El consumo riesgoso y dañino de alcohol y sus factores predictivos en adolescentes estudiantes del bachillerato
- Autores: Leonila Rosa Díaz Martínez, Alejandro Díaz Martínez, Carlos A. Hernández Avila, Héctor Fernández Varela Mejía, Cuauhtemoc Solís Torres, José Narro Robles
- Localización: Salud mental, ISSN 0185-3325, Vol. 32, Nº. 6, 2009, págs. 447-458
- Idioma: español
- Títulos paralelos:
- Hazardous and harmful drinking among Mexican adolescents: prevalence and predictive factors
- Enlaces
- Dialnet Métricas: 3 Citas
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Resumen
- español
Introducción De acuerdo a la Encuesta Nacional de Adicciones (ENA) (Medina–Mora et al., 2003), de 1990 al 2002, la prevalencia en el consumo de alcohol durante los últimos 12 meses entre los jóvenes mexicanos de 12 a 17 años de edad, se elevó del 27.6% al 30%. De manera más reciente, la Encuesta de Estudiantes de Nivel Medio y Medio Superior de la Ciudad de México (EENMMS) (Villatoro et al., 2003), describió que el consumo alguna vez en la vida y el consumo durante el último mes de bebidas etílicas afectó respectivamente al 65.8% y al 35.2% de los estudiantes. Llama la atención que la frecuencia del consumo alguna vez en la vida reportada por la EENMMS es considerablemente mayor que la descrita en los adolescentes de la población general urbana (39.8%) por la ENA. Además, las diferencias de género reportadas por la ENA, en las que los hombres tradicionalmente beben con más frecuencia que las mujeres, no fueron encontradas por la EENMMS en la población estudiantil del nivel medio y medio superior.
Hasta lo que nosotros sabemos, se desconoce cuál es la prevalencia en esta población de patrones de consumo problemático de alcohol como serían el consumo riesgoso y dañino (CRDA) o el consumo dependiente. Por lo que se desconoce si existen diferencias entre la población estudiantil y los adolescentes de la población general, en la prevalencia de estos problemas.
El CRDA se define como un patrón de consumo de bebidas embriagantes, que se sitúa en un continuum de severidad, que coloca al sujeto en riesgo de desarrollar problemas de salud y/o que puede desembocar en francas complicaciones físicas y/o psicológicas (accidentes, victimización, violencia, dependencia al alcohol, etc.).
Objetivo En el estudio que se presenta aquí, nos propusimos: 1) estimar la prevalencia durante el último año del CRDA en los estudiantes de primer ingreso al nivel bachillerato de la UNAM, y 2) evaluar la influencia de las variables sociodemográficas y familiares en el riesgo para el CRDA.
Material y métodos El diseño del estudio fue el de una encuesta transversal en los estudiantes del primer año del bachillerato en el sistema escolarizado de la UNAM. Se estudiaron a 28 784 estudiantes (87.4 % de la población total). Se utilizó el Alcohol Use Disorders Identification Test (AUDIT) –versión en español para detectar el CRDA en la población adolescente. En este análisis empleamos tanto los puntos de corte recomendados para evaluar el CRDA en adultos (AUDIT≥8) como el puntaje recomendado para la población adolescente (AUDIT≥3). Se utilizaron porcentajes, promedios y desviaciones estándar para el análisis de las variables demográficas, y pruebas de contraste de medias (análisis de varianza) y de proporciones ( χ2) de acuerdo a la variable. Se utilizó la regresión logística multinomial para examinar la asociación de las variables demográficas y familiares con el CRDA. Se calcularon los odds ratios (OR) con intervalo de confianza al 95% para resumir el nivel de riesgo de ser afectado por el CRDA.
Resultados Cuando se usó la definición del CRDA para la población adulta, se encontró que 4.0% de los estudiantes lo presentaron, frente a 1 7.2% cuando se utilizó el puntaje del AUDIT recomendado para los adolescentes.
El riesgo de experimentar el CRDA fue casi dos veces mayor en los hombres que en las mujeres.
En el total de la muestra, se observó que la frecuencia y el mayor riesgo de ser afectado por el CRDA se incrementó con la edad; el menor riesgo se observó en los estudiantes de 14 a 15 años, triplicándose en el grupo de 16 a 17 años y cuadruplicándose en los estudiantes de 18 a 19 años de edad. Una mayor prevalencia y una mayor probabilidad de CRDA se encontró en los estudiantes que reportaron trabajar. También la mayor probabilidad de padecer el CRDA se incrementó con un mayor ingreso mensual familiar, particularmente en los varones en quienes el mayor riesgo para el CRDA se encontró entre aquellos con los ingresos familiares más elevados (≥10 salarios mínimos mensuales), mientras que en las adolescentes, se observó una disminución en el riesgo para el CRDA con menores ingresos familiares.
