Resumen de Comparación del ambiente familiar y el tipo de consumo de tabaco en adolescentes mexicanos de nivel medio superior

Bertha Lidia Nuño Gutiérrez, José Alvarez Nemegyei, Alejandra Velázquez Castañeda, Amparo Tapia Curiel

• español

  Introducción Aunque el tabaquismo no es exclusivo de adolescentes y jóvenes, la enfermedad ha sido definida como pediátrica por su inicio antes de los quince años de edad, por lo es necesario el desarrollo de estudios que identifiquen las diferentes influencias del consumo de tabaco factibles de ser modificadas. La familia es una de las influencias más importantes para las personas, pues modela comportamientos relacionados con la salud y es donde ocurre el desarrollo psico–emocional de sus miembros. Estudios preliminares han sugerido que algunos factores del ambiente familiar podrían influir en el consumo de tabaco en adolescentes como, por ejemplo, el de consumo de tabaco de familiares, bajos niveles de cohesión familiar, pautas de interacción defectuosas, falta de vínculos de apoyo, tolerancia familiar al consumo, bajos ingresos y bajo nivel educativo, bajo monitoreo paterno en las actividades adolescentes y el pobre control de la influencia del contexto social. Dado que no se han localizado antecedentes de la asociación entre el ambiente familiar y el tipo de consumo de tabaco en adolescentes mexicanos, el objetivo de este estudio fue comparar el ambiente familiar entre los tipos de consumo de tabaco en adolescentes escolares de nivel medio superior en Guadalajara, México.

  Material y métodos Se incluyeron a 1158 estudiantes seleccionados aleatoriamente de dos preparatorias de la Universidad de Guadalajara en el segundo semestre de 2005. La recolección de los datos se realizó por medio de dos escalas de autoaplicación estandarizadas para población mexicana: 1. Consumo de tabaco en el que el patrón de consumo fue categorizado: leve y moderado; 2. Ambiente familiar evaluado por medio de cinco dominios: hostilidad y rechazo, comunicación con el hijo, apoyo de padres a hijos, comunicación entre padres y apoyo del hijo a los padres.

  Resultados Seiscientos quince (53.1%) adolescentes fueron no fumadores, 419 (36.1%) calificaron como fumadores leves y 124 (10.8%) como fumadores moderados. Ser no fumador se asoció consistentemente con un mejor estado en todos los dominios de la escala de ambiente familiar. Los no fumadores tuvieron mayores calificaciones en los dominios de comunicación padre–hijo, apoyo de los padres, comunicación entre los padres y apoyo significativo del hijo, así como menores calificaciones en hostilidad y rechazo en comparación con los fumadores leves. Los no fumadores tuvieron mayores calificaciones en el dominio de comunicación con el hijo y menores calificaciones en el dominio de hostilidad y rechazo en comparación con los fumadores moderados. No se apreció ninguna diferencia entre fumadores leves y moderados.

  Discusión El estudio reveló consistentemente que existe un ambiente familiar más favorable para los adolescentes no fumadores comparados con los fumadores. Las principales diferencias en el ambiente familiar radicaron entre los no fumadores y los fumadores leves, y en menor grado, entre los no fumadores y los fumadores moderados. No apreciamos ninguna diferencia en el ambiente familiar entre los fumadores leves al compararlos con los moderados. A partir de que el ambiente familiar no parece deteriorarse una vez que el adolescente ya inició el consumo de tabaco, sugerimos que existen ciertas estructuras familiares que favorecen su consumo. Partiendo de estas consideraciones, pensamos que el consumo de tabaco en adolescentes es un fenómeno social en el que intervienen diferentes actores sociales, por lo que no es suficiente desarrollar sólo acciones educativas y de tratamiento para los adolescentes, sino que además deben involucrarse los padres.

• English

  Introduction Tobacco use is an addiction of which prevalence, incidence, morbimortality, and medical and social impact have turned it into a global public health problem. It has been related with eleven causes of death and every year 4.9 million tobacco–related deaths occur at 30 years of age. By 2030, an estimated 10 million annual deaths will be tobacco–related. In the United States health care expenses for tobacco–related problems have been estimated from US8.2 to 77 million annually, meaning between 0.46 and 1.15% of GNP. Because of tobacco use is not an exclusive activity of adolescents and young adults it has been defined as a pediatric disease because it frequently begins before fifteen years of age. Even more alarming is that The Global Youth Tobacco Survey reported an increase in the tobacco consumption, particularly among women in developing countries like Mexico. This is so common that the previously reported gap between male and female adolescent tobacco users in these countries has all but disappeared. There is a need to develop more studies in order to identify the different influences of tobacco use that in the long run can be modified. Family is one of the most significant influences on people as it models many health–related behaviors, such as diet, exercise, tobacco and alcohol use. It is also the source of its members' psycho–social development, meaning it can both provide support and create stress. Preliminary studies suggest that some family environment factors may influence adolescent tobacco use risk, such as: a background of tobacco use among family members; low levels of family cohesion; defective interaction examples and lack of support bonds; family tolerance to use; low income and low education level; type of family; minimal parental monitoring of adolescent activities; and poor control of the influence of an adolescent's social context, focused on school choice and extra–curricular activity spaces.

