[Contraception in Mexican adolescents in upper secondary schools: use and unmet needs]. / Anticoncepción en adolescentes mexicanos de escuelas del nivel medio superior: uso y necesidades insatisfechas.

OBJECTIVE: To describe sexual behavior and contraceptive use in adolescent students. MATERIALS AND METHODS: National representative survey in upper secondary schools in Mexico 2014. Logistic regressions identify the factors associated with contraceptive use and unmet needs for contraception (UNC). RESULTS: For male adolescents, non-contraceptive use in the last sexual relation is associated with non-contraceptive use in the sexual debut (OR=11.5; IC95%:5.6,23.4) and not recognizing effective contraceptive methods (OR=2.4;IC95%:1.04,5.5). For female adolescents, non-contraceptive use is associated with non-contraceptive use in sexual debut (OR=4.5;IC95%:2.3,8.4) and low self-efficacy towards condom use and negotiation (OR=3.1; IC95%:1.1,8.2). UNC were associated with insecure attitudes towards condom use and negotiation (OR=3.5;IC95%:1.3,9.4), non-contraceptive use in sexual debut (OR=9.0;IC95%:2.5,32.4) and use of alcohol or drugs during sexual relations (OR=3.0;IC95%:1.1,8.1). CONCLUSIONS: Strategies to ensure contraceptive use from sexual debut onwards are required, promoting self-efficacy and safe sex practices among adolescents.

OBJETIVO: Describir el comportamiento sexual y el uso de anticonceptivos en adolescentes escolarizados. MATERIAL Y MÉTODOS: Encuesta representativa nacional en escuelas de educación media superior en México, realizada en 2014. Modelos logísticos identifican factores asociados al uso de anticonceptivos y a necesidades insatisfechas de anticoncepción (NIA). RESULTADOS: Entre los hombres, no emplear anticonceptivos en la última relación sexual se asocia con la no utilización de éstos durante el debut sexual (RM=11.5; IC95% 5.6-23.4) y desconocer anticonceptivos efectivos (RM=2.4; IC95% 1.04-5.5). Entre las mujeres, no emplear anticonceptivos se asocia con el no uso de éstos durante el debut sexual (RM=4.5; IC95% 2.3-8.4) y la falta de autoeficacia en el uso/negociación del condón (RM=3.1; IC95% 1.18.2). Las NIA se asocian con baja autoeficacia respecto al uso/negociación del condón (RM=3.5; IC95% 1.3-9.4), no usar anticonceptivos en el debut sexual (RM=9.0; IC95% 2.5-32.4) y usar alcohol o drogas en relaciones sexuales (RM=3.0; IC95% 1.1-8.1). CONCLUSIONES: Se requieren estrategias que garanticen el uso de anticonceptivos desde el debut sexual y que promuevan la autoeficacia y las prácticas seguras entre los adolescentes.

Population profiles associated with severe functioning difficulties and disability among two to four years old children in Mexico.

OBJECTIVE: To describe the prevalence and factors associated with severe child functioning difficulties and disability (CFD) among two to four year old children in Mexico, and estimates the probability of presenting CFD based on specific population profiles. MATERIALS AND METHODS: The sample consists of 5 104 children who participated in the National Survey of Children and Women 2015 (ENIM). We used post-estimation exploration by computing predicted values of CFD to interpret the logistic models for discrete combinations of the independent variables. RESULTS: CFD prevalence is 2%, which means at least 130 000 two to four year-old children are at risk of experiencing severely limited participation in an unaccommodating environment. The probability of presenting CFD is dramatically higher in specific sub-groups of the population, in particular, male children of women with low education, who live in the poorest households. CONCLUSIONS: A significant proportion of Mexican children face important challenges due to functioning difficulties and disability. Public policies must be developed to accommodate the needs of these children and provide a proper environment for their development.

