[Vegetables and fruits in early childhood: maternal nutritional practices]. / Vegetales y frutas en la primera infancia: prácticas alimentarias maternas.

INTRODUCTION: Global consumption of vegetables and fruits is currently below recommendations, impacting the prevalence of obesity and non-communicable diseases. In addition to environmental factors, mothers' feeding practices influence children's eating patterns. METHODS: Questionnaires were conducted with mothers of children 7 months to 7 years of age (n = 727), in 12 Primary Health Care Centers in the capital cities of three Argentine provinces. Fruit and vegetable consumption was evaluated with the Children's Dietary Questionnaire (CDQ). We tested the association with maternal feeding practices distributed across three domains: role modeling, accessibility, and socialization of the products in the home. We tested 11 practices separately and a variable summing the 11 practices. RESULTS: The majority of children (86%) had low fruit and vegetable intake. In regression models, each of the 11 practices showed a significant association with children's fruit and vegetable intake (beta 0,6-1,8). However, the variable testing the sum of the 11 practices showed a larger association parameter with intake, even in multiple regression (beta 3,9). Proximity of sale points and cost of products also showed a significant association with intake. CONCLUSION: Results provide information on home based strategies to promote children's fruit and vegetable intake that do not require complex resources and can be incorporated into community health education programs.

Introducción: El consumo de vegetales y frutas a nivel global está por debajo de lo recomendado, incidiendo sobre la prevalencia de obesidad y enfermedades crónicas no transmisibles a corto y largo plazo. Además de factores ambientales, las prácticas maternas influyen sobre los patrones alimentarios de hijos e hijas. Métodos: Se aplicaron cuestionarios a 727 madres con hijos/hijas de 7 meses a 7 años de edad, en 12 Centros de Atención Primaria de Salud en las ciudades capitales de Tucumán, Santiago del Estero y Jujuy, Argentina. La ingesta de vegetales y frutas se evaluó mediante el Cuestionario de Dieta para Niños (CDQ por sus siglas en inglés) y se evaluó su asociación con prácticas maternas en 3 dominios conceptuales, rol modélico, accesibilidad, y socialización de esos alimentos en el hogar. Con regresión simple se analizaron 11 prácticas en forma separada, y con regresión multivariada una variable compuesta por la sumatoria de las 11 prácticas. Resultados: El 86% de niños/niñas tenía un bajo consumo de vegetales y frutas. Cada una de las 11 prácticas alimentarias mostró una asociación significativa con el consumo (beta 0.6 a 1.8). Sin embargo, la sumatoria de las distintas prácticas, su utilización en forma combinada, mostró un mayor efecto (beta 3.9). Cercanía a locales de venta y costo también estaban asociados significativamente con el consumo. Conclusión: Los resultados informan sobre estrategias para promover el consumo de vegetales y frutas, que pueden aplicarse en el contexto del hogar no requieren de recursos complejos y pueden incorporarse a programas de educación para la salud a nivel comunitario.

Vegetales y frutas en la primera infancia: prácticas alimentarias maternas / Vegetables and fruits in early childhood: maternal nutritional practices

Resumen Introducción: El consumo de vegetales y frutas a nivel global está por debajo de lo recomendado, incidiendo sobre la prevalencia de obesidad y enfermedades crónicas no transmisibles a corto y largo plazo. Además de factores ambientales, las prácticas maternas influyen sobre los patrones alimentarios de hijos e hijas. Métodos: Se aplicaron cuestionarios a 727 madres con hijos/hijas de 7 meses a 7 años de edad, en 12 Centros de Atención Primaria de Salud en las ciudades capitales de Tucumán, Santiago del Estero y Jujuy, Argentina. La ingesta de vegetales y frutas se evaluó mediante el Cuestionario de Dieta para Niños (CDQ por sus siglas en inglés) y se evaluó su asociación con prácticas maternas en 3 dominios conceptuales, rol modélico, accesibilidad, y socialización de esos alimentos en el hogar. Con regresión simple se analizaron 11 prácticas en forma separada, y con regresión multivariada una variable compuesta por la sumatoria de las 11 prácticas. Resultados: El 86% de niños/niñas tenía un bajo consumo de vegetales y frutas. Cada una de las 11 prácticas alimentarias mostró una asociación significativa con el consumo (beta 0.6 a 1.8). Sin embargo, la sumatoria de las distintas prácticas, su utilización en forma combinada, mostró un mayor efecto (beta 3.9). Cercanía a locales de venta y costo también estaban asociados significativamente con el consumo. Conclusión: Los resultados informan sobre estrategias para promover el consumo de vegetales y frutas, que pueden aplicarse en el contexto del hogar no requieren de recursos complejos y pueden in corporarse a programas de educación para la salud a nivel comunitario.

