Fernando A. Wagner

The association of tobacco smoking and depression in adolescence: Evidence from the United States

Introduction. We examine a suspected causal association between tobacco smoking and depression. Using data from the National Household Survey on Drug Abuse (NHSDA), we explore variation in depression severity among current and former smokers compared to nonsmokers. We focus on the association between time since last smoke in former smokers and depression severity, to examine whether the level of tobacco–depression relationship might vary in a time-dependent fashion. Methods. Our cross-sectional data come from three public use files of the U.S. National Household Survey on Drug Abuse (NHSDA), collected with different respondents each year from 1994 to 1996, for participants 12–17 years old (N = 13,827). Ordinal logistic regression is used to assess the association between severity of depression and cigarette smoking among former and current smokers. Results. Current smokers had the highest odds for depression, followed by former smokers, then nonsmokers. Females had higher odds of depression compared to males. The odds of depression varied in subgroups of former smokers. Odds of depression were lower with more elapsed time since last smoke. Discussion. We add new evidence on depression in association with tobacco smoking. Teens who quit smoking may reduce their odds of depressed mood, but more research is needed before a definite causal path can be established.

Inicio en el consumo de alcohol y tabaco y transición a otras drogas en estudiantes de Morelos, México

OBJETIVO: Estimar la probabilidad acumulada de ocurrencia del primer uso de alcohol y tabaco, y el riesgo de transitar hacia el uso inicial de otras sustancias (marihuana, cocaina y heroina, entre otras) en estudiantes adolescentes y adultos jovenes de Morelos, Mexico. MATERIAL Y METODOS: Se llevo a cabo un estudio transversal en el ciclo escolar 1998-1999, en el estado de Morelos, en una muestra probabilistica de estudiantes de entre 11 a 24 anos de edad (n=13 293) a quienes se distribuyo un cuestionario auto-aplicable validado. Los datos se restructuraron para construir una cohorte sintetica que se estudio con metodos de sobrevida y unidades discretas de tiempo. Se obtuvieron riesgos relativos y sus intervalos de confianza de 95%, con modelos multivariados de regresion de Cox. RESULTADOS: Sesenta por ciento de los varones iniciaron el uso de alcohol en promedio a los 17 y el uso de tabaco a los 18 anos de edad. Las mujeres iniciaron el uso de alcohol y tabaco un ano despues que los hombres. El uso de otras drogas ocurrio a los 19 anos de edad en promedio en 5% de las mujeres y 13% de los varones. Nueve de cada 100 estudiantes que consumieron drogas ilegales iniciaron directamente sin antes haber usado alcohol ni tabaco. En general, los estudiantes usuarios de alcohol o tabaco, o ambos, presentaron mayor riesgo de iniciar el uso de otras drogas que los no usuarios (RR=6.72; IC 95%=4.13-10.93). CONCLUSIONES: Son claras las implicaciones potenciales del presente estudio al considerar que, junto con intervenciones encaminadas a disminuir el consumo de drogas, resulta igualmente importante retardar la edad de inicio de alcohol y tabaco por sexo, ya que mediante un nuevo enfoque brinda evidencia epidemiologica que relaciona el uso de estas sustancias con el uso posterior de otras drogas en estudiantes mexicanos.

Opportunities to use drugs and stages of drug involvement outside the United States: Evidence from the Republic of Chile

BACKGROUND Studying youthful drug involvement in the Republic of Chile, we sought to replicate North American research findings about the earliest stages of drug involvement (e.g., initial opportunities to use tobacco and alcohol, and transitions leading toward illegal drug use). METHODS A nationally representative multistage probability sample of middle and high school students was drawn; 30,490 youths completed surveys that assessed age at first drug exposure opportunities and first actual drug use. Cox discrete-time survival models accommodate the complex sample design and provide transition probability estimates. RESULTS An estimated 39% of the students had an opportunity to use cannabis, and 70% of these transitioned to actual cannabis use. The probability of cannabis use and the conditional probability of cannabis use (given opportunity) are greater for users of alcohol only, tobacco only, and alcohol plus tobacco, as compared to non-users of alcohol and tobacco. Male-female differences in cannabis use were traced back to male-female differences in drug exposure opportunities. CONCLUSION In Chile as in North America, when cannabis use follows alcohol and tobacco use, the mechanism may be understood in two parts: users of alcohol and tobacco are more likely to have opportunities to try cannabis, and once the opportunity occurs, they are more likely to use cannabis. Male-female differences do not seem to be operative within the mechanism that governs transition to use, once the chance to use cannabis has occurred.

