Analysis of the Application of Professional Society Screening Guidelines for Colorectal Polyposis Syndromes at a Single Institution.

Several professional society guidelines suggest germline genetic testing for colorectal polyposis syndromes in patients with ≥10 lifetime adenomatous polyps. This study evaluated factors associated with genetic testing decisions and outcomes when germline testing was recommended per guidelines. Surgical archives revealed 145 patients with a recommendation for germline genetic polyposis testing based on guidelines. Demographic data and medical history were collected to examine for association with testing decisions and results. Germline genetic testing was ordered in 90/145 patients and was ordered in younger patients with more lifetime adenomas. Pathogenic alterations were detected in 12/53 patients who completed testing. Younger age and higher numbers of lifetime adenomas were not associated with the detection of germline genetic alterations. In fact, patients with a pathogenic germline alteration had higher median ages and fewer lifetime adenomas than those without an alteration. Half of the twelve patients with a pathogenic germline mutation were not White non-Hispanic, though White non-Hispanic patients comprised 75.5% of those tested. This study supports the 10 adenomatous polyp threshold for recommending germline genetic polyposis testing, as an alteration was detected in a sizable proportion (>20%) of patients tested. Though younger age and a higher number of lifetime adenomas were associated with an increased likelihood of ordered tests, no evidence was found to support these additional factors in testing decisions.

Situaciones estresantes y estrategias de afrontamiento en comunidad LGB / Stressful situations and coping strategies in the LGB community / Situações stressantes e Estratégias de Cópia na Comunidade LGB

Resumen Introducción: El estrés en la comunidad LGB está asociada a su orientación sexual, violencia o discriminación, eventos estresantes los cuales son distintos a los reportados por personas heterosexuales. La literatura reporta relación del nivel de estrés con problemáticas de salud mental, de mayor intensidad y frecuencia en la población LGB. Objetivo: El propósito fue identificar las situaciones estresantes, estrategias de afrontamiento y emociones asociadas en la comunidad LGB. Método: Se realizó un estudio descriptivo con un diseño no experimental de tipo transversal, mediante un muestreo no probabilístico; participaron 272 hombres y mujeres de 14 a 56 años. Se empleó el Cuestionario de Emociones, Estrés y Afrontamiento de Vega et al. (2012). Resultados: Los participantes homosexuales, bisexuales y lesbianas coinciden en reportar en primer lugar situaciones de comunicar su orientación sexual, las situaciones restantes son escolares, laborales y de discriminación por pertenecer a la comunidad LGB. Los participantes usan estrategias de afrontamiento centradas en la acción y en la emoción en proporciones similares (48 %50 %). Las emociones asociadas a situaciones estresantes son ansiedad, temor, vergüenza, culpa. En situaciones placenteras reportan también emociones negativas. Conclusiones: El tipo de situaciones estresantes son distintas en estas poblaciones, debido a que enfrentan con mayor frecuencia eventos relacionados con discriminación o confrontación por su orientación sexual. Se aporta información sobre qué y cómo se afrontan las situaciones que generan estrés en población LGB. Se sugiere generar intervenciones cognitivoconductuales de regulación emocional y afrontamiento efectivo.

Abstract Introduction: Stress in the LGB community is associated with their sexual orientation, violence or discrimination, stressful events which are different from those reported by heterosexual people. The literature reports a relationship between the level of stress and mental health problems, of greater intensity and frequency in the LGB population. Objective: The purpose was to identify stressful situations, coping strategies and associated emotions in the LGB community. Method: A descriptive study was carried out with a non-experimental cross-sectional design, through non-probabilistic sampling, with the participation of 272 men and women aged 14 to 56 years. The Questionnaire of Emotions, Stress and Coping of Vega et al. (2012). Results: Homosexual, bisexual and lesbian participants agree in first reporting situations of communicating their sexual orientation, the remaining situations are school, work and discrimination for belonging to the LGB community. Participants use action-focused and emotion-focused coping strategies in similar proportions (48 % 50 %). Emotions associated with stressful situations are anxiety, fear, shame, guilt. In pleasant situations they also report negative emotions. Conclusions: The type of stressful situations are different in these populations because they more frequently face events related to discrimination or confrontation due to their sexual orientation. Information is provided on what and how situations that generate stress in the LGB population are coped with. It is suggested to generate cognitive behavioral interventions for emotional regulation and effective coping.

Resumo Introdução: O estresse na comunidade LGB está associado à sua orientação sexual, violência ou discriminação, eventos estressantes diferentes dos relatados por pessoas heterossexuais. A literatura relata uma relação entre o nível de estresse e problemas de saúde mental, de maior intensidade e frequência na população LGB. Objetivo: O objetivo foi identificar situações estressantes, estratégias de enfrentamento e emoções associadas na comunidade LGB. Método: Foi realizado um estudo descritivo com delineamento transversal não experimental, utilizando amostragem não probabilística, com a participação de 272 homens e mulheres com idades entre 14 e 56 anos. O Questionário de Emoções, Estresse e Enfrentamento de Vega et al. (2012). Resultados: Os participantes homossexuais, bissexuais e lésbicas concordam no primeiro relato de situações de comunicação de sua orientação sexual, as demais situações são escola, trabalho e discriminação por pertencer à comunidade LGB. Os participantes usam estratégias de enfrentamento focadas na ação e na emoção em proporções semelhantes (48 % 50 %). As emoções associadas a situações estressantes são ansiedade, medo, vergonha, culpa. Em situações agradáveis também relatam emoções negativas. Conclusões: Os tipos de situações estressantes são diferentes nestas populações, pois enfrentam mais frequentemente eventos relacionados à discriminação ou confronto devido à sua orientação sexual. São fornecidas informações sobre o que e como as situações geradoras de estresse na população LGB são enfrentadas. Sugere-se gerar intervenções cognitivo-comportamentais para regulação emocional e enfrentamento eficaz.

