Psycho-Emotional Factors Associated with Depressive Symptoms during Lockdown Due to the COVID-19 Pandemic in the Mexican Population.

The COVID-19 pandemic has had a significant impact on mental health, leading to the increase of depressive symptoms. Identifying these symptoms and the factors associated with them in women and men will allow us to understand possible mechanisms of action and develop more specific interventions. An online survey was conducted from 1 May to 30 June 2020 using snowball sampling; the final sample comprised 4122 adult inhabitants of Mexico; 35% of the total sample displayed moderate-to-severe depressive symptoms, with a greater proportion of depression being among female respondents. A logistic regression analysis revealed that individuals under 30 years of age, those with high levels of stress due to social distancing, those with negative emotions, and those who reported a significant impact of the pandemic on their lives have a higher risk of depression. Women with a history of mental health treatment and men with a history of chronic disease were also more likely to experience depressive symptoms. Social environment and sex are factors that intervene in the development of depressive symptoms, meaning that appropriate early identification and intervention models should be designed for the care of men and women in highly disruptive situations such as the recent pandemic.

ISPCAN Child Abuse Screening Tool for Children (ICAST-C): Translation and adaptation to Mexican Spanish, and psychometric properties tested in Mexico City adolescents.

BACKGROUND: Research using the IPSCAN Child Abuse Screening Tool for Children (ICAST-C), has provided ample evidence of the magnitude of violence against children. Knowledge about its psychometric characteristics and validity is limited. Hence, our objective was to translate and culturally adapt the ICAST-C in adolescents from Mexico City and determine its psychometric properties. PARTICIPANTS AND SETTING: To determine the psychometric properties of the instrument 723 adolescents between 11 and 18 years of age from 9 public secondary schools in Mexico City participated. METHODS: The study was carried out in two phases: 1) translation and adaptation of the instrument (in 5 steps) and 2) pilot evaluation of the psychometric properties. Total and factor reliabilities were determined, Pearson correlation was used for temporal stability while construct validity was determined by Confirmatory Factor Analysis (CFA), and final adequacy of the items eliminated by the CFA. RESULTS: We developed the culturally relevant Mexican Spanish version of the ICAST-C. The CFA confirmed the six-factor structure hypothesis. To improve the original model we eliminated ten items, the final model showed good global fit indices (χ2(1310) = 2207.68, p < .01, χ2/df = 1.68; CFI =0.95; RMSEA = 0.02 [CI95% 0.02-0.03]; SRMR = 0.08). Total and factor reliabilities were adequate (Alpha = 0.79-0.92, r = 0.52-0.75), except for the non-violent discipline factor (Alpha = 0.59, r = 0.38). CONCLUSIONS: While these data suggest that this version of the ICAST-C is valid and reliable for adolescents in Mexico City public secondary schools, further research should evaluate the psychometric properties in a national sample.

Evaluation of Psychometric Properties of the Acceptability of ICT Use for Mental Health Care Questionnaire.

The adoption of e-mental health strategies is determined by the acceptability of Information and Communication Technologies (ICT) to professionals, an issue barely explored in Mexico. The objective was to evaluate the psychometric properties of the Acceptability of ICT Use for Mental Health Care Questionnaire. A convenience sample of 492 Mexican mental health professionals answered the questionnaire on ICT use for mental health care. Internal consistency analyses, exploratory, and confirmatory factor analyses were performed. Around 73.4% of the sample are women, aged between 21 and 30 (32.1%), around 50% has completed graduate studies, and 88.3% is practicing psychologists. The questionnaire comprised 11 items grouped into three factors: perceived usefulness, risk perception, and subjective norm. The CFA indicated a good fit χ2 SB/gl = 443.38/206 = 2.15; CFI = 0.930; RMSEA = 0.068 (95% CI [0.059-0.077]). The instrument has adequate psychometric properties for evaluating the acceptability of ICT use for mental health care.

Prioritizing Variables for Evaluating the Efficacy and Effectiveness of Brief Interventions for Reducing Alcohol Consumption: A Latin American Perspective.

OBJECTIVE: The purpose of this study was to identify priority variables to evaluate alcohol brief interventions from the perspective of experts in the field in Latin America. METHOD: A two-round Delphi procedure was carried out through online surveys of 465 individuals from 18 Latin American countries, including core outcome set developers, researchers, health professionals, users of healthcare services, journal editors, members of nongovernmental organizations, and policymakers. The questionnaire, in Spanish and Portuguese, rated 101 variables according to their relevance to the efficacy and effectiveness of brief interventions. RESULTS: Round 1 yielded 47 variables that met the consensus criterion of at least 70% of participants; Round 2 yielded 63 variables. To reduce the possible effect of varying levels of expertise, data were analyzed by subgroup, with consensus defined as 70% of each subgroup rating a variable as critical. Seventeen outcome variables met this criterion, 14 from the initial set and 3 suggested by the participants in Round 1. CONCLUSIONS: Only four outcomes coincide with the findings of a similar international Delphi study that underrepresented Latin American countries. The findings point to the importance of including a wider variety of professionals and cultural backgrounds in international consensus panels to minimize the risk of predominance of a single perspective.

How culturally unique are pandemic effects? Evaluating cultural similarities and differences in effects of age, biological sex, and political beliefs on COVID impacts.

Despite being bio-epidemiological phenomena, the causes and effects of pandemics are culturally influenced in ways that go beyond national boundaries. However, they are often studied in isolated pockets, and this fact makes it difficult to parse the unique influence of specific cultural psychologies. To help fill in this gap, the present study applies existing cultural theories via linear mixed modeling to test the influence of unique cultural factors in a multi-national sample (that moves beyond Western nations) on the effects of age, biological sex, and political beliefs on pandemic outcomes that include adverse financial impacts, adverse resource impacts, adverse psychological impacts, and the health impacts of COVID. Our study spanned 19 nations (participant N = 14,133) and involved translations into 9 languages. Linear mixed models revealed similarities across cultures, with both young persons and women reporting worse outcomes from COVID across the multi-national sample. However, these effects were generally qualified by culture-specific variance, and overall more evidence emerged for effects unique to each culture than effects similar across cultures. Follow-up analyses suggested this cultural variability was consistent with models of pre-existing inequalities and socioecological stressors exacerbating the effects of the pandemic. Collectively, this evidence highlights the importance of developing culturally flexible models for understanding the cross-cultural nature of pandemic psychology beyond typical WEIRD approaches.

Development and Psychometric Properties of the Adversity and Stress Scale (ASS): Validation in the Adult Mexican Population.

Since stress is known to play a role in the development of physical and mental illness, empirically validated measurements are required to assess the effect of adverse events such as the COVID-19 pandemic. The purpose of this study was to develop and evaluate the psychometric properties of the Adversity and Stress Scale (ASS). A sample of 3937 adults living in Mexico was used. The structure of the instrument was evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Construct validity was measured through associations between the ASS and psychological symptoms. In the EFA, the relational and contextual dimensions of stress were identified. A good fit was obtained in the CFA (CFI = 0.980, RMSEA = 0.040). The ASS score was associated with all the selected variables in the expected direction, and internal consistency was α = .86. The ASS is a valid, reliable measure, with the potential to be used in other adverse events.

