Age of Onset, Current Use of Alcohol, Tobacco or Marijuana and Current Polysubstance Use Among Male and Female Mexican Students.

AIMS: This study aimed to examine alcohol, tobacco or marijuana use onset and associations between age of onset and current use, and between age of onset and current polysubstance use among a sample of Mexican young people aged 17-20 years. METHODS: Alcohol, tobacco, marijuana and other substance use were identified in a 2012 cross-sectional survey of male and female students entering first year university in Mexico City. Chi-square tests and logistic regression models examined associations between gender, age of onset, order of onset, family substance use and current polysubstance use among 22,224 students. RESULTS: The largest proportions of males and females initiated alcohol at age 15, tobacco at ages 15-16 and marijuana at ages 16-17. Earlier alcohol and tobacco initiation was associated with past 30-day use of the same substance. Gender differences in alcohol and tobacco use were small but males were significantly more likely than females to use marijuana and be polysubstance users. Family substance use was associated with earlier onset. There was a significant association between the earliest age of any of the three substances and current polysubstance use. CONCLUSIONS: A number of contextual and cultural factors in Mexico may be contributing to early onset, continued use and polysubstance use and deserve attention in research and by prevention programs.

Parental monitoring and family relations: associations with drinking patterns among male and female Mexican students.

INTRODUCTION: Parental monitoring and family relations are recognized as protective factors for youth alcohol use. The purpose of this study was to investigate perceived parental monitoring and family relations among subgroups of Mexican youths with different patterns of drinking behaviors and consequences. METHODS: A latent profile analysis (LPA) identified profiles of drinking behavior in a cross-sectional survey of entering first year university students. Multinomial regression examined associations between parental monitoring, family relations and drinking profiles among 22,224 students. RESULTS: Both lower perceived parental monitoring and weaker perceived family relations were associated with heavier drinking profiles among males and females, but more strongly associated with female than male heavier drinking profiles. Being older, having parents with lower education, and not living with parents were also associated with lower parental monitoring and weaker family relations. There was a general trend of lower parental monitoring and weaker family relations as the profiles increased from Non/Infrequent-No Consequences to Excessive-Many Consequences Drinkers. Lower perceived parental monitoring and weaker perceived family relations were more strongly associated with drinking profiles among females than among males. Both the parental monitoring and family relations scales had similar associations with drinking profiles. CONCLUSIONS: Findings suggest that drinking norms and values may contribute to any protective influences of parental monitoring and family relations on Mexican youths' drinking. Research about changes in drinking norms, contextual factors, and youth-parent trust would inform the utility of parental monitoring or family relations as protective strategies against alcohol misuse among Mexican and Mexican American youths and also youths from other backgrounds.

Natural mentors and youth drinking: a qualitative study of Mexican youths.

Parental influences on youth drinking are well documented but not the influence of extended family members. This article explores extended family influences on alcohol use among Mexican youths and whether extended family members can be considered natural mentors. We conducted a qualitative study using ethnographic open ended interviews with 117 first year university students in Mexico City. The ethnographic interviews revealed six drinking groups: excessive, heavy, regular, occasional, abstainers and non drinkers. Youths reported close relationships with extended family members who provided counsel and acted as representatives of familial norms and values. The alcohol beliefs and behaviors of these family members, including their alcohol misuse, had a positive influence on youths' alcohol attitudes. The naturally occurring mentoring relationships of Mexican extended family members can positively influence moderate youth drinking. Natural mentoring relationships should be encouraged and facilitated in prevention efforts for Mexican youths, Mexican-American youths and potentially other Hispanic/Latino youths.

Alcohol Use among Mexican Youths: Is Familismo Protective for Moderate Drinking?

The construct of familismo has been identified as a potential protective cultural value in Hispanic cultures. This paper considers familismo and alcohol use among young people in Mexico. We conducted a qualitative study using ethnographic open ended interviews with 117 first year students at a large free public university in Mexico City between April-May 2011. The findings indicate that dimensions of familismo can act as protective factors against misuse of alcohol among Mexican youths and may be protective for moderate drinking. Future research should explore the relationship of familismo to gender roles and other cultural values during adolescence. Given the enduring influence of Mexican cultural values among Mexican Americans the research has implications for prevention programs for both Mexican and Mexican American youths.

Changes in alcohol use among first year university students in Mexico.