Abstract Introduction: Global consumption of vegetables and fruits is currently below recommendations, im pacting the prevalence of obesity and non-communicable diseases. In addition to environmental factors, mothers' feeding practices influence children's eating patterns. Methods: Questionnaires were conducted with mothers of children 7 months to 7 years of age (n = 727), in 12 Primary Health Care Centers in the capital cities of three Argentine provinces. Fruit and vegetable consumption was evaluated with the Children's Dietary Questionnaire (CDQ). We tested the association with maternal feeding practices distributed across three domains: role model ing, accessibility, and socialization of the products in the home. We tested 11 practices separately and a vari able summing the 11 practices. Results: The majority of children (86%) had low fruit and vegetable intake. In regression models, each of the 11 practices showed a significant association with children's fruit and vegetable intake (beta 0,6-1,8). However, the variable testing the sum of the 11 practices showed a larger association parameter with intake, even in multiple regression (beta 3,9). Proximity of sale points and cost of products also showed a significant association with intake. Conclusion: Results provide information on home based strategies to promote children's fruit and vegetable intake that do not require complex resources and can be incorporated into community health education programs.

Obesidad infantil, conocimientos y actitudes maternas en un centro de atención primaria de salud de la provincia de Jujuy / Childhood obesity, maternal knowledge and attitudes in a primari health care center of the province of Jujuy

Introducción: A nivel mundial la obesidad es el principal trastorno por malnutrición en niñas y niños. Objetivos: Conocer el estado nutricional y los conocimientos y actitudes maternas relacionadas con la obesidad, en niñas y niños de 2 a 5 años asistentes al control del niño sano en un Centro de Atención Primaria de la Salud (CAPS) de una localidad de la región Valles, de la provincia de Jujuy. Métodos: En un CAPS del Departamento El Carmen, en el periodo octubre-diciembre del 2014, se aplicaron cuestionarios a 100 madres en los que se examinaron factores sociodemográficos, conocimientos y actitudes respecto de la obesidad infantil y se relevaron datos de peso y talla de sus hijos. Para determinar el estado nutricional de los niños y niñas se calculó el Índice de Masa Corporal (IMC), según los estándares de la Organización Mundial de la Salud (OMS). Resultados: El 83% de los niños presentaba un estado nutricional normal, el 6% sobrepeso y el 8% obesidad. En cuanto a los conocimientos maternos, el 60% no acordaba con que el exceso de peso puede causar diabetes, solo el 1% percibió que sus hijos eran "gordos" y un 72% observó que eran activos. En relación con las actitudes maternas, para el 85% era muy importante que los niños realicen actividades físicas, el 89% estaba algo o muy de acuerdo con la frase "si un niño/a come normalmente, no es importante que haga ejercicio físico para cuidar su salud", y un 64% estaba algo de acuerdo con la frase "un niño/a gordito es sano". Conclusiones: Los resultados señalan un alto porcentaje de niños/as con exceso de peso y la existencia de conocimientos y actitudes escasos o inadecuados sobre la obesidad infantil y su prevención entre las madres. Esto pone de manifiesto la necesidad de implementar intervenciones de Educación para la Salud que potencien el desarrollo de habilidades maternas

Introduction: worldwide, obesity is a prominent manifestation of malnutrition among children. Objectives: to determine the nutritional status of children and to evaluate maternal knowledge and attitudes regarding childhood obesity, among clients of a Primary Health Care Clinic (PHC) in a locality of the lowland regions of the province of Jujuy. Methods: a questionnaire was administered to 100 mothers of children 2 to 5 years of age, attending the healthy children control program in a PHC. During October-November 2014 we obtained information regarding sociodemographic factors, maternal knowledge and attitudes regarding childhood obesity and measures of children's weight and height. We calculated children's body mass index (BMI) with the World Health Organization's standards. Results: 83% of the children had normal nutritional status, 6% had overweight and 8% had obesity. Among mothers, 60% did not acknowledge that excess weight can cause diabetes, only 1% perceived that their children were "fat" and 72% reported that their children were 'active"; 85% of the mothers considered important for their children to be active, 89% agreed with the statement "if a child eats normally, it is not important to be physically activite in order to be healthy", and 64% agreed with the statement "a fat child is a health child". Conclusions: Our results indicate a high prevalence of excess weight among children and a considerable level of inadequate maternal knowledge and attitudes regarding childhood obesity. There is a need to implement health education interventions to strengthen maternal abilities

Country and gender differences in the association between violence and cigarette smoking among youth.