[Methodological bases and implementation results of Mexico's National Survey of Children and Women 2015]. / Bases metodológicas y resultados de la implementación de la Encuesta Nacional de Niños, Niñas y Mujeres en México 2015.

OBJECTIVE:: To describe the methodology and the implementation survey results from National Survey of Children and Women Mexico's (ENIM 2015). MATERIALS AND METHODS:: The ENIM 2015 is a probability survey with multistage, stratified and cluster sample, with regional, rural and urban strata, and indigenous population representation.We applied questionnaires to get information from the household, women aged 15 to 49 years, children under five years and children and adolescents aged 5-17 years. RESULTS:: The response rate for households and women was 94%, obtaining information from 10 760 households and 12 110 women; while for children and adolescents and children under five years was 98%, 11 607 and 8 066, respectively. CONCLUSION:: The ENIM 2015 probabilistic design allows generate indicators that can be stratified into five regions, rural and urban strata and from indigenous population, as well as a baseline for 15 indicators of the ODS.

Overweight and obesity status among adolescents from Mexico and Egypt.

BACKGROUND: Obesity is on the rise among adults, adolescents and children worldwide, including populations living in developing countries. This study aimed to describe body mass index of adolescents from Mexico and Egypt and to evaluate non-nutritional correlates from two cohort studies. METHODS: Questionnaire data and weight and height measurements were collected in two large baseline studies in adolescents between 11 and 19 years old attending public school during the 1998-1999 school year in Mexico (n = 10,537) and the 1997 school year in Egypt (n = 1,502). The authors compared body mass index and correlates stratified by sex and country through multivariate linear regression. RESULTS: Overall prevalence of overweight and obesity was 19.8 and 7.9%, respectively, among the Mexican adolescents and 12.1 and 6.2%, respectively, among the Egyptian adolescents. Based on U.S. Centers for Disease Control and Prevention (CDC) definition growth charts, for Mexico 18% of boys and 21% of girls were overweight and 11% of boys and 9% of girls were obese. In the Egyptian sample, 7% of boys and 18% of girls were overweight and 6% of boys and 8% of girls were obese. The most consistent correlates of body mass index in the Mexican population were age, years of education, smoking, vitamin intake and participating in sports, whereas the factors correlated among Egyptian adolescents were age and rural residence. CONCLUSIONS: Obesity and overweight are becoming a problem among Mexican and Egyptian youth. Information about the risk factors associated with excessive weight gain during the adolescent period is a first step towards proposing prevention strategies.

[Challenges to implement strategies for the primary and secondary prevention of cervical cancer in Mexico]. / Retos en la implementación de estrategias de prevención primaria y secundaria del cáncer cervical en México.

Mortality due to cervical cancer (CC) has decreased in developed countries given extensive screening and effective coverage. In developing countries mortality rates due to CC remain high. Since the mid-nineties there has been a decrease in mortality due to CC in Mexico, which can be attributed to the increase in coverage of the Papanicolaou (PAP) (beta -.195, IC95% -.274, -.117) and the decrease in the birth rate (beta -.407, IC95% -.632, -.182). The use of the PAP in conjunction with an HPV test within the early CC detection program would have a synergistic effect; HPV testing should be combined with the Pap test. Primary prevention of CC is possible with the HPV vaccine. This vaccine will be an additional tool for reducing CC-related morbidity and mortality, but will not replace screening and treatment. To adopt a prevention policy that includes an HPV vaccine we will need to: determine the burden of HPV-related disease; have sufficient epidemiological evidence and data about technical aspects of the vaccine; take into account the psyschosocial and ethical aspects of the vaccine and guarantee good organization of vaccine implementation.

Associations between individual and contextual factors and smoking in 13,293 Mexican students.