  However, no study to date has evaluated if there is a relationship between family environment and type of tobacco use in Mexican adolescents. As a response to this lack of information, a comparative survey was done to compare family environment and type of adolescent tobacco use in high school students in the city of Guadalajara, Jalisco, Mexico.

  Materials and methods A cross–sectional, prolective, comparative study was done in a population of 6987 students enrolled in high schools No. 5 and No. 9 of the University of Guadalajara during the September to December 2005 semester.

  These schools were chosen as being the most representative of the city of Guadalajara based on their enrollment and graduation academic indicators. Sample size was calculated with the miscellaneous statistics module of the True Epistat Program using a 95% confidence level. Previous studies showed a tobacco use prevalence of 27% in the University of Guadalajara high schools, meaning minimum sample size, including an additional 10% for unrelocated students, was 205 for high school No. 5 (3056 enrolled students) and 400 for high school No. 9 (3931 enrolled students). Selection of eligible subjects was randomly done.

  All students enrolled in each school were numbered consecutively and a random selection table was generated using True Epistat. Later on the students corresponding to these numbers were located by the school prefects by group and shift. They were then called to answer the electronic self–administered survey in the school's computer room. Location rate was 96% because some students had dropped out and/ or changed schools. Data collection was done by using two standardized self–application scales for Mexican population: 1. Tobacco use categorized as light (one to five cigarettes by day) and moderate (six to fifteen cigarettes by day); and 2. Family environment, evaluated by five items: hostility and rejection, communication with children, mutual support from parents and children, and communication between parents.

  For each type of tobacco use, the mean grades ± 95% confidence interval of the items of the family environment scale were obtained and then, they were compared graphically. The project was approved by the Ethics and Research Committee of the Mexican Institute of Social Security. The survey included an informed consent form with electronic signature. If any participation was not accepted, the survey application did not open. Student participation was anonymous and an electronic mail address was provided for orientation. No users were recorded as requesting orientation.

  Results A total of 11 58 students (average age = 16.1 ± 1.1 years, range 14 to 20 years) took the survey, from which 659 (56.9%) were women and 499 (43.1%) were men. Of this total, 615 (53.1%) were non–smokers, 419 (36.1%) were light smokers and 124 (10.8%) were moderate smokers. Non–smoker status was consistently associated with better conditions in all the family environment scale dominions. In comparison with light smokers, non–smokers had higher grades of communication with their parents, there was support from parents to children, as well as communication between parents, and support from the son to the parents dominions; and lower grades in the hostility and rejection dominion. In comparison with moderate smokers, non–smokers had better grades in the communication with the son/ daughter dominion and lower grades in the hostility and rejection dominion. No significant differences were observed in the family environment scale between light and moderate smokers.

  Discussion Family environment was consistently shown to be more favorable for adolescent non–smokers compared to smokers; the main differences were between non–smokers and light smokers with fewer differences between non–smokers and moderate smokers. No differences in the family environment items were observed between light and moderate smokers. This finding of favorable family conditions for non–smokers coincides with previous reports.

  The fact that family environment does not deteriorate once an adolescent begins tobacco use may mean that certain family structures exists previously that favor tobacco use. Given the cross–sectional design used here, it could not be determined if the evaluated items generate any vulnerability or acted as preventing factors for tobacco use. This would require a more detailed study about these variables. Based on these results and those of previous studies, the starting point of adolescent tobacco use is probably favored by a coincidence among certain family structures such as: family type, family resources, family interactions, type of parent involvement with children, stress management strategies, family modeling, adolescent's psychology, as well as communication and support among family members. Given the above, adolescent tobacco use is likely a social phenomenon involving different social actors like the adolescent, his/her family and the influence of other agents. Educational actions and treatment of adolescents is therefore not enough to address the problem. Parent participation is needed that is specifically focused on understanding typical adolescent behavior; promoting harmonious parent/child relationships; training parents in parental functions such as negotiation and effective communication; and supervision of adolescent activities.

  The present study is an initial effort in evaluating the relationship between family environment and adolescent tobacco use. Although it is limited by its cross–sectional design and there is a lack of control of possible confusing variables, it does suggest that adolescent non–smokers have more favorable family environments than adolescent smokers. Future research on this matter will require studies using designs that allow a more thorough understanding of the influence of family environment at the onset of adolescent tobacco use.