Introducción:

Los principales estudios realizados para población adolescente y joven entre los años 2000 y 2003 indican que hay un incremento en el consumo de drogas, especialmente de alcohol, mariguana y metanfetaminas. Cabe aclarar que el índice general de consumo se mantiene estable a partir del 2001, sobre todo el relacionado con la cocaína. También ha habido cambios en la respectiva contribución de hombres y mujeres, de manera que las prevalencias de consumo de alcohol y tabaco presentan valores similares. Se han observado variaciones regionales que indican que el consumo es mayor en las grandes urbes. Sin embargo, las nuevas generaciones se ven más afectadas sin importar el nivel de urbanización del lugar en que viven. Ya se ha señalado con anterioridad que estar estudiando es un factor protector contra el consumo de drogas, por lo que el consumo es más alto entre los adolescentes que han dejado de estudiar, y es un factor diferencial que protege en mayor medida a los hombres que a las mujeres. Como derivación de lo anterior, estas mismas fuentes y las diver sas encuestas de estudiantes, señalan que trabajar siendo menor de edad incrementa la probabilidad de consumir drogas. Asimismo, los estudios establecen que el inicio temprano del consumo de tabaco o alcohol, principalmente antes de los 13 años, incrementa mucho las probabilidades de consumir otras drogas, lo cual es preocupante ya que la bibliografía muestra que la edad de inicio del consumo de estas sustancias es cada vez menor.

Objetivo:

Se presentan los resultados de la Ciudad de México de la Encuesta de otoño de 2003 sobre el uso de drogas entre la comunidad escolar.

Materiales y método:

El estudio se realizó con una muestra aleatoria de 10,659 estudiantes de todo el Distrito Federal, con un diseño de muestra bietápico (escuela-grupo) y estratificado (secundarias, bachilleratos y bachilleratos técnicos). Los datos de este estudio son representativos por delegación y por nivel educativo y el diseño es comparable al de estudios anteriores realizados en escuelas por el INP y la SEP. En cuanto a la precisión de las estimaciones, la tasa de no respuesta considerada fue de 15%, con un error absoluto promedio de 0.004 y con un efecto de diseño igual a 2. La edad de los sujetos fue de 12 a 22 años, con una media de 14.6 años; 50.5% eran hombres y 49.5%, mujeres. El cuestionario se conformó con los indicadores de consumo de drogas que se han venido utilizando en este tipo de estudios y que corresponden a los empleados por la OMS. Además, se exploraron diversas conductas de los adolescentes, como el intento suicida, su nivel de depresión y sus conductas alimentarias de riesgo, así como diversos aspectos de su conducta sexual.

Resultados:

El estudio señala un ligero incremento, de 14.7% a 15.2%, en el consumo de drogas en los últimos tres años, que no es un aumento estadísticamente significativo. No obstante, al interior de las distintas sustancias se observan situaciones distintas. En tanto que el incremento en la mariguana es grande, en los inhalables y los tranquilizantes el consumo se mantiene estable y el de la cocaína decrece ligeramente. Por hombres y mujeres, se encontró que han aumentado los niveles de consumo de las mujeres, en tanto que en los hombres se han mantenido iguales o han disminuido ligeramente. Además, la preferencia por droga se mantiene muy similar a la reportada hace tres años: el primer lugar lo sigue ocupando la mariguana, seguida de los inhalables, los tranquilizantes y la cocaína con niveles de consumo similares. En el caso de las mujeres, la droga preferida son los tranquilizantes. El consumo de alcohol se ha incrementado, en tanto que el consumo de tabaco se mantiene similar. Un cambio importante es que el nivel de consumo de ambas sustancias es prácticamente igual entre hombres y mujeres. En el abuso de alcohol, se encontró un incremento de 2%, de manera que 23.8% de los adolescentes han consumido por lo menos cinco copas en una sola ocasión durante el último mes previo al estudio. También ha cambiado la radiografía regional de la Ciudad de México de esta problemática. En este sentido, las delegaciones más afectadas por el consumo de drogas son Azcapotzalco, Venustiano Carranza, Miguel Hidalgo y Cuauhtémoc, las cuales desplazaron a Gustavo A. Madero y Coyoacán, que en el estudio del 2000 eran las de mayor consumo. Este dato es importante, si se considera que la SEP desarrolló esfuerzos puntuales de prevención en las dos últimas delegaciones para disminuir el consumo. Por lo que se refiere a la autoevaluación de los estudiantes (con el folleto que se entregó al final de la aplicación a cada estudiante), los resultados fueron muy positivos. Así, principalmente se obtuvo que 15% de los adolescentes indicó dejar de fumar y un porcentaje similar señaló fumar menos. Otro 15% mencionó haber usado los números telefónicos de ayuda incluidos en el folleto, y más de 60% comentó el contenido del folleto con su familia.