OBJECTIVE: Factors correlated with cigarette smoking in young people have yet to be documented in most developing countries. This study assesses the correlates of smoking in Mexican young people. METHODS: School-based, cross-sectional study in the central Mexican state of Morelos during the 1998-1999 school year of 13,293 public school students aged 11 to 24 years. Multinomial logistic regression models were constructed with smoking as the dependent variable. RESULTS: Regular smoking (one or more cigarettes daily) prevalence was 13.1% (95% confidence interval [CI]=12.2-13.9) in males, and 6.1% (95% CI=5.6-6.6) in females. Frequent alcohol intoxication was strongly associated with regular smoking (females, odds ratio [OR]=68.5, 95% CI=37.6-125.2; males, OR=34.5, 95% CI=22.6-52.7). Regular smoking was associated with illegal drug use and smoking by both parents in females, and with illegal drug use in males (males, OR=4.9, 95% CI=3.7-6.5). Also associated with tobacco smoking were high socioeconomic status, low academic achievement, illegal drug use by peers, marijuana use by parents, and depression in adolescents. CONCLUSIONS: This study documents a strong correlation between tobacco smoking and other health risk behaviors, especially alcohol and drug abuse. In young women especially, the risk of tobacco use increased with alcohol abuse and higher socioeconomic status. School-based interventions are needed that focus on preventing smoking and also take into account other unhealthy behaviors.

The contribution of international agencies to the control of communicable diseases.

Although inequality is often measured through three critical indicators-education, income and life expectancy-health-related differences are also essential elements for explaining levels of equality or inequality in modern societies. Investment and investigation in health also involve inequalities at the global level, and this includes insufficient North-South transfer of funds, technology and expertise in the health field, including the specific area of communicable diseases. Globally, epidemics and outbreaks in any geographic region can represent international public health emergencies, and this type of threat requires a global response. Therefore, given the need to strengthen the global capacity for dealing with threats of infectious diseases, a framework is needed for collaboration on alerting the world to epidemics and responding to public health emergencies. This is necessary to guarantee a high level of security against the dissemination of communicable diseases in an ever more globalized world. In response to these needs, international health agencies have put a number of strategies into practice in order to contribute to the control of communicable diseases in poor countries. The principle strategies include: 1) implementation of mechanisms for international epidemiologic surveillance; 2) use of international law to support the control of communicable diseases; 3) international cooperation on health matters; 4) strategies to strengthen primary care services and health systems in general; 5) promotion of the transfer of resources for research and development from the North to the South.

Consumption of higher numbers of cigarettes in Mexican youth: the importance of social permissiveness of smoking.

This study sought to assess the relationship between level of cigarette smoking and social factors indicating permissiveness of smoking among youth. This was a school-based cross-sectional questionnaire study carried out in a random sample of students (n=13,293, 11-24 years) at public schools in Morelos, Mexico. Chi2 test and multiple logistic regression analysis were used to evaluate correlates of level of smoking (> or < or = 5 cigarettes/day). There is a rising trend in smoking among Mexican in-school youth, a tendency towards smoking initiation at increasingly younger ages and a decrease in the gender gap regarding smoking. When young people smoked at home, at school and outside, they were over fives times as likely to smoke >5 cigarettes/day. Prevention of smoking among Mexican adolescents should emphasize smoke-free schools, no smoking policies in the community and parental anti-tobacco education.

Intra-familial physical violence among Mexican and Egyptian youth.

OBJECTIVE: To determine the prevalence of experiencing intra-familial violence among Mexican and Egyptian youth and to describe its associated risk factors. METHODS: Data from questionnaires applied to 12,862 Mexican and 5,662 Egyptian youth, aged 10 to 19, who attended public schools were analyzed. Biviarate and logistic regression analysis were used to determine the relationship between socio-demographics, the experience of intra-familial violence and violence perpetration. RESULTS: The prevalence of having experienced intra-familial violence was comparable across the Mexican and Egyptian populations (14% and 17%, respectively). In Mexico, young men were more likely to have experienced such violence (OR=2.36) than women, whereas in Egypt, young women were at slightly greater risk than young men (OR=1.25). Older age, male gender and urban residence were independent correlates of experiencing intra-familial violence among Mexican youth. For Egyptian adolescents, in contrast, younger age, female gender and having non-married parents were independent correlates of victimization. Intra-familial violence victims were also more likely than non-victims to perpetrate violence (Mexico: OR=13.13; Egypt: OR=6.58). CONCLUSIONS: Mexican and Egyptian youth experienced intra-familial violence at a relatively low prevalence when compared with youth of other countries. A strong association was found between experiencing intra-familial violence and perpetrating violence.

