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OBJECTIVES: A growing body of research points to a relationship between exposure to migration-related cultural stress and mental health problems. However, such research is often conducted with the tacit assumption that postmigration experiences are the primary-if not singular-driver of psychological distress. In the present study, we aim to extend the cultural-stress paradigm by examining the influences of both premigration crisis exposure and postmigration cultural stress on depression in a sample of Venezuelan crisis migrants in Colombia. METHOD: Survey data for the present study were collected from Venezuelan youth (N = 429, ages 12-17, Mage = 14.0 years, 49% female) and adults (N = 566, ages 18+, Mage = 35.1 years, 82% female) in Bogota and Medellin, Colombia between April and June 2023. RESULTS: Both crisis exposure and discrimination were independently related to depressive symptoms. However, when examined in a multivariate model along with discrimination, crisis exposure was not a significant predictor of depressive symptoms among youth, and its influence weakened considerably among adults. Among both youth and adults, a Crisis Exposure × Discrimination interaction term significantly predicted depressive symptoms, indicating that discrimination was a more robust predictor of depressive symptoms among those endorsing lower levels of crisis exposure than among those reporting high levels of crisis exposure. CONCLUSION: Our research provides new insights into the experiences of Venezuelan migrant youth and adults in Colombia. It provides further support for the importance of drawing from a crisis-informed cultural-stress framework when working with crisis migrant populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Depresión , Estrés Psicológico , Migrantes , Humanos , Femenino , Masculino , Colombia , Adolescente , Adulto , Venezuela/etnología , Depresión/etnología , Depresión/psicología , Estrés Psicológico/etnología , Estrés Psicológico/psicología , Migrantes/psicología , Migrantes/estadística & datos numéricos , Niño , Adulto Joven , Encuestas y CuestionariosRESUMEN
Emerging research provides insights into migration-related cultural stress experiences and mental health among Venezuelan migrants; however, prior studies have not considered the critical distinction between online xenophobia and in-person discrimination. To address this gap, we assess the psychometric properties of an abbreviated version of the Perceived Online Racism Scale (PORS) with Venezuelan migrant youth and examine the interplay between online xenophobia, in-person discrimination, and mental health. Survey data were collected from Venezuelan migrant youth (N = 319; ages 13-17, 49.5% female) in Colombia in April-July 2023. Confirmatory factor analysis (CFA) was used to examine the PORS, and multiple regression was conducted to examine key associations. The CFA showed excellent model fit: χ²(7) = 13.498, p = .061; comparative fit index = .989; Tucker-Lewis index = .977; root-mean-square error of approximation = .055; standardized root-mean-square residual = .026. Controlling for demographic factors, online xenophobia was associated with depressive symptoms (ß = .253, p < .001) and anxiety (ß = .200, p = .001). The online xenophobia-mental health association weakened when controlling for in-person discrimination but remained nevertheless significant (depression: ß = .181, p = .002, anxiety: ß = .135, p = .026). Interaction effects (Online × In-Person) revealed a pattern in which greater exposure to online xenophobia was associated with greater distress, but only at relatively low levels of in-person discrimination. Findings provide new insights regarding (a) the properties of an increasingly relevant measure of cultural stress, (b) how online xenophobia relates to mental health, and (c) the interplay of online and in-person cultural stressors vis-à-vis mental health among Venezuelan migrant youth. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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OBJECTIVE: Although prior research has shown that an array of distinct experiences related to crisis migration are associated with mental health, there is a pressing need for a theory-driven, multidimensional measure to assess the broad spectrum of crisis migration experiences. As such, the present study focused on developing and validating the Crisis Migration Experience Scale (CMES) with a sample of Venezuelan migrants in Colombia. METHOD: Participants were adolescent (ages 12-17; n = 430) and adult migrants from Venezuela (ages 18+; n = 569). Randomly splitting the adolescent and adult samples in half, exploratory factor analysis and confirmatory factor analyses were conducted with 26 original items. After identifying a satisfactory factor structure to generate a 16-item CMES (CMES-16), we examined the associations of the CMES-16 with mental health outcomes. RESULTS: We provide evidence for reliability, factorial validity, and concurrent validity of scores generated by the CMES-16 in a sample of Venezuelan crisis migrants in Colombia. Whereas our a priori conceptualization included seven domains, the exploratory and confirmatory factor analyses indicated that four are especially salient: material hardship, desperation, danger, and unplanned