Teoría de la Conducta Planeada en la predicción del uso del condón en mujeres latinas / Theory of Planned Behavior in predicting condom use in Latin-American Women

RESUMEN Introducción: La Teoría de la Conducta Planeada (TCP) se utiliza para predecir el uso del condón. El presente estudio evaluó la TCP en un contexto cultural diferente al cual fue propuesto. Objetivo: Evaluar las relaciones causales entre las variables que propone la TCP para determinar si éstas predicen el uso consistente del condón en dos grupos de mujeres latinas e identificar las semejanzas inter grupales en ambos colectivos y las discrepancias con lo que propone el modelo para la población norteamericana. Método: Se evaluaron en dos muestras de mujeres latinas (mexicanas y argentinas) un conjunto de variables como: la consistencia del uso del condón, la intención de usarlo en el próximo encuentro sexual, la norma subjetiva de amigos y padres, las actitudes hacia el preservativo y el control conductual percibido para usarlo. Se utilizó un análisis de regresión lineal. Resultados: Se encontró que la intención del uso del condón es el mejor predictor del uso del condón. La norma subjetiva fue más importante que las actitudes; aunque esta última variable, no se configuró como un predictor en las mujeres argentinas. Conclusiones: Las asociaciones entre las variables de la TCP y los valores predictivos de las variables, pueden cambiar de acuerdo con el grupo cultural evaluado; el control conductual percibido, en ambas muestras, no resultó ser un predictor directo de la conducta para usar condón, pero si para la intención de utilizarlo. Además, se discute la relevancia de las variables que propone la TCP en relación al contexto cultural de los latinos y el uso crítico del modelo en poblaciones diferentes a la norteamericana.

ABSTRACT Background: The theory of Planned Behavior (TPB) is used to predict condom use. The present study assessed the causal relationships of the TPB in a cultural context different from the one that was proposed. Objective: To assess the causal relationships among the variables proposed by the TCP to determine if they predict consistent condom use in two groups of Latina women and to identify the inter-group similarities in both groups and the discrepancies with what the model proposes for the North American population. Method: A set of variables were evaluated in two samples of Latina women (Mexican and Argentine): consistency of condom use, intention to use condoms in the next sexual encounter, the subjective norm of friends and parents, attitudes towards condoms, and perceived behavioral control to use condoms. We used the Linear regression analysis. Results: Intention to use condoms was found to be the best predictor of condom use. Subjective norm was more important than attitudes; although the latter variable was not configured as a predictor in Argentine women. Conclusion: The associations between the CTP variables and the predictive values of the variables may change according to the cultural group evaluated; perceived behavioral control, in both samples, was not a direct predictor of condom use behavior, but it was a predictor of intention to use condoms. In addition, we discussed the relevance of the variables proposed by the TCP about the cultural context of Latinos and the critical use of the model in populations other than North America.

Genotoxicity of Marijuana in Mono-Users.

Marijuana (Cannabis sp.) is among the most recurred controlled substances in the world, and there is a growing tendency to legalize its possession and use; however, the genotoxic effects of marijuana remain under debate. A clear definition of marijuana's genotoxic effects remains obscure by the simultaneous consumption of tobacco and other recreational substances. In order to assess the genotoxic effects of marijuana and to prevent the bias caused by the use of substances other than cannabis, we recruited marijuana users that were sub-divided into three categories: (1) users of marijuana-only (M), (2) users of marijuana and tobacco (M+T), and (3) users of marijuana plus other recreative substances or illicit drugs (M+O), all the groups were compared against a non-user control group. We quantified DNA damage by detection of γH2AX levels and quantification of micronuclei (MN), one of the best-established methods for measuring chromosomal DNA damage. We found increased levels of γH2AX in peripheral blood lymphocytes from the M and M+T groups, and increased levels of MNs in cultures from M+T group. Our results suggest a DNA damage increment for M and M+T groups but the extent of chromosomal damage (revealed here by the presence of MNs and NBuds) might be related to the compounds found in tobacco. We also observed an elevated nuclear division index in all marijuana users in comparison to the control group suggesting a cytostatic dysregulation caused by cannabis use. Our study is the first in Mexico to assess the genotoxicity of marijuana in mono-users and in combination with other illicit drugs.

Psychosocial reintegration process in patients who receive maintenance treatment with methadone: A qualitative analysis / Proceso de reintegración psicosocial en pacientes que reciben tratamiento de mantenimiento con metadona: un análisis cualitativo

Abstract Introduction The evaluation of methadone maintenance programs reports generally positive outcomes. Objective To explore the psychosocial factors that contribute to achieve treatment goals even when patients live in conditions of precariousness and exclusion. Method Qualitative study of multiple cases, with a sample of 12 interviews with patients participating in a maintenance and detoxification program with methadone; a thematic and discursive-narrative analysis was undertaken. Results We identified the predominance of a typical discursive scheme composed of clearly differentiated narrative segments: previous conditions, establishment of a relationship with the therapeutic system, process of adjustment as a part of treatment and social reintegration. Two main themes were also identified: addiction and dealing with substances, and the problem of normative integration; there was also an experience of acceptance and recognition that constitutes a central factor for treatment. Discussion and conclusion These findings are discussed in light of the disaffiliated conditions of people using injected heroin and the need to consider psychosocial and normative adjustment as a relevant factor for treatment and social reintegration, which leads to the suggestion to include psychotherapeutic interventions to accompany and reinforce the process.