Psychoactive Substance Use and Its Relationship to Stress, Emotional State, Depressive Symptomatology, and Perceived Threat During the COVID-19 Pandemic in Mexico.

People can increase their use of psychoactive substances in response to stressful situations as a maladaptive mechanism for reducing negative affective states. It is therefore necessary to examine changes in the use of such substances and their relationship to mental health in light of the COVID-19 pandemic. Objective: Evaluate the relationship between psychoactive substances and stress, emotional state, and symptomatology during the COVID-19 lockdown in Mexico. Method: A national survey was conducted, using the free Google Forms platform, of residents of Mexico aged 18 and older. The survey was disseminated through social media. Results: The sample comprised 4,122 individuals, mostly women (71.8%), with an age range of 18-81 years (M = 37.08, SD = 12.689), of which 46.8% were single, and 42.9% married. In general, there was a reduction in substance use during the first 2 months of the quarantine; the most commonly used substances were alcohol, tobacco, and tranquilizers. Respondents who described having greater use than before the pandemic presented greater stress, depressive symptomatology, and perceived threat than those who did not use substances. Conclusions: Respondents who did not use substances reported lower levels of stress, depressive symptomatology, impact of the coronavirus pandemic, and perception of its threat. Women reported greater stress, depressive symptomatology, and emotional intensity than men.

The Effectiveness of a Web-Based Self-Help Program to Reduce Alcohol Use Among Adults With Drinking Patterns Considered Harmful, Hazardous, or Suggestive of Dependence in Four Low- and Middle-Income Countries: Randomized Controlled Trial.

BACKGROUND: Given the scarcity of alcohol prevention and use disorder treatments in many low- and middle-income countries (LMICs), the World Health Organization has launched an eHealth portal that includes the web-based self-help program "Alcohol e-Health." OBJECTIVE: We aimed to test the effectiveness of the Alcohol e-Health program in a randomized controlled trial. METHODS: This was a two-arm, individually randomized, and controlled trial across four LMICs comparing the self-help program and a psychoeducation and internet access as usual waiting list. Participants were broadly recruited from community samples in Belarus, Brazil, India, and Mexico from January 2016 through January 2019. The primary outcome measure was change in the Alcohol Use Disorders Identification Test (AUDIT) score with a time frame of 6 months between baseline and follow-up. Secondary outcomes included self-reported numbers of standard drinks over the previous week and cessation of harmful or hazardous drinking (AUDIT score <8). RESULTS: For this study, we recruited 1400 predominantly male (n=982, 70.1%) at least harmful or hazardous alcohol drinkers. The mean age was 37.6 years (SD 10.5). The participants were recruited from Brazil (n=587), Mexico (n=509), India (n=212), and Belarus (n=92). Overall, complete case analysis identified higher AUDIT changes in the intervention group (B=-4.18, 95% CI -5.42 to -2.93, P<.001, d=0.56) that were mirrored by changes in weekly standard drinks (B=-9.34, 95% CI -15.90 to -2.77, P=.005, d=0.28) and cessation rates for harmful or hazardous drinking (χ21=14.56, N=561, P<.001). The supplementary intention-to-treat analyses largely confirmed these initial results. CONCLUSIONS: The expansion of the Alcohol e-Health program to other LMICs with underdeveloped alcohol prevention and treatment systems for alcohol use disorders should be considered after successful replication of the present results. TRIAL REGISTRATION: ISRCTN ISRCTN14037475; https://www.isrctn.com/ISRCTN14037475. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1111/add.14034.

Salud mental infantil: una prioridad a considerar / Children's mental health: a priority to consider

Resumen: Objetivo: Identificar posibles cambios en la frecuencia de manifestaciones sindromáticas sugerentes de problemas de salud mental en población infantil mexicana empleando el Cuestionario Breve de Tamizaje y Diagnóstico (CBTD), a lo largo de 15 años. Material y métodos: Se analiza información de diferentes estudios en población general, escuelas y práctica médica. La estimación obtenida en la Ciudad de México fue utilizada como población de referencia para comparación. Resultados: Se apreciaron incrementos notables respecto a la prevalencia de síndromes como el déficit de atención e hiperactividad, y conducta oposicionista y explosiva, así como manifestaciones de ansiedad y depresivas. Estas últimas resultaron más frecuentes en la edad escolar tardía. Las alteraciones en el lenguaje y la epilepsia también mostraron incremento en diferentes grupos de edad. Conclusiones: Se discuten los hallazgos a la luz de estudios longitudinales en la literatura, así como de reportes de población adolescente en nuestro país.

Abstract: Objective: To identify possible changes in the frequency of psychopathological syndromes in Mexican children population over a 15-year period using the Brief Screening and Diagnostic Questionnaire (CBTD in Spanish). Materials and methods: Information gathered from different studies on the general population, schools and medical general practice are analyzed. Results from the Mexico City study were used as base rates for comparisons. Results: Higher prevalence of externalizing syndromes such as attention deficit and hyperactivity, oppositional and explosive conduct were very evident. Also, anxiety and depressive syndromes showed a notable increase. Prevalence of abnormal language and probable epilepsy were also increased on different age-groups. Conclusions: Findings are discussed in light of longitudinal reports in the literature as well as on reports in adolescent population in Mexico.

[Children's mental health: a priority to consider]. / Salud mental infantil: una prioridad a considerar.

OBJECTIVE: To Identify possible changes in the frequency of psychopathological syndromes in Mexican children population over a 15-year period using the Brief Screening and Diagnostic Questionnaire (CBTD in Spanish). MATERIALS AND METHODS: Information gathered from different studies on the general population, schools and medical general practice are analyzed. Results from the Mexico City study were used as base rates for comparisons. RESULTS: Higher prevalence of externalizing syndromes such as attention deficit and hyperactivity, oppositional and explosive conduct were very evident. Also, anxiety and depressive syndromes showed a notable increase. Prevalence of abnormal language and probable epilepsy were also increased on different age-groups. CONCLUSIONS: Findings are discussed in light of longitudinal reports in the literature as well as on reports in adolescent population in Mexico.

OBJECTIVE: Identificar posibles cambios en la frecuencia de manifestaciones sindromáticas sugerentes de problemas de salud mental en población infantil mexicana empleando el Cuestionario Breve de Tamizaje y Diagnóstico (CBTD), a lo largo de 15 años. MATERIALS AND METHODS: Se analiza información de diferentes estudios en población general, escuelas y práctica médica. La estimación obtenida en la Ciudad de México fue utilizada como población de referencia para comparación. RESULTS: Se apreciaron incrementos notables respecto a la prevalencia de síndromes como el déficit de atención e hiperactividad, y conducta oposicionista y explosiva, así como manifestaciones de ansiedad y depresivas. Estas últimas resultaron más frecuentes en la edad escolar tardía. Las alteraciones en el lenguaje y la epilepsia también mostraron incremento en diferentes grupos de edad. CONCLUSIONS: Se discuten los hallazgos a la luz de estudios longitudinales en la literatura, así como de reportes de población adolescente en nuestro país.

The association between substance use and depressive symptomatology in nursing university students in Mexico.