Discusión:

Los datos sobre consumo de drogas concuerdan con los obtenidos en otros estudios e indican que el consumo de drogas y tabaco se ha estabilizado, aunque presenta variantes por droga y por sexo. En cambio, el consumo de alcohol continúa incrementándose, si bien permanece estable el abuso. Con fines preventivos, es importante analizar la nueva radiografía del problema y relacionarla con los indicadores de criminalidad y otras conductas delictivas, para compartir esfuerzos de prevención en las zonas más afectadas de la ciudad. Aunque el panorama es problemático, el sector menos afectado es el de los adolescentes que continúan sus estudios, en comparación con los que ya los han interrumpido. Por otra parte, los datos del folleto "¿Qué onda con tu vida?" son alentadores para las prácticas de prevención y, ante el surgimiento y crecimiento de estos problemas, hay que señalar que el levantamiento de información tiene que enfocarse también como una oportunidad para llegar directamente a los adolescentes con materiales de prevención desarrollados para ellos. Por último, la prevención debe iniciarse desde la infancia y la niñez, no hasta la adolescencia. A esta tarea se deben destinar los mayores recursos humanos posibles. Las probabilidades de lograr mejores resultados bajo esta concepción son más altas, ya que la interacción con los niños y su completa integración en el hogar en esa edad facilitan la tarea preventiva. Durante la infancia y la niñez el ser humano es más receptivo a este tipo de medidas y se puede trabajar mejor y en forma más sencilla con sus familias. Así, será más fácil comunicarnos con los adolescentes para apoyarlos en el proceso de formación de su identidad. Aunque se trabaja a más largo plazo, se obtienen mejores resultados y se pueden ofrecer mejores opciones a las nuevas generaciones a partir de construir juntos una mejor cultura de la prevención.

Introduction:

Research focused on drug consumption in schools has been developed in México since 1976 and has allowed for a constant monitoring of this behavior in the population. The National Institute of Psychiatry Ramón de la Fuente (INP) and the Public Education Administration (SEP) have been the pionering institutions in these efforts, where other interested institutions and states add their contributions to the assessment of the problem in this social sector. Due to the need of developing local preventive programs to reduce drug consumption, several regions of the country have carried out, in a first stage, situational diagnoses of drug consumption. These data, in addition to other community information sources, have helped to enhance efforts in terms of prevention. To date, the main investigations related to students are the Fourth National Survey on Addictions, the National Survey from the National System for the Integral Family Development, regional surveys with young students from 7^th to 91 grades (Queretaro; Ríoverde, San Luis Potosí; Sinaloa; Tamaulipas and Ciudad Guzmán, Jalisco.), from 101 to 12^th grade (same states, except for Ciudad Guzman and the study done in Guanajuato whose results have not been published yet) and college (Ríoverde). The main findings for adolescents and youths obtained from these studies show an increase in drug consumption, specially for alcohol, cannabis and metamphetamines, although the general index of consumption remains steady since 2001, specially in the case of cocaine. There have also been changes in men and female contributions to the consumption index, giving similar prevalences for alcohol and tobacco in both. Regional variations have been observed, where drug consumption is higher in more urbanized cities. However, new generations are more affected by this phenomenon regardless of the level of urbanization of the place where they live. Also, as it has been previously established, being in a scholastic environment is a protective factor against drug consumption, beacause consumption is higher among adolescents who do not study, and it is a differential factor that protects men more than women. As a consequence, these sources and different students' surveys point out that the probability of drug consumption increases when a minor is working. Additionally, studies report that an early consumption onset for tobacco and alcohol, mainly before 13 years old, increases the possibility of consuming other drugs. This fact is important because several reports on the literature show that age of onset for consuming these drugs is becoming earlier. It is relevant to consider that drug consumption is not an isolated factor. It is known that some precursors for drug consumption are the same for other behaviors, such as sexual intercourses without protection, antisocial, delinquent behaviors or suicide attempt. In behalf of this, prevention programs must be designed in an integral way considering the global environment of adolescents, and not just focused on drug consumption. From this point of view, results from the survey on drug use carried out among students in Mexico City in autumn, 2003, are presented. This survey is the most recent diagnosis about this problem in Mexican adolescents, and keeps the methodological standards of previous surveys.

Objective:

The aim of the present work is to give a recent and complete view about this problem and prevention opportunities for adolescents of Mexico City and the whole country.