Resumen Introducción La evaluación de los programas de mantenimiento con metadona reporta, en general, resultados positivos. Objetivo Explorar factores psicosociales que contribuyan al logro de los objetivos del tratamiento, incluso cuando los pacientes se encuentran en condiciones de precariedad y exclusión. Método Estudio cualitativo de casos múltiples, con una muestra de 12 entrevistas con pacientes participantes en un programa de mantenimiento y deshabituación con metadona; se realizó un análisis discursivo-narrativo y temático. Resultados Identificamos el predominio de un esquema discursivo típico compuesto de segmentos narrativos claramente diferenciados: condiciones previas, vinculación con el sistema terapéutico, proceso de ajuste al interior del tratamiento y proceso de reintegración social. También se identificaron dos ejes de articulación temática: la adicción y el manejo de sustancias, y el problema de la integración normativa; hubo además una experiencia de aceptación y reconocimiento que constituye un factor central en el tratamiento. Discusión y conclusión Estos hallazgos se discuten a la luz de las condiciones de desafiliación del usuario de heroína y de la necesidad de considerar el ajuste psicosocial y normativo como un factor relevante para el tratamiento y la reintegración social, lo que lleva a sugerir que los programas incluyan componentes psicoterapéuticos con el objeto de acompañar y reforzar efectivamente el proceso.

Diferencias entre hombres y mujeres en el significado psicológico de las prácticas de socialización sexual fraternas / Differences between men and women regarding psychological meaning of sexual socialization practices among siblings

Resumen Objetivo: describir el significado psicológico de diferentes prácticas de socialización sexual fraterna y determinar si existen diferencias por sexo. Método: estudio transversal con muestreo no probabilístico (n = 214 universitarios); se utilizó la técnica de Redes Semánticas Naturales Modificadas para analizar el significado psicológico de diferentes prácticas de socialización sexual fraterna. Resultados: Las mujeres refieren prácticas y significados centrados en un rol afectivo y los varones en un rol instrumental; sin embargo, existe un amplio espectro de tácticas de socialización que son compartidas por ambos sexos. Conclusiones: el género y la cultura son elementos que deben ser considerados en las prácticas fraternas de socialización sexual.

Abstract Objective: to describe the psychological meaning of diverse of fraternal sexual socialization practices within a group of college students and determine whether there are significant differences among genders. Methods: cross-sectional study, non-probabilistic sample method (n = 214 college students) and the Modified Natural Semantic Networks were all used in order to analyze the psychological meaning of different practices of fraternal sexual socialization. Results: female participants were found to refer practices and meanings centered on an affective role, while men were centered on an instrumental role; however, there is a broad spectrum of socialization tactics shared by both men and women. Conclusion: gender and culture play a role in the fraternal sexual socialization practices that should be taken into account.

Trends and patterns of marijuana use in men and women seeking drug treatment / Tendencias y patrones de consumo de mariguana en hombres y mujeres solicitantes de tratamiento

Abstract Introduction Marijuana is the world's most widely used illegal drug. In Mexico, it is the drug of choice for both male and female users of all ages, and there has been a recent increase in its use. Objective To describe drug use trends in people seeking treatment by sex and age range, and to explore different patterns. Method To provide a description of trends and rates of increase for the population attended between 2005 and 2016 and to make a comparative analysis of patterns of use in a sample of 11 595 marijuana users who received treatment in 2016. Results In general, there has been a greater increase in use in the group ages twelve to seventeen. The greatest increase in lifetime use was reported among women in this age range. The greatest increase in marijuana use in the past month was found among women aged eighteen to thirty-five. Women use a greater variety of substances, and a higher number of younger women report using cocaine, methamphetamines, benzodiazepines and hallucinogens than men. Discussion and conclusion Significant increases in marijuana use have been registered among girls under 18 and women in recent years. The differences in trends and patterns of use for men and women are being reduced and reconfigured.

Resumen Introducción La mariguana es la droga de mayor consumo en el mundo. En México, es la droga preferida por ambos sexos y en todos los grupos de edad, y en su consumo ha habido un incremento desde hace varios años. Objetivo Describir las tendencias del uso de mariguana en solicitantes de tratamiento, por sexo y rango de edad, y explorar diferencias en el patrón de consumo, según sexo. Método Se describieron tendencias y tasas de crecimiento en población atendida entre 2005 y 2016 y se realizó un análisis comparativo del patrón de consumo con una muestra de 11 595 usuarios de mariguana recibidos para tratamiento en 2016. Resultados En general, se registran mayores tasas de crecimiento en el grupo de 12 a 17 años. El mayor incremento del uso alguna vez en la vida corresponde a las mujeres de este rango; el del uso en el último mes y como droga de mayor impacto, a las de 18 a 35 años. Las mujeres consumen un mayor número de sustancias. Las de menor edad refieren el uso de cocaína, metanfetaminas, éxtasis, benzodiacepinas y alucinógenos en mayor proporción que los hombres. Discusión y conclusión Los menores de edad y las mujeres tienen un mayor peso en el aumento del uso de mariguana registrado en los últimos años. Las diferencias en las tendencias y el patrón de consumo entre sexos se están reduciendo y reconfigurando.