The present study represents an ex post facto non-experimental study of undergraduate nursing students (N = 1,176) residing in Mexico whereby we examined the association between substance use and depressive symptomatology. The sample was composed primarily of women (70.1%), between the ages of 18 and 23 years (89.5%). Outcomes suggest a significant association between current clinically relevant depressive symptomatology 3-month marijuana, alcohol, and sedative use. Additionally, current depressive symptomatology was significantly associated with lifetime alcohol and sedative use. Lastly, current depressive symptomatology was significantly associated with both moderate/high risk level due to alcohol and sedative use. The present study is innovative as it examines possible associations between depressive symptomatology and 10 classes of substances concurrently for a group that is largely understudied, further contributing to the international literature in this area. Findings are discussed with regards to study limitations.

Web-Based Intervention to Reduce Substance Abuse and Depressive Symptoms in Mexico: Development and Usability Test.

BACKGROUND: The development of Web-based interventions for substance abuse in Latin America is a new field of interest with great potential for expansion to other Spanish-speaking countries. OBJECTIVE: This paper describes a project aimed to develop and evaluate the usability of the Web-based Help Program for Drug Abuse and Depression (Programa de Ayuda para Abuso de Drogas y Depresión, PAADD, in Spanish) and also to construct a systematic frame of reference for the development of future Web-based programs. METHODS: The PAADD aims to reduce substance use and depressive symptoms with cognitive behavioral techniques translated into Web applications, aided by the participation of a counselor to provide support and guidance. This Web-based intervention includes 4 steps: (1) My Starting Point, (2) Where Do I Want to Be? (3) Strategies for Change, and (4) Maintaining Change. The development of the program was an interactive multistage process. The first stage defined the core structure and contents, which were validated in stage 2 by a group of 8 experts in addiction treatment. Programming of the applications took place in stage 3, taking into account 3 types of end users: administrators, counselors, and substance users. Stage 4 consisted of functionality testing. In stage 5, a total of 9 health professionals and 20 drug users currently in treatment voluntarily interacted with the program in a usability test, providing feedback about adjustments needed to improve users' experience. RESULTS: The main finding of stage 2 was the consensus of the health professionals about the cognitive behavioral strategies and techniques included in PAADD being appropriate for changing substance use behaviors. In stage 5, the health professionals found the functionalities easy to learn; their suggestions were related to the page layout, inclusion of confirmation messages at the end of activities, avoiding "read more" links, and providing feedback about every activity. On the other hand, the users said the information presented within the modules was easy to follow and suggested more dynamic features with concrete instructions and feedback. CONCLUSIONS: The resulting Web-based program may have advantages over traditional face-to-face therapies owing to its low cost, wide accessibility, anonymity, and independence of time and distance factors. The detailed description of the process of designing a Web-based program is an important contribution to others interested in this field. The potential benefits must be verified in specific studies. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 25429892; http://www.controlled-trials.com/ISRCTN25429892 (Archived by WebCite at http://www.webcitation.org/6ko1Fsvym).

Las aportaciones de 40 años de investigación epidemiológica en México sobre consumo de solventes inhalables / Contributions from 40 years of epidemiological research on inhalant use in México

RESUMEN: Antecedentes: El estudio del consumo de solventes inhalables en México se inició en la década de 1970 y a pesar de que por periodos ha disminuido el interés en el mismo, éste no ha desaparecido y debido a que el consumo prevalece entre la población joven, es relevante actualizar el estado del arte en la materia. Objetivo: Identificar el estado del conocimiento sobre los solventes inhalables, las consecuencias, las alternativas de prevención y su tratamiento en las cuatro últimas décadas en México. Método: Se realizó una búsqueda bibliográfica entre agosto y septiembre de 2014, de los artículos publicados entre 1970 y 2014 sobre el consumo de solventes inhalables en México. Se integraron publicaciones incluidas en el archivo histórico de la Dirección de Investigaciones Epidemiológicas y Psicosociales, en la revista SALUD MENTAL, Medline, Elsevier y Scielo México. Resultados: Se identificaron 1083 artículos, 83 cumplieron con todos los criterios para ser incluidos en el análisis. Estos trabajos se realizaron en diferentes poblaciones: grupos marginales, integrantes de bandas juveniles, niños en situación de calle, adultos y menores recluidos en centros de detención, sexoservidoras, personas que acuden a solicitar tratamiento, estudiantes y población general. Discusión y conclusión: Se identificaron diferentes aspectos relevantes de la población consumidora de solventes inhalables en nuestro país, así como acciones pendientes en materia de investigación, con lo que se pueden desarrollar programas de prevención y tratamiento que atiendan las necesidades específicas de estos grupos, ya que son pocos los programas existentes y algunos no han tenido seguimiento o evaluación.

ABSTRACT: Background: The study about the misuse of inhalant solvents started in Mexico during the 1970, although the interest in this subject decreased during some periods, its consumption continued among the young population, thus, it is relevant to update the state of the art on this matter. Objective: Identify the state of knowledge on inhalant abuse, its consequences, prevention and the treatment alternatives in Mexico in the last four decades. Method: We performed a bibliographical inquiry between August and September 2014 on the papers published between 1970 and 2014 about inhalant solvents consumption in Mexico. It integrated the publications included in the historical archive of the Epidemiological and Psycho-social Research Direction, Mental Health Journal, Medline, Elsevier and Scielo México. Results: After revision, 83 out of 1083 papers fulfilled all the criteria that we considered for inclusion in the analysis. This body of work has been performed on different population segments: marginalized groups, juvenile gang members, children in street situation, adults and minors secluded in detention centers, sex workers, people seeking treatment, students, and the general population. Discussion and conclusion: The several relevant aspects of the consumer population of inhalant solvents in Mexico were identified. Detection of this ample profile of individuals at risk could serve as the basis for the development of prevention and treatment programs to attend to the specific needs of these groups, since the programs currently in progress are scarce and some of them have not had follow up assessments or have not been evaluated at all.

Validity and Reliability of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) in University Students.

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), developed by the World Health Organization (WHO), has been used successfully in many countries, but there are few studies of its validity and reliability for the Mexican population. The objective of this study was to determine the psychometric properties of the self-administered ASSIST test in university students in Mexico. This was an ex post facto non-experimental study with 1,176 undergraduate students, the majority women (70.1%) aged 18-23 years (89.5%) and single (87.5%). To estimate concurrent validity, factor analysis and tests of reliability and correlation were carried out between the subscale for alcohol and AUDIT, those for tobacco and the Fagerström Test, and those for marijuana and DAST-20. Adequate reliability coefficients were obtained for ASSIST subscales for tobacco (alpha = 0.83), alcohol (alpha = 0.76), and marijuana (alpha = 0.73). Significant correlations were found only with the AUDIT (r = 0.71) and the alcohol subscale. The best balance of sensitivity and specificity of the alcohol subscale (83.8% and 80%, respectively) and the largest area under the ROC curve (81.9%) was found with a cutoff score of 8. The self-administered version of ASSIST is a valid screening instrument to identify at-risk cases due to substance use in this population.