departure. CONCLUSIONS: Crisis migration is an increasingly important construct frequently referenced in the literature on migrant health and by international humanitarian organizations. The number of crisis migrant groups worldwide is increasing, with Ukrainians and Afghans recently added to the list of such groups, along with Venezuelans, Syrians, South Sudanese, Iraqis, and Central Americans. Developing and validating the CMES-16 with Venezuelan crisis migrants opens up important avenues of research, including work that incorporates other crisis migrant populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Anxiety is the most prevalent mental health disorder among adults worldwide. Given its increased prevalence among migrants due to their marginalized position in the societies where they reside, psychometric evaluations of anxiety measures such as the Generalized Anxiety Disorder-7 (GAD-7) are needed for use with migrants. The present study is the first attempt to compare the structure of GAD-7 scores for (a) different Latino groups in the same country and (b) the same Latino group in two different countries. Using three samples of Mexican and Venezuelan migrants (total N = 933), we provide reliability and validity evidence of the GAD-7 for use with adult Latino migrants. Utilizing confirmatory factor analysis and item response theory, we demonstrate that the GAD-7 is internally consistent, possesses a strong single-factor structure, and generates scores with equivalent psychometric properties. GAD-7 is appropriate for use with Mexican and Venezuelan migrants across differing gender groups and education levels.
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Emigrantes e Inmigrantes , Hispánicos o Latinos , Psicometría , Humanos , Femenino , Masculino , Adulto , México/etnología , Hispánicos o Latinos/psicología , Venezuela , Emigrantes e Inmigrantes/psicología , Persona de Mediana Edad , Reproducibilidad de los Resultados , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/etnología , Análisis Factorial , Adulto Joven , Comparación Transcultural , AdolescenteRESUMEN
Researchers and practitioners recognise the importance of context when implementing healthcare interventions, but the influence of wider environment is rarely mapped. This paper identifies the country and policy-related factors potentially explaining the country differences in outcomes of an intervention focused on improving detection and management of heavy alcohol use in primary care in Colombia, Mexico and Peru. Qualitative data obtained through interviews, logbooks and document analysis are used to explain quantitative data on number of alcohol screenings and screening providers in each of the countries. Existing alcohol screening standards in Mexico, and policy prioritisation of primary care and consideration of alcohol as a public health issue in Colombia and Mexico positively contributed to the outcome, while the COVID-19 pandemic had a negative impact. In Peru, the context was unsupportive due to a combination of: political instability amongst regional health authorities; lack of focus on strengthening primary care due to the expansion of community mental health centres; alcohol considered as an addiction rather than a public health issue; and the impact of COVID-19 on healthcare. We found that wider environment-related factors interacted with the intervention implemented and can help explain country differences in outcomes.
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COVID-19 , Pandemias , Humanos , México/epidemiología , Colombia/epidemiología , Perú/epidemiología , COVID-19/diagnóstico , COVID-19/epidemiología , Políticas , Atención Primaria de SaludRESUMEN
Background: Alcohol misuse is a serious problem among university students in Colombia as well as in other Latin American countries. Studies show consistently that this population presents the highest rates of alcohol use. Despite such a situation, there is a lack of preventive programs for university students in this region of the world. The purpose of this paper is to present the protocol to evaluate a preventive strategy called IBEM-U, based on Motivational Interviewing and the I-Change Model. Method: This protocol shows how the evaluation of the effectiveness of the IBEM-U program will be carried out. A randomized control trial with a within-subjects design with one follow-up at six months after the post-test will be implemented. The comparison group will receive an alternative program similar in length but focusing on another issue. Around 1000 participants over 18 years of age, from at least six different universities around the country, will be recruited. Results: It is expected that the program will be effective in reducing past month alcohol consumption up to 15% in the experimental group as the main outcome. Secondary and tertiary outcomes include decreasing heavy episodic drinking and increasing knowledge, awareness, risk perception, attitude, self-efficacy, intention, and action planning, regarding heavy episodic drinking. Conclusion: IBEM-U can be considered a highly appropriate approach for reducing alcohol misuse among university students. The main reasons for these results are the self-imposed goals based on long-term purposes, that could be seriously affected by the ingestion of high amounts of alcohol.