Evaluación de un programa de intervención para promover la salud sexual en adolescentes mexicanos en conflicto con la ley / Evaluation of an intervention program to promote sexual health among Mexican adolescents in conflict with the law / Avaliação de um programa de intervenção para promover a saúde sexual de adolescentes mexicanos em conflito com a lei

El propósito de la presente investigación fue evaluar la efectividad de un programa de intervención para promover la salud sexual de adolescentes que se encuentran en conflicto con la ley. Se trabajó con 118 adolescentes pertenecientes a una comunidad de diagnóstico. Se utilizó un diseño cuasiexperimental con un grupo de intervención y uno control, conformado por tres fases: preevaluación, intervención y postevaluación. La intervención consistió en cinco sesiones de dos horas cada una, y estuvo conformada por los elementos que responden al modelo ecológico en sus tres niveles: microsistema (conocimientos, creencias, actitudes, intención y autoeficacia para usar condón, autoestima, comunicación con pareja, estilos de negociación para usar condón, entre otras); mesosistema (apoyo, supervisión y comunicación con padre y madre, entre otras), y macrosistema (estereotipos de género). Se realizó un análisis de medidas repetidas. Los resultados mostraron cambios entre el grupo control y el experimental, a favor de este último en todas las variables del modelo, excepto en comunicación con la pareja y autoestima. Los hallazgos se discuten en términos de la importancia de diseñar programas con base en el modelo ecológico dirigidos a población que se encuentran en un ambiente privado de la libertad.

The purpose of this research was to evaluate the effectiveness of an intervention program to promote sexual health of adolescents in conflict with the law. The study was carried out with 118 adolescents belonging to a diagnosis community. A quasi-experimental design was used with an intervention group and one control group, consisting of three phases: preevaluation, intervention and post-evaluation. The intervention, which consisted of five sessions of two hours each one, comprised the elements that respond to the ecological model in its three levels: micro-system (knowledge, believes, attitudes, intentions and self-efficacy to use condoms, self-esteem, communication with partner, negotiating styles, etc.); meso-system (support, supervision and communication with parent, etc.) and macro-system (gender stereotypes). An analysis of repeated measures was performed. Results showed changes between control and experimental groups, in favor of the latter in all the variables of the model, except for partner communication and self-esteem. The findings are discussed in terms of the importance of designing programs based on the ecological model aimed at people who are deprived of freedom.

O propósito desta pesquisa foi avaliar a efetividade de um programa de intervenção para promover a saúde sexual de adolescentes que se encontram em conflito com a lei. Trabalhou-se com 118 adolescentes pertencentes a uma comunidade de diagnóstico. Foi utilizado um desenho quase-experimental com um grupo de intervenção e um de controle, conformado por três fases: pré-avaliação, intervenção e pós-avaliação. A intervenção consistiu em cinco sessões de duas horas cada uma e foi formada pelos elementos que respondem ao modelo ecológico em seus três níveis: microssistema (conhecimentos, crenças, atitudes, intenção e autoeficácia para usar preservativo, autoestima, comunicação com o parceiro, estilos de negociação para usar preservativo, entre outros); mesossistema (apoio, supervisão e comunicação com os pais, entre outros) e macrossistema (estereótipos de gênero). Foi realizada uma análise de medidas repetidas. Os resultados mostraram mudanças entre o grupo controle e o experimental a favor deste último em todas as variáveis do modelo, exceto em comunicação com o parceiro e autoestima. Os achados são discutidos quanto à importância de desenhar programas com base no modelo ecológico dirigidos à população que se encontra num ambiente privado de liberdade.

Comparación de Tres Modelos de Riesgo de Uso Nocivo de Alcohol en Estudiantes Mexicanos / Comparison of Three Risk Models of Harmful Use of Alcohol in Mexican Students

Resumen: El presente estudio se planteó como objetivo identificar correlatos psicosociales del consumo nocivo de alcohol en estudiantes mexicanos, así como probar comparativamente la validez y capacidad explicativa de tres modelos teóricos y de medición de estos factores, a fin de apoyar la investigación del problema y dar pauta al desarrollo de acciones preventivas teórica y empíricamente sustentadas. Estos tres modelos son: la teoría de las expectativas, la teoría del aprendizaje social de R. Akers y la teoría de la conducta planificada. Los hallazgos indican que los tres modelos tienen una buena capacidad predictiva del consumo nocivo de alcohol en la población de estudio. El mayor peso corresponde a las expectativas positivas asociadas a los efectos del alcohol, seguidas por el uso de alcohol entre pares, una baja percepción de riesgo y, como factor protector, la capacidad percibida para controlar la cantidad que se bebe. Los hallazgos reflejan la conveniencia de aplicar un modelo multivariado compuesto por variables provenientes de los tres modelos.

Abstract: The aim of this study was to identify psychosocial correlates of harmful alcohol use among young Mexican students, and to comparatively prove the predictive validity of three theoretical models, each one capable to support the research of the problem and to guide the design of theoretically and empirically grounded preventive and treatment programs: a) the alcohol expectancies theory, b) the social learning theory by R. Akers, and c) the planned behavior theory. Findings indícate that these three models are appropriate predictive models for harmful alcohol use in the studied group. The highest predictive weight belongs to positive expectancies associated to the effects of alcohol, followed by alcohol use among friends, low risk perception, and self-control of alcohol drinking as a protective factor. Findings suggest the convenience of the application of a composed multi-varied algorithm, integrated by factors and variables extracted from the three models.

