Resumen de Efecto de una intervención antitabaco en estudiantes de enseñanza media superior en Gualajara, México

José Alvarez Nemegyei, Eduardo A. Madrigal de León, Bertha Lidia Nuño Gutiérrez

• español

  Introducción La mayor parte de los reportes de intervenciones escolares para reducir el consumo de tabaco en estudiantes han sido realizados en Estados Unidos y han mostrado un impacto positivo además de que son costo/efectivas. En México solamente existe el antecedente de un estudio exitoso de un programa de prevención de tabaco realizado en primaria, cuyos resultados sugieren que el desarrollo de habilidades conductuales reduce la prevalencia de la experimentación de tabaco y promueve el cese en quienes ya lo consumen. Ante la falta de intervenciones educativas y la tendencia hacia el aumento del consumo de tabaco en adolescentes escolares de educación media superior en México, realizamos el presente estudio con el objetivo de implementar y evaluar el efecto de una intervención educativa sobre el consumo de tabaco en adolescentes de una preparatoria de la Universidad de Guadalajara, en la ciudad de Guadalajara, capital del Estado de Jalisco, México.

  Material y métodos Basándose en un diagnóstico previo se diseño una campaña antitabaco, dirigida a adolescentes fumadores, con una duración de un semestre escolar, que incluyó la participación de padres de familia, maestros y pares no fumadores. Antes del inicio e inmediatamente después de finalizar la campaña se evaluaron, mediante dos muestras independientes por medio de encuestas validadas y estandarizadas, la frecuencia de consumo de tabaco, el tipo de consumo, la probabilidad de consumir tabaco en un futuro cercano y el nivel de conocimientos sobre los efectos nocivos para la salud que produce su consumo.

  Resultados El efecto positivo de la campaña se apreció en el tipo de consumo de tabaco puesto que hubo una reducción de la proporción de fumadores leves así como un incremento del número de no fumadores en la evaluación final con respecto a la basal; la proporción de fumadores moderados no se modificó en ambas evaluaciones. La frecuencia de consumo una vez en la vida, en los últimos doce meses, en el último mes, así como la probabilidad de fumar en un futuro cercano no mostró modificaciones en la evaluación final con respecto a la basal.

  Discusión La intervención educativa antitabaco tuvo efectos positivos sobre el tipo de consumo de tabaco en los adolescentes de la escuela sede, que se evidenciaron en la disminución de la proporción de fumadores leves, en el incremento de no fumadores y en el incremento del nivel de conocimientos sobre los efectos nocivos del consumo de tabaco sobre la salud. Creemos que la explicación se vinculó a tres aspectos: 1) por haber diseñado la intervención a partir de un diagnóstico escolar, 2) por haber tomado en cuenta las diferentes influencias sociales al incorporar la participación de maestros, pares no fumadores y padres de familia, 3) por la inclusión de sugerencias de programas exitosos en la modificación actitudinal. La intervención implementada resultó ineficaz para fumadores moderados, por lo que se tendría mayor efecto preventivo si se aplicaran en estudiantes de educación básica y media básica, en quienes el consumo de tabaco aún tiene un impacto inicial. A partir de la falta de interés mostrado por los padres, hipotetizamos que en ellos parece prevalecer una actitud permisiva en el consumo de tabaco de sus hijos y parecen subestimar la posibilidad de influir en su consumo. Se considera que los padres representan un contexto preventivo importante en el tabaquismo del adolescente. A partir de esto se plantean hipótesis y nuevas preguntas para ser investigadas. El estudio presenta limitaciones al no haberse incluido un grupo control y por haber limitado la evaluación de la intervención al periodo inmediato posterior. Sin embargo, pensamos que a pesar de estas limitaciones la intervención educativa antitabaco es efectiva para la reducción del consumo de tabaco experimental y en el incremento del nivel de conocimientos de los efectos deletéreos sobre la salud.

• English

  Introduction Recent data, both domestic and from the world over, have shown that the epidemiologic impact of tobacco consumption has a higher increase rate among adolescent population, particularly women, than in the general population. This has highlighted the need to implement preventive intervention programs focused on young people. The school environment seems to be the most adequate space to achieve such a goal. Most school intervention reports aimed at reducing tobacco consumption among students have been carried out in the United States and have both had a positive effect and proven to be cost–effective. In Mexico, there is only one antecedent of a successful prevention program conducted in an elementary school. Results from this suggest that behavioural abilities acquisition reduces the prevalence of tobacco experimentation and promotes cessation among those already using it. Given the lack of educational interventions and the fact that tobacco consumption tends to increase among Mexican high school students, we conducted this study aiming to implement an educational intervention on tobacco consumption among adolescent high school students from the Universidad de Guadalajara, Mexico. Later on we proceeded to evaluate its effect.

