En las mujeres, la primera aumentó de 2.1% a 3.0% y la segunda de 1.0% a 2.3%. Las drogas de preferencia continúan siendo la mariguana (6.5%) y la cocaína (3.6%). A nivel regional el consumo de cualquier droga creció significativamente en la Occidental (5.5% a 10.3%), Nororiental (5.5% a 10.3%), Norcentral (7.5% a 9.2%) y Centro Sur (4.2% a 7.5%). En cuanto a las drogas ilegales, también se encuentra un incremento estadísticamente significativo en estas regiones, sin embargo el crecimiento fue proporcionalmente mayor en la región Centro Sur, al pasar de 3.5% a 6.8%. Conclusiones Los resultados de la ENA señalan un crecimiento en el consumo de drogas ilegales de 2002 a 2011, especialmente de la mariguana. Asimismo, se observa que los hombres de 18 a 34 años son la población más afectada por dicho consumo, mientras que en los adolescentes el aumento ha sido mínimo. Por otra parte, el estudio muestra que quienes han recibido algún tipo de prevención presentan las prevalencias de consumo más pequeñas, lo cual indica que es necesario seguir trabajando en esta área con los jóvenes para consolidar las acciones de promoción de la salud y prevención; así como trabajar más con la población infantil, con una evaluación sistemática de todas estas acciones. En el contexto internacional los datos confirman que México continúa con niveles bajos de consumo.

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 familia y el maltrato como factores de riesgo de conducta antisocial

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Summary: Antisocial behavior emerges as the result of different factors such as scholar problems, drug consumption, alcoholism, antisocial peer relationships, emotional problems, etc., which may in turn predispose to the individual to develop a pattern of antisocial behavior. The present work aims to determine the association of antisocial behavior between the factors of a bad family environment and mistreatment, and to determine if they can predict the presence of antisocial behaviors in adolescents. Family plays a primary role in the development of a person, especially in adolescent. In recent times, several problems of family disintegration and inadequate parent-child relationships are observed, and it has been described that antisocial personalities may arise from environments with child abuse, economical problems, humiliation, physical punishment and family disintegration. The experience of such emotions during childhood may lead to a severe impairment in the conformation of an emotionally-adapted personality, and may promote a tendency for the commitment of delictive behaviors in the future. It is necessary to close the vicious cycle where mistreated parents mistreat their own children and avoid that the parents who lived unpleasant experiences of hostility, rejection, lack of communication, inestability, etc., repeat these patterns with their children. It is important to revalorize the role of family, its functions and characteristics and the most important, its determinant influence on young people that have behavior problems as antisocial behavior. It is vital to create conscience about the harm that some children, adolescents and even adults have from their negative familial experiences of hostility, aggression, and mistreatment, because these experiences increase the possibilities of delictive behavior in these individuals. Objective. In this context, the present research has its main interest in showing the relationship between past experiences of mistreatment or inadequate familial environments and the presence of antisocial behaviors in adolescents. Method. The present research is supported on results of the Mexico City Survey on drug consumption in 7 th to 12 th grade population carried on October 2003. The total sample of the survey comprised 10659 students. For this research we used 3603 students, that corresponds to the number of students that completed the Form A of the questionnaire, that contained the areas of interest of the study. The questionnaire was previously validated an its main indicators have shown adequate stability in different surveys. This instrument was applied in three different times due to its extension. Total time for its application was of 75 minutes. Raters were trained for the application of the questionnaire. The course lasted 12 hours and included all the theoretical aspects related to addictions, objectives of the study, management of the questionnaire and the instructions for its application in the groups. Results. First of all, a comparative analysis by gender was performed. It was observed that antisocial behaviors were more frequent in men than in women. It is important to mention that men committed this acts in a double frequency than women, specially in terms of severe acts, where 10% of men committed them in contrast to the 3.3% observed in women. Additionally, two factor ANOVA was performed (gender and antisocial behaviors) with the variables of this study, mistreatment and family environment, to determine if there were differences between groups (p<0.05) and significant differences were observed in all the areas of family environment. The interaction analysis of the two factors: gender, act-non acts with family environment showed that for the area of hostility and rejection there were significant differences where women that committed antisocial acts were the ones that reported higher levels of hostility and rejection. In terms of communication of the son/daughter, women that committed antisocial acts were also the ones that reported a lower level of communication. In the area of parent support, women that committed antisocial acts were also the ones that reported the lower levels. In the areas of parent communication and support to the son/daughter, men and women that committed antisocial acts reported less communication and support, respectively. For the area of mistreatment, women reported higher levels of prosocial discipline and negative discipline when compared to men. No significant differences emerged between men an women in the area of severe negative discipline. Also, no significant differences emerged between adolescents that committed antisocial acts and adolescents than do not committed these acts, in terms of prosocial discipline. Nevertheless, adolescents that committed antisocial acts reported higher levels of severe negative discipline. For the analysis of the interaction of the factors gender, acts-non acts in the area of mistreatment, no differences emerged in the area of negative discipline. Significant differences emerge for prosocial discipline, where men that do not committed antisocial acts reported the lowest levels of prosocial discipline. For severe negative discipline, both men and women that committed antisocial acts reported the highest levels. Finally, using logistic regression, we find that the main predictors of antisocial behavior were the presence of high hostility, low level of communication from the children, less child support and the presence of higher negative discipline and negative severe discipline. Communication, parent support and prosocial discipline were not predictive variables for antisocial behavior. Our results support what is described in other studies where family is the main agent of socialization as family teaches the ways of social interaction, values, habit, etc. Furthermore, several studies that evaluated the relationship of the family and antisocial behavior were performed by analyzing the role of the family as a mediator of behavior and society, on the basis that family teaches children rules, abilities and motivations that in some way constitute their cultural and social patterns. We conclude that family environment and mistreatment are factors associated to the presence of antisocial behavior. We must prevent this problem by improving familial relationships and providing a positive family environment to adolescents. In this way, our adolescents may have an adequate development throughout their lives. If an adequate and positive environment is provided during childhood and is maintained through adolescence, with positive affective family relationships, the adolescent may see his/her parents as a guide; a reasonable not arbitrary discipline allows the adolescent to develop a social behavior that leads to an adequate self-control and self-directedness. On the contrary, if the relationships between parents and children are not favorable, the social behavior of the adolescent may be easily impaired and it is very common that these adolescents exhibit severe difficulties for social adaptation.

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.