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Brief alcohol advice offered to patients was shown to be a clinically- and cost-effective intervention to prevent and manage alcohol-related health harm. However, this intervention is not yet optimally implemented in practice. A suggested strategy to improve the implementation of brief alcohol advice is through community actions which would enhance the environment in which primary healthcare providers must deliver the intervention. However, there has been scarce research conducted to date regarding which community actions have most influence on the adoption and implementation of brief alcohol advice. The current protocol presents the development of a package of community actions to be implemented in three Latin American municipalities, in Colombia, Mexico and Peru. The community actions were based on the Institute for Health Care Improvement's framework for going to full scale, and include: (i) involvement of a Community Advisory Board, (ii) involvement of a project champion, (iii) adoption mechanisms, (iv) support systems and (v) a communication campaign. By presenting a protocol for developing community actions with input from local stakeholders, this article contributes to advancing the public health field of alcohol prevention by potentially stimulating the sustainable adoption and implementation of brief alcohol advice in routine practice.
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Participación de la Comunidad , Atención a la Salud , Humanos , América Latina , México , Salud PúblicaRESUMEN
Since 2015, the Venezuelan diaspora has poured forth from the Venezuelan sending context into an array of (mostly) middle-income receiving countries and into the United States (US) as well. For many Venezuelan migrants, post-migration reception has been mixed, and multiple studies suggest that mental health is an important challenge with discrimination and negative context reception contributing to mental health burden in terms of depression, anxiety, and posttraumatic stress. Cross-national research points to important sociodemographic differences between Venezuelan migrants resettled in South American contexts and in the US, and suggests that-on average-migration-related cultural stress is lower and mental health outcomes are better among those resettling in South Florida and elsewhere in the US.
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Salud Mental , Migrantes , Ansiedad , Migración Humana , Humanos , Renta , Estados UnidosRESUMEN
Background: During the COVID-19 pandemic, an increase of heavy alcohol use has been reported in several high-income countries. We examined changes in alcohol use during the pandemic among primary health care (PHC) patients in two middle income countries, Colombia and Mexico. Methods: Data were collected during routine consultations in 34 PHC centres as part of a large-scale implementation study. Providers measured patients' alcohol consumption with the three item 'Alcohol Use Disorders Identification Test' (AUDIT-C). Generalized linear mixed models were performed to examine changes in two dependent variables over time (pre-pandemic and during pandemic): 1) the AUDIT-C score and 2) the proportion of heavy drinking patients (8+ on AUDIT-C). Results: Over a period of more than 600 days, data from N = 17 273 patients were collected. During the pandemic, the number of patients with their alcohol consumption measured decreased in Colombia and Mexico. Each month into the pandemic was associated with a 1.5% and 1.9% reduction in the mean AUDIT-C score in Colombia and Mexico, respectively. The proportion of heavy drinking patients declined during the pandemic in Colombia (pre-pandemic: 5.4%, 95% confidence interval (CI) = 4.8% to 6.0%; during the pandemic: 0.8%, 95% CI = 0.6% to 1.1%) but did not change in Mexico. Conclusions: Average consumption levels declined and the prevalence of heavy drinking patterns did not increase. In addition to reduced opportunities for social drinking during the pandemic, changes in the population seeking PHC and restrictions in alcohol availability and affordability are likely drivers for lower levels of alcohol use by patients in this study.