BACKGROUND: Alcohol use and misuse is widespread among university students in many countries. Specific cultural factors may impact alcohol use after entering university. OBJECTIVE: This paper considers changes in alcohol use among first year university students in Mexico. METHODS: A qualitative study using ethnographic interviews with 57 female and 60 male student drinkers in Mexico City from March to June 2011. Each interview was evaluated by a set of thematic codes developed inductively from the interviews. Findings from excessive, heavy, regular, occasional drinkers, abstainers, and non-drinkers were analyzed to explore whether or not linkages existed between and/or among particular themes. RESULTS: Students reported factors associated with changes in role and status, friendships, and increased autonomy as reasons for increasing or decreasing their alcohol use after entering university. CONCLUSIONS/IMPORTANCE: Understanding the influence of Mexican cultural norms on alcohol use among Mexican and Mexican Americans can be helpful in informing studies and preventive efforts among both Mexican and Mexican American young people.

Drinking patterns and victimization among male and female students in Mexico.

AIMS: The purpose of this study is to estimate the prevalence of alcohol use and alcohol-related consequences, identify drinking profiles using latent profile analysis (LPA), and investigate associations between profiles and violent victimization among young people in Mexico. METHODS: LPA identified profiles of drinking behavior in a survey of entering first year university students. Multinomial and logistic regression examined associations between drinking patterns, socio-demographic variables and violent victimization. RESULTS: The LPA identified five profiles of behaviors and consequences among the 22,224 current, former and never drinkers: Non/Infrequent-No Consequences, Occasional-Few Consequences, Regular-Some Consequences, Heavy-Many Consequences and Excessive-Many Consequences drinkers. The Occasional-Few Consequences profile comprised the largest, and the Excessive-Many Consequences profile the smallest, group of drinkers. Multinomial regression showed males and older students more likely to be Heavy or Excessive-Many Consequences drinkers. Living alone was associated with higher odds, and higher maternal education with lower odds, of being a Non/Infrequent-No Consequences drinker. Heavier drinking profiles were more likely to experience violent victimization adverse consequences. Logistic regression showed male and female Heavy and Excessive-Many Consequences drinkers had the highest odds, and Non/Infrequent drinkers the lowest odds, of experiencing any victimization. CONCLUSION: Findings suggest changes in male and female drinking behavior and a continuation of the established pattern of infrequent but high consumption among Mexican youths. Both male and female Heavy and Excessive-Many Consequences drinkers were at elevated risk for experiencing victimization. Identifying cultural gender norms about drinking including drinker expectations and drinking context that contribute to these patterns can inform prevention efforts.

Parental monitoring and alcohol use among Mexican students.

Parental monitoring has been described as a protective factor and useful strategy to prevent substance misuse among youths. The aim of this study was to examine whether perceived parental monitoring influences frequency of alcohol use, age of drinking onset and risky drinking among entering public high school and university students in Mexico City. The study is a cross-sectional survey of entering first year students in the high school and university school system of a large public university in Mexico City conducted during registration at the beginning of the school year. In 2008, of 34,840 students accepted to the affiliated high schools, 28,996 students (51.8% female) completed the alcohol survey and of 37,683 students accepted into university 30,084 students (51.5% female) completed the alcohol survey. The findings suggest that compared to students with higher perceived parental monitoring those reporting lower perceived parental monitoring were more likely to report risky behavior. They were more likely to be ever drinkers, frequent drinkers, have earlier age of onset and high AUDIT scores. Overall, higher parental monitoring was strongly associated with being female and lower parental monitoring with being male. Our findings suggest that more research on parental monitoring as a protective strategy against alcohol misuse is needed. Research focusing on cultural factors including gender and age-related norms and familismo would increase knowledge of the association of parental monitoring and alcohol use among Mexican youths, Mexican American youths and potentially youths from other Hispanic backgrounds.

Eficacia de un programa de intervenciones terapéuticas en estudiantes universitarios diagnosticados con dependencia al alcohol / Efficacy of a therapeutic intervention program among Mexican college students diagnosed with alcohol dependence

