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Objective: The purpose of this study was to identify priority variables to evaluate alcohol brief interventions from the perspective of experts in the field in Latin America.Method: A two-round Delphi procedure was carried out through online surveys of 465 individuals from 18 Latin American countries, including core outcome set developers, researchers, health professionals, users of healthcare services, journal editors, members of nongovernmental organizations, and policymakers. The questionnaire, in Spanish and Portuguese, rated 101 variables according to their relevance to the efficacy and effectiveness of brief interventions.Results: Round 1 yielded 47 variables that met the consensus criterion of at least 70% of participants; Round 2 yielded 63 variables. To reduce the possible effect of varying levels of expertise, data were analyzed by subgroup, with consensus defined as 70% of each subgroup rating a variable as critical. Seventeen outcome variables met this criterion, 14 from the initial set and 3 suggested by the participants in Round 1.Conclusions: Only four outcomes coincide with the findings of a similar international Delphi study that underrepresented Latin American countries. The findings point to the importance of including a wider variety of professionals and cultural backgrounds in international consensus panels to minimize the risk of predominance of a single perspective. [ABSTRACT FROM AUTHOR]

There have been few qualitative approaches to the study of substance use treatment, despite the potential for such studies to provide researchers and clinicians with information that reflects the actual experience of substance users. This study focused on the main themes associated with the perceived advantages and disadvantages of continuing or discontinuing substance use by 74 substance users with comorbid depressive symptoms, prior to entering a brief cognitive-behavioral intervention in Mexico City. Through pile sorting, a structured inductive qualitative method, nine themes were identified as a result of a decisional balance measure: (1) mental health and emotional well-being, (2) beliefs and expectations about substances, (3) physical health, (4) family relationships, (5) social relationships, (6) daily life functioning, (7) finances, (8) sexuality, and (9) functioning in the workplace. The most common themes were "mental health and emotional well-being" and "beliefs and expectations about substances." The least common were "family relationships," "sexuality," and "functioning in the workplace." Our results suggest areas to be addressed in prevention and intervention programs. [ABSTRACT FROM AUTHOR]

Background: Web-based cognitive-behavioral interventions to reduce substance use can be a useful low-cost treatment for a large number of people, and an attractive option in countries where a greater availability of treatment is needed. Objective: To evaluate the feasibility and initial effectiveness of a web-based cognitive-behavioral intervention for the reduction of substance use and depression compared with treatment as usual, with and without a printed self-help manual. Method: Individuals seeking outpatient treatment for substance use were randomly assigned to one of the following: (1) the web-based Help Program for Drug Abuse and Depression (n = 23); (2) an in-person session with an addiction therapist and use of the Alcohol, Smoking, and Substance Involvement Screening Test Self-Help Strategies guide, followed by treatment as usual (n = 25), or (3) treatment ordinarily offered in the participating treatment centers (n = 26). The study took place in 2013-2014 (trial registration: ISRCTN25429892), and participants completed baseline, posttreatment, and 1-month follow-up evaluation interviews. Results: Treatment retention and data availability were comparable in all three conditions. A reduction was observed from baseline to follow-up in average days of use [F(1,28) = 29.70, p < 0.001], severity of use [F(2,28) = 143.66, p < 0.001], and depressive symptomatology [F = (4)16.40, p < 0.001], independent of the type of treatment provided. Conclusions: The findings suggest that the web-based intervention to reduce substance abuse is feasible, although it is not more effective than other intervention modalities; its effectiveness must be evaluated in a larger sample. Attrition was a main limitation; future studies must improve retention and assess cost-effectiveness. [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: Given the scarcity of alcohol prevention and alcohol use disorder treatments in many low and middle‐income countries, the World Health Organization launched an e‐health portal on alcohol and health that includes a Web‐based self‐help program. This paper presents the protocol for a multicentre randomized controlled trial (RCT) to test the efficacy of the internet‐based self‐help intervention to reduce alcohol use. Design: Two‐arm randomized controlled trial (RCT) with follow‐up 6 months after randomization. Setting: Community samples in middle‐income countries. Participants: People aged 18+, with Alcohol Use Disorders Identification Test (AUDIT) scores of 8+ indicating hazardous alcohol consumption. Intervention and comparator: Offer of an internet‐based self‐help intervention, ‘Alcohol e‐Health’, compared with a ‘waiting list’ control group. The intervention, adapted from a previous program with evidence of effectiveness in a high‐income country, consists of modules to reduce or entirely stop drinking. Measurements: The primary outcome measure is change in the Alcohol Use Disorders Identification Test (AUDIT) score assessed at 6‐month follow‐up. Secondary outcomes include self‐reported the numbers of standard drinks and alcohol‐free days in a typical week during the past 6 months, and cessation of harmful or hazardous drinking (AUDIT < 8). Analysis: Data analysis will be by intention‐to‐treat, using analysis of covariance to test if program participants will experience a greater reduction in their AUDIT score than controls at follow‐up. Secondary outcomes will be analysed by (generalized) linear mixed models. Complier average causal effect and baseline observations carried forward will be used in sensitivity analyses. Comments: If the Alcohol e‐Health program is found to be effective, the potential public health impact of its expansion into countries with underdeveloped alcohol prevention and alcohol use disorder treatment systems world‐wide is considerable. [ABSTRACT FROM AUTHOR]