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Alcoholismo , COVID-19 , Consumo de Bebidas Alcohólicas/epidemiología , Alcoholismo/epidemiología , COVID-19/epidemiología , Colombia/epidemiología , Humanos , México/epidemiología , Pandemias , Atención Primaria de SaludRESUMEN
Alcohol measurement in health care settings is an effective intervention for reducing alcohol-related harm. However, in many countries, costs related to alcohol measurement have not yet been transparently assessed, which may hinder its adoption and implementation. Costs of an alcohol measurement programme in three upper-middle-income Latin American countries were assessed via questionnaires and compared, as part of the quasi-experimental SCALA study. Additional to the intervention costs, the costs of three implementation strategies: standard training and clinical package, intensive training and clinical package, and community support, were assessed and subsequently translated into costs per additional alcohol measurement session. Results demonstrated that costs for one alcohol measurement session ranged between Int$ 0.67 and Int$ 1.23 in Colombia, Int$ 1.19 and Int$ 2.57 in Mexico, and Int$ 1.11 and Int$ 2.14 in Peru. Costs were mainly driven by the salaries of the health professionals. Implementation strategies costs per additional alcohol measurement session ranged between Int$ 1.24 and Int$ 6.17. In all three countries, standard training and a clinical package may be a promising implementation strategy with a relatively low cost per additional alcohol measurement session.
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Atención a la Salud , Colombia , América Latina , México , PerúRESUMEN
INTRODUCTION: Implementation of evidence-based care for heavy drinking and depression remains low in global health systems. We tested the impact of providing community support, training, and clinical packages of varied intensity on depression screening and management for heavy drinking patients in Latin American primary healthcare. MATERIALS AND METHODS: Quasi-experimental study involving 58 primary healthcare units in Colombia, Mexico and Peru randomized to receive: (1) usual care (control); (2) training using a brief clinical package; (3) community support plus training using a brief clinical package; (4) community support plus training using a standard clinical package. Outcomes were proportion of: (1) heavy drinking patients screened for depression; (2) screen-positive patients receiving appropriate support; (3) all consulting patients screened for depression, irrespective of drinking status. RESULTS: 550/615 identified heavy drinkers were screened for depression (89.4%). 147/230 patients screening positive for depression received appropriate support (64%). Amongst identified heavy drinkers, adjusting for country, sex, age and provider profession, provision of community support and training had no impact on depression activity rates. Intensity of clinical package also did not affect delivery rates, with comparable performance for brief and standard versions. However, amongst all consulting patients, training providers resulted in significantly higher rates of alcohol measurement and in turn higher depression screening rates; 2.7 times higher compared to those not trained. CONCLUSIONS: Training using a brief clinical package increased depression screening rates in Latin American primary healthcare. It is not possible to determine the effectiveness of community support on depression activity rates due to the impact of COVID-19.
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Consumo de Bebidas Alcohólicas/psicología , Alcohólicos/psicología , Depresión/terapia , Adulto , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/prevención & control , Intoxicación Alcohólica/psicología , Alcoholismo/diagnóstico , Colombia/epidemiología , Comorbilidad , Atención a la Salud , Depresión/psicología , Trastorno Depresivo/psicología , Trastorno Depresivo/terapia , Femenino , Humanos , Masculino , Tamizaje Masivo/métodos , México/epidemiología , Persona de Mediana Edad , Perú/epidemiología , Atención Primaria de Salud/métodos , Atención Primaria de Salud/tendencias , Derivación y Consulta , Detección de Abuso de Sustancias/métodosRESUMEN
OBJECTIVES: Millions of Venezuelans have left their country in search of safety and stability in the United States (U.S.) and Colombia, two countries where recent increases in anti-immigrant rhetoric and sentiment have occurred. The Perceived Negative Context of Reception Scale captures the degree to which immigrants report feeling that people from their country are unwanted/marginalized within their new receiving context. In the present study, we examine the psychometric properties of the Perceived Negative Context of Reception Scale with recent Venezuelan immigrant adolescents and adults in the U.S. and Colombia. METHOD: We conducted confirmatory factor analysis using data from the Colombia and Miami's Newest Arrivals (CAMINAR) Study, which collected data from Venezuelan adults in Bogotá, Colombia, and South Florida in October-November 2017, and the Venezolanos en Nuevos Entornos (VENE) Youth Project which surveyed Venezuelan youth living in Florida between November 2018 and July 2019. RESULTS: We found that the negative context of reception evidenced strong psychometric properties among immigrants in both the U.S. and in Colombia, among adolescents and adults, and among male and female respondents. We also found that negative context of reception scores was associated with elevated scores on criterion-related factors-that is, perceived discrimination and depressive symptoms-in ways that are theoretically coherent and support measure validity. CONCLUSION: We provide new evidence that the Perceived Negative Context of Reception scale is reliable and valid for use with Venezuelan immigrants in the U.S. and Colombia. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Emigrantes e Inmigrantes , Adolescente , Adulto , Colombia , Femenino , Florida , Hispánicos o Latinos , Humanos , Masculino , Psicometría , Estados UnidosRESUMEN