Materials and method:

The study comprised a randomized sample of 10,659 students from Mexico City, with a two-stage design (school-group), and stratified (from 71 to 9 grades, and from 10 to 123 grades, technical and normal), where the last selection unit was the scholar group. Data is representative for delegation and educational level, and the design is similar to those previously applied in schools by the INP and SEP. The reviewed sample frame was obtained from the registrations to the 2001-2002 school period of SEP A randomized sample was obtained for each county and educational level. Regarding estimations precision, calculated non-response index was 15%, with an absolute error average of 0.004, and a design effect equaling 2. The confidence intervals obtained were generated by the STATA program, version 7.0. The mean-age of the subjects was 14.6 years (12-22 years), 50.5% of the sample were men and 49.5% were women. The indicators of drug consumption included in the questionnaire are the same used in similar studies and are the same used by the WHO. In addition to drug consumption and related problems, several behaviors were assessed among adolescents, such as suicide attempt, level of depression, eating risk behaviors and some features of their sexual behavior. Interviewers were trained to obtain the most reliable information from the adolescents and to keep confidentiality. A total of 23 interviewers and five supervisors participated in the study.

Results:

First of all, a slightly increase in drug consumption was found in the last three years, from 14.7% to 15.2%, which is not significative. Nevertheless, there are significant changes in the consumption of specific drugs. There is a significant increase in cannabis consumption, while inhalants and tranquilizers remain steady and cocaine use showed a slightly decrease. By sex, it was observed that drug consumption in women has increased, while in men it remains steady or has even decreased a little. In this context, drug preferences remain very similar to those reported three years ago, where cannabis occupied the first place, followed by inhalants, tranquilizers and cocaine (with similar levels of consumption between the last three ones). The drugs of preference among women are tranquilizers. With respect to legal drugs, alcohol consumption has increased, while tobacco consumption remains similar to the reported in the survey of 2000. A significant change in these drugs, as mentioned above, is that their consumption is almost the same among men and women. Talking about alcohol abuse, a 2% increase was observed, which indicates 23.8% of the adolescents had consumed at least five drinks per occasion during the month previous to the study. In regional terms, there were also changes. The most affected delegations are Azcapotzalco, Venustiano Carranza, Miguel Hidalgo and Cuauhtemoc. In the last survey, the most affected delegations were Gustavo A. Madero and Coyoacan. This is very important information, because the SEP implemented several prevention strategies in these two delegations in order to reduce drug consumption. Considering the results of the present study, it can be concluded these efforts were successful. Even though results will be presented in a specific publication, according to the adolescents' evaluation of the brochure given to each student at the end of the application, we can say they were very positive, as 15% of the adolescents indicated they had quitted smoking and a similar percentage reported a decrease in their tobacco consumption. Another 15% mentioned they had used help telephone lines, and more than 60% shared the content of the brochure with their families. Most of them have kept the brochure for future occasions and have also lent it to friends.

Discussion:

The data about drug consumption is similar to the data of other national studies reporting that consumption of medical and illegal drugs and tobacco, is steadier on the whole, although there are changes in specific drugs consumption and by sex. Meanwhile, the prevalence of alcohol consumption has been increasing, even when its abuse remains stable. For prevention, it is important to consider the new location of the problem (most affected delegations), and to use crime indicators and other delinquent behaviors, to share prevention efforts in the most affected areas of the city. Another interesting result is the low level of risk perception for tobacco and alcohol consumption, which are important precursors for the consumption of other drugs, especially if there is an early consumption onset for these substances. In the context of drug consumption associated with other adolescents' problems, suicide attempt is the most frequent situation reported by the participants (16%) and it is even more frequent than drug consumption. Although this situation seems to be quite problematic, adolescent population in scholastic environments is the least affected in comparison to those that quit or stop studying. On the other hand, the information obtained about the brochure "What's up with your life?" is encouraging for prevention practices, and the presence and growth of these problems makes it important to consider that the process of obtaining information as an integral part of the diagnosis may also be used as an opportunity to reach adolescents with information or materials created for them. Finally, it is important to point out that prevention must be applied during childhood and not only during adolescence. To reach this goal, it is important to include all possible human resources. The point is simple: the possibilities to obtain better results under this conception are greater, because the interaction with children and their complete integration at home facilitate this prevention task. During childhood, the human being is more receptive to this kind of interventions and it is simpler to work with the families. So, when children grow up, it will be easier to communicate with them as adolescents and to give them all the support they require in their identity formation. Even when the work is focused on the longer term, the results will be better and we will be able to offer better options to the new generations from the construction of an adequate prevention culture.