La Organización Mundial de la Salud desarrolló la Prueba de Detección de Consumo de Alcohol, Tabaco y Sustancias (Alcohol, Smoking and Substance Involvement Screening Test [ASSIST]) que se ha empleado con éxito en muchos países. Sin embargo, hay pocos estudios acerca de su validez y fiabilidad en la población mexicana. El objetivo del estudio fue determinar las propiedades psicométricas de la versión autoaplicable del ASSIST. Para ello, se realizó un estudio no experimental, ex post facto con una muestra de 1.176 estudiantes universitarios mexicanos. El 70,1% eran mujeres, el 89,5% tenían entre 18 y 23 años y el 87,5% eran solteros. Se obtuvo la fiabilidad mediante la prueba de consistencia interna Alfa de Cronbach. La validez concurrente se determinó con pruebas de correlación entre el ASSIST, AUDIT, FTND y CAD-20; se realizaron análisis factoriales exploratorio y confirmatorio para evaluar la validez de constructo. Se obtuvieron coeficientes de fiabilidad aceptables para las subescalas de tabaco (alfa = 0,83), alcohol (alfa = 0,76) y marihuana (alfa = 0,73). La subescala de alcohol obtuvo una correlación significativa con la puntuación total del AUDIT (r = 0,71). La prueba de sensibilidad y especificidad mostró que al usar una calificación de 8 como punto de corte en la subescala de alcohol se obtiene un mejor balance entre ambos indicadores (83,8% y 80%, respectivamente), así como un área bajo la curva (ROC) mayor (81,9%). La versión autoaplicable del ASSIST es un instrumento de cribado aceptable, válido y sensible para la identificación de casos de riesgo asociados al consumo de sustancias.

Relación entre supervisión parental y conducta antisocial en menores infractores del Estado de Morelos / Relationship between parent supervision and anti-social behavior in juvenile offenders from the state of Morelos

Resumen: INTRODUCCIÓN: La supervisión parental comprende: cuidado de los hijos, conocimiento de su paradero y actividades y adaptación. Para que ésta se dé es necesario que exista comunicación y apoyo entre padres e hijos, de manera que el ambiente familiar sea agradable. Por otro lado, se ha encontrado que la inconsistencia o ausencia de ésta es un factor de riesgo de la conducta antisocial y, en casos más graves, de delincuencia en los hijos. OBJETIVO: Conocer cuál es la relación que existe entre el ambiente familiar, la supervisión parental y la gravedad de la conducta antisocial en menores infractores. MÉTODO: La población estuvo conformada por menores infractores de un Centro Tutelar del Estado de Morelos. El instrumento se aplicó a 86 hombres. RESULTADOS: La comunicación del hijo fue un predictor de: 1. el manejo de reglas y conocimiento de pares, y 2. el conocimiento de las actividades del hijo. Esto último es lo que predice de manera significativa la gravedad de la conducta antisocial. DISCUSIÓN Y CONCLUSIÓN: De acuerdo con los hallazgos, es importante que exista un ambiente familiar basado en la comunicación y el apoyo, que fomente una comunicación más libre de los adolescentes con sus padres, de manera que la supervisión parental se consiga más fácilmente. Esto ayudará para que los jóvenes no se involucren en comportamientos que los puedan llevar a delinquir.

Abstract: INTRODUCTION: Parental supervision is constituted by a series of correlated parental behaviors involving children care, knowing their where abouts, which activities they are performing, and the situation of their adaptive processes. In order for parental supervision to take place, it is necessary that communication and mutual support exist between mother and father, as well as between parents and children so that the family environment becomes pleasant. Supervision is one of the most studied factors related to anti-social behavior, and it has been observed that its absence or inconsistency allows for the occurrence of anti-social behavior, which in the more serious cases leads to delinquency. OBJECTIVE: To know the relationship between family environment, supervision and the seriousness of anti-social behavior in juvenile offenders confined in a state penitentiary from Morelos. METHOD: A survey was used to collect data from a population of 86 juvenile male offenders from a state penitentiary located in Morelos. RESULTS: Parent-children communication and support are interrelated and form the familiar environment. Thus, children's communication predicts proper supervision and monitoring, specifically in the area of knowing children's activities, which, at the same time, predict less serious anti-social behavior. DISCUSSION AND CONCLUSION: It is important that families have an environment based on communication and support. It is also relevant to encourage adolescents to freely communicate with their parents so supervision and monitoring become common elements that help adolescents to stay away from behaviors that could lead them to crime.

Validez y confiabilidad de la prueba de detección de consumo de alcohol, tabaco y sustancias (ASSIST) en estudiantes universitarios / Validity and Reliability of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) in University Students

La Organización Mundial de la Salud desarrolló la Prueba de Detección de Consumo de Alcohol, Tabaco y Sustancias (Alcohol, Smoking and Substance Involvement Screening Test [ASSIST]) que se ha empleado con éxito en muchos países. Sin embargo, hay pocos estudios acerca de su validez y fiabilidad en la población mexicana. El objetivo del estudio fue determinar las propiedades psicométricas de la versión autoaplicable del ASSIST. Para ello, se realizó un estudio no experimental, ex post facto con una muestra de 1.176 estudiantes universitarios mexicanos. El 70,1% eran mujeres, el 89,5% tenían entre 18 y 23 años y el 87,5% eran solteros. Se obtuvo la fiabilidad mediante la prueba de consistencia interna Alfa de Cronbach. La validez concurrente se determinó con pruebas de correlación entre el ASSIST, AUDIT, FTND y CAD-20; se realizaron análisis factoriales exploratorio y confirmatorio para evaluar la validez de constructo. Se obtuvieron coeficientes de fiabilidad aceptables para las subescalas de tabaco (alfa = 0,83), alcohol (alfa = 0,76) y marihuana (alfa = 0,73). La subescala de alcohol obtuvo una correlación significativa con la puntuación total del AUDIT (r = 0,71). La prueba de sensibilidad y especificidad mostró que al usar una calificación de 8 como punto de corte en la subescala de alcohol se obtiene un mejor balance entre ambos indicadores (83,8% y 80%, respectivamente), así como un área bajo la curva (ROC) mayor (81,9%). La versión autoaplicable del ASSIST es un instrumento de cribado aceptable, válido y sensible para la identificación de casos de riesgo asociados al consumo de sustancias

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), developed by the World Health Organization (WHO), has been used successfully in many countries, but there are few studies of its validity and reliability for the Mexican population. The objective of this study was to determine the psychometric properties of the selfadministered ASSIST test in university students in Mexico. This was an ex post facto non-experimental study with 1,176 undergraduate students, the majority women (70.1%) aged 18-23 years (89.5%) and single (87.5%). To estimate concurrent validity, factor analysis and tests of reliability and correlation were carried out between the subscale for alcohol and AUDIT, those for tobacco and the Fagerström Test, and those for marijuana and DAST-20. Adequate reliability coefficients were obtained for ASSIST subscales for tobacco (alpha = 0.83), alcohol (alpha = 0.76), and marijuana (alpha = 0.73). Significant correlations were found only with the AUDIT (r = 0.71) and the alcohol subscale. The best balance of sensitivity and specificity of the alcohol subscale (83.8% and 80%, respectively) and the largest area under the ROC curve (81.9%) was found with a cutoff score of 8. The self-administered version of ASSIST is a valid screening instrument to identify at-risk cases due to substance use in this population