En el total de la muestra, la prevalencia y la probabilidad del CRDA también se incrementó en los estudiantes que reportaron tener un padre pero no una madre con siete a 12 de años de educación.
En cuanto a los factores protectores, una variable que se asoció con una reducción en la frecuencia y el riesgo del CRDA (AUDIT≥3) en la muestra total y en las mujeres por separado, fue el ser sostenido económicamente por los padres. Los efectos protectores de esta variable también se observaron separadamente en los varones, pero al nivel de una tendencia no significativa (p = 0.07).
Conclusiones En este estudio encontramos que el CRDA es un problema relativamente frecuente, especialmente cuando se utilizó la definición recomendada para los adolescentes. Aproximadamente uno de cada cinco estudiantes se vio afectado por este problema, siendo los hombres y los estudiantes de mayor edad quienes experimentan el mayor riesgo. En los estudiantes de ambos sexos, una mayor edad y el trabajar, incrementaron el riesgo de ser afectados por el CRDA. En los hombres, considerados por separado, un mayor ingreso familiar fue un factor de riesgo, mientras que en las mujeres un menor ingreso familiar fue un factor protector. Independientemente del género, una educación media y/o media superior en el padre, pero no en la madre, se relacionó con un incremento en la probabilidad del CRDA. Contrariamente, el riesgo de ser afectado por este problema fue menor en los estudiantes de ambos sexos que reportaron ser sostenidos por los padres. Nuestros hallazgos tienen implicaciones para la prevención y tratamiento del CRDA en la población estudiantil. En este sentido, un mejor conocimiento de los grupos y factores de riesgo permitiría el diseño de políticas de prevención e intervenciones potencialmente más efectivas en esta población.
- English
Background Alcohol is commonly used among adolescents in Mexico. In a representative survey of Mexico's general population, 30% of the teenagers reported current drinking, whereas 8% incurred in binge drinking (5 or more drinks per occasion) at least once during the last year. In addition, 3% reported three or more alcohol dependence symptoms over the last 12 months.
In this Mexican age group, alcohol consumption importantly contributes to the most frequent causes of morbidity and mortality (e.g. accidents, violence, homicides, suicide and risky behaviors).
Data from a representative survey of adolescents attending middle and high school in Mexico City suggests that adolescents attending Mexico's schools run a high risk for alcohol problems. In this study, prevalence of lifetime and current drinking, and of current binge drinking (5 or more drinks per occasion) were, respectively, 65.8%, 35.2%, and 23.8%. These rates are substantially higher than those described in teenagers from Mexico's general population. Furthermore, although among Mexico's general population the prevalence of drinking has traditionally been higher among male than female adolescents, no gender differences in prevalence of alcohol consumption have been reported among Mexican middle and high school students. This suggests that female adolescents in Mexico's schools have become equally exposed to drinking as their male counterparts.
Despite these trends, there is a paucity of studies examining drinking patterns and their respective correlates among Mexican adolescents attending post–elementary education. To our knowledge, in this population, there are no published prevalence estimates of Hazardous and Harmful Drinking (HHD). HHD is defined as a pattern of alcohol consumption conferring to the individual a greater risk for health problems, or frankly conducive to medical or psychological complications (e.g. accidents, victimization, violence, alcohol dependence, liver cirrhosis and/or other medical complications).
The Alcohol Use Disorders Identification Test (AUDIT), developed by the World Health Organization, is currently the only instrument specifically designed to identify HHD. Although the AUDIT was initially validated only among adult patients in primary care settings, this instrument has consistently shown to be valid and reliable in detecting alcohol problems in different populations, such as the adolescent population in many countries around the world.
Given the public health implications of estimating the frequency of HHD among adolescents attending high school in Mexico, and given the importance of elucidating the variables influencing this problem, we decided to conduct the analysis presented here. To our knowledge, this is the first report published in the international literature on the prevalence of HHD among adolescents attending high school in a Latin American country.
Objective In the study described here, derived from a Universidad Nacional Autónoma de México (UNAM) project entitled "Early Identification and Treatment of Problem Drinkers", we aimed at examining the frequency and risk factors for HHD among Mexican high school students. More specifically, our objectives were: 1. to determine the past–year prevalence of HHD among high school freshmen; and 2. to examine, in this population, the effects of demographic and family variables in the likelihood of HHD.