In recent years, consumption of alcoholic beverages has become a common practice among young adults attending higher education institutions in Mexico. Over the past two decades, prevalence of alcohol consumption in this population has doubled. In campuses located in Mexico City, 70-90% of undergraduate students have consumed alcoholic beverages during the past year and approximately 25% have engaged in binge drinking. Past year prevalence of Alcohol Dependence (AD) has been estimated in 4.6% and 18.4%. Higher education institutions around the world have implemented programs aimed at reducing students' drinking that have included educational interventions and/or psychosocial treatments delivered individually or in group format. In this regard, the available evidence suggests that programs that have included elements of the Motivational Enhancement Therapy (MET) or components of the Cognitive Behavioral Therapy (CBT) have shown the greatest efficacy in reducing drinking problems in this population. Despite this, there are no studies examining the efficacy of these interventions in Mexico's college student population. In the report presented here, we aim at examining the efficacy of Individual or Group MET and CBT in reducing drinking among undergraduate students diagnosed with AD. We hypothesized that in comparison to CBT, MET would show evidence of a greater reduction in alcohol consumption. To evaluate this hypothesis we examined the treatment effects on the number of consumed drinks, on the number of drinking days, and on the number of drinks per drinking day during the preceding 30 days. Methods We prospectively evaluated during an 8-week treatment phase and during a 12-month follow-up period, 158 undergraduate students who received a diagnosis of AD (ICD-10) at the students' Mental Health and Counseling Center of the National Autonomous University of Mexico (UNAM) in Mexico City. Instruments. In order to screen and to establish the diagnosis of AD we respectively used the Alcohol Use Disorders Identification Test (AUDIT) Mexican version and the Composite International Diagnostic Interview (CIDI). We also used The Alcohol Time line Followback (TLFB) method to retrospectively record the amount and frequency of alcohol consumption. Procedures. Students seeking services at the UNAM Mental Health and Counseling Center, and who had a diagnosis of AD, were invited to participate in the study. After informed consent was obtained, they were randomly assigned to one of four manualized treatment interventions: Individual or Group MET, or Individual or Group CBT. These were delivered in eight weekly sessions lasting one hour. The alcohol TLFB was administered at the beginning and at the end of the 8-week treatment phase, and subsequently monthly for the following 12 months. Statistical analysis. An analysis of variance (ANOVA) for repeated measures was used to examine the treatment effect on drinking during the treatment phase and separately during the 12-month follow-up period. A one-way ANOVA was used to examine differences between treatment groups at specific assessment points. Results Demographic characteristics. In the entire sample the majority of students were men (73.2%), while the mean age was 18.8 [± 2.9] years. There were no differences between intervention groups in their demographic characteristics. Baseline characteristics of alcohol consumption. In the entire sample and separately in each of the intervention groups there was a predominant pattern of weekly heavy drinking. There were no baseline differences between treatment groups in the monthly amount or frequency of drinking, or in the number of drinks consumed during drinking days (all comparisons P>0.50). The average number of Alcohol Dependence symptoms was 6.0 [± 2.6]. There were no differences among groups in the number of these symptoms (P=0.10). Patient Retention during the Treatment Phase and the Follow-up Period. At the end of the 8-week treatment phase, 92% of the students remained in treatment. During this phase, the Individual CBT group had the greatest number of dropouts with 18% of them leaving prematurely (Pearson X² = 15.7, df=3, P = 0.001). During the follow-up period, specifically at the 3, 6 and 12-month follow-up, the retention rates in the study were respectively 91%, 89% and 86%. There were no differences among groups in this variable at any of these follow up points. Alcohol consumption during the treatment phase. In the ANOVA for repeated measures we found that during the treatment phase there was a main effect of time over the three indicators of alcohol consumption (range of F: 7.59-11.81, df=1.142, range of P:0.001-0.007). This reflected the fact that at the end of the four interventions there was a reduction in the amount and frequency of monthly drinking and a reduction in the number of drinks during drinking days. There were no main effects of treatment (range of P:0.07- 0.56) or interactive time X treatment effects (range of P:0.55 to 0.79) on any of the drinking variables. However, at the level of a non-significant trend (F = 2.37, df=3.143, P = 0.07), there was a treatment effect reflecting that in comparison to Individual CBT, there was a trend toward a greater reduction in the frequency of monthly drinking in Group MET (one-way ANOVA: F=2.60, df=3.146, P=0.05, Tukey HSD P=0.07). Alcohol consumption during the follow-up period. In the ANOVA for repeated measures, there was a main effect of time on the amount and frequency of monthly alcohol consumption (range of F: 8.54-9.53, df=3.393, P range: 0.001-0.004), reflecting that during this period there was a reduction in these two drinking variables in the entire sample. This effect was observed mainly during the first six months of follow-up. During the following six months, there was a gradual increase in the amount and frequency of drinking (range of F for the quadratic component of Time: 5.36-10.36, df=1.131, range of P: 0.02-0.002) that approached the levels seen at the end of treatment. There were no main effects of time on the number of drinks consumed during drinking days (P=0.27). There was a treatment X time interaction (F=2.65, df=3.131, P=0.05) on monthly frequency of drinking, indicating that, in comparison to Individual CBT, there was a greater reduction in this drinking variable in Group MET. This effect was specifically observed during the first three months of follow-up (one-way ANOVA: F=3.63, df=3.142, P=0.02, Tukey HSD P=0.007). Subsequently, there were no differences among the intervention groups in this variable for the remaining nine months of follow-up. Finally, there were no main effects attributable to treatment or interactive effects of time X treatment on the number of monthly drinks (P range: 0.49 to 0.65) or on the number of drinks consumed per drinking day (P range: 0.55 to 0.79). Discussion In this sample of alcohol dependent college students, we found that at the end of the 8-week treatment phase there was a comparable reduction in the amount and frequency of alcohol consumption and in the number of drinks consumed during drinking days across the four intervention groups. However, we observed that at the level of a non significant trend (P=0.07), Group MET appeared to be more effective than Individual CBT in reducing the frequency of alcohol drinking.

