Resumen de Prevalencia del consumo riesgoso y dañino de alcohol y factores de riesgo en estudiantes universitarios de primer ingreso
Alejandro Díaz Martínez, Leonila Rosa Díaz Martínez, Carlos A. Hernández Avila, José Narro Robles, Héctor Fernández Varela Mejía
- español
Antecedentes En México, el alcohol es la sustancia potencialmente adictiva que se utiliza con mayor frecuencia por los adultos jóvenes. Información proveniente de la Encuesta Nacional de Adicciones más reciente muestra que más de 50% de los jóvenes entre los 18–29 años ha consumido bebidas alcohólicas al menos una vez durante el último mes. En la Ciudad de México se ha encontrado que más de la mitad de las mujeres y cerca de dos terceras partes de los hombres entre 18–29 años de edad consume regularmente bebidas alcohólicas. Durante los últimos años, el consumo de bebidas alcohólicas se ha venido incrementando importantemente entre los jóvenes mexicanos de ambos sexos en edad de recibir una educación superior. A nivel internacional, la bibliografía sugiere que la población estudiantil de los centros de educación superior es un grupo de mayor riesgo para el desarrollo de problemas por consumo de alcohol. En México, aunque se desconoce si los estudiantes de educación superior son un grupo de mayor riesgo para estos abusos, algunas encuestas y reportes sugieren que los problemas por consumo de alcohol tienen una importancia creciente. En cuanto al consumo de alcohol que excede los niveles seguros para la salud (≥2 bebidas estándar al día en las mujeres o ≥3 bebidas estándar al día en los hombres), el Observatorio Mexicano del Alcohol y Drogas describió que en el año 2002 el consumo de cinco o más copas por ocasión de consumo afecta a tres de cinco hombres y a una de cinco mujeres. Aunque problemas metodológicos y sesgos de selección potenciales en estas encuestas dificultan su interpretación, sus resultados sugieren que el consumo de alcohol, particularmente el consumo riesgoso y potencialmente dañino, es común entre los estudiantes universitarios de la Ciudad de México.
El consumo riesgoso y dañino de alcohol (CRDA) se sitúa en un continuum de severidad y se define como un patrón de consumo de bebidas embriagantes que colocan al sujeto en riesgo de desarrollar problemas de salud y/o que desemboca en francas complicaciones físicas y/o psicológicas (accidentes, victimización, violencia, dependencia al alcohol, cirrosis hepática, etc.). De acuerdo a los reportes de la bibliografía internacional, este es el primer estudio publicado sobre la prevalencia de consumo peligroso y dañino de alcohol en estudiantes universitarios en América Latina.
Objetivo En el trabajo que se presenta aquí, que forma parte del proyecto para la Identificación Temprana y Tratamiento Oportuno de bebedores con Consumo Excesivo de Alcohol en Estudiantes Universitarios de la UNAM, nos propusimos evaluar la prevalencia del CRDA durante el último año y examinar los factores de riesgo y protección respectivos en estudiantes de primer ingreso a la licenciatura de la Universidad Nacional Autónoma de México. De manera especifica, nos propusimos: 1) estimar la prevalencia del CRDA durante el último año en los estudiantes de primer ingreso a la licenciatura de la UNAM, y 2) evaluar en esta población la influencia de las variables sociodemográficas y familiares en el riesgo para el CRDA.
Material y métodos Se trató de un estudio transversal en el que se estudiaron 24921 estudiantes del primer año de la licenciatura de la UNAM (edad=18.7±4.3 años; 55% mujeres). Para detectar aquellos estudiantes que en el último año incurrieron en el CRDA, se utilizó el instrumento de tamizaje Alcohol Use Disorder Identification Test (AUDIT). Se utilizó la regresión logística multinomial para examinar los efectos de las variables demográficas y sociofamiliares, así como para calcular Odds Ratios (OR) y sus respectivos intervalos de confianza al 95%. Este instrumento consiste de 10 preguntas que exploran la frecuencia e intensidad del consumo de bebidas alcohólicas. Con el objetivo de poder comparar nuestros hallazgos con los de otros investigadores, se examinaron y se reportan separadamente las prevalencias del CRDA con base en puntos de corte de 8 y de 6 en el AUDIT. Para el reporte de datos demográficos y puntajes del AUDIT, se utilizaron porcentajes, promedios y desviaciones estándar. Se emplearon las pruebas de contraste de medias (análisis de varianza) y de proporciones (χ2) dependiendo de la naturaleza de cada variable. Se calcularon las prevalencias del CRDA con sus respectivos intervalos de confianza al 95%.