Ethics and communication between physicians and their patients with cancer, HIV/AIDS, and rheumatoid arthritis in Mexico.

BACKGROUND: Despite evidence that open communication concerning diagnosis of a disease substantially improves the doctor-patient relationship, in developing countries physicians often provide partial information. METHODS: We carried out a cross-sectional study with 379 physicians practicing at 11 hospitals in Mexico City and in the central Mexican state of Morelos to quantify their communication patterns with patients with cancer, HIV/AIDS, and rheumatoid arthritis. Communication patterns were defined as physician self-reported communication with patients with regard to their diagnosis, prognosis, and treatment. Logistic, ordinal, multivariate models were constructed for analysis. RESULTS: Assigning a high level of value to communication (odds ratio [OR] 5.5, 95% confidence interval [95% CI] 2.1-14.8), and bioethics training (OR 1.5, 95% CI 1.0-2.3) were principal predictors of explicit communication with cancer patients. We found a very strong association between explicit communication with HIV/AIDS patients and an accepting attitude of the physician toward death (OR 34.6, 95% CI 8.5-141.0). As for communication with rheumatoid arthritis patients, we observed an association between a very paternalistic attitude on the part of the physician (OR 6.8, 95% CI 1.9-24.1) and complete communication. CONCLUSIONS: In Mexico, physicians exercise power and authority over patients in an effort that they perceive as beneficial or preventing harm. In most cases, physicians do not seem to recognize or respect their patients' autonomy; therefore, communication is generally partial and vague. Our study established the need among physicians for bioethics and communication training. A discussion of this topic is necessary to transform the doctor-patient relationship and to establish a consensus for policies and norms for communication that benefits patients.

Associations among condom use, sexual behavior, and knowledge about HIV/AIDS. A study of 13,293 public school students.

BACKGROUND: This school-based study explored associations between Mexican young people's condom use, other sexual behaviors, and HIV/AIDS knowledge. METHODS: Students (n=13,293, 11-24 years of age) from a random sample of public schools in the central Mexican state of Morelos completed a self-administered questionnaire. We performed logistic regression analysis of condom use and sexual behavior variables and a knowledge-based index on HIV/AIDS prevention and transmission. RESULTS: Average age at sexual debut was 13.6 +/- 1.9 years among young men and 14.2 +/- 2.2 years among young women; 34.5% of sample participants reported using condoms during their first sexual intercourse. More students had intermediate HIV/AIDS knowledge levels (46%, 95% confidence interval [95% CI], 45.2-46.9) than high levels (37%, 95% CI 36.2-37.8, p <0.01). Students knew more concerning HIV transmission than about prevention of HIV infection. Among young men, high levels of HIV/AIDS knowledge increased likelihood of condom use (odds ratio [OR] 1.4, 95% CI, 1.1-1.7), while among young women high levels of knowledge decreased likelihood of using condoms (OR 0.7, 95% CI, 0.5-1.0). Young men with high levels of HIV/AIDS knowledge were more likely to have had three or more sexual partners (OR 1.7, 95% CI, 1.3-2.2), but young women with high knowledge levels were more likely to have only one lifetime sexual partner (OR 0.6, 95% CI, 0.4-0.9). CONCLUSIONS: As in previous studies in smaller samples, levels of knowledge with regard to HIV/AIDS were low in Mexican youth. HIV/AIDS education programs for Mexican students should focus on conveying knowledge on HIV prevention. Because apparently knowledge is not directly correlated with condom use among young women, prevention strategies that deal with social acceptability of condoms and social skills related with condom negotiation are also needed.