Introducción Se ha descrito que entre los estudiantes de educación superior de nuestro país la prevalencia del consumo de alcohol se ha duplicado durante las últimas dos décadas. Se han estimado prevalencias durante los últimos 12 meses del diagnóstico de Dependencia al Alcohol (DA) de 4.6%. Aunque se desconoce la magnitud de las consecuencias de estos problemas entre los estudiantes universitarios mexicanos, en Estados Unidos han sido identificados como un problema de salud pública mayor y como el principal problema de salud en las universidades. Para reducir estos problemas, se ha evidenciado que las intervenciones como la Terapia de Incremento de la Motivación (TM) o la Terapia Cognitivo Conductual (TCC) podrían ser igualmente efectivas a largo plazo. Se ha observado una ligera ventaja del formato individual sobre el grupal. Pero al analizar el costo-beneficio, el formato grupal suele ser el más utilizado en las universidades. A pesar de la importancia de los problemas por consumo de alcohol en las universidades y no obstante la efectividad demostrada de estas intervenciones, no hay, hasta lo que sabemos, investigaciones publicadas que comparen la eficacia de la TM y la TCC en el tratamiento de los universitarios con problemas por consumo de alcohol en México o en otros países de habla hispana. Objetivo Examinar los efectos de las intervenciones TM y TCC tanto en su modalidad individual como grupal, en el tratamiento de estudiantes universitarios con diagnóstico de dependencia al alcohol. Material y métodos Se evaluó prospectiva y comparativamente a 158 estudiantes universitarios con diagnóstico de Dependencia al Alcohol. Instrumentos: 1. Alcohol Use Disorders Identification Test (AUDIT); 2. Composite International Diagnostic Interview (CIDI); 3. Línea Base Retrospectiva (LIBARE); 4. Cuestionario de Datos Demográficos. Procedimientos. A los estudiantes con problemas con su manera de beber, se les aplicó el AUDIT; a los que tuvieran respuestas positivas para Dependencia al Alcohol, se les aplicó la sección de <

Factors associated with illegal substance use initiation among young students in Mexico City.

INTRODUCTION AND AIMS: To assess risk factors for illegal substances use initiation in a cohort of Mexican high-school teenage students. DESIGN AND METHODS: Longitudinal study of a cohort of 10th grade students, with follow up at the time of their enrolment in college (3-4 year follow up). The associations of parental educational level, alcohol abuse in the family, employment status, experiences of physical and sexual aggression, sexual initiation, emotional distress and previous legal substance use at the baseline measurement, with the initiation of illegal substance use were explored. RESULTS: The follow-up analysis was carried out in 21,616 at-risk students. The incidence of substance use initiation was 7%. Male gender (odds ratio 3.86, 95% confidence interval 3.45, 4.32), a higher father's education level, sexual initiation for women (odds ratio 2.67, 95% confidence interval 1.49, 4.79] and use of legal substances at baseline were associated with risk of substance use initiation. DISCUSSION AND CONCLUSIONS: The social circumstances surrounding adolescents influence their risk of illegal substance consumption. Although the complex network of factors affecting substance use requires further exploring, young people at risk can be identified and should receive preventive attention.

El consumo riesgoso y dañino de alcohol y sus factores predictivos en adolescentes estudiantes del bachillerato / Hazardous and harmful drinking among Mexican adolescents: prevalence and predictive factors

