Epidemiology of solvent abuse MEXICO

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 Epidemiology of solvent abuse MEXICO
Maria Elena Medina-Mora, Jorge Villatoro
Gutiérrez R Vega, L. National Institute on
Psychiatry
Ricardo Sanchez Huesca Centros de Integración
Juvenil CIJ
Patricia Cravioto SISVEA General Direction of
Epidemiology, SS,
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Sources of information
1998 3rd
1993 2nd
2002 4rd
1988 1st
1970-1980 First household Surveys (selected
cities)
National Household Surveys
WHO NATIONAL HOUSEHOLD SURVEY ON PSCHIATRY
EPIDEMIOLOGY 2002
Information Systems CIJ/SRID/ SISVEA 1974 1986
1990 2005
Student surveys IMP/SEP 1976-2003
Special populations 1972-2005
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Underage workers in 101 Mexican cities

• Method
• Identification of working areas (11,156
  places)
• Streets
  streets, avenues, etc.
• Public spaces markets,
  bus stops, etc.
• Places where they sleep street
  educators
• Population count and characterization
• observation and interview (N 114, 497 minors)
• Selection of a sample (n 44, 454)

6 to 17 years of age 8 in the first phase (100
cities) and 17 in Mexico City, live without
parental figures 72 to 61 males
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Typologies of users

• Children and adolescents that experiment with
  drugs
• Poly drug users that include inhalants,
  frequently as the drug if first use.
• Minors whos drug of preference is inhalants who
  inhale every day with periods of abstinence
• These groups usually stop using solvents
  upon entering adulthood.
• Workers exposed to solvents some of whom become
  dependent and inhale for intoxication
• Other adults that continue using, these group
  shows a high degree of deterioration

Source Villatoro et al., 2004, 2005 Gutierrez
Vega, 2000 Stern et al., 1990 Medina.-Mora et
al., 1998,
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Substances used

• Traffic of Toluene 98 pure, in the same places
  where cocaine is sold

Variety of substances
Preferred substance Toluene greater effects
and less hangover
One finishes with one self in a few years
One finishes with one self in a few
months

• Glue Toluene
• chemo activo

Consciousness of differential effects
(Ortiz Galván, 1998 Gutierrez Vega, 1998,
2005
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National household surveys
Urban population 12 to 65 years Rates of ever use
1988
1993
1998
2002
URBAN
RURAL
Marihuana 2.99 3.32 4.70
3.87 2.28 Inhalants 0.76
0.50 0.80 0.53
0.20 Hallucinogens 0.26 0.22 0.36
0.29 0.14 Cocaine 0.33 0.56
1.45 1.44 0.57 Any drug
3.33 3.90 5.27 5.57 3.34
Source SSA, CONADIC, DGE, INP
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Drug use among patients entering for the first
time to treatment CIJ
90
80
70
60
50

40
30
20
10
0
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
Marijuana
Inhalants
Cocaine
Depressives med. use
Heroin
Methamphetamine
CIJ, 1990-2001
Hallucinogens
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MAIN DRUGS OF ABUSE AMONG PATIENTS IN TREATMENT
CIJ 2003
N 20,179
Fuente Consumo de drogas entre pacientes que
ingresaron a tratamiento en Centros de
Integración Juvenil en 2003. Dirección de
Investigación y Enseñanza.
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Rates of drug use - Mexico City (12-17 years of
age)

HOSE-HOLD SURVEY
Inhalants Marihuana Cocaine
1.08 2.47 0.99
0.20 0.45 0.22
STREET WORKERS
House Street
House Street
Inhalants Marihuana Cocaine
3.9 73.6 2.0 35.8 1.6
18.9
2.4 69.6 1.0 30.4
1.0 17.4
DIF-DF/UNICEF
SSA,IMP ENA 1 998
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Age of first use

from total users of each drug
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STRUCTURAL EQUATION MODEL FOR MINORS THAT WORK IN
THE STREETS
Boys and Girls Between 6 and 17 Years of Age

• Living with parental figures is correlated to
  school attendance (0.58)
• School enrolment is a protective factor for
• Working in a high risk environment (-0.76)
• Drug use (-0.32)
• Early sexual intercourse (-0.73)
• Years worked (-0.47)

Medina-Mora, Robles, Villatoro, Ruz, Fleiz, 1999
DIF/UNICEF/UNDCP
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STRUCTURAL EQUATION MODEL FOR MINORS THAT WORK IN
THE STREETS GENDER DIFERENCES 12 -17 YEARS OF
AGE
School enrolment
Living in a house with 1 or 2
Parents reduce the risk of working in a
dangerous

environment The place of work is
an important factor for drug abuse And for
sexual abuse Problems with the police increase
with The use of drugs - The
working place
Medina-Mora, Robles, Villatoro, Ruz, Fleiz, 1999
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Impact Inhalant abusers vs. non users High
school students (n7,874)

• Social maladjustment 1.28 (1.00-1.64)
• Stress 1.22 (1.03-1.45)
• Suicidality 1.17 (1.06-1.29)
• Sexual abuse 1.83
  (1.21-2.75)
• Antisocial behavior 2.25 (1.66-3.06)
• (severe)

Logistic regression models
Villatoro, Medina-Mora et al., 2005
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Inhalant abusers vs. users of other drugs
Impact Inhalant abusers vs. non users

• Friends use 2.91 (2.28-3.71)
• Family members use 2.22 (1.66-2.98)

• Attending secondary school 1.87 (1.40-2.49)
• Parents have lower school status 1.38
  (1.22-1.56)
• Lower perception of risk 2.22 (1.63-3.03)
• More antisocial behavior
• Low severity 1.63
  (1.18-2.24)
• High severity
  1.79 (1.26-2.54)

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Pregnancy and exposure to solvents
Girls are exposed to violence sexual abuse in
their families of origin and in the streets They
inhale more frequently by themselves or get
involve with one partner to avoid being sexually
used Have little information about their
reproductive health and pregnancy and infectious
risks. Females inhale while pregnant Babies are
exposed since birth when parents and others
inhale in close environments
Gutierrez y Vega, 1998
Matlapa, 2005
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Implications for policy, prevention and treatment

• Efforts to control availability for minors
• Programs established to protect these children
  require support for the treatment of health
  conditions including mental disorders, cognitive
  impairment and substance dependence.
• Support for street educators is also required
• Widen scope of specialized treatment programs to
  include vulnerable populations

• Support research aimed at developing and testing
  intervention models tailored to the needs of
  vulnerable populations evaluation of programs

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Problems reported research needs

• Mortality and Morbidity
• Lack vaccination schemes
• Malnourished
• Sleep in unsafe conditions
• Exposed to violence and accidents related to
  their work
• Exposed to violence and accidents while
  intoxicated
• Pregnancy, fetal exposure and during the
  perinatal period
• Cognitive impairment
• Distorted sleep cycles

Life styles, exposure to solvents, individual
vulnerabilities
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NATIONAL INSTITUTE OF PSYCHIATRYInformation
Center on Mental Health and Addictions

• 56552811 or 56552816, ext. 196 and 157
• cisma_at_imp.edu.mx
• www.inprfm.org.mx