Chronic disease risk factors among healthy adolescents attending public schools in the state of Morelos, Mexico.

BACKGROUND: Little research (and fewer interventions) has been done on longitudinal exposure to risk factors for chronic diseases in young people in Latin America, including Mexico, although chronic diseases constitute the first cause of death in Mexico. Our objective was to document the prevalence of chronic disease risk factors among adolescents as a baseline measurement for a cohort study and to develop educational interventions. METHODS: Questionnaires, blood samples, and anthropometric measurements were collected from 13,293 public school students of both sexes, ages 11-24 years in Morelos, Mexico. This constitutes the baseline measurement for a cohort study. Twenty focus groups and 10 in-depth interviews were done with girls aged 12-17 years. Two educational interventions promoting physical activity and sexual health were designed. RESULTS: Prevalence of obesity was 21.2%. On average, participants spent 0.5 h/day on vigorous physical activity and 3.7 h/day watching television. Sexual initiation was reported by 14.5% (girls = 9.1%, boys = 21.5%); 52.3% of whom reported using condoms. Young women demonstrated correct condom use and perceived themselves at risk for HIV/AIDS but did not have condom negotiation skills. Prevalence of experimenting with tobacco was 15.1% (girls = 10.4%, boys = 21.1%); current smoking was 14.4% (girls = 10.6%) and boys = 19.2%), while 6.3% of participants reported monthly intoxication with alcohol, and 4.5% reported past and 2.1% reported current illegal drug use. CONCLUSIONS: Results indicate substantial exposure to risk factors for chronic diseases and reproductive health problems in this population. The study will generate interventions and constitutes initiation of a longitudinal study able to explore causal associations between risk factors and chronic diseases in this population.

Anticoncepción en adolescentes mexicanos de escuelas del nivel medio superior: uso y necesidades insatisfechas / Contraception in Mexican adolescents in upper secondary schools: use and unmet needs

Resumen: Objetivo: Describir el comportamiento sexual y el uso de anticonceptivos en adolescentes escolarizados. Material y métodos: Encuesta representativa nacional en escuelas de educación media superior en México, realizada en 2014. Modelos logísticos identifican factores asociados al uso de anticonceptivos y a necesidades insatisfechas de anticoncepción (NIA). Resultados: Entre los hombres, no emplear anticonceptivos en la última relación sexual se asocia con la no utilización de éstos durante el debut sexual (RM=11.5; IC95% 5.6-23.4) y desconocer anticonceptivos efectivos (RM=2.4; IC95% 1.04-5.5). Entre las mujeres, no emplear anticonceptivos se asocia con el no uso de éstos durante el debut sexual (RM=4.5; IC95% 2.3-8.4) y la falta de autoeficacia en el uso/negociación del condón (RM=3.1; IC95% 1.18.2). Las NIA se asocian con baja autoeficacia respecto al uso/negociación del condón (RM=3.5; IC95% 1.3-9.4), no usar anticonceptivos en el debut sexual (RM=9.0; IC95% 2.5-32.4) y usar alcohol o drogas en relaciones sexuales (RM=3.0; IC95% 1.1-8.1). Conclusiones: Se requieren estrategias que garanticen el uso de anticonceptivos desde el debut sexual y que promuevan la autoeficacia y las prácticas seguras entre los adolescentes.