Background: Screening for unhealthy alcohol use in routine consultations can aid primary health care (PHC) providers in detecting patients with hazardous or harmful consumption and providing them with appropriate care. As part of larger trial testing strategies to improve implementation of alcohol screening in PHC, this study investigated the motivational (role security, therapeutic commitment, self-efficacy) and organizational context (leadership, work culture, resources, monitoring, community engagement) factors that were associated with the proportion of adult patients screened with AUDIT-C by PHC providers in Colombia, Mexico and Peru. Additionally, the study investigated whether the effect of the factors interacted with implementation strategies and the country. Methods: Pen-and-paper questionnaires were completed by 386 providers at the start of their study participation (79% female, Mage = 39.5, 37.6% doctors, 15.0% nurses, 9.6% psychologists, 37.8% other professional roles). They were allocated to one of four intervention arms: control group; short training only; short training in presence of municipal support; and standard (long) training in presence of municipal support. Providers documented their screening practice during the five-month implementation period. Data were collected between April 2019 and March 2020. Results: Negative binomial regression analysis found an inverse relationship of role security with the proportion of screened patients. Self-efficacy was associated with an increase in the proportion of screened patients only amongst Mexican providers. Support from leadership (formal leader in organization) was the only significant organizational context factor, but only in non-control arms. Conclusion: Higher self-efficacy is a relevant factor in settings where screening practice is already ongoing. Leadership support can enhance effects of implementation strategies.
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Personal de Salud , Atención Primaria de Salud , Adulto , Colombia , Femenino , Humanos , Masculino , México , PerúRESUMEN
As the identification and targeting of salient risk factors for adolescent substance use become more widely used globally, an essential question arises as to whether U.S.-based cut points in the distributions of these risk factors that identify "high" risk can be used validly in other countries as well. This study examined proportions of youth at "high" risk using different empirically derived cut points in the distributions of 18 measured risk factors. Data were obtained from large-scale samples of adolescents in Colombia and the United States. Results indicated that significant (p < 0.05) differences in the proportions of "high" risk youth were found in 38.9% of risk factors for 6th graders, 61.1% for 8th graders, and 66.6% for 10th graders. Colombian-based cut points for determining the proportion of Colombian youth at "high" risk were preferable to U.S.-based cut points in almost all comparisons that exhibited a significant difference. Our findings suggest that observed differences were related to the type of risk factor (e.g., drug specific vs. non-drug specific). Findings from this study demonstrate the need for collecting large-scale national data on risk factors for adolescent substance use and developing country-specific cut points based on the distributions of these measures to avoid misidentification of youth at "high" risk.
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Conducta del Adolescente , Trastornos Relacionados con Sustancias , Adolescente , Trastorno de Personalidad Antisocial , Colombia/epidemiología , Humanos , Factores de Riesgo , Trastornos Relacionados con Sustancias/epidemiología , Estados UnidosRESUMEN
BACKGROUND: Providing alcohol screening and brief advice (SBA) in primary health care (PHC) can be an effective measure to reduce alcohol consumption. To aid successful implementation in an upper middle-income country context, this study investigates the perceived appropriateness of the programme and the perceived barriers to its implementation in PHC settings in three Latin American countries: Colombia, Mexico and Peru, as part of larger implementation study (SCALA). METHODS: An online survey based on the Tailored Implementation for Chronic Diseases (TICD) implementation framework was disseminated in the three countries to key stakeholders with experience in the topic and/or setting (both health professionals and other roles, for example regional health administrators and national experts). In total, 55 respondents participated (66% response rate). For responses to both appropriateness and barriers questions, frequencies were computed, and country comparisons were made using Chi square and Kruskal-Wallis non-parametric tests. RESULTS: Alcohol SBA was seen as an appropriate programme to reduce heavy alcohol use in PHC and a range of providers were considered suitable for its delivery, such as general practitioners, nurses, psychologists and social workers. Contextual factors such as patients' normalised perception of their heavy drinking, lack of on-going support for providers, difficulty of accessing referral services and lenient alcohol control laws were the highest rated barriers. Country differences were found for two barriers: Peruvian respondents rated SBA guidelines as less clear than Mexican (Mann-Whitney U = -18.10, P = 0.001), and more strongly indicated lack of available screening instruments than Colombian (Mann-Whitney U = -12.82, P = 0.035) and Mexican respondents (Mann-Whitney U = -13.56, P = 0.018). CONCLUSIONS: The study shows the need to address contextual factors for successful implementation of SBA in practice. General congruence between the countries suggests that similar approaches can be used to encourage widespread implementation of SBA in all three studied countries, with minor tailoring based on the few country-specific barriers.