Alcohol is commonly used among adolescents in Mexico. In a representative survey of Mexico's general population, 30% of the teenagers reported current drinking, whereas 8% incurred in binge drinking (5 or more drinks per occasion) at least once during the last year. In addition, 3% reported three or more alcohol dependence symptoms over the last 12 months. In this Mexican age group, alcohol consumption importantly contributes to the most frequent causes of morbidity and mortality (e.g. accidents, violence, homicides, suicide and risky behaviors). Data from a representative survey of adolescents attending middle and high school in Mexico City suggests that adolescents attending Mexico's schools run a high risk for alcohol problems. In this study, prevalence of lifetime and current drinking, and of current binge drinking (5 or more drinks per occasion) were, respectively, 65.8%, 35.2%, and 23.8%. These rates are substantially higher than those described in teenagers from Mexico's general population. Furthermore, although among Mexico's general population the prevalence of drinking has traditionally been higher among male than female adolescents, no gender differences in prevalence of alcohol consumption have been reported among Mexican middle and high school students. This suggests that female adolescents in Mexico's schools have become equally exposed to drinking as their male counterparts. Despite these trends, there is a paucity of studies examining drinking patterns and their respective correlates among Mexican adolescents attending post-elementary education. To our knowledge, in this population, there are no published prevalence estimates of Hazardous and Harmful Drinking (HHD). HHD is defined as a pattern of alcohol consumption conferring to the individual a greater risk for health problems, or frankly conducive to medical or psychological complications (e.g. accidents, victimization, violence, alcohol dependence, liver cirrhosis and/or other medical complications). The Alcohol Use Disorders Identification Test (AUDIT), developed by the World Health Organization, is currently the only instrument specifically designed to identify HHD. Although the AUDIT was initially validated only among adult patients in primary care settings, this instrument has consistently shown to be valid and reliable in detecting alcohol problems in different populations, such as the adolescent population in many countries around the world. Given the public health implications of estimating the frequency of HHD among adolescents attending high school in Mexico, and given the importance of elucidating the variables influencing this problem, we decided to conduct the analysis presented here. To our knowledge, this is the first report published in the international literature on the prevalence of HHD among adolescents attending high school in a Latin American country. Objective In the study described here, derived from a Universidad Nacional Autónoma de México (UNAM) project entitled <>, we aimed at examining the frequency and risk factors for HHD among Mexican high school students. More specifically, our objectives were: 1. to determine the past-year prevalence of HHD among high school freshmen; and 2. to examine, in this population, the effects of demographic and family variables in the likelihood of HHD. Subjects and methods This study was a cross-sectional survey conducted at the beginning of the school year during the registration period between September 1st and September 30th, 2005. In 2005, a total of 34000 students were accepted to initiate college at the nine UNAM college campuses located in the Mexico City metropolitan area. Of these, 28784 students (87.4 %) (age=14.8 [±2.5] years; 51.0% women) consented in answering the survey and provided complete data. Consequently, 521 6 students (12.6%) were excluded from the analysis due to a lack of consent, incomplete data or their absence at the time of registration. We used the AUDIT to examine past-year prevalence of HHD. This self-report instrument includes 10 items that examine frequency and intensity of drinking (items 1-3), presence of alcohol dependence symptoms (items 4-6), and negative consequences of drinking (items 7-10), yielding a maximum possible score of 40 points. Among adult patients in primary care settings, it has been accepted that an AUDIT score of 0-7 points reflects safe levels of alcohol consumption, whereas a score of 8 points or higher indicates the presence of Hazardous and/or Harmful Drinking. It has been described however, that among adolescents, an AUDIT score of 3 points or higher reliably identifies those students experiencing this problem. In the analysis presented here, we separately examined and reported prevalence estimates and correlates for HHD using both AUDIT's cut-off scores (≥3 and ≥8). The AUDIT was administered at the same time that a wellness screening survey that the UNAM Medical Services routinely administer to all registering high school freshmen at the beginning of the school year. Questions in the wellness survey pertained students' medical and dental health, family medical history, immunizations, and use of tobacco and other drugs. In addition, demographic and socioeconomic information was obtained from a questionnaire also routinely administered by the UNAM registrar's office. This questionnaire included 37 items inquiring about gender, age, employment and marital status, monthly family income, parental education, place and type of residency, persons with whom the student resided, and questions on previous academic performance. We estimated the prevalence of HHD and their respective 95% confidence intervals (95% CI) in the total of the sample, and separately by age group, gender, working status, monthly family income, parental education, and by variables reflecting whether the students lived with their family, peers, or alone. These variables were modeled using simulated binary terms (0, 1). Subsequently, a multinomial logistic regression was used to examine the relationship between HHD and the demographic and socioeconomic variables listed above. Variables were entered simultaneously into the logistic regression equation. To summarize the level of risk of HHD conferred by significant variables in the logistic regression model, odds ratios (OR) and their respective 95% CI's were estimated. All the significant effects reported here were adjusted considering the effects of the remaining demographic and socioeconomic variables. Results Among the high school students examined here, the prevalence of HHD was 4.0% when an AUDIT cut-off score of ≥ 8 was used. When an AUDIT score of ≥3 was considered, a frequency of 1 7.2% was observed. Men (AUDIT ≥8: 5.4%; AUDIT ≥3: 21.4%) experienced this problem more frequently than women (AUDIT≥8: 2.6%; AUDIT≥3: 13.1%). The highest prevalence of HHD among men was observed in all age groups and regardless of working status, family income, parents' education, or regardless of the persons with whom the student reported to live with. Controlling for demographic and socioeconomic differences between men and women, we found that the risk of experiencing HHD among men was approximately two times higher than among women (OR's and 95% CI's for AUDIT's cut-off score ≥8 or ≥3, respectively 2.0[1.6-2.4] and 1.6[1.5-1.8]).