BACKGROUND: Exposure to violence in youth may be associated with substance use and other adverse health effects. This study examined cigarette smoking in two middle-income areas with different levels and types of exposure to violence. METHODS: Association of exposure to verbal and physical violence with cigarette smoking in the West Bank oPt (2008) and in Jujuy Argentina (2006) was examined using cross-sectional surveys of 14 to 17-year old youth in 7th to 10th grade using probabilistic sampling. RESULTS: Violence exposure rates were more than double for Palestinian girls (99.6% vs. 41.2%) and boys (98.7% vs. 41.1%) compared with Argentinians. The rate of current cigarette smoking was significantly higher among Argentinian girls compared with Palestinian girls (33.1% vs. 7.1%, p < 0.001). Exposure to verbal violence from family and to physical violence increased the odds of current cigarette smoking, respectively, among Argentinian girls (aOR = 1.3, 95% CI = 1.0-1.7; aOR = 2.5, 95%CI = 1.7-3.8), Palestinian girls (aOR 2.2, 95%CI = 1.1-2.4; aOR = 2.0, 95%CI = 1.1-3.6) and Argentinian boys (aOR = 1.5, 95%CI = 1.1-2.0; aOR = 2.2, 95%CI = 1.6-3.0), but not among Palestinian boys. CONCLUSION: Findings highlight the importance of producing context and gender specific evidence from exposure to violence, to inform and increase the impact of targeted smoking prevention strategies.

Youth working in tobacco farming: effects on smoking behavior and association with health status.

BACKGROUND: Cultivation of tobacco raises concerns about detrimental health and social consequences for youth, but tobacco producing countries only highlight economic benefits. We compared sociodemographic and health-related characteristics of school-age youth who worked and did not work in tobacco farming and assessed the effects on smoking behavior and health at 1 year. METHODS: We used existing data collected in the province of Jujuy, Argentina where 3188 youth 13 to 17 years of age from a random middle school sample responded to longitudinal questionnaires in 2005 and 2006. Multivariate logistic regression models predicted association of tobacco farming work with health status and smoking behavior at 1 year. RESULTS: 22.8% of youth in the tobacco growing areas of the province were involved in tobacco farming. The mean age of initiation to tobacco farming was 12.6 years. Youth working in farming had higher rates of fair or poor versus good or excellent self-perceived health (30.3% vs. 19.0%), having a serious injury (48.5% vs. 38.5%), being injured accidentally by someone else (7.5% vs. 4.6%), being assaulted (5.5% vs. 2.6%), and being poisoned by exposure to chemicals (2.5% vs. 0.7%). Youth working in tobacco farming also had higher prevalence of ever (67.9% vs. 55.2%), current (48.0% vs. 32.6%) and established smoking (17.8% vs. 9.9%). In multivariate logistic regression models tobacco farming in 2005 was associated with significant increased reporting of serious injury (OR = 1.4; 95%CI 1.1-2.0), accidental injury by someone else (OR = 1.5; 95% 1.0-2.1), assault (OR = 2.2; 95% CI 1.3-3.8), and poisoning by exposure to chemicals (OR = 2.5; 95% CI 1.2-5.4). Tobacco farming in 2005 predicted established smoking 1 year later (OR = 1.5; 95% CI 1.1-2.0). CONCLUSION: Youth who work in tobacco faming face a challenging burden of adversities that increase their vulnerability. Risk assessments should guide public policies to protect underage youth working in tobacco farming. (298 words).

Emerging themes in food security: environmental justice, extended families and the multiple roles of grandmothers.

BACKGROUND: Pre- and perinatal nutritional status defines the development of adult metabolism and energy balance in humans. Young children in poor households are disproportionately more vulnerable to food insecurity given the cumulative impact of chronic stress on susceptibility to chronic diseases as an adult. Qualitative studies focusing on the experience of food insecurity in Latin America are scarce. In Argentina, although socioeconomic indicators improved in the aftermath of the 2001ecomomic crisis, the disadvantaged provinces in the north continue to bear the burden of historical inequities. The study was conducted among Primary Health Care patients in the city of San Salvador de Jujuy, Argentina. It analyzes environmental and household level stressors through the narratives of mothers with young children living with food insecurity, from the perspectives of eco-developmental conceptual frameworks. METHODS: We conducted 11 semi-structured interviews with mothers of children < 1 to 6 years of age who participated in maternal-child health programs in Primary Health Care clinics and lived in food insecure households. Interviews focused on the environmental context and the resources and processes for obtaining and preparing daily meals. RESULTS: The Eco-bio-developmental (EBD) framework and the vulnerability-assets approach, provided a basis for conceptualizing the significance of findings. Our results indicated the need to understand pathways in the association of stressors, vulnerability and ill health, as well as the mitigating role of social relationships. For example, understanding the link between the stress of being exposed to environmental contaminants and the capacity to overcome food insecurity, or developing strategies to integrate the support provided by kinship networks like extended families into food security programs. The results also indicate the importance of developing support mechanisms for vulnerable family members like grandmothers in food insecure households who play instrumental roles as providers and caretakers of younger relatives. CONCLUSION: The empirical evidence generated by this study may inform community based strategies and public health policies to address food insecurity in vulnerable population groups who face health effects from multiple stressors.