El papel de la cercanía entre hermanos sobre la conducta sexual protegida / The Role of the Closeness between Siblings on Sexual Behaviour Protected

El propósito del estudio fue investigar si la cercanía fraterna por configuración diádica de sexo y rol (hermano/a mayor/menor) predice el uso del condón o si tiene un papel mediador en variables parentales asociadas al uso del preservativo. Participaron 592 universitarios elegidos con un muestreo no probabilístico. Se evaluó la comunicación sexual con padres, estilos parentales, cercanía fraterna y frecuencia del uso del condón en los últimos seis meses. Las mujeres con una hermana mayor usan frecuentemente el preservativo a diferencia de los varones. La cercanía con el hermano menor en mujeres (β-) y con la hermana menor en varones son predictores del uso del condón. Las variables parentales se constituyeron como predictoras de la cercanía fraterna pero no del uso del condón. Se discuten la importancia de incluir en el análisis de la conducta sexual protegida al grupo fraterno en relación con variables parentales, para así tener una interpretación de cómo la familia influye en el comportamiento sexual.

The purpose of the study was to investigate whether dyadic configuration fraternal closeness by gender and role (brother/sister older/younger) predicts condom use or if it's a mediating role in parental variables associated with frequency of condom use. 592 university students participated elected a non-probability sampling (43.8% men and 56.3% women). Assessed sexual communication with parents, parenting styles, fraternal closeness and frequency of condom use in the last six months. Women with an older sister frequently used condoms unlike men. The fraternal closeness with younger brother in women (β-) and closeness to the younger sister in males are predictors of condom use. Parental variables were set as predictors of fraternal closeness but not condom use. Discuss the importance of including in the analysis of sexual behavior protected fraternal group in relation to parental variables in order to have a different interpretation on how the family (parents-siblings) influences sexual behavior.

Evaluación de un programa de prevención del consumo de drogas para adolescentes / Evaluation of a drug abuse prevention program for adolescents

This paper shows the evaluation of the effectiveness of a selective prevention on drug use in adolescents, based on the Theory of Planned Behavior by Azjen. To develop this program, different theoretical models were evaluated considering their suitability to the institutional context in which it will be implemented. The criteria used to select a model that could be useful as a basis to design and evaluate a preventive intervention for drug use included: a) incorporation of protective and risk factors that could be malleable; b) consistency, parsimony and theoretical economy; c) a demonstrated explanatory and predictive capacity; d) empirical effectiveness; e) practical applicability. One of the models that complies with these requirements is the Model of Planned Behavior by Azjen, which proposes that the most immediate causes for drug use are the intentions of the subject to consume them or not. These intentions are determinated by the «attitudes¼ toward drug use, by the normative beliefs or «subjective norm¼ and by the Perceived Behavior Control. Attitudes toward the behavior are a person's overall evaluation of the behavior (i.e drug use) and the corresponding positive or negative judgments about it. The normative beliefs or subjective norms are a person's own estimate of social pressure to use or not to use drugs. Subjective norms have two interacting components: beliefs about how other people, who may be significant to the person, would like them to behave (normative beliefs), and the positive or negative judgments about each belief (outcome evaluations). Perceived behavioral control is the magnitude to which a person feels able to carry out the behavior. It includes two aspects: how much control a person has over the behavior; and how confident a person feels about being able to perform or not the behavior. It is determined by control beliefs about the power of both situational and internal factors to inhibit or facilitate the performance of the behavior. Perceived behavioral control, the last element introduced in the theory, along with the attitude to conduct, and the subjective norm, contribute, all of them, to predict the behavior intention. Generally speaking, there is important empirical evidence concerning the predictive and explicative capacity of this model in different populations. Once the theoretical model was chosen, indicators related to constructs of the Theory of Planned Behavior were elaborated adapting these constructs to the features of middle education Mexican population by means of a series of interviews with focal groups. Based on these indicators, a scale was constructed to prove the explanatory capacity of the theoretical model in Mexican population. The reliability and validity of this self-applied questionnaire was proved. Once this was done, based on these antecedents, the model was adapted in a practical sense. This means that the content, objectives and techniques for a preventive intervention were developed. This preventive intervention was piloted and then evaluated through the aforementioned scale. The program included attitudinal and normative components, conformed by informative strategies and persuasive messages directed to an attitudinal change, as well as the development of strategies of behavioral control focused on social abilities that included components derived from social learning theory, and a series of cognitive behavioral techniques accorded to the Planned Behavioral Theory. It was expected a reduction in the drugs use intention by means of a change of drug use favorable beliefs as well as reinforcing unfavorable beliefs of drug use. It was also tried to change the perception about the magnitude of drug users in the subject's immediate surroundings and on its perception about social acceptance or tolerance for drugs. Also it was tried to increase the perception of self control, in order to the develop behavioral control skills to refuse the offer of drugs. The first sessions (devoted to work on subjective norm) were directed to create an interest in the participants regarding to their relation with favorable situations to drug consumption, and to modify their perception about the real magnitude of drug use and about approval and social tolerance to them, both topics frequently overestimated for some adolescents. These sessions were also devoted to identifying beliefs associated with drug use and the value that participants give to these beliefs, in order to question those that are established upon false premises. The next sessions (devoted to perceived behavioral control) had as an objective to learn appropriated behavioral responses to confront risk situations, in order to increase the perception of self-control in those circumstances. This was achieved by means of modeling, essay and reinforcing techniques. This model was designed to be applied in groups no greater than 15 persons, twice a week in five sessions of 50 minutes each. The program was applied by professional personnel such as psychologists or social workers with previous experience in drugs use prevention. The program was implemented in three groups (one for each grade) of five high schools in Mexico City and was applied to three groups of school, randomly chosen; other three groups, in the same grades, were used as control groups. The groups were randomly chosen. Other three groups, in the same grades, were used as comparison groups. Then, the final sample was composed by 250 participants (96 from intervened groups and 154 from comparison groups) from 1 2 to 15 years old, and with slightly more men than women, but equivalent for cases and control. The results showed that the intervened group had a statistical significant reduction in the intention of drugs use. On the contrary, the comparative group showed an increasing intention to use them. With respect to the set of variables that predicted the behavioral intention, the perceived behavioral control stands out as the variable that had the greatest change. There were no significant differences in pre-post measures in the control group. Differences between pre-post measurements were also contrasted between both groups using a Student's /test that showed significant differences in perceived behavioral control and behavioral intention variables. Finally, in order to get a greater control on the test scores, an ANCOVA analysis was applied using the post-test scores as dependent variable and the pre-test scores as covariables. This analysis was useful to corroborate the significance of the drug use intention in the future, mainly in situations that require an amount of self-control, while attitude and normative variables did not show significative changes. Outcomes confirmed the pertinence to give greater resources (time, quantity, and complexity of activities, didactic materials, etc.) to the sessions devoted to developing behavioral control skills. These results can be considered satisfactory, because the main objective of the program was to reduce the intention to use drugs; however, it is also necessary to strengthen the attitudinal and normative components. It is necessary to consider that the variable «subjective norm¼ obtained the lowest levels in confidence, possibly because of the use of self-reported answers in a variable so sensitive to the influence of social elements. For this reason, it is necessary to develop questions that diminish this element that, according to Doll and Azjen, can explain, even a 5% of variance in «behavioral intention¼. Finally, it must be considered that this evaluation shows the effectiveness of the program to achieve the expected changes in behavioral intention variable only in controlled situations. It is necessary to investigate if it is possible to obtain similar results in more usual conditions and with other populations. This means that as well as to grant the internal validity of the evaluation it is also necessary to establish its external validity.