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Atención Primaria de Salud , Adolescente , Adulto , Anciano , Colombia , Intervención en la Crisis (Psiquiatría) , Estudios Transversales , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Perú , Adulto JovenRESUMEN
BACKGROUND: In recent years, more than 5 million Venezuelans have left their once prosperous country, with several hundred thousand settling in the United States (US). At present, our understanding of the health risk behavior profiles of Venezuelan émigré youth, and their links with cultural stress, remains limited. OBJECTIVES: Drawing from a sample of recently-immigrated Venezuelan youth in the US, we aim to identify subtypes of youth according to their involvement in health risk behaviors (i.e., substance use, sexual risk behavior, violence) and assess the associations between class membership and key constructs related to cultural stress theory (i.e., negative context of reception, family communication/support). METHOD: Latent profile analysis and multinomial regression were performed using data from a community-based convenience sample of 402 recently-arrived Venezuelan immigrant youth (ages 10-17; 56% male). RESULTS: We identified five subtype classes: (1) "Abstainer" (36%), (2) "Alcohol Only" (24%), (3) "Alcohol/Tobacco" (24%), (4) "Aggression" (8%), and (5) "Multidimensional Risk" (8%). Compared to Class #1, youth in Classes #3 and #5 reported significantly higher levels of negative context of reception and lower levels of family functioning while controlling for demographic factors. Youth in Class #5 reported the lowest levels of family economic hardship and the longest duration in the US. CONCLUSION: It is vital that we support both Venezuelan youth who abstain from risk behavior and, at the same time, develop and implement programs that target the needs of those who are at elevated risk for serious consequences related to substance use, sexual risk behavior, and violence.
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Conducta del Adolescente , Trastornos Relacionados con Sustancias , Adolescente , Agresión , Niño , Femenino , Conductas Relacionadas con la Salud , Conductas de Riesgo para la Salud , Hispánicos o Latinos , Humanos , Masculino , Asunción de Riesgos , Conducta Sexual , Trastornos Relacionados con Sustancias/epidemiología , Estados UnidosRESUMEN
Many effective community health service delivery systems implemented in the USA assess risk and protective factors (RPFs) for youth problem behaviors in a community, and report these data back to local coalitions for prevention planning. This study examined whether community prevention coalitions in Chile and Colombia perceived these reports of RPFs-based on the results of the Communities That Care Youth Survey-to be understandable, valid, useful, and worth disseminating. Thematic content analysis was used to analyze qualitative data collected from 7 focus groups with 75 coalition members. Results indicated heterogeneity between and within coalitions in terms of participants' understanding of RPFs. However, most participants found reports of RPFs to be easy to understand, thorough, 'true' to their communities, and useful for diagnosing and prioritizing needs, action planning, and mobilizing others in their communities. Findings suggest the viability of preventive systems that rely on community-level RPF data, for use in Latin America.