Subjects and methods This study was a cross–sectional survey conducted at the beginning of the school year during the registration period between September 1st and September 30th, 2005. In 2005, a total of 34000 students were accepted to initiate college at the nine UNAM college campuses located in the Mexico City metropolitan area. Of these, 28784 students (87.4 %) (age=14.8 [±2.5] years; 51.0% women) consented in answering the survey and provided complete data. Consequently, 521 6 students (12.6%) were excluded from the analysis due to a lack of consent, incomplete data or their absence at the time of registration.
We used the AUDIT to examine past–year prevalence of HHD. This self–report instrument includes 10 items that examine frequency and intensity of drinking (items 1–3), presence of alcohol dependence symptoms (items 4–6), and negative consequences of drinking (items 7–10), yielding a maximum possible score of 40 points. Among adult patients in primary care settings, it has been accepted that an AUDIT score of 0–7 points reflects safe levels of alcohol consumption, whereas a score of 8 points or higher indicates the presence of Hazardous and/or Harmful Drinking. It has been described however, that among adolescents, an AUDIT score of 3 points or higher reliably identifies those students experiencing this problem.
In the analysis presented here, we separately examined and reported prevalence estimates and correlates for HHD using both AUDIT's cut–off scores (≥3 and ≥8).
The AUDIT was administered at the same time that a wellness screening survey that the UNAM Medical Services routinely administer to all registering high school freshmen at the beginning of the school year. Questions in the wellness survey pertained students' medical and dental health, family medical history, immunizations, and use of tobacco and other drugs.
In addition, demographic and socioeconomic information was obtained from a questionnaire also routinely administered by the UNAM registrar's office. This questionnaire included 37 items inquiring about gender, age, employment and marital status, monthly family income, parental education, place and type of residency, persons with whom the student resided, and questions on previous academic performance.
We estimated the prevalence of HHD and their respective 95% confidence intervals (95% CI) in the total of the sample, and separately by age group, gender, working status, monthly family income, parental education, and by variables reflecting whether the students lived with their family, peers, or alone. These variables were modeled using simulated binary terms (0, 1). Subsequently, a multinomial logistic regression was used to examine the relationship between HHD and the demographic and socioeconomic variables listed above. Variables were entered simultaneously into the logistic regression equation. To summarize the level of risk of HHD conferred by significant variables in the logistic regression model, odds ratios (OR) and their respective 95% CI's were estimated. All the significant effects reported here were adjusted considering the effects of the remaining demographic and socioeconomic variables.
Results Among the high school students examined here, the prevalence of HHD was 4.0% when an AUDIT cut–off score of ≥ 8 was used. When an AUDIT score of ≥3 was considered, a frequency of 1 7.2% was observed. Men (AUDIT ≥8: 5.4%; AUDIT ≥3: 21.4%) experienced this problem more frequently than women (AUDIT≥8: 2.6%; AUDIT≥3: 13.1%). The highest prevalence of HHD among men was observed in all age groups and regardless of working status, family income, parents' education, or regardless of the persons with whom the student reported to live with. Controlling for demographic and socioeconomic differences between men and women, we found that the risk of experiencing HHD among men was approximately two times higher than among women (OR's and 95% CI's for AUDIT's cut–off score ≥8 or ≥3, respectively 2.0[1.6–2.4] and 1.6[1.5–1.8]).
In both, men and women, the frequency and risk of HHD correlated positively with age. Thus, older students experienced the highest risk of HHD.
Among those students who reported to work to support themselves, there was a greater frequency and likelihood of HHD. In men, this risk increased with the number of weekly working hours, whereas in women this last effect was seen unequivocally only when an AUDIT cut–off score of 3 was used.
Also, a higher monthly family income was associated with a higher chance of HHD. Men in the highest family income group (10 or more minimum salaries) tend to experience the highest risk for this problem, while women in one of the lowest income groups experienced the lowest risk.
Although we did not find any effects of the number of years of parental education on the likelihood of HHD separately in men or women, in the total sample, there was a greater risk of HHD among those students having a father with 7–12 years of education.
Regarding protective factors, among those students who reported to be financially supported by their parents, there was a non–significant trend (p = 0.1 5) toward a lower risk of HHD when an AUDIT's cut–off score of 8 was used. The protective effect of this variable was significantly evident when an AUDIT's cut–off score of 3 was used, particularly among women.
Finally, in our sample there were no effects on the likelihood of HHD from variables reflecting whether the students lived with family, peers, or alone.
Conclusions HHD is not an uncommon problem among Mexican adolescents. In this sample, predictors for an increased risk of this problem may reflect the effects of variables facilitating teenagers' access to alcoholic beverages and exposure to high–risk activities. These findings have direct implications in designing preventive and treatment interventions addressing alcohol problems among Mexican adolescents in Mexico.
- español