La búsqueda de moderación en el consumo de alcohol: Adaptación de los conocimientos a la práctica / Searching moderation in alcohol consumption adjusting knowledge to practice

Alcohol abuse in Mexico has an enormous impact on people's health. This problem has led authorities to undertake actions to combat and reduce both consumption levels and their consequences. The interventions, focusing on handling problem drinkers -people who already show symptoms of dependence and consume more than one drug, including alcohol-, have proved their effectiveness in various scenarios. In the work setting, this problem is no exception and has also been a focus of concern and the implementation of actions to prevent excess alcohol consumption and provide care for persons beginning to display problems. However, implementing programs in the workplace has proved complicated. Other countries have found that many programs are not correctly evaluated or simply not evaluated, making it impossible to determine their effectiveness in solving the problems for which they were designed. Moreover, the personnel that implement them are not properly trained, programs are expensive to implement, and conflicts of interest tend to arise. In Mexico, low-cost, effective actions have been implemented for this population. However, the time available for undertaking preventive activities is limited, while the length of workers' shifts means that they do not have enough time for these activities. One current challenge is the Translation of Research as a tool for the development of efficient, simpler, more practical, and safer interventions, without ignoring the discovery of new information regarding health and disease prevention, as well as creating more efficient treatments and improving existing ones. Within this perspective, researchers worked to produce a brief intervention to reduce harmful alcohol consumption among the working population. It is based on the principles of cognitive social theory put forward by Bandura, in which alcohol consumption is regarded as learned behavior, that causes problems and may be replaced by healthy behaviors, provided dependence has not developed. Another of the components included is motivational theory, according to which the effectiveness of a particular form of treatment is related to individuals' motivation to continue it. The aim of this article is to describe the process of translation of research, derived from the implementation of cognitive social and motivational theories to adapt an intervention program designed in a comic book format that is easy to read and understand to teach workers with excess alcohol consumption to moderate their consumption. Method The work was carried out in two stages: Phase 1. Adaptation of a brief intervention to a comic book format. A comic was produced using the elements of a brief intervention. In order to ensure that the concepts put forward in the base theory were accessible to the target population, they were subjected to a process of cognitive laboratories following the methodology proposed by Beatty. The comic was produced to make the material easier to read and understand. The process began with a scriptwriter who translated the theoretical contents, together with the terms obtained in the cognitive laboratories into a story that would reflect the target population. This version was subjected to an evaluation described in stage 2. Phase 2. Evaluation of language, characters, contents, and format of comic. Participants: Researchers worked with 49 subjects from various firms and states in Mexico, 59.2% of whom were men, mostly between the ages of 24 and 42, and over half of whom were married (61.2%). Half had only completed high school or less. Instrument: The questionnaire contained demographic questions and indicators to evaluate the comic for: format, understanding of contents, characters, language, and perceived usefulness for reducing problem drinking, among other things. Procedure: Participants attended a training course during which they were asked to evaluate the comic. Each one was given a printed copy and a questionnaire. The subjects volunteered to participate and were guaranteed the confidentiality of the information they provided. Results Over 85% said that they were used to reading on a daily to weekly basis. Most of them thought that the illustrations were attractive and felt that the characters reflected the role they played in the story. They did not like the length of the comic or the fact that the drawings were extremely detailed, with too much text. They also disliked the font and the type of language used. Nearly 80% thought that the reading material was neither tedious nor dull. Most rated the story good or very good and thought that the title encouraged people to read it and that they would use it if they had drinking problems. They also identified themselves with the characters and the situations described in the comic. What they liked best was the way the topic was dealt with in a comic, the way the problem was highlighted, the type of language used (colloquial), the message given, the goal setting, the way they became involved in the reading, and the link between users and the family environment. Finally, the evaluations of the comic showed that some drawings were regarded as aggressive, the children's language did not match their parents', and the order of the dialogues was confusing. This moment in the translation of the intervention made it possible to make changes in several aspects included in the final version. The comic was given to a proofreader to correct spelling mistakes while maintaining the colloquial tone. Discussion This activity resulted in a comic in which the characters guide the workers through a series of strategies to reduce consumption. This complies with the principles of translating research by adapting the concepts derived from social and motivational cognitive theory, which have proved their effectiveness in dealing with addictive behaviors. The inclusion of experts from various areas made it possible to adapt knowledge, by incorporating strategies from the latter into a script that included the dialogues and sketched the characters that would form part of the story. The experts continued to participate during the evaluation process until the final version, with the definitive images, and final dialogues and exercises. Having the workers targeted by the intervention try out various aspects of the material made it possible to adjust the language, contents and the story told, the characters' performance and appearance and the way the exercises and dialogues were carried out. This also made it possible to see how useful the workers found it in reducing their own consumption or helping the people around them -family, co-workers and friends- to do so. In order to produce this sort of material, it is essential to use colloquial language that will be understood by the target population, which is the most delicate stage of the process since it involves the correct use of technical assumptions, since otherwise, one would work from a totally different perspective. This material can reach men of productive age, who are those that make less use of health services, meaning that it is a tool that covers this inaccessible sector of the population. However, the workers were also given the possibility of seeking help from specialists if they failed to achieve their objectives, in which case the comic achieves the objective of raising awareness. Lastly, one of the limitations of the material concerns the fact that the subject himself has to follow up his own progress, meaning that the adaptation must be carried out as rigorously as possible. It also implies that the material must be evaluated through an analysis of the changes that take place in workers as a result of using it. The next stage will therefore be to test the intervention through the comic in a controlled test and to evaluate its efficiency in reducing alcohol abuse problems, as well as the subject's possible progression to severe dependence.