De acuerdo a la Encuesta Nacional de Adicciones (ENA) (Medina-Mora et al., 2003), de 1990 al 2002, la prevalencia en el consumo de alcohol durante los últimos 12 meses entre los jóvenes mexicanos de 12 a 17 años de edad, se elevó del 27.6% al 30%. De manera más reciente, la Encuesta de Estudiantes de Nivel Medio y Medio Superior de la Ciudad de México (EENMMS) (Villatoro et al., 2003), describió que el consumo alguna vez en la vida y el consumo durante el último mes de bebidas etílicas afectó respectivamente al 65.8% y al 35.2% de los estudiantes. Llama la atención que la frecuencia del consumo alguna vez en la vida reportada por la EENMMS es considerablemente mayor que la descrita en los adolescentes de la población general urbana (39.8%) por la ENA. Además, las diferencias de género reportadas por la ENA, en las que los hombres tradicionalmente beben con más frecuencia que las mujeres, no fueron encontradas por la EENMMS en la población estudiantil del nivel medio y medio superior. Hasta lo que nosotros sabemos, se desconoce cuál es la prevalencia en esta población de patrones de consumo problemático de alcohol como serían el consumo riesgoso y dañino (CRDA) o el consumo dependiente. Por lo que se desconoce si existen diferencias entre la población estudiantil y los adolescentes de la población general, en la prevalencia de estos problemas. El CRDA se define como un patrón de consumo de bebidas embriagantes, que se sitúa en un continuum de severidad, que coloca al sujeto en riesgo de desarrollar problemas de salud y/o que puede desembocar en francas complicaciones físicas y/o psicológicas (accidentes, victimización, violencia, dependencia al alcohol, etc.). Objetivo En el estudio que se presenta aquí, nos propusimos: 1) estimar la prevalencia durante el último año del CRDA en los estudiantes de primer ingreso al nivel bachillerato de la UNAM, y 2) evaluar la influencia de las variables sociodemográficas y familiares en el riesgo para el CRDA. Material y métodos El diseño del estudio fue el de una encuesta transversal en los estudiantes del primer año del bachillerato en el sistema escolarizado de la UNAM. Se estudiaron a 28 784 estudiantes (87.4 % de la población total). Se utilizó el Alcohol Use Disorders Identification Test (AUDIT) -versión en español para detectar el CRDA en la población adolescente. En este análisis empleamos tanto los puntos de corte recomendados para evaluar el CRDA en adultos (AUDIT≥8) como el puntaje recomendado para la población adolescente (AUDIT≥3). Se utilizaron porcentajes, promedios y desviaciones estándar para el análisis de las variables demográficas, y pruebas de contraste de medias (análisis de varianza) y de proporciones ( χ²) de acuerdo a la variable. Se utilizó la regresión logística multinomial para examinar la asociación de las variables demográficas y familiares con el CRDA. Se calcularon los odds ratios (OR) con intervalo de confianza al 95% para resumir el nivel de riesgo de ser afectado por el CRDA. Resultados Cuando se usó la definición del CRDA para la población adulta, se encontró que 4.0% de los estudiantes lo presentaron, frente a 1 7.2% cuando se utilizó el puntaje del AUDIT recomendado para los adolescentes. El riesgo de experimentar el CRDA fue casi dos veces mayor en los hombres que en las mujeres.

Prevalencia del consumo riesgoso y dañino de alcohol y factores de riesgo en estudiantes universitarios de primer ingreso / Prevalence of risky and harmful alcohol consumption and risk factors in freshmen students