Se presentan los resultados de la evaluación de la eficacia de un programa de prevención selectiva del consumo de drogas para adolescentes, basado en la teoría de la conducta planificada de Ajzen. Para el desarrollo de este programa se identificaron y evaluaron distintos modelos teóricos. Los criterios considerados para seleccionar un modelo que pudiera servir de base para el diseño y evaluación de una alternativa de intervención preventiva del uso de drogas, teórica y empíricamente sustentada, comprendieron: a) la inclusión de factores de riesgo o protectores maleables; b) consistencia, parsimonia y economía teóricas; c) probada capacidad explicativa y predictiva; d) eficacia empírica; e) aplicabilidad práctica. Uno de los modelos teóricos que cumplen satisfactoriamente estos requisitos es el Modelo de la Conducta Planificada de Ajzen, el cual plantea que la causa más inmediata del uso de drogas son las intenciones del individuo respecto a consumirlas o no. Estas intenciones están determinadas a su vez por dos componentes; por una parte, las actitudes hacia el consumo, y por otra, las creencias normativas o norma subjetiva. Las actitudes están conformadas por el conjunto de creencias sobre las consecuencias del consumo y por el valor afectivo que tales consecuencias tienen para el sujeto. Las creencias normativas o norma subjetiva también están determinadas por dos componentes. Por un lado, la percepción de que otras personas significativas para el sujeto aprueban o desaprueban el consumo y, por otro, la motivación del sujeto para acomodarse a las expectativas o deseos de estas personas. El control conductual percibido, último componente introducido en la teoría, contribuye ¡unto con la actitud hada la conducta y la norma subjetiva a predecir la intención conductual. En general, se cuenta con importante evidencia empírica acerca de la validez predictiva y explicativa de este modelo, en relación con el consumo de drogas entre distintas poblaciones. Una vez elegido el modelo teórico se elaboró una escala de medición para probar su capacidad explicativa para el caso de uso de drogas en población mexicana. Probada la capacidad explicativa del modelo, se llevó a cabo su adaptación práctica, en términos de desarrollar contenidos, objetivos y técnicas de una intervención preventiva basada en el mismo. Por último, se realizó la prueba piloto y la evaluación de la aplicación controlada de tal intervención. La evaluación de resultados se apoyó en un diseño experimental con prueba-postprueba y un grupo control. El programa se aplicó en cinco escuelas secundarias de la Ciudad de México. Se intervino a tres grupos de cada escuela, uno por grado, elegidos aleatoriamente. La muestra final, una vez depurada, quedó conformada por 250 jóvenes (96 casos y 154 controles) de entre 12 y 15 años de edad. Para la evaluación se utilizó una cédula creada ex profeso y probada previamente en una muestra de 1 200 alumnos, mostrando buenos niveles de confiabilidad y validez. Los resultados muestran que en el grupo intervenido tuvo lugar una disminución estadísticamente significativa de la intención de usar drogas, en tanto que los alumnos del grupo comparativo mostraron, por el contrario, un incremento en la intención de uso durante el mismo lapso. Del mismo modo, entre las variables antecedentes de la intención conductual, a saber, actitud, norma subjetiva^ control conductual percibido, la variable que mostró un mayor cambio fue esta última. También se contrastaron las «puntuaciones de ganancia¼ (diferencias antes-después) del grupo de los casos contra las del grupo de los controles, con lo que se pudo observar que las diferencias significativas entre ambos grupos se presentaron en las variables control conductual percibido e intención conductual. Finalmente, mediante el Modelo Lineal General (MLG) ANCOVA, se pudo corroborar la significativa reducción de la intención de utilizar sustancias y el incremento en la percepción de autocontrol, mientras que la actitud y la variable normativa no mostraron cambios significativos, lo que confirma la pertinencia de haber dotado de mayores recursos (tiempo, número y complejidad de las actividades, materiales didácticos, etc.) a las sesiones dedicadas al desarrollo de habilidades de control conductual, sobre la base previamente probada, tanto en población anglosajona como entre jóvenes mexicanos, de que esta variable suele tener un mayor peso en la explicación de la intención de usar drogas.