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Servicios de Salud Comunitaria , Factores Protectores , Adolescente , Chile , Colombia , Humanos , Medicina Preventiva , Encuestas y CuestionariosRESUMEN
Communities That Care (CTC) is a prevention system aimed at reducing antisocial behaviors in adolescents. In Colombia, this system has been developed and adapted under the name of Comunidades Que se Cuidan (CQC). Successful implementation of CQC depends on valid associations between measured risk and protective factors (RPFs) for substance use and substance use outcomes. This study assessed these associations using large-scale, school-based surveys of Colombian youth. A cross-sectional analysis was performed. Data from 23 communities in Colombia were collected between 2012 and 2016 from young people (N = 50,946) aged 10 to 19 years. Dichotomous alcohol, cigarette, cannabis, and other illegal drug use outcomes were assessed for past 30-day, past-year, and lifetime use. Logistic regression analyses, adjusting for age, gender, and age by RPF, and gender by RPF interactions, were performed for each RPF. All the associations of the 14 RPF evaluated were statistically significant (p<,001). Regarding observed effect sizes, 3.0% were considered very small (0.70 ≥ OR ≤ 1.43), 51.7% small (0.70 ≥ OR ≥ 1.43), 42.6% medium (0.40 ≥ OR ≥ 2.48) and 7.1% large (0.23 ≥ OR ≥ 4.27). Significant main effects for age and gender, and their interactions with RPFs were found for most RPFs. Findings from this study demonstrate the viability of RPFs for adolescent substance use as focal points for intervention planning, development, and evaluation of community-based prevention systems like CQC that rely on epidemiologic data for local decision making.
Communities That Care (CTC) es un sistema preventivo que busca disminuir comportamientos problemáticos en adolescentes. En Colombia, este sistema ha sido adaptado bajo el nombre de Comunidades Que se Cuidan (CQC). Este estudio validó las asociaciones entre los factores de riesgo y protección (FRP) para el uso de sustancias psicoactivas (SPA) medidos por CQC y las prevalencias de consumo de estas en adolescentes colombianos. Entre 2012 y 2016, se aplicó una encuesta a gran escala en jóvenes de 10 a 19 años (N = 50,946) pertenecientes a 23 comunidades de Colombia. Se analizó de forma transversal la asociación entre los FRP con el consumo de alcohol, cigarrillo, marihuana y otras drogas ilegales en los últimos 30 días, año y alguna vez en la vida. Se realizaron regresiones logísticas, ajustando por edad, sexo y sus interacciones con cada FRP. Todas las asociaciones de los 14 FRP evaluados fueron significativas (p<,001). De los efectos observados, 3,0% se consideraron efectos muy pequeños (0,70 ≤ OR ≤ 1,43), 51,7% pequeños (0,70 ≥ OR ≥ 1,43), 42,6% medianos (0,40 ≥ OR ≥ 2,48) y 7,1% grandes (0,23 ≥ OR ≥ 4,27). Se encontraron asociaciones significativas para edad, sexo y sus interacciones con los FRP para la mayoría de FRP. Los hallazgos demuestran la validez de los FRP estudiados para la planificación, el desarrollo y la evaluación futura de sistemas preventivos comunitarios como CQC, los cuales se basan en datos epidemiológicos para la toma de decisiones locales.
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Conducta del Adolescente , Consumo de Bebidas Alcohólicas/epidemiología , Fumar Cigarrillos/epidemiología , Factores Protectores , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Colombia/epidemiología , Estudios Transversales , Femenino , Humanos , Drogas Ilícitas , Masculino , Uso de la Marihuana/epidemiología , Factores de Riesgo , Instituciones Académicas , Trastornos Relacionados con Sustancias/prevención & control , Encuestas y CuestionariosRESUMEN
The growing use of evidence-based preventive interventions for youth substance use in Latin American countries has prompted governments, researchers, and practitioners to ask if communities are ready for implementing these interventions, especially in light of the elevated costs and long-term commitment necessary for successful implementation. This study explores the construct validity of a measure of community readiness for prevention, using confirmatory factor and latent profile analyses of 7 measures theorized to be indicators of community readiness for implementing preventive interventions for youth substance use. Data were obtained from 211 community leaders in 16 communities in Colombia. Results indicate that community readiness can be represented as a unidimensional construct with multiple profiles of varying levels of readiness. Findings suggest community readiness can be measured adequately as a latent construct and that its indicators can be used diagnostically to assess areas where readiness could be improved for better implementation of evidence-based preventive interventions.