Background In Mexico, alcohol is the most widely used substance among young adults. Alcohol consumption in this age group contributes importantly to the most frequent causes of mortality and morbidity (e.g., accidents, violence, homicides, suicide and risky behaviors). Around the world, college or university attendance has emerged in the literature as a risk factor for drinking problems among young adults. In Mexico, data from the most recent National Survey on Addictions showed that lifetime and current drinking is experienced by more than half of the Mexicans attending college education. Despite this, in our country there is a paucity of epidemiological studies examining drinking behavior and correlates among those attending college. Findings in non-representative samples of students attending public and private universities in Mexico City suggest that, during the last two decades, there has been an increase in the frequency of lifetime and current drinking in this population. Additionally, these studies have shown that, in comparison to young adults of the same age in the general population, university students may experience a greater prevalence of lifetime and current alcohol drinking. Regarding the frequency of unhealthy drinking among Mexican college students, to our knowledge there are no prevalence estimates of hazardous or harmful drinking published. However, observations in non-random samples of university students in Mexico City suggested that at least one in three men and one in five women incurred in unhealthy drinking (e.g., ≥ 5 drinks per occasion or drinking to intoxication) at least once during the last month. Hazardous and harmful drinking is respectively defined by a pattern of alcohol consumption conferring a greater risk for health problems or that is frankly conducive to medical or psychological complications (e.g., accidents, victimization, violence, alcohol dependence, liver cirrhosis and/or other medical complications). The Alcohol Use Disorders Identification Test (AUDIT), developed by the World Health Organization, is currently the only instrument specifically designed to identify hazardous and harmful drinking. Although the AUDIT was initially validated among older adult patients in primary care settings, this instrument has consistently shown to be valid and reliable in detecting alcohol problems in different populations such as the college students in many countries around the world. Given the public health implications of estimating the frequency of hazardous and harmful drinking among college students in Mexico, and given the importance of elucidating the variables influencing this problem, we decided to conduct the present study. To our knowledge, this is the first report published in the international literature on the prevalence of hazardous and harmful drinking among college students in a Latin American country. Objective In the analysis described here, derived from the project entitled Early Identification and Treatment of Problem Drinkers at the National Autonomous University of Mexico (UNAM), our aim was to examine the frequency and risk factors for hazardous and harmful drinking among Mexican university students. More specifically, our objectives were: 1. To determine the past-year prevalence of hazardous and harmful drinking among UNAM college freshmen; and 2. To examine in this population the effects of demographic and family variables on the likelihood of hazardous and harmful drinking. Subjects and methods This study was a cross-sectional survey that was conducted at the beginning of the school year during the registration period between September 1st and September 30th, 2005. In 2005, a total of 34 000 students were accepted to initiate college at the nine UNAM college campuses located in the Mexico City metropolitan area. Of these, 24 921 (73.3%) students (age=18.7±4.3 years; 55.7% women) consented in answering the survey and provided complete data. Consequently, 9 079 students (26.7%) were excluded from the analysis due to lack of consent, incomplete data or due to their absence at the time of registration. We used the Alcohol Use Disorders Identification Test (AUDIT) to examine past-year prevalence of hazardous and harmful drinking. This self-report instrument includes 10 items that examine frequency and intensity of drinking (items 1-3), presence of alcohol dependence symptoms (items 4-6) and negative consequences of drinking (items 7-10), yielding a maximum possible score of 40 points. Among adult patients in primary care settings, it has been accepted that an AUDIT score of 0-7 points reflects safe levels of alcohol consumption, whereas a score of 8 points or greater indicates the presence of hazardous and harmful drinking. It has been described, however, that among college students, an AUDIT score of 6 points or greater reliably identifies those students experiencing this problem. In the analysis presented here, we separately examined and reported the prevalence estimates and correlates of hazardous and harmful drinking using both AUDIT cut-off scores (≥ 6 and ≥ 8). The AUDIT was administered at the same time as a wellness screening survey that the UNAM Medical Services routinely administer to all registering freshmen at the beginning of the school year. Questions in the wellness survey pertained students' medical and dental health, family medical history, immunizations, use of tobacco and other drugs. In addition, demographic and socioeconomic information was obtained from a questionnaire also routinely administered by the UNAM registrar's office. This questionnaire included 37 items inquiring about gender, age, employment and marital status, monthly family income, parental education, place and type of residency, persons with whom the student resided, and questions on previous academic performance.