Resultados Usando un puntaje de corte en el AUDIT de ocho y de seis puntos, la prevalencia del CRDA durante el último año fue respectivamente de 11.1% y de 18.4%. Esta fue mayor en los hombres (AUDIT≥8: 17.3%; AUDIT≥6: 27.4%) que en las mujeres (AUDIT≥8: 6.2%; AUDIT≥6: 11.3%). Además del sexo masculino, aquellos estudiantes que trabajaban y que reportaron un mayor ingreso familiar mensual, tuvieron un mayor riesgo de experimentar el CRDA. En las mujeres, pero no en los hombres, un mayor nivel educativo tanto en el padre como en la madre también se relacionó con un incremento en el CRDA. Contrariamente, una mayor edad y el ser casado se asoció con una reducción en el riesgo del CRDA.
Conclusiones El CRDA entre los estudiantes de nuevo ingreso a la licenciatura de la UNAM es un problema frecuente que al parecer se relaciona con variables que facilitarían la disponibilidad y el acceso a bebidas alcohólicas y la exposición a actividades de alto riesgo para el consumo. Estos hallazgos tienen implicaciones directas en el diseño de intervenciones enfocadas a la prevención y tratamiento del CRDA en la población estudiantil universitaria de nuestro país.
Para lograr lo anterior se estudió a una muestra mayoritaria de los estudiantes de primer ingreso a la licenciatura en los nueve campus que comprende el sistema de escuelas y facultades de la UNAM ubicadas en el área metropolitana de la Ciudad de México.
- English
Background In Mexico, alcohol is the most widely used substance among young adults. Alcohol consumption in this age group contributes importantly to the most frequent causes of mortality and morbidity (e.g., accidents, violence, homicides, suicide and risky behaviors).
Around the world, college or university attendance has emerged in the literature as a risk factor for drinking problems among young adults. In Mexico, data from the most recent National Survey on Addictions showed that lifetime and current drinking is experienced by more than half of the Mexicans attending college education. Despite this, in our country there is a paucity of epidemiological studies examining drinking behavior and correlates among those attending college. Findings in non–representative samples of students attending public and private universities in Mexico City suggest that, during the last two decades, there has been an increase in the frequency of lifetime and current drinking in this population. Additionally, these studies have shown that, in comparison to young adults of the same age in the general population, university students may experience a greater prevalence of lifetime and current alcohol drinking.
Regarding the frequency of unhealthy drinking among Mexican college students, to our knowledge there are no prevalence estimates of hazardous or harmful drinking published. However, observations in non–random samples of university students in Mexico City suggested that at least one in three men and one in five women incurred in unhealthy drinking (e.g., ≥ 5 drinks per occasion or drinking to intoxication) at least once during the last month. Hazardous and harmful drinking is respectively defined by a pattern of alcohol consumption conferring a greater risk for health problems or that is 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 hazardous and harmful drinking. Although the AUDIT was initially validated among older 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 college students in many countries around the world.
Given the public health implications of estimating the frequency of hazardous and harmful drinking among college students in Mexico, and given the importance of elucidating the variables influencing this problem, we decided to conduct the present study. To our knowledge, this is the first report published in the international literature on the prevalence of hazardous and harmful drinking among college students in a Latin American country.
Objective In the analysis described here, derived from the project entitled Early Identification and Treatment of Problem Drinkers at the National Autonomous University of Mexico (UNAM), our aim was to examine the frequency and risk factors for hazardous and harmful drinking among Mexican university students. More specifically, our objectives were: 1. To determine the past–year prevalence of hazardous and harmful drinking among UNAM college freshmen; and 2. To examine in this population the effects of demographic and family variables on the likelihood of hazardous and harmful drinking.