El abuso en el consumo de alcohol en México es un problema de salud pública por lo que se han realizado diferentes acciones para reducir los niveles de consumo y las consecuencias derivadas de éste. Entre estas acciones hay intervenciones que han probado su eficacia en diferentes escenarios. En el ambiente laboral, sin embargo, ha sido complicado instrumentarlas, por el rechazo, el poco apoyo y el desinterés de funcionarios e instituciones, porque los empleados no disponen de tiempo en sus jornadas y por la falta de espacios para realizar actividades de prevención. Por esta razón es importante adaptar el conocimiento científico para el desarrollo de intervenciones eficientes, más simples, más prácticas y más seguras. Actualmente el proceso de traducción de la investigación es una vía para lograrlo. El objetivo de este artículo es describir este proceso mediante la adaptación de una intervención basada en las teorías cognitiva social y motivacional, cuyos conceptos se presentan en forma de estrategias guiadas por personajes en una historieta -de fácil lectura y comprensión- con la finalidad de que trabajadores que presentan consumo nocivo de alcohol aprendan a moderarlo. Método El trabajo se realizó en dos fases: Fase 1. Se creó la historieta para lograr que los conceptos planteados en la teoría base fueran accesibles a la población objetivo en un formato fácil de leer y entender. Fase 2. Evaluación de lenguaje, personajes, contenidos y formato de la historieta. Participantes: Cuarenta y nueve sujetos voluntarios de diferentes empresas y Estados de la República Mexicana, 59.2% hombres, la mayoría de entre 24 y 43 años, más de la mitad casados y con escolaridad de preparatoria o menos. Instrumento: Un cuestionario que contenía preguntas demográficas e indicadores para evaluar la historieta. Procedimiento: Los participantes se encontraban en un curso de capacitación, ahí se les dio una historieta y un cuestionario invitándolos a que ayudaran para evaluarla. La participación fue voluntaria y se garantizó la confidencialidad de la información proporcionada. Resultados En su mayoría las ilustraciones les resultaron agradables, consideraron a los personajes acordes con el papel que desempeñan en la historia, que la lectura del material no era tediosa o cansada, mencionaron que la historia era buena o muy buena y que el título motivaba a la lectura, que usarían la guía si tuvieran problemas con su consumo de alcohol, además de sentirse identificados con los personajes y las situaciones descritas. Lo que más les agradó es el modo en que se trató el tema en una historieta, el lenguaje utilizado, el mensaje que se les da, el planteamiento de metas, la forma de involucrarlos en la lectura, la relación del consumidor y la familia, cómo los van motivando, lo que sucede en la recaída y cómo se recupera el usuario. La información recabada fue utilizada para realizar la versión final de la historieta. Discusión El resultado fue un material de fácil lectura que permite su utilización individual, en momentos y lugares que cada persona deseé utilizar. Cumple con los principios de la traducción de la investigación al adaptar conceptos derivados de la teoría. Para lograrlo fue importante el uso de lenguaje coloquial que facilitó su lectura y la apropiación de los conocimientos por la población objetivo, esto implicó incluir cuidadosamente los supuestos teóricos para no distorsionar la perspectiva planteada originalmente. Esta intervención permite además llegar a grupos de difícil acceso como los hombres en edad productiva, que acuden poco a servicios de salud. Es necesario probar la intervención mediante la historieta, por ello la siguiente etapa será hacerlo mediante un ensayo controlado para evaluar su eficiencia para reducir los problemas de abuso de alcohol, así como la eventual progresión a la dependencia grave.

Relación entre el consumo de tabaco, salud mental y malestares físicos en hombres trabajadores de una empresa textil mexicana / Relationship among current tobacco use, mental health and physical distress in male workers of a Mexican textile industry

Introduction Tobacco use is considered a worldwide public health problem because of the amount of death and disease it causes. The WHO reports that 30% of the adult population in the world are cigarette smokers, and that nearly five million of these will die within one year. Prospective studies performed by the WHO show that if current tobacco use continues, in 2020 there will be 8.4 million deaths due to tobacco-related diseases every year; seven out of 10 of these deaths will occur in emergent countries, like Mexico. More than 53000 tobacco users die every year in Mexico because of tobacco-related diseases, and at least 147 of these die daily. Data from the National Addictions Survey (NAS) 2002 showed that 26.4% of the people between 12 and 65 years old were active tobacco consumers; this amounted to nearly 14 million individuals. Of these, 7.1% were under 18 years old. The number of tobacco consumers in Mexico has increased from nine million in 1988 to 14 million in 2002. According to the NAS, 52% of the users smoke on a daily basis, and 61.4% of them began smoking when they were minors. To know the actual consumption levels, it is important to consider some factors: the number of cigarettes a person smokes, the different situations where a person smokes, and the social and physical consequences of smoking. Thus, it would be possible to develop a consumer classification (i. e. soft consumers, mild consumers, and hard consumers). There may be numerous causes for a person to be ill. When speaking about the harmful effects of tobacco use, the literature is clear in stating that these begin with the first cigarette smoked. However, it can take up to 30 years for a consumer to notice the damage on his health after his/her consumption began; but within the first ten years there are problems in lung function and in physical endurance. When a person starts smoking there are acute and unpleasant side effects that are rarely associated with smoked tobacco use. Consumption creates a tolerance which makes unpleasant effects to stop or fade away, giving place to pleasant sensations produced by nicotine; concentration improves and psychomotor skills, alert, and activation get better and there is a reduction in anxiety and stress. The relationship between tobacco use and mental health is evident at the level of the emotional outcomes of suffering a chronic illness, such as lung cancer. On the other hand, nicotine use has been related to a reduction in the severity of depression. Chemical alternatives for reducing consumption, based on the substance physical effects that promote addiction, have not proven to be effective so far. There is also evidence that consumers that fail in quitting smoking or people that have dependence problems with nicotine show a high prevalence of mayor depression when compared to non-dependent consumers. This association was direct with the severity of nicotine dependence. It also has been observed that smoking interferes often with psychological learning tools, mainly when consumption starts at very early ages. Emotional distress can produce low self-esteem and a lack of self-confidence. Therefore, the chances to begin tobacco consumption increase when it is used as a crutch to cope with social pressure and acceptance. Since tobacco use is a conduct that has shown to have serious repercussions on physical health and an important relationship with mental health in human beings, and is therefore a growing public health problem, the objective of this study is to explore a possible link among smoked tobacco consumption, mental health and physical problems in male workers from a textile factory. Method A non-probabilistic convenience sample was used in the study. Subjects voluntarily agreed to complete the questionnaire: 279 male workers were interviewed; 54% were between 18 and 27 years old and 23% were between 28 and 37. Most of them had studied junior high school or higher (74%) and 65% were in a serious relationship (married or living with a couple). Data about tobacco use were collected using a questionnaire with questions from the NAS 2002. To explore mental health the five-item Mental Health Inventory was used (MHI-5). As it is a self-answered screening test, it does not give a diagnosis, but it does allow establishing if subjects have symptoms of a probable mental health problem. Information about physical distress was collected through an 11-item somatization sub-scale from the Symptoms Check List-90 (SCL-90). The number of physical troubles that subjects reported during the last month was considered. All instruments have good levels of reliability and validity. Finally, several socio-demographic questions were included. The questionnaire was answered in groups inside a training room. Trained interviewers participated in the process of collecting information. Subjects' participation was voluntary and their verbal acceptation was obtained before answering the questionnaires. Anonymity and confidentiality were guaranteed. Workers were told that no information would be given to the union or business authorities, and those who asked for their results received them personally. Neither invasive procedures nor intervention techniques were used. The union authorities received a global report so they could acknowledge the importance of smoked tobacco and mental health-related problems among their workers. Statistical analyses were performed using SPSS 11.