Antecedentes En México, el alcohol es la sustancia potencialmente adictiva que se utiliza con mayor frecuencia por los adultos jóvenes. Información proveniente de la Encuesta Nacional de Adicciones más reciente muestra que más de 50% de los jóvenes entre los 18-29 años ha consumido bebidas alcohólicas al menos una vez durante el último mes. En la Ciudad de México se ha encontrado que más de la mitad de las mujeres y cerca de dos terceras partes de los hombres entre 18-29 años de edad consume regularmente bebidas alcohólicas. Durante los últimos años, el consumo de bebidas alcohólicas se ha venido incrementando importantemente entre los jóvenes mexicanos de ambos sexos en edad de recibir una educación superior. A nivel internacional, la bibliografía sugiere que la población estudiantil de los centros de educación superior es un grupo de mayor riesgo para el desarrollo de problemas por consumo de alcohol. En México, aunque se desconoce si los estudiantes de educación superior son un grupo de mayor riesgo para estos abusos, algunas encuestas y reportes sugieren que los problemas por consumo de alcohol tienen una importancia creciente. En cuanto al consumo de alcohol que excede los niveles seguros para la salud (≥2 bebidas estándar al día en las mujeres o ≥3 bebidas estándar al día en los hombres), el Observatorio Mexicano del Alcohol y Drogas describió que en el año 2002 el consumo de cinco o más copas por ocasión de consumo afecta a tres de cinco hombres y a una de cinco mujeres. Aunque problemas metodológicos y sesgos de selección potenciales en estas encuestas dificultan su interpretación, sus resultados sugieren que el consumo de alcohol, particularmente el consumo riesgoso y potencialmente dañino, es común entre los estudiantes universitarios de la Ciudad de México. El consumo riesgoso y dañino de alcohol (CRDA) se sitúa en un continuum de severidad y se define como un patrón de consumo de bebidas embriagantes que colocan al sujeto en riesgo de desarrollar problemas de salud y/o que desemboca en francas complicaciones físicas y/o psicológicas (accidentes, victimización, violencia, dependencia al alcohol, cirrosis hepática, etc.). De acuerdo a los reportes de la bibliografía internacional, este es el primer estudio publicado sobre la prevalencia de consumo peligroso y dañino de alcohol en estudiantes universitarios en América Latina. Objetivo En el trabajo que se presenta aquí, que forma parte del proyecto para la Identificación Temprana y Tratamiento Oportuno de bebedores con Consumo Excesivo de Alcohol en Estudiantes Universitarios de la UNAM, nos propusimos evaluar la prevalencia del CRDA durante el último año y examinar los factores de riesgo y protección respectivos en estudiantes de primer ingreso a la licenciatura de la Universidad Nacional Autónoma de México. De manera especifica, nos propusimos: 1) estimar la prevalencia del CRDA durante el último año en los estudiantes de primer ingreso a la licenciatura de la UNAM, y 2) evaluar en esta población la influencia de las variables sociodemográficas y familiares en el riesgo para el CRDA. Material y métodos Se trató de un estudio transversal en el que se estudiaron 24921 estudiantes del primer año de la licenciatura de la UNAM (edad=18.7±4.3 años; 55% mujeres). Para detectar aquellos estudiantes que en el último año incurrieron en el CRDA, se utilizó el instrumento de tamizaje Alcohol Use Disorder Identification Test (AUDIT). Se utilizó la regresión logística multinomial para examinar los efectos de las variables demográficas y sociofamiliares, así como para calcular Odds Ratios (OR) y sus respectivos intervalos de confianza al 95%. Este instrumento consiste de 10 preguntas que exploran la frecuencia e intensidad del consumo de bebidas alcohólicas. Con el objetivo de poder comparar nuestros hallazgos con los de otros investigadores, se examinaron y se reportan separadamente las prevalencias del CRDA con base en puntos de corte de 8 y de 6 en el AUDIT. Para el reporte de datos demográficos y puntajes del AUDIT, se utilizaron porcentajes, promedios y desviaciones estándar. Se emplearon las pruebas de contraste de medias (análisis de varianza) y de proporciones (χ2) dependiendo de la naturaleza de cada variable. Se calcularon las prevalencias del CRDA con sus respectivos intervalos de confianza al 95%. Resultados Usando un puntaje de corte en el AUDIT de ocho y de seis puntos, la prevalencia del CRDA durante el último año fue respectivamente de 11.1% y de 18.4%. Esta fue mayor en los hombres (AUDIT≥8: 17.3%; AUDIT≥6: 27.4%) que en las mujeres (AUDIT≥8: 6.2%; AUDIT≥6: 11.3%). Además del sexo masculino, aquellos estudiantes que trabajaban y que reportaron un mayor ingreso familiar mensual, tuvieron un mayor riesgo de experimentar el CRDA. En las mujeres, pero no en los hombres, un mayor nivel educativo tanto en el padre como en la madre también se relacionó con un incremento en el CRDA. Contrariamente, una mayor edad y el ser casado se asoció con una reducción en el riesgo del CRDA.

La Comisión Nacional de Arbitraje Médico y la calidad de la Atención / The Comision Nacional de Arbitraje Medico and quality of care

El presente artículo presenta un panorama general sobre las atribuciones que tiene la Comisión Nacional de Arbitraje Médico (CONAMED) para vigilar el cumplimiento de la prestación de servicios de salud, así como de la calidad de atención médica prestada por las diversas instituciones de salud. Dicha institución reconoce la existencia de limitaciones de carácter económico y otras, derivadas de problemas de organización, administración e incluso de actitudes del personal de salud. Se presentan las 10 especialidades médicas con mayor frecuencia de quejas