Objectives: This study analyses changes in drug use in Mexican junior high and high-school students and identifies differences over two decades in the social factors (availability of drugs, perceptions of risk and social tolerance) associated with such use. Method: Data from two national surveys, conducted in 1991 and 2014, were analysed. Results: Data show that the proportion of students who had tried drugs doubled in 2014. In both surveys, substance use was significantly associated with a high perception of availability and use by friends and older siblings; in 2014, there was a decrease in the perception of risk for marijuana use and an increase in social tolerance toward illegal drugs. Conclusions: It can be inferred from this analysis that public policy to prevent drug use has not had the expected impact, at least not on the social factors considered here. [ABSTRACT FROM AUTHOR]

Presents information on a study which focuses on marital violence in Mexico, and its relationship to excessive alcohol use. Characterization of alcohol-related family violence; Social factors associated with alcohol abuse and violent behavior; Examination of the pattern of alcohol consumption in Mexico; Findings of the study.

Background. Information on the way menstrual cycle phases can influence the achievement of tobacco abstinence is contradictory. Objective. A scope review was conducted to determine the effect of the menstrual cycle on tobacco abstinence, considering the phases of the cycle, hormone levels, and premenstrual syndrome. Method. A literature search was conducted in Scopus, PubMed, MEDLINE, and PsycINFO databases. Ten articles comparing the phases of the menstrual cycle or analyzing the association between premenstrual syndrome and a withdrawal condition (length of abstinence or withdrawal symptoms) were included. Results. Two main results were identified: 1) there is no difference in withdrawal symptoms and craving between menstrual cycle phases and 2) abstinence rates in the studies were higher during the luteal phase. Discussion and conclusion. The advisability of suggesting that women wishing to quit smoking should begin to do so at the start of the luteal phrase is discussed. However, smoking cessation interventions must consider all the symptoms experienced during the luteal phase. [ABSTRACT FROM AUTHOR]

Abstract Introduction Although first sexual experience (understood as first sexual intercourse) is one of the most commonly assessed characteristics of adolescents, recent research emphasizes the importance of understanding other related social factors. This study highlights factors associated with first sexual experience in a nationally representative sample of adolescent students in Mexico. Aims The goals of this study were (i) to determine the proportion of adolescents aged 12–17 who had had their first sexual experience; (ii) to identify the factors associated with first sexual experience; and (iii) to analyze the conditions (condom use, substance use) in which first sexual experience takes place. Method The data presented in this study are drawn from the 2014 National Survey on Drug Use in Students (Spanish acronym ENCODE), undertaken with the purpose of identifying the prevalence of drug use and associated variables, including sexual activity, in Mexican students. Kaplan-Meier analysis was used to estimate the probability of first sexual experience at a given age, taking sex as an outcome variable and age as a follow-up period. Logistic regression was used to assess possible factors for sexual initiation. Main Outcome Measures Validated standard questionnaires were used to assess sociodemographic characteristics, first sexual experience (framed as first sexual intercourse), frequency of sexual relations, sexual partners, sexual preference (framed as preferred sex of partners), substance use, having a physical illness or a behavioral problem, condom or other contraceptive use, as well as the absence or presence of parents, parents' educational attainment, and parents' substance use. Results A total of 26,187 students aged 12–17 participated. Of this total, 14.8% had already had their first sexual experience, at a median age of 15; 64.5% used some type of contraceptive, and 53.2% used condoms. Proportional probabilities for having first sexual experience using age as a follow-up period showed that the probability of having sex earlier was higher among boys than girls: the probability of having sex at age of 15 was 26.5% for boys and 13.9% for girls. Predictors of first sexual experience included substance use (alcohol OR = 2.5, tobacco OR = 2.6, and other drugs OR = 2.3), having a mother who used drugs (OR= 2.2), sexual preference (female homosexual, OR = 2.2), and sex (male, OR = 2.1). Conclusions Boys are more likely to have had a first sexual experience than girls. Future strategies should incorporate specifically targeted elements with different messages that consider adolescents' sex and age. Barragán V, Berenzon S, Tiburcio M, et al. Factors Associated with Sexual Debut in Mexican Adolescents: Results of the National Survey on Drug Use among Students in 2014. J Sex Med 2019;16:418–426. [ABSTRACT FROM AUTHOR]