Aplicación de la Escala de Depresión del Center of Epidemiological Studies en adolescentes de la Ciudad de México

Objective. To assess the internal consistency, as well as the construct, concurrent and external consistency of the Center for Epidemiologic Studies Depression Scale (CESD-R) in Mexican adolescents. Material and Methods. The data are from two samples of middle-school students from Mexico City. The questionnaire included the CES-D-R and other scales for suicide problems, peer and family violence, and drug use. Results. The sample included 1 549 students (mean age 14 years, SD=1.2). The CES-D-R showed a sixfactor structure (explained variance, 55%) with an excellent internal consistency ( α=0.93), a significant discriminative power for opposite scores (z=-3.695, p<0.001), and a positive significant correlation with the Roberts Suicidal Ideation Scale (r=0.685, p<0.001). Conclusions. The CES-D-R has excellent psychometric characteristics for Mexican adolescents and therefore is deemed as an adequate tool for the assessment of depressive symptoms in large samples to detect mental health needs and design preventive interventions.

Childhood predictors of first chance to use and use of cannabis by young adulthood

AIMS To prospectively examine the linkage between childhood antecedents and progression to early cannabis involvement as manifest in first chance to try it and then first onset of cannabis use. METHODS Two consecutive cohorts of children entering first grade of a public school system of a large mid-Atlantic city in the mid 1980s (n=2311) were assessed (mean age 6.5 years) and then followed into young adulthood (15 years later, mean age 21) when first chance to try and first use were assessed for 75% (n=1698) of the original sample. Assessments obtained at school included standardized readiness scores (reading; math) and teacher ratings of behavioral problems. Regression and time to event models included covariates for sex, race, and family disadvantage. RESULTS Early classroom misconduct, better reading readiness, and better math readiness predicted either occurrence or timing of first chance to try cannabis, first use, or both. Higher levels of childhood concentration problems and lower social connectedness were not predictive. CONCLUSIONS Childhood school readiness and behavioral problems may influence the risk for cannabis smoking indirectly via an increased likelihood of first chance to use. Prevention efforts that seek to shield youths from having a chance to try cannabis might benefit from attention to early predictive behavioral and school readiness characteristics. When a youths chance to try cannabis is discovered, there are new windows of opportunity for prevention and intervention.

Late-life depressive symptoms: Prediction models of change

BACKGROUND Depression is a well-recognised problem in the elderly. The aim of this study was to determine the factors associated with predictors of change in depressive symptoms, both in subjects with and without baseline significant depressive symptoms. METHODS Longitudinal study of community-dwelling elderly people (>60 years or older), baseline evaluations, and two additional evaluations were reported. Depressive symptoms were measured using a 30-item geriatric depression scale, and a score of 11 was used as cut-off point for significant depressive symptoms in order to stratify the analyses in two groups: with significant depressive symptoms and without significant depressive symptoms. Sociodemographic data, social support, anxiety, cognition, positive affect, control locus, activities of daily living, recent traumatic life events, physical activity, comorbidities, and quality of life were evaluated. Multi-level generalised estimating equation model was used to assess the impact on the trajectory of depressive symptoms. RESULTS A number of 7882 subjects were assessed, with 29.42% attrition. At baseline assessment, mean age was 70.96 years, 61.15% were women. Trajectories of depressive symptoms had a decreasing trend. Stronger associations in those with significant depressive symptoms, were social support (OR.971, p<.001), chronic pain (OR 2.277, p<.001) and higher locus of control (OR.581, p<.001). In contrast for those without baseline significant depressive symptoms anxiety and a higher locus of control were the strongest associations. CONCLUSIONS New insights into late-life depression are provided, with special emphasis in differentiated factors influencing the trajectory when stratifying regarding basal status of significant depressive symptoms. LIMITATIONS The study has not included clinical evaluations and nutritional assessments.