Subjects and methods This study was a cross–sectional survey that was conducted at the beginning of the school year during the registration period between September 1st and September 30th, 2005. In 2005, a total of 34 000 students were accepted to initiate college at the nine UNAM college campuses located in the Mexico City metropolitan area. Of these, 24 921 (73.3%) students (age=18.7±4.3 years; 55.7% women) consented in answering the survey and provided complete data. Consequently, 9 079 students (26.7%) were excluded from the analysis due to lack of consent, incomplete data or due to their absence at the time of registration.
We used the Alcohol Use Disorders Identification Test (AUDIT) to examine past–year prevalence of hazardous and harmful drinking. 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 greater indicates the presence of hazardous and harmful drinking. It has been described, however, that among college students, an AUDIT score of 6 points or greater reliably identifies those students experiencing this problem.
In the analysis presented here, we separately examined and reported the prevalence estimates and correlates of hazardous and harmful drinking using both AUDIT cut–off scores (≥ 6 and ≥ 8).
The AUDIT was administered at the same time as a wellness screening survey that the UNAM Medical Services routinely administer to all registering freshmen at the beginning of the school year. Questions in the wellness survey pertained students' medical and dental health, family medical history, immunizations, 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 hazardous and harmful drinking and their respective 95% confidence intervals [95% CI] in the total of the sample, and separately by age group, gender, marital and working status, monthly family income group, 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, multinomial logistic regression was used to examine the relationship between hazardous and harmful drinking and the demographic and socioeconomic variables listed above. These were entered simultaneously into the logistic regression equation. In order to summarize the level of risk of hazardous and harmful drinking 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 university freshmen examined here, when an AUDIT cutoff score of ≥ 8 was used, the prevalence of hazardous and harmful drinking was 11.1%. When an AUDIT score of ≥ 6 was considered, a frequency of 18.4% was then observed. Men (AUDIT ≥ 8: 17.3%; AUDIT ≥ 6: 27.4%) experienced this problem more frequently than women (AUDIT ≥ 8: 6.2%; AUDIT ≥ 6: 11.3%). The greater prevalence of hazardous and harmful drinking among men was observed in all age groups and regardless of working or marital status, family income, parental education or regardless of the persons with whom the student reported to reside. Controlling for demographic and socioeconomic differences between men and women, we found that the risk of experiencing hazardous and harmful drinking among men was almost three times greater than in women (OR's [95% CI]: AUDIT ≥ 8 or ≥ 6 respectively: 2.9[2.7–3.3] or 2.8[2.6–3.0]).
In both, men and women, the greatest frequency of hazardous and harmful drinking occurred among those 20 to 25 years of age. Older students showed a gradual reduction in the prevalence of this problem; with those who were 29 years old or older experiencing the lowest risk of being affected.
Among those students who reported to work, there was a greater frequency and increased risk of hazardous and harmful drinking. Furthermore, this risk increased with the number of reported weekly working hours. This last effect was seen unequivocally only in men, with the greatest likelihood of hazardous and harmful drinking being observed among the group of male students weekly working 32 hours or longer.
Also, a higher monthly family income was associated with a greater chance of hazardous and harmful drinking. Men in the highest family income group (10 or more minimum salaries) experienced the greatest risk for this problem. Among women, however, this effect was only observed when an AUDIT cut–off score of six or greater was used to screen for hazardous and harmful drinking.
Although we did not find any effects of the number of years of parental education on the probability of drinking problems in male students, among women, there was a greater risk of hazardous and harmful drinking among students having a father with a greater number of years of education (≥ 12 years). Similarly, among female students, a greater number of years of education in the mother (≥ 12 years) also increased the chance of being affected by hazardous and harmful drinking.
Regarding variables that conferred a reduction in the prevalence and in the risk of hazardous and harmful drinking, we observed that those students who were married experienced a reduction in the likelihood of this problem.
Finally, in our sample, there were no effects on the probability of hazardous and harmful drinking from variables reflecting whether the students lived with their family, with peers or alone.
Conclusions Hazardous and harmful drinking is a frequent problem among Mexican university freshmen. Variables associated with an increased risk of this problem may exert their effects by facilitating availability and access to alcoholic beverages, and facilitating exposure to high–risk activities for alcohol consumption. These findings have direct implications in designing preventive and treatment interventions in the larger population of college and university students in Mexico.