Abstrac: Objective: To describe sexual behavior and contraceptive use in adolescent students. Materials and methods: National representative survey in upper secondary schools in Mexico 2014. Logistic regressions identify the factors associated with contraceptive use and unmet needs for contraception (UNC). Results: For male adolescents, non-contraceptive use in the last sexual relation is associated with non-contraceptive use in the sexual debut (OR=11.5; IC95%:5.6,23.4) and not recognizing effective contraceptive methods (OR=2.4;IC95%:1.04,5.5). For female adolescents, non-contraceptive use is associated with non-contraceptive use in sexual debut (OR=4.5;IC95%:2.3,8.4) and low self-efficacy towards condom use and negotiation (OR=3.1; IC95%:1.1,8.2). UNC were associated with insecure attitudes towards condom use and negotiation (OR=3.5;IC95%:1.3,9.4), non-contraceptive use in sexual debut (OR=9.0;IC95%:2.5,32.4) and use of alcohol or drugs during sexual relations (OR=3.0;IC95%:1.1,8.1). Conclusions: Strategies to ensure contraceptive use from sexual debut onwards are required, promoting self-efficacy and safe sex practices among adolescents.

Population profiles associated with severe functioning difficulties and disability among two to four years old children in Mexico / Perfiles poblacionales asociados a dificultades severas de funcionamiento y discapacidad en niños de dos a cuatro años de edad en México

Abstract: Objective: To describe the prevalence and factors associated with severe child functioning difficulties and disability (CFD) among two to four year old children in Mexico, and estimates the probability of presenting CFD based on specific population profiles. Materials and methods: The sample consists of 5 104 children who participated in the National Survey of Children and Women 2015 (ENIM). We used post-estimation exploration by computing predicted values of CFD to interpret the logistic models for discrete combinations of the independent variables. Results: CFD prevalence is 2%, which means at least 130 000 two to four year-old children are at risk of experiencing severely limited participation in an unaccommodating environment. The probability of presenting CFD is dramatically higher in specific sub-groups of the population, in particular, male children of women with low education, who live in the poorest households. Conclusions: A significant proportion of Mexican children face important challenges due to functioning difficulties and disability. Public policies must be developed to accommodate the needs of these children and provide a proper environment for their development.

Resumen: Objetivo: Describir la prevalencia y los factores asociados con las dificultades severas de funcionamiento y discapacidad (CFD, por sus siglas en inglés) en niños de dos a cuatro años de edad en México y estimar la probabilidad de presentar CFD basada en perfiles poblacionales específicos. Material y métodos: La muestra fue conformada por 5 104 niños participantes de la Encuesta Nacional de los Niños, Niñas y Mujeres (ENIM) 2015. Se realizó una post-estimación calculando los valores predichos de CFD para interpretar los modelos logísticos a partir de combinaciones discretas de las variables independientes. Resultados: La prevalencia de CFD es de 2%, lo que significa que al menos 130 000 niños de 2 a 4 años de edad están en riesgo de experimentar una participación severamente limitada en un ambiente no adaptado a sus necesidades. La probabilidad de presentar CFD aumenta dramáticamente en subgrupos específicos de la población, en particular los hijos varones de mujeres con baja educación, que viven en los hogares más pobres. Conclusión: Una proporción importante de la población infantil mexicana enfrenta retos importantes derivados de las dificultades de funcionamiento y la discapacidad. Es necesario desarrollar políticas públicas que respondan a las necesidades específicas de este grupo poblacional, proporcionando un entorno apropiado para su desarrollo.

Bases metodológicas y resultados de la implementación de la Encuesta Nacional de Niños, Niñas y Mujeres en México 2015 / Methodological bases and implementation results of Mexico's National Survey of Children and Women 2015

Resumen: Objetivo: Describir la metodología y los resultados del levantamiento de la Encuesta Nacional de Niños, Niñas y Mujeres en México (ENIM 2015). Material y métodos: La ENIM 2015 es una encuesta probabilística con muestreo polietápico, estratificado y por conglomerados, con representatividad regional, por estratos rural y urbano, y para la población indígena. Se aplicaron cuestionarios para obtener información sobre el hogar, mujeres de 15 a 49 años, niños y niñas menores de cinco años y niños y niñas y adolescentes de 5 a 17 años. Resultados: La tasa de respuesta en hogares y en mujeres fue de 94%; se obtuvo información de 10 760 hogares y 12 110 mujeres; para los niños y niñas y adolescentes y niños y niñas menores de cinco años, estos valores fueron de 98%, 11 607 y 8 066, respectivamente. Conclusión: El diseño probabilístico de la ENIM 2015 permite generar indicadores que se pueden desagregar en cinco regiones, para los estratos rural y urbano y para la población indígena, así como una línea base para 15 indicadores de los ODS.