Depressed mood and the effect of two universal first grade preventive interventions on survival to the first tobacco cigarette smoked among urban youth

INTRODUCTION As part of an evaluation of two first-grade, universal preventive interventions whose proximal targets were early learning and behavior, we investigated the influence of depressed mood, the interventions, and their interaction on survival to the first tobacco cigarette smoked through age 19. One intervention focused on improving teacher behavior management and instructional skills (Classroom-Centered, CC) as a means of improving student behavior and learning and the other on the family-school partnership (FSP). Variation in the relationship between depressed mood and first cigarette smoked by gender and grade was also examined. METHODS Self-reports of smoking behavior and depressed mood were collected on an annual basis from grade 6 through age 19. The present analyses were restricted to the 563 youth who had never smoked by grade 6, or 83% of the original sample of first grade participants. Discrete-time survival analysis was used to examine the effects of depressed mood and the interventions on survival to the first tobacco cigarette smoked. RESULTS Depressed mood was associated with reduced survival time to the first cigarette smoked (adjusted hazard ratio, aHR: 1.4; 95% CI: 1.1-1.9), whereas the CC intervention prolonged survival time (aHR: 0.8; 95% CI: 0.7-0.9). No significant variation in the effect of depressed mood on survival was found by gender or grade, nor was the effect of the CC intervention moderated by depressed mood. CONCLUSIONS Strategies to prevent tobacco cigarette smoking should include both a focus on depressed mood in adolescence as well as on early success in elementary school.

Drug Use and High-Risk Sexual Behaviors Among African American Men Who Have Sex With Men and Men Who Have Sex With Women

OBJECTIVES We investigated covariates related to risky sexual behaviors among young African American men enrolled at historically Black colleges and universities (HBCUs). METHODS Analyses were based on data gathered from 1837 male freshmen enrolled at 34 HBCUs who participated in the 2001 HBCU Substance Use Survey. The covariates of risky sexual behavior assessed included condom nonuse, engaging in sexual activity with multiple partners, and history of a sexually transmitted disease. RESULTS Young Black men who had sex with men were more likely to engage in risky sexual behaviors than were young men who had sex with women. Two additional factors, early onset of sexual activity and consumption of alcohol or drugs before sexual activity, were independently associated with modestly higher odds of sexual risk behaviors. CONCLUSIONS Services focusing on prevention of sexually transmitted diseases should be provided to all male college students, regardless of the gender of their sexual partners. Such a general approach should also address drug and alcohol use before sexual activity.

Usefulness of two instruments in assessing depression among elderly Mexicans in population studies and for primary care

OBJECTIVE To determine the psychometric qualities of the CES-DR and GDS scales in the elderly and compare them to clinical psychiatric diagnoses. MATERIAL AND METHODS The first phase consisted of home interviews for determining the psychometric qualities of the GDS and CES-DR scales. In the second phase, psychiatrists conducted diagnostic interviews. The sample consisted of 534 participants older than 60 years of age insured by the Mexican Institute of Social Security. RESULTS First phase: Cronbachs alpha for the GDS was 0.87 and 0.86 for CES-DR. The GDS factorial analysis found eight factors that could explain 53.5% of the total variance and nine factors that explained 57.9% in the CES-DR. Second phase: Compared to the psychiatric diagnoses, CES-DR reported a sensitivity of 82% and a specificity of 49.2%; GDS reported 53.8% sensitivity and 78.9% specificity. CONCLUSIONS CES-DR and GDS scales have high reliability and adequate validity but the CES-DR reports higher sensitivity.

Social cohesion, cultural identity, and drug use in Mexican rural communities.

The objective of this study was to explore drug use in Mexican rural communities and its relationship to social cohesion, cultural identity, migration, and transculturation. Community models typification was used, considering cohesion as the central point of analysis. The research was conducted during 15-day periods in each of nine communities during 1991. Both documentary and ethnographic techniques were used to gather information. Results indicated that rural communities where there was little or no drug use among its members show more social cohesion, cultural identity, and community links consolidation, and more capacity for integrating change. This pattern is most apparent among young community members who have had more contact with the outer world (drug trafficking, North American culture, and Mexican urban culture). [Translations are provided in the International Abstracts Section of this issue.]