Global alcohol consumption and harmful use of alcohol is projected to increase in the coming decades, and most of the increase will occur in low- and middle-income countries (LMICs); which calls for cost-effective measures to reduce alcohol exposure in these countries. One such evidence based measure is screening and brief intervention (BI) for alcohol problems. Some of the characteristics of BI make them a particularly appealing choice of interventions in low-resource settings. However, despite evidence of effectiveness, implementation of BI in LMICs is rare. In this paper we discuss barriers to implementation of BI in LMICs, with examples from Latin America and India. Key barriers to implementation of BI in LMICs are the lack of financial and structural resources. Specialized services for alcohol use disorders are limited or non-existent. Hence primary care is often the only possible alternative to implement BI. However, health professionals in such settings generally lack training to deal with these disorders. In our review of BI research in these countries, we find some promising results, primarily in countries from Latin America, but so far there is limited research on effectiveness. Appropriate evaluation of efficacy and effectiveness of BI is undermined by lack of generalisability and methodological limitations. No systematic and scientific efforts to explore the implementation and evaluation of BI in primary and community platforms of care have been published in India. Innovative strategies need to be deployed to overcome supply side barriers related to specialist manpower shortages in LMICs. There is a growing evidence on the effectiveness of non-specialist health workers, including lay counsellors, in delivering frontline psychological interventions for a range of disorders including alcohol use disorders in LMICs. This paper is intended to stimulate discussion among researchers, practitioners and policy-makers in LMICs because increasing access to evidence based care for alcohol use disorders in LMICs would need a concerted effort from all these stakeholders. [ABSTRACT FROM AUTHOR]

El artículo discute los resultados de una intervención realizada entre familias indígenas de México con algún miembro alcoholdependiente. Los autores analizan el rol del consumo de alcohol en la dinámica social del grupo indígena, presentan el modelo de intervención y evalúan los efectos obtenidos.

Aims. To compare two contrasting socio-cultural groups in terms of parameters relating to the stress - coping - health model of alcohol, drugs and the family, and to test hypotheses derived from the model in each of the two groups separately. Design. Cross-sectional, comparative and correlational, using standard questionnaire data, supplemented by qualitative interview data to illuminate the findings. Participants. One hundred close relatives, mainly partners or parents, from separate families in Mexico City, and 100 from South West England. Data sources. Coping Questionnaire (CQ), Family Environment Scale (FES), Symptom Rating Test (SRT), Semi-structured interview. Findings. Mean symptom scores were high in both groups, and not significantly different. The hypothesis that relatives in Mexico City, a more collectivist culture, would show more tolerant - inactive coping was not supported, but there was support for the prediction that relatives in South West England would show more withdrawal coping. This result may be as much due to differences in poverty and social conditions as to differences in individualism - collectivism. As predicted by the stress - coping - health model, tolerant - inactive coping was correlated with symptoms, in both groups, after controlling for family conflict, but there was only limited support for a moderating role of coping. Wives of men with alcohol problems in Mexico City, and wives of men with other drug problems in South West England, reported particularly high levels of both engaged and tolerant - inactive coping. Conclusions. Tolerant - inactive coping may be bad for relatives' health: causality may be inferred but is not yet proved. Certain groups are more at risk of coping in this way. Qualitative data help understand the nature of tolerant - inactive coping and why it occurs despite the view of relatives themselves that it is counter-productive. [ABSTRACT FROM AUTHOR]