Community utilization of risk and protective factor data for prevention planning in Chile and Colombia.

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.

Adolescent substance use and its association with risk and protective factors. An exploratory analysis of the large-scale school survey of Comunidades Que se Cuidan, Colombia. / Uso de sustancias en adolescentes y su asociación con factores de riesgo y protección. Un análisis exploratorio de la encuesta escolar a gran escala de Comunidades Que se Cuidan, Colombia.

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.

A Comparison of Cut Points for Measuring Risk Factors for Adolescent Substance Use and Antisocial Behaviors in the U.S. and Colombia.

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.

Perfiles asociados al consumo de alcohol en adolescentes colombianos / Perfis associados ao consumo de álcool em adolescentes colombianos / Profiles associated with alcohol consumption in Colombian adolescents

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.