RESUMEN
Resumen El consumo de alcohol en adolescentes tiene una serie de consecuencias negativas desde el punto de vista de salud, comportamiento y riesgo de consumo problemático a edades tempranas. En este estudio, se aplicó un instrumento de 24 preguntas a 9348 estudiantes de ambos sexos en nueve ciudades de Colombia, de los cuales 7625 fueron incluidos en este análisis por haber consumido alcohol. Específicamente, se exploraron temas como la edad de inicio de consumo, el tipo de alcohol y las cantidades ingeridas, así como los sitios y la facilidad de adquisición, la presencia de adultos, el consumo en el colegio y las actitudes frente a las restricciones legales, entre otros. Se hizo un análisis de correspondencias múltiples que determinó inicialmente tres factores que fueron después clasificados en dos grupos y, por último, en cuatro subgrupos en función de cuatro categorías de consumo: experimental, selectivo, regular y alto, que representan dos grandes grupos: bajo y alto consumo. De este análisis surgieron perfiles bastante claros que muestran diferencias importantes, especialmente entre dos grupos: los de bajo consumo, que son los más jóvenes, no toman solos, no han estado en fiestas con alcohol, nunca toman en el colegio ni durante varios días seguidos; y los de alto consumo, que son un poco mayores, cuando toman se emborrachan, tienden a tomar todas las semanas, han tomado en el colegio y antes de entrar por las mañanas, se han metido en problemas por tomar y rechazan las restricciones a los menores de edad o que se sancione a quienes les venden.
Resumo O consumo de álcool em adolescentes tem uma série de consequências negativas desde o ponto de vista da saúde, do comportamento e do risco de consumo problemático em idades precoces. Neste estudo, aplicou-se um instrumento de 24 perguntas e 9348 estudantes de ambos os sexos em nove cidades da Colômbia, dos quais 7625 foram incluídos nesta análise por terem consumido álcool. Especificamente, foram explorados temas como a idade inicial de consumo, o tipo de álcool e as quantidades ingeridas, assim como os lugares e a facilidade de aquisição, a presença de adultos, o consumo no colégio e as atitudes frente às restrições legais, entre outros. Foi realizada uma análise de correspondências múltiplas que determinou inicialmente três fatores que depois foram desclassificados em dois grupos e, por último, em quatro subgrupos em função de quatro categorias de consumo: experimental, seletivo, regular e alto, que representam dois grandes grupos: baixo e alto consumo. A partir dessa análise, surgiram perfis bastante claros que mostram diferenças importantes, especialmente entre dois grupos: os de baixo consumo, que são os mais jovens, não bebem sozinhos, não estiveram em festas com bebidas alcoólicas, nunca bebem no colégio nem durante vários dias consecutivos; e os de alto consumo, que são um pouco mais velhos, embriagam-se quando bebem, tendem a beber semanalmente, já beberam no colégio e antes de ir para a aula de manhã, já se meteram em problemas por beber e se opõem às restrições aos menores de idade ou às sanções àqueles que vendem para menores.
Abstract Alcohol abuse in adolescents has several negative consequences on health, behavior and risk of becoming involved in problematic consumption at early ages. In this study a 24-item questionnaire was answered by 9,348 school adolescents of both sexes in nine Colombian cities. 7,625 students were included in this analysis due to their consumption of alcohol. The questions inquired about age of first intake, kind and amounts of alcohol consumed on each occasion, places and availability, presence of adults, alcohol use at school and attitudes toward legal restrictions, among others. A multiple correspondence analysis was carried out, generating four factors which were condensed later into two groups, and finally in four sub-groups based on categories of alcohol use: experimental, selective, regular and high, representing two categories: low and high use. The analysis produced identifiable profiles, quite different especially for two categories: the 'low consumption' group, that is younger, never drinks alone, does not attend parties where alcohol is offered to minors, has never drunk at school or during several days. In the 'high consumption' group are those over 16 years of age, who generally get drunk when they drink, have taken alcohol while at school and before arriving to school, have been in trouble because of alcohol and consider as inappropriate the legal restrictions to minors and the sanctions imposed to adults who sell or offer alcohol to minors.