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Abstract
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Introduction. Our research took place following a prior work developed by James C. Anthony's research group, over the past ten years. In this group's research, the concept of exposure to opportunities to use drugs has been deemed as a useful element to understand the earliest stages of drug involvement, as well as the transition from using one drug such as tobacco and alcohol to consuming other drugs. The concept of exposure opportunity is based on Wade Hampton Frost's balanced force model, which underscores the importance of exposure for an epidemic to happen. The concept of exposure to opportunities to use a drug refers to the chance one may have to use any particular drug, for instance a friend or relative who invites someone to use the drug; to use the drug after actively seeking out the opportunity, or else to have being exposed to an opportunity, without any active involvement (when the drug is being used by others and could have been used if wanted, or after an unexpected finding of a drug which was left or hidden by someone else). In spite of the relevance of the exposure to opportunity concept, very little research has been conducted in Mexico in this area. However, before more research on the matter may take place, it is necessary to develop appropriate measurement instruments for large-scale studies. The main goals of this study were to develop an instrument to assess exposure to opportunities to use drugs, and to obtain a first estimation of the degree to which middle schools students have been exposed to the use of inhalant drugs, marihuana, and cocaine.
METHODS. Quali-quantitative methods were used in this research, which were used for the whole population of students of two middle schools located in the Historic downtown area of Mexico City. Prior work had been developed at these schools, which allowed to have a better understanding of certain characteristics of the school population, of their parents, and also of the specific organization of the schools. The qualitative area of the study was developed first, as the basis on which the quantitative area would be developed later. Focal groups were selected in order to assess if students could understand and accurately report timing and sequence of exposure to opportunities to use drugs. The focal groups were also used to evaluate the potential usefulness of items fora self-administered, paper and pencil survey. The survey was then designed, with questions on exposure to opportunities to use each of the following substances of groups of substances: alcohol, tobacco, marihuana, cocaine, and inhalant drugs, and in regard to current use of each drug. The questionnaire also included other sections to assess suicide ideation and attempts, exposure to violence, depression, and free-time activities.
RESULTS from these sections will be reported in future. For each of the sections we used revised versions of previously developed instruments, with the exception of the specific section on violence exposure that was especially introduced in this survey for the first time. It might also be noteworthy that the depression section included a revised version of the CES-D scale, originally developed by Eaton and colleagues in the US, and which has been translated and adapted in Mexico. Once the school authorities gave their permission to visit the classrooms, the students were invited to participate in the survey, clearly explaining to them their right to accept of reject our invitation, as well as their right to skip any question that would make them feel uncomfortable. Students were offered strict confidentiality regarding their answers. In fact, the survey was anonymously answered. While none of the students openly refused to participate in the survey, some questions were left unanswered (most questionnaire items showed no more than 5% missing rates). Survey administrators were hired among the staff that participated in the prior study. In spite of this prior experience, on behalf of quality and safety insurance purposes, survey administration procedures and human protection criteria were discussed with the staff of the present study during a special re-training session. We suspect that part of the excellent response from students and teachers was due to the good understanding between school and the survey administrators.
RESULTS. A total of four focal groups were conducted, in which 23 students participated. Mean age for the focal groups was 13.8 for females and 14.3 for males. Among participants in these focal groups, almost one of three students (actually, 8 out of 23) reported to have had a marihuana exposure opportunity, and also 8 students reported to have had the opportunity of using cocaine. The majority of students reporting marihuana opportunities reported a cocaine exposure opportunity as well. In all groups, students were able to state the sequence of exposure opportunities and current drug use correctly, as well as to identify the age of first drug use. The chief mechanism reported for exposure to opportunities of using marihuana, cocaine and inhalants was the "altruistic" invitation of a friend to try a new drug. Out of 810 students who were surveyed, 768 provided useful information for the analyses presented in this paper. One out of four students have been exposed to opportunities to use drugs, with higher exposure among males, older students, subjects who did not attend school in the past year or who were part-time students, those who had been full-time or part-time workers during the past year, and those who lived only with their father (without a "mother"). Regardless of sex, one out of three students who had had an opportunity to use marihuana, cocaine or inhalants were using at the time one or more of these drugs. Thus, only 65 students reported to have used drugs (8.5% of the total). No significant differences were found between males and females in regard to lifetime prevalence of drug use (9.0% and 7.9%, respectively, with p <0.426). One out of three students who had an opportunity to use inhalant drugs, marihuana, or cocaine, currently use either of these drugs. The chief mechanism of exposure was that "a friend or acquaintance offered a chance to use the drug as a present". In fact, 8 out of 10 students who had an opportunity to use marihuana were offered the drug by a friend, and similar ratio was found among those with an opportunity to use cocaine. However, only 6 out of 10 students with an opportunity to use inhalants reported that a friend had offered the drug to them as a present. Half of all students with an opportunity to use marihuana and cocaine were approached by someone who offered them these drugs for sale, and the proportion was much smaller for inhalant drugs (40%). Only 18-24% of the students with opportunities to use drugs had actively sought out a chance to try marihuana, cocaine, and inhalants.
DISCUSSION. This study offers new insights to understand stages of drug involvement, which in turn can illuminate the design and evaluation of prevention interventions. One out of four students has been exposed to an opportunity to use drugs such as marihuana, inhalants, and cocaine. Early identification of risk factors or markers might allow public health practitioners to offer interventions to those who might need them most urgently. However, interventions need to consider and address mechanisms associated with the risk of exposure to opportunities to use drugs, in order to maximize their results. Friends and relatives were the most likely persons to deliver the opportunity to use drugs. It is possible that students who are in the early stages of drug involvement (honey moon stage) might play an important role in creating opportunities to use drugs by other students. Here, pediatricians and school advisors may be able to anticipate the pseudo-altruistic exposure, and reduce the possibility of transition from exposure opportunity to initial drug use. The notion of exposure to opportunities to use drugs allows to identify two stages of drug involvement that are significant for intervention design and implementation, as well as for intervention evaluation: before and after exposure. This distinction may be relevant because the prevention potential of an intervention cannot be developed in the absence of exposure.
Language: es |