  Material and methods Based on a diagnostic and a literature review from successful anti–tobacco consumption programs, we devised a campaign called "Stop burning yourself out". This lasted for half a school year and included parents, teachers and non–smoking peers. Parents participated in five sessions aimed at promoting abstinence from tobacco consumption at home. Forty–two teachers, trained as campaign mediators, participated. A manual describing the contents from each session was elaborated for quality control purposes. Students themselves participated in four monthly sessions, were given anti–tobacco messages, watched anti–tobacco educational documentaries —under the supervision and discussion of a professor—, and exchanged cigarettes for chewing gum with non–smoking peers. In addition, a Tobacco Clinic was established, a mouth–teeth exam was carried out, and an anti–tobacco poster was displayed at the school. The poster message was changed each month. School measures regarding the ban on cigarettes sale on the school premises were likewise reinforced.

  Right before starting the campaign and immediately after finishing it, tobacco consumption rates, the type of consumption, the likelihood of using tobacco in the near future and the level of understanding as to the harmful effects on health of tobacco consumption were all evaluated using validated and standardized surveys. All measurements were carried out with an electronic questionnaire.

  The intervention effect evaluation was carried out with two independent samples: a base sample and a final sample before the campaign conclusion. Calculation of the sample size required for both surveys was based on data from a diagnostic study conducted at the same school. Participants were randomly selected. The project was approved by an Ethics and Research Committee from the Instituto Mexicano del Seguro Social (National Social Security Institute) and all the students participated in the educational intervention.

  Results Whereas 621 adolescents participated in the base evaluation, a total of 524 of them took part in the final evaluation. Parental attendance at the various sessions changed from 90% to 20%. A total of 2675 mouth–teeth exams were carried out. At these, tooth cavities decay, lack of dental hygiene and gengivitis were detected. In turn, this resulted in suggestions to attend regular health care services for treatment. At the Tobacco Clinic, a group of 20 family parents was formed for treatment. The once–in–a–lifetime, in the last 12 months, and in the last previous month tobacco consumption prevalence accounted to 43.6%, 23.0%, and 24.3%, respectively. Experimental versus regular tobacco consumption were 34.9% and 7.2%. Nonsmoking population was 57.8%. In the same base evaluation, 9.7% of the students considered it was very likely they would smoke in the future, 46.9% considered it barely likely, and 43.5% considered they would never smoke in the future. The positive effect of the campaign was reflected in the type of tobacco consumption as there was a reduction in the rate of experimental smokers, as well as an increase in the number of non–smokers in the final evaluation compared to the base one. The rate of regular smokers did not change from one evaluation to the other. The once–in–a–lifetime, in the last twelve months, and in the last month frequency of consumption, together with the likelihood of smoking in the near future, showed no changes in the final evaluation compared to the base one.

  In the base evaluation, a high level of understanding about the harmful effects of tobacco on the pulmonary system and a moderate level of understanding about the harmful effects of tobacco on the heart and the female reproductive system, as well as on the stomach and liver, were observed, while there was a low level of understanding about the harmful effects of tobacco on the rest of the organic systems.

  In the final evaluation, it was observed that the understanding level of organic systems about which it was moderate or high remained the same. In addition, a significant increase of the understanding about the harmful effects of tobacco on the ocular system and the urinary tracts was observed. The level of understanding about the harmful effects of tobacco on the rest of the organic system remained also the same.

  Discussion The educational anti–tobacco intervention had positive effects on the type of tobacco consumption among adolescents from the seat school. These effects were evidenced in a reduction in the rate of experimental smokers, an increase in the number of non–smokers, and an increase in the understanding level about the harmful effects of tobacco consumption on health. Our findings agree with the positive impact reported in the literature. We believe the explanation is related with three aspects: 1. the intervention was designed from a school diagnostic; 2. the different social influences were taken into account by incorporating the teachers, non–smoking peers and parents' involvement; 3. suggestions from successful programs were included in the attitudinal change. It is worth pointing out that, despite having achieved a positive change in the tobacco–related behaviour from the experimental consumption adolescents, our intervention did not show any significant effects in the group of adolescents who were already regular tobacco users. This allowed us to hypothesize that an intervention as the one we implemented turns out to be ineffective once adolescents move from being experimental to regular smokers. Such a differential effect reveals that interventions with features akin to the ones we included in this study are effective with students in whom the tobacco consumption habit is not firmly rooted. In the light of this, interventions such as this one would have a higher effect when applied in elementary and upper elementary school students, among whom tobacco consumption has had only an initial impact. One difficulty we dealt with on conducting this study was to obtain a response from the parents for, as educational sessions moved on, attendance rates gradually lowered. This fact allowed us to suggest, on the one hand, that among parents there seemed to prevail a permissive attitude towards their children tobacco consumption, because parents might be users as well; on the other hand, because it might very well be the case they do not consider tobacco consumption as a wrong behaviour which should be corrected. Nevertheless, studies report that families, and especially the parents' behaviour, do have an influence on their teenage offspring tobacco consumption and so it is suggested to explore more in depth this hypothesis and to approach some other interventions forms and contexts. Limitations from this study were, firstly, the fact we did not include a control group in order to compare the independent variable behaviour. Secondly, having restricted the evaluation from the intervention to the period of time immediately following it. Finally, despite these limitations, we consider our efforts resulted in an effective anti–tobacco consumption educational proposal which may be applied to reduce experimental tobacco use. Raising the understanding level about the deleterious effects on health is another achievement.