Abstract: Objective: To describe the methodology and the implementation survey results from National Survey of Children and Women Mexico's (ENIM 2015). Materials and methods: The ENIM 2015 is a probability survey with multistage, stratified and cluster sample, with regional, rural and urban strata, and indigenous population representation.We applied questionnaires to get information from the household, women aged 15 to 49 years, children under five years and children and adolescents aged 5-17 years. Results: The response rate for households and women was 94%, obtaining information from 10 760 households and 12 110 women; while for children and adolescents and children under five years was 98%, 11 607 and 8 066, respectively. Conclusion: The ENIM 2015 probabilistic design allows generate indicators that can be stratified into five regions, rural and urban strata and from indigenous population, as well as a baseline for 15 indicators of the ODS.

[Physical and sexual abuse during childhood and revictimization during adulthood in Mexican women]. / Abuso físico y sexual durante la niñez y revictimización de las mujeres mexicanas durante la edad adulta.

OBJECTIVE: To quantify the association between physical and sexual abuse during childhood and violence during adulthood in a representative sample of female health care users in Mexico. MATERIAL AND METHODS: A questionnaire was administered to 26 042 women over 14 years of age who sought medical consultation from public health care services between October 2002 and March 2003, in all 32 states in Mexico. Two models were constructed: a) Multiple polytomic logistic regression models to explore the association between violent victimization by the partner during adulthood and violence during childhood. b) Multiple logistic regression models to explore the association between experiencing rape during adulthood and violence during childhood. RESULTS: Among women studied, an association was found between experiencing physical violence during childhood and suffering physical and sexual violence from the male partner or experiencing rape, during adulthood. When physical violence during childhood occurred "almost always", it was more likely that the woman undergo physical and sexual violence (OR = 3.1; 95% CI 2.6-3.7) and rape (OR = 2.9; 95% CI 2.4-3.6), during her adult life. In addition, when violence during childhood was more frequent, the likelihood of experiencing violence during adulthood was greater. A positive association was found between physical and sexual abuse before 15 years of age (OR = 2.8; 95% CI 2.2-3.5). Experiencing rape during adulthood was also associated with sexual abuse before 15 years of age (OR = 11.8; 95% CI 10.2-13.7). CONCLUSIONS: In this sample of Mexican women, both physical and sexual violence during childhood has negative results during adulthood, including a greater likelihood of revictimization by the male partner and rape. Physical and sexual abuse during childhood must be prevented or at least detected and treated.

[Dating violence and associations with depression and risk behaviors: female students in Morelos, Mexico]. / Violencia durante el noviazgo, depresión y conductas de riesgo en estudiantes femeninas (12-24 años).

OBJECTIVE: Determine the prevalence of dating violence and its association with depression and various risk behaviors in a sample of female students from the state of Morelos. MATERIAL AND METHODS: This is a baseline cohort study of a sample of 13 293 students from 12 to 24 years of age who attended public schools in the state of Morelos during the 1998-1999 school year. The participants were selected from a random sample of 260 junior high schools, 92 high schools and one university. For the purpose of this analysis, a total of 4 587 female students who had a previous dating relationship were selected. To control for possible confounding variables, multiple logistic regression analysis was used. RESULTS: The total prevalence of dating violence in females who attended public schools in Morelos was 28%. The following variables were associated with dating violence: depression (OR = 1.92; 95% CI 1.61-2.28); tobacco smoking (OR = 1.31; 95% CI 1.06-1.60); alcohol abuse (OR = 1.30, 95% CI 1.12-1.51); poor academic performance (low grades) (OR = 1.25; 95% CI 1.03-1.52); a history of sexual relations (OR = 1.52; 95% CI 1.26-1.82). CONCLUSIONS: The results of this study clearly indicate that women experience partner violence beginning with dating during adolescence. Health and education professionals need to establish intervention strategies to prevent or treat dating violence among female students. Such strategies should take into account the association between depression and violence, as well as other related risk behaviors.