Introducción El consumo de tabaco es considerado un problema de salud pública en todo el mundo debido a la cantidad de enfermedades y muertes relacionadas con su uso. La Organización Mundial de la Salud (OMS) reporta que 30% de los adultos son fumadores y, de éstos, aproximadamente cinco millones de personas morirán en un año. También se estima que para 2020 habrá 8.4 millones de muertes anuales por enfermedades relacionadas con el consumo de tabaco, de las cuales siete de cada 10 ocurrirán en países en vías de desarrollo, como México, donde más de 53 mil personas fumadoras mueren al año por enfermedades asociadas al tabaquismo y al menos 147 personas mueren diariamente. Por otro lado, en la bibliografía se ha encontrado que el daño en el organismo por fumar comienza desde el primer cigarro, que a los 10 años se presentan síntomas sutiles en la función pulmonar y disminución de la tolerancia al ejercicio, y que es entre 20 y 30 años después cuando los síntomas hacen a un fumador tomar conciencia del daño a su salud. En cuanto a la relación entre el uso de tabaco y la salud mental, ésta se evidencia por las consecuencias emocionales que conlleva padecer una enfermedad crónica. En este contexto, el objetivo del presente trabajo fue conocer la relación de problemas emocionales y malestares físicos con el consumo de tabaco en hombres trabajadores de una empresa textil mexicana. Método La muestra estuvo conformada por 279 sujetos que laboraban en una empresa textil, en su mayoría jóvenes entre 18 y 27 años (54.5%), con escolaridad de secundaria (59.3%) y casados o en unión libre (65.6%). El instrumento utilizado incluyó las escalas de salud mental (MHI-5), malestares físicos (SCL-90) y consumo de tabaco. La aplicación del instrumento se realizó de manera grupal dentro de la empresa textil en que laboraban los sujetos. Resultados No se encontraron diferencias significativas en cuanto a problemas de salud mental y síntomas físicos entre fumadores y no fumadores. Mediante un modelo de análisis de trayectorias, se analizó la relación existente entre síntomas físicos, problemas de salud mental e indicadores de consumo de tabaco. Se encontró así que el principal predictor de los síntomas físicos en fumadores es el tiempo que llevan consumiendo y que los síntomas físicos son un importante predictor de problemas de salud mental. Discusión Sin importar la cantidad de cigarrillos consumidos, la frecuencia de consumo ni otros indicadores de consumo elevado, el tiempo que se lleva consumiendo es un predictor importante del número de síntomas físicos que se manifiestan, lo que puede deberse a los efectos dañinos que tiene el consumo prolongado del tabaco. De este modo se confirma lo mencionado en otras investigaciones de que, después de los primeros 10 años de consumo, se presentan malestares físicos sutiles y que a lo largo de 20 o 30 años se presentaran malestares importantes. Si bien no se encontró una relación directa entre consumo de tabaco y salud mental, se puede sugerir una relación indirecta derivada de la influencia que tiene el consumo sobre el plano del bienestar físico. En este sentido es de esperarse que, a medida que se continúe consumiendo tabaco y los malestares físicos aumenten, también se incrementen los problemas de salud mental. Por otro lado, el modelo aquí presentado requiere ser completado incluyendo otras áreas que puedan influir sobre el bienestar físico y mental. Sin embargo, se logró evidenciar la importancia que tiene el consumo de tabaco sobre el malestar físico, a la vez que aumenta la probabilidad de que se presenten más problemas en la salud mental de la población consumidora.

Características organizacionales, estrés y consumo de alcohol en trabajadores de una empresa textil mexicana

resumen está disponible en el texto completo

Abstract: There are different factors within work environment that could créate both wellbeing and distress in workers. The climate perception employees have, as well as their evaluation of some, could have positive and negative consequences at personal and organizational levels. Work stress is another element that has meaningful repercussions on the health of people and on the quality of their performance; it has been related to alcohol and psychoactive substances abuse, besides of an increase in different social and work problems. The main objective of this paper is to determine the relationship between organizational factors (such as work stress, organization climate, and work satisfaction) and alcohol use, and the occurrence of industrial problems and accidents in Mexican workers in a textile organization. Method In order to interfere as less as possible with the production process, this study was carried out at the facilities of the organization, during work hours and during weekends. Thus, only employees who attended to work these days were interviewed. The sample included 277 workers who basically performed as operative staff. No more organization characteristics are described on behalf of an agreement, and of the anonymity of the answers given by the subjects. All the interviewees were men, their ages fluctuated between 16 and 65 years, 85% of them had attained junior high school, and 72% were married or living with a partner. A self rated questionnaire was used, along with the AUDIT (alcohol use disorder identification test) alcohol test, a work stress scale, another scale for organization climate, one more for work satisfaction, and some general questions. All the scales had good internal consistency. The procedure consisted in gathering 20 workers in a well-ventilated and illuminated room. The interviewer, who was previously trained, read the instructions aloud, emphasizing anonymity and confidentiality of any information the workers give, and stating that no one from the company would have access to the data. Analyses were performed with statistical software SPSS 11.5. EQS 6.0 was used to test the structural equation model with the relationship between organizational factors, alcohol use and negative consequences at work. Results Organizational climate. Most of the workers (92%) perceived a good level of communication with the work group, 87.2% mentioned to receive help from the boss when they have to do an activity they are not familiar with, 78% said they have enough support to solve the problems related to work. There were differences between the workers according to education level; the ones with the higher level perceived a more adverse climate. There were differences also between shifts (morning, evening, and mixed); the workers from the first one perceived a less favorable climate. Work satisfaction. Most of the workers think of their job as something useful (95%), 93% said they liked it, and 88.3% mentioned their families are satisfied. There are statistical differences be-tween satisfaction and education levels; subjects who had only basic education were more satisfied than those with a higher level. The stress sources are related to the effort implied in the struggle to move forward (87.6%), to have too much work to do (60.5%), and to the possibility of an accident when subjects are careless (51.6%). The total scale scores indicated that 14.2% of the workers had high levels of work stress. Alcohol use: 61.7% of the workers consumed alcohol during the previous year. According to the AUDIT (using eight or more as a cutoff score) 25.8% were classified as cases for alcohol related problems; 26.5% of the subjects had risk consumption, and 5.3% were consuming in a dangerous way because of the frequency and the amount they drink. Work problems: 24.1% of the subjects mentioned they have invested more time than usual in some activity related to work, 21% have been told off because of their performance, 18% felt they could not achieve quality outcomes. The incidents that workers mentioned were: hand injuries (17.5%), finger injuries (15.7%), being close to suffer an accident (13.5%), and suffering damage or injuries when working (10%). A structural equation model allowed to observe that organizational factors, climate, satisfaction, and work stress are meaningful predictors of work accidents and problems. Of all the variables included in this analysis, work stress also was the one that best predicted alcohol use at the work place. A direct effect of the individual level of alcohol use and of the use at the work place on problems and accidents, was observed. This effect was not initially considered in the model of individual consumption, neither were the frequency, the amount consumed, nor the excessive use; it was necessary to add this direct path to adjust the model so they were observed as important elements. Discussion Interviewees perceived communication as an important climate issue, mainly when established with the work group. Another element mentioned as important was perceived, that is support from the boss or supervisor to solve problems. Education level has a relevant role in the way workers live their work climate; those with a lower level experience it as more favorable. This could be the consequence of higher work expectations related to a higher education level. There are differences among shifts; workers from the first shift experienced a more favorable climate. The model included climate as a meaningful element for the presence of consequences at work place; this had a direct effect over the existence of problems and the occurrence of accidents, it was opposite to the results observed in other studios were there was not a direct relationship. Work satisfaction has to do with job usefulness, the joy for the task done, and family satisfaction with the position. The education at level affects perception of work climate. This evaluation of the worker climate has been identified as a significant factor for the reduction of negative effects at work. It is necessary to mention that employees with a higher stress level are the married ones, which may be caused by the responsibilities implied in being a family supplier. This concurs with the result of a study on burnout, which found that being married is a risk factor to develop high stress. Work stress was the most predictive component of accidents and problems at the work place, which had a direct relation (0.50). It also directly predicted alcohol use at the work place (0.22), and had a negative statistical difference with climate (-.29). Thus, it is important to consider that when workers perceive a better climate, stress level goes down, and it is necessary to consider this organizational factor to improve work conditions besides employees' physical and mental health. According to the model tested in this study, alcohol use has a direct and meaningful effect on performance and on the frequency of problems and accidents, inside and outside the organization. It is important to consider that prevention in work places must be done globally, taking into account organizational factors such as climate, stress, and worker satisfaction. It also should include educative and practical elements that allow reducing excessive alcohol use and its negative consequences (poor performance, bad interpersonal relationships, and bad outcome quality) at work, besides reducing also industrial accidents. The most frequent work problems were as follows: to invest more time than necessary in an activity, to be told-off because of mistakes, and to have problems with the boss or supervisor. These events have an impact on productivity and represent money loss for the company. The most frequent accidents were as follows: hand injuries, which are related to heavy machinery operation, basic in the production process of this industry. This reflects the need to consider the physical aspects of the place where activities are performed, as well as the psychosocial factors affecting individuals, all of which will result in benefit of any organization.