[Psychosocial correlates of drug abuse and dependence among young Mexicans]. / Correlatos psicosociales del abuso y dependencia de drogas entre jóvenes mexicanos.

Objective: to test that drug abuse and dependence would be greater among those who have: higher depression, a family with dysfunctional cohesion and adaptability, greater exposure to stressful situations; maladaptive coping strategies. Methods: a case-control study design was used, with three controls matched to each case by on age, sex, and neighborhood of residence. The sample included 218 cases and 677 controls. Results: cases of drug abuse and dependence were estimated to have higher odds of elevated depression symptoms, as well as high psychosocial stress from maladaptive school adjustment, compared to controls. Cases of drug dependence had higher odds to maladaptive family cohesion and adaptation, as well as higher odds of exposure to high-impact stress related to family separations, as well as family communication problems. Conclusions: findings indicate that drug abuse and dependence are significantly related to maladaptative adjustment indicators, family disfunctionality and affective disorders.

Objetivo: este estudio pretende probar que las posibilidades de abuso o dependencia de drogas son mayores entre jóvenes con un modelo maladaptativo para afrontar el estrés y aliviar la ansiedad y la depresión. Métodos: estudio de casos y controles, con tres controles pareados a cada caso según edad, sexo y colonia de residencia. La muestra comprendió 218 jóvenes con abuso o dependencia de drogas ilícitas y 677 no usuarios. Resultados: comparados con los no usuarios, los jóvenes con abuso y dependencia tuvieron síntomas más elevados de depresión y alta tensión psicosocial derivada de un ajuste escolar maladaptativo. Hay mayores posibilidades de dependencia de drogas entre quienes señalan cohesión y adaptabilidad familiar maladaptativas y presentan estrés de alto impacto relacionado con separaciones familiares o con problemas de comunicación familiar. Conclusiones: los hallazgos indican que el abuso y dependencia de drogas están relacionados con indicadores de ajuste maladaptativo, con el deterioro de las relaciones familiares y con signos de malestar afectivo. La diversidad de factores identificados confirma la conveniencia de aplicar modelos multifactoriales para la comprensión del fenómeno.

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

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Summary The need of cost-effective drug abuse prevention programs has derived in a growing interest to develop scientific based alternatives. On this context, this study forms part of a project for the design and evaluation of a theoretical and empirically sustained intervention for illicit drug abuse prevention among Mexican junior high school students. Starting with the revision and assessment of different theoretical models that could be adapted to the conditions of the institutional context wherein the intervention will be developed, the Azjen and Fishbein's Theory of Planned Behavior was chosen. This theory includes proximal cognitive and attitude factors directly related to the initiation of drug use. In accordance with it, the experimental use of substances is a result of the intention of consuming them, which, in turn, depends on three elements: a) the attitude toward the drug use, b) the normative beliefs on this matter (subjective norm) and c) the perceived behavioral control regarding drug use or, in turn, confronting social pressure. In a first instance, several items were developed adapting the constructs of the Theory of Planned Behavior to the target population's characteristics. On this base, the reliability and validity of a self-applied questionnaire for the measurement of the variables of the model was proved. In this work are reported the findings of the evaluation of Theory of Planned Behavior's potential to predict both behavioral intention of using illicit drugs and consumption of substances among Mexican high school students, in order to set a precedent to apply the model later on in the design and evaluation of a preventive intervention directed to such population. Method: The study was carried on with an ex post facto, correlational design, and with a non-probabilistic sample of 1,019 subjects. Sample. The sample size was estimated considering the possibility of selecting a subsample of drug users and comparison subjects for a post-stratified analysis, assuring a statistical power of 80% and adequate sensibility and stability. Therefore, this work includes the performed analyses with a sample of 75 drug users and 75 non users, paired by gender, age, school grade and occupation. Instrument. The instrument was a self-applied questionnaire specially developed for the study, according to information obtained in previous focal groups interviews with high school students. The questionnaire showed a global realiability of 0.9154 and between 0.62 and 0.94 in each one of its scales, which included: behavioral beliefs (0.9121), attributed value to behavioral beliefs (0.7964), normative beliefs (0.6480), subject's disposition to adjust to normative expectations (0.8564), descriptive norm (0.6254), drug use opportunities (0.8129) and perceived behavioral control coping with such opportunity situations (0.9442). A factorial analysis of principal components yielded 16 factors of at least three items each, with factorial weights higher than 0.4, and closely attached to Theory of Planned Behavior's variables, with an explained variance of 59%. Analysis. Previous to data analysis, normality tests (Kolmogorov- Smirnov) were performed, indicating the necessity to apply nonparametric tests of differences and to transform the data to be adapted to the requirements of later parametric analyses. A correlation analysis was carried out to prove the association between behavioral intention and drug use, as well as between the different components of the Theory of Planned Behavior. Finally, linear and logistic regression analyses were conducted to determine the explicative potential of the model and the predictive weight of each variable on the model with regard to the behavioral intention and the consumption of drugs. Findings: According to the Mann-Whitney test, compared with students who had not used drugs, subjects that used them at least once in their life showed more favorable attitudes toward consumption (median= 6.9 vs. 3.9, z=-5.22, p=0.000), perceived more social tolerance (median=3.8 vs. 3.5, z=-2.27, p=0.023), were more willing to give in to social pressure for using substances (median=2.0 vs. 1.0, z=-5.598, p=0.000), perceived a higher number of users among their significant others, and less negative consequences Salud Mental, Vol. 30, No. 1, enero-febrero 2007 69 of drug use in themselves (median=16.3 vs. 7.1, z=-4.246, p=0.000), and felt less capable of behavioral control when coping with opportunities for consumption, which, in turn, are more frequent in their case (median=5.7 vs 1.8, z=-6.76, p=0.000). The correlation between the intention and the behavior of drug use (r=0.41, p<0.000) was allocated inside the range reported in other populations. Drug use intention correlated with attitude toward drug use at r=0.45 (p=0.000), with subjective norm, including additional components at r=0.48 (p=0.000), and with perceived behavioral control at r=0.59 (p=0.000). Drug use correlated with attitude at r=0.51 (p=0.000), with subjective norm at r=0.28 (p=0.001), and with perceived behavioral control at r=0.37 (p=0.000). Linear regression analysis yielded that the model explained 34% of the variance of drug use intention, which increased to 38% when adding personal and descriptive norm elements to the subjective norm construct. Behavioral control (measured on the basis of the product of exposition to drug use facilitating situations punctuations by perceived behavioral control to cope with these situations punctuations) was identified as the best predictor of drug use intention (B=0.32, p=0.001), followed by attitude toward drug use (B=0.24, p=0.004) and subjective norm, which originally showed a non-significant effect but increased its predictive weight when additional elements were added (B=0.24, p=0.004). According to the logistic regression analysis, behavioral control is also the best predictor of illicit drug use on the model (odds ratio= 1.42, p<0.000). On the contrary, subjective norm (including personal and descriptive norm) and attitude (odds ratio=1.144, p=0.06) were not significant predictors of drug use. Discussion: In general, this findings indicate that the Theory of Planned Behavior showed an acceptable predictive capacity (similar to that found in other populations), and can be taken as a valid theoretical ground to develop a preventive intervention directed to Mexican students of high school education. As is the case with other populations, the variable in the Planned Behavior Theory with more predictive weight was perceived behavioral control, followed by attitude to drug use and, in third place, by subjective norm. Despite it could be supposed that subjective norm would have a higher predictive weight in Mexican teenagers, findings probably reflected idiocentric and individualistic tendencies reported in other studies. Results also point out to the convenience of including it in the program of intervention informative components to produce an awareness effect and an impact in the intention of using drugs. Still, they indicate above all, the need to integrate components directed to the development and reinforcement of behavioral control abilities that have an effect in the use of drugs itself. Specifically, it is considered the convenience of including components for the development of group pressure resistance abilities and assertive communication, appropriate to the contexts in which young people face drug abuse risk situations.