Chapter 24: Psychosocial aspects of vaccine acceptability.

In this chapter we identify psychosocial issues that have been raised with respect to human papillomavirus (HPV) vaccination and review the research literature on HPV vaccine acceptability. Many women and physicians have relatively poor knowledge about HPV, but despite this, most healthcare providers are willing to recommend HPV vaccination and parents are interested in having their children vaccinated. Concerns about post-vaccination sexual behavior change do not appear to be justified, but can certainly be addressed through anticipatory guidance. Most research studies have come out of the United States and other English-speaking industrialized countries. More psychosocial research regarding HPV vaccination is therefore needed from developing countries.

[Analysis of the impact of cigarette pack graphic warnings on Mexican smokers]. / Análisis del impacto en fumadores mexicanos de los avisos gráficos en las cajetillas de cigarros.

OBJECTIVE: To determine which graphic warnings on cigarette packs (images on the labels indicating the negative impact on health that tobacco can have) provoke the strongest desire to quit smoking among adult Mexican smokers. MATERIAL AND METHODS: A pile sort method was used among 60 smokers over 18 years old to determine which images made them think about quitting smoking. Averages were determined and non-parametric statistical methods were used to determine differences in ranks. RESULTS: Within each of the five themes, one or two graphic warnings provoked the strongest responses in smokers. The graphic warnings with the greatest impact used the following images: a close-up of a lung tumor; a man with cancer of the larynx with a large tumorous mass on the exterior part of his neck; an unconscious young man in a bed in an intensive care unit with text mentioning benzene, formaldehyde and cyanide as tobacco components; an image of two healthy children indicating that cigarettes contain carbon monoxide; an image of a dead fetus in a specimen jar; and a close up of a mouth with yellow, rotting teeth and text describing tooth loss and mouth cancer as a result of tobacco use. CONCLUSIONS: The graphic warnings used on cigarette packs in other countries could contribute to cessation among Mexican smokers and should be implemented in Mexico.

Comparative study of correlates of early age at menarche among Mexican and Egyptian adolescents.

We compared the median age at menarche in two developing countries to determine whether early age at menarche varies across body mass index (BMI), socioeconomic level, and urban/rural residence in Mexican and Egyptian adolescents. Questionnaire data and weight and height measurements were collected from 4,143 Mexican and 493 Egyptian adolescent girls (age, 10-19 years). Statistical analysis included Pearson chi-squared, Student t-test, and multiple logistic regression models. Median age at menarche was 12 years (range, 8-19 years) for Mexican girls and 13 years (range, 9-16) for Egyptian girls. In both countries, the odds of undergoing menarche at an earlier age were higher among adolescents with the following characteristics: overweight or obesity, as compared to those with a normal BMI (Mexican adolescents, OR = 1.45, 95% CI 1.25-1.69; Egyptian adolescents, OR = 2.20, 95% CI 1.21-4.03); living in urban versus rural areas (OR = 1.38, 95% CI 1.19-1.61 and OR = 1.38, 95% CI 0.74-2.59, respectively); high socioeconomic level versus the lowest level (OR = 1.46, 95% CI 1.22-1.74 and OR = 1.41, 95% CI 0.67-2.98, respectively). The associations between early age at menarche and urban residence or high socioeconomic level were statistically significant only in Mexican adolescents. Menarche at an earlier age was most strongly associated with overweight and obesity in both Mexican and Egyptian adolescents, while urban residence and high socioeconomic level were significantly associated only in Mexican adolescents.