Relación entre nivel de consumo de alcohol, salud mental y síntomas somáticos en un grupo de trabajadores de la industria gastronómica y hotelera de la Ciudad de México

resumen está disponible en el texto completo

Abstract: In facilitating the presence of risk behaviors for health, some conditions inherent to the gastronomical and hotel industry may significantly affect the people working in this market. Among them are non-regular working days, temporary employment, law salaries, problems at work, low professional prestige, minimum development opportunities, bad relationships with managers, and unsafe conditions in the job environment. In comparison with other work areas, this is one of the sectors with higher risk of problems related to alcohol use, mainly due to the availability of the substance in the work place, to the social pressure, to the working schedules, and to the way people cope with stress at work. Due to movements, rhythm, and techniques used in the activities performed in this kind of job, it is possible to develop bones and muscles alterations, and because of constant changes in labor shifts circadian cycles suffer disruptions that lead to different somatic symptomatologies. Studies in workers have shown that problematic alcohol consumption is present in 33-44% of this population. Other studies have found prevalences up to 24% of mental disorders in workers. The Department of Labor has reported that, as part of work diseases, mental and behavioral disorders increased its prevalence of 0.3% in 1999 to 1.9% in 2003. On the other hand, some studies report an association between mental disorders, somatization, and alcohol use in general population. People spend a considerable portion of their lives at their work places and working in gastronomic and hotel industry implies high risk for health. The objective of this paper is to know the association among alcohol use, the number of symptoms regarding mental health problems, and the level of discomfort caused by somatic symptoms in a sample of gastronomic and hotel industry workers from Mexico City. Material and method Population and sample Sampling was non-random, on convenience, and by quota. The sample included 194 men, over 18 years old, who were working at companies from the gastronomic and hotel industry in Mexico City. Most of the subjects were under 45 years old, over half of them studied until junior high school. The most frequent position among the subjects was waiter. Working days vary, depending on the day and time banquets and receptions are programmed. Over two thirds of the subjects mentioned having three or less years working in this kind of job. Questionnaire The short version of the AUDIT (first three questions) was used to establish the level of alcohol use. This version allows to rate subjects in three levels, according to the amount and frequency of consumption: low risk use, risk use, and dangerous use. The five-item Mental Health Inventory (MHI-5) was used to determine the presence of mental health problems. The MHI-5 is a screening test that measures non-psychotic affective disorders, according to DSM-IV criteria, with no reference to specific disorders. The Symptoms Check List-90 (SCL-90) was used to identify psychological stress derived from somatic symptoms. The three scales have good levels of reliability and validity. The field team talked to the managers of the training department at the union, because all the subjects in the sample were affiliated, to get permission to collect the information. No invasive techniques were used nor any other type of intervention. Subjects responded to the questionnaire gathered in groups inside a training room. The fieldwork involved trained interviewers, whose training was voluntary. All the workers accepted to participate and to respond the questionnaire through a verbal agreement. Participation was anonymous and neither the union representatives nor the managers had access to individual questionnaires, which granted confidentiality. The union representatives acknowledged a global report that intended to make them aware of the magnitude of the alcohol use and mental health problems among their affiliates. SPSS 10 software was used to analyze data. Results A total of 44.2% of the subjects reported drinking four or more drinks per occasion; 60.9% of them mentioned they had drunk six or more drinks per occasion during the last year; 55.5% of the workers were located in a low risk consumption level; 43.1% had a risky consumption level, and 10.4% consumed at a dangerous level. Results regarding mental health showed that a quarter of the subjects «have felt uneasy¼ (26.1%), 16.7% «have felt happy¼, 9.7% «have felt sad and melancholic¼, 8.4% «have felt down or as if nothing could cheer them up¼, and 4.3% «have been very nervous¼. A cut-off score of 16 or higher allowed identifying 11% of cases with symptoms of a possible mental health problem. Most of the subjects (69.6%) mentioned having experienced at least one somatic symptom during the last month. The ones that caused more discomfort were muscular pain (17.6%), backaches (12%), headaches (9.7%), weakness in some part of the body (7.1%), and nausea (6.7%). A cut-off score of eight or higher allowed to identify 14.7% of cases with somatic symptomatology that caused psychological distress. A Pearson correlation analysis was performed and the results showed a significant association between the level of alcohol consumption and the discomfort due to somatic symptoms (pr=.404^><.01). Significant associations were also found between the mental health state and the discomfort due to somatic symptoms (pr=.339 ^><.01), and between the level of alcohol consumption and the mental health state (pr=.260 ^><.01). Discussion and conclusions The percentage of alcohol consumers, the amount of alcohol consumed, the frequency of consumption, and the prevalence of problematic consumption were higher in this group of workers when compared to employees from other occupations. This can be the result of a mayor substance availability within gastronomic and hotel work environments. The association between alcohol use and the number of symptoms of mental health problems may be an indicator of co-morbidity between both conditions. It is also possible that the association is related to excessive alcohol use as a way to cope with emotional problems. The somatic symptoms with the highest prevalence were part of the somatization scale, but there is a possibility that they are indicators of an illness or disease derived from the labor activity instead of indicators of somatic symptoms. On the other hand, whether alcohol use increases frequency of mental and physical troubles or that consumption is present as a reaction to these troubles, more research is necessary to know more about these variables co-morbidity because these relate to the presence of accidents, problems at work, social and family problems, as well as economic burden. The use of screening scales in working settings is important because it reduces costs and helps to identify related problems. In addition, they are easy to use at factories and businesses without interfering with the manufacturing processes. Nevertheless, it is important to use more specific instruments with identified cases. This would permit a more precise diagnosis and, if necessary, to refer subjects to institutions that provide specialized health care. To have such a structure would reinforce protective factors for subjects to cope with the risks inherent to their professional activity. Limitations and suggestions Conclusions are valid only for the workers in this sample because of the sampling method and they cannot be applied to all the workers of the gastronomic and hotel industry. So far, studies about substance use in working settings have focused on men population; however, women are an important segment that researchers should consider investigating to collect information that can sustain proper and necessary actions.