Adaptación del Drug Use Screening Inventory para su aplicación con adolescentes mexicanos / Adaptation of the Drug Use Screening Inventory for its application with Mexican adolescents

El presente estudio evalúa la confiabilidad y validez de constructo de una versión adaptada del Drug Use Screening Inventory (DUSI) aplicada a jóvenes mexicanos, mediante la utilización de cuestionarios autoadministrados, con una muestra no probabilística de estudiantes de educación media (n=1.983) con edad promedio de 15,7 años (DE=1,4). Se llevó a cabo un análisis factorial exploratorio de componentes principales con rotación varimax y un análisis de consistencia interna (alfa de Cronbach). Los resultados indican que esta versión adaptada del DUSI constituye un instrumento válido y confiable. Se identificaron ocho factores (Abudo de alcohol o drogas, Malestar afectivo, Bajo control conductual, Baja adherencia escolar, Baja competencia social, Relaciones familiares disfuncionales, Pertenencia a redes sociales desviantes y Aislamiento) estrechamente relacionados con la estructura factorial original del DUSI, los cuales explicaron el 44,2% de la varianza, agrupando reactivos con cargas factoriales superiores a 0,4. Por su parte, la consistencia interna global ascendió a 0,9451, mientras que las escalas correspondientes a los factores indentificados registrados, en su mayor parte, índices de confiabilidad superiores a 0,8. Los hallazgos permitieron identificar y depurar el contenido de la estructura factorial del DUSI en población estudiantil mexicana, en el sentido de proveer una mayor homogeneidad conceptual, proporcionando un instrumento útil para el estudio de correlatos o predoctores psicosociales del uso de drogas, así como para la evaluación de resultados e impacto de servicios de prevención y tratamiento

This study assessed the construct reliability and validity of an adapted version of the Drug Screening Inventory (DUSI) administeres to a young Mexican population on the basis of questionnaires, self-administered by a non-probabilistic sample of high school students (n=1,983, mena age=15.7 years, SD=1.4). An exploratory factor analysis was made of the principal components with Varimax rotation, in addition to a reliability analysis (Cronbach´alpha). Results indicate that this adapted version constitutes a valid and reliable instrument. Eight factors were indentified, closely related to the original factor structure of the DUSI: Alcohol and drug abuse, Emotional distress, Low behavioral control, Low school attachment, Low social competence, Dysfunctional familiy relationships, Deviant peer networks, and Isolation. These factors explained 44.2% of the variance, each one including items with factor weights above 0.4. The overall internal consistency reached 0.9451, whereas the scales corresponding to the majority of the identified factors registered reliability scores of more than 0.8. These findings enabled the identification and refinement of the DUSI factorial structure in a young Mexican student population, in the sense of providing a greater conceptual homogeneity, leading to a useful instrument in studying psychosocial correlates to explore psychosocial correlated or predictors of drug abuse, and in evaluating the outcome and impact of prevention and treatment services