Use of Smoking Cessation Interventions by Physicians in Argentina.

BACKGROUND: Physician-implemented interventions for smoking cessation are effective but infrequently used. We evaluated smoking cessation practices among physicians in Argentina. METHODS: A self-administered survey of physicians from six clinical systems asked about smoking cessation counselling practices, barriers to tobacco use counselling and perceived quality of training received in smoking cessation practices. RESULTS: Of 254 physicians, 52.3% were women, 11.8% were current smokers and 52% never smoked. Perceived quality of training in tobacco cessation counselling was rated as very good or good by 41.8% and as poor/very poor by 58.2%. Most physicians (90%) reported asking and recording smoking status, 89% advised patients to quit smoking but only 37% asked them to set a quit date and 44% prescribed medications. Multivariate analyses showed that Physicians' perceived quality of their training in smoking cessation methods was associated with greater use of evidence-based cessation interventions. (OR = 6.5; 95% CI = 2.2-19.1); motivating patients to quit (OR: 7.9 CI 3.44-18.5), assisting patients to quit (OR = 9.9; 95% CI = 4.0-24.2) prescribing medications (OR = 9.6; 95% CI = 3.5-26.7), and setting up follow-up (OR = 13.0; 95% CI = 4.4-38.5). CONCLUSIONS: Perceived quality of training in smoking cessation was associated with using evidence-based interventions and among physicians from Argentina. Medical training programs should enhance the quality of this curriculum.

Effect of appreciation for Indigenous cultures and exposure to racial insults on alcohol and drug use initiation among multiethnic Argentinean youth.

OBJECTIVES: This study evaluated the effect of factors reflecting appreciation of Indigenous culture and racial insults on alcohol and drug use initiation among multi-ethnic youth in Jujuy, Argentina. METHODS: Students were surveyed from 27 secondary schools that were randomly selected to represent the province. A total of 3040 eligible students in 10th grade, age 14 to 18years were surveyed in 2006 and 2660 of these same students completed surveys in 11th grade in 2007. Multivariate logistic regression models assessed the effect of appreciation for Indigenous cultures and reported exposure to racial insults in 10th grade on incident current alcohol drinking in previous 30days, binge drinking (≥5 drinks at one sitting), and lifetime drug use (marijuana, inhalants or cocaine) in 11th grade among students not reporting these behaviors in 2006. RESULTS: In 2006, 63% of respondents reported high appreciation for Indigenous cultures and 39% had ever experienced racial insults. In 2007, incident current drinking was 24.4%, binge drinking 14.8%, and any drug use initiation was 4.1%. Exposure to racial insults increased the likelihood of binge drinking (OR=1.6; 95% CI 1.2-2.1) but was not significant for any drug use. Appreciation for Indigenous cultures reduced the risk of any drug use initiation (OR=0.5, 95% CI 0.3-0.7) but had no effect for alcohol drinking outcomes. These effects were independent of Indigenous ethnicity. CONCLUSIONS: Enhancing appreciation for Indigenous cultures and decreasing racial insults are achievable goals that can be incorporated into programs to prevent youth substance use.

Effectiveness of an Intervention to Teach Physicians How to Assist Patients to Quit Smoking in Argentina.

INTRODUCTION: We evaluated an intervention to teach physicians how to help their smoking patients quit compared to usual care in Argentina. METHODS: Physicians were recruited from six clinical systems and randomized to intervention (didactic curriculum in two 3-hour sessions) or usual care. Smoking patients who saw participating physicians within 30 days of the intervention (index clinical visit) were randomly sampled and interviewed by telephone with follow-up surveys at months 6 and 12 after the index clinical visit. Outcomes were tobacco abstinence (main), quit attempt in the past month, use of medications to quit smoking, and cigarettes per day. Repeated measures on the same participants were accommodated via generalized linear mixed models. RESULTS: Two hundred fifty-four physicians were randomized; average age 44.5 years, 53% women and 12% smoked. Of 1378 smoking patients surveyed, 81% were women and 45% had more than 12 years of education. At 1 month, most patients (77%) reported daily smoking, 20% smoked some days and 3% had quit. Mean cigarettes smoked per day was 12.9 (SD = 8.8) and 49% were ready to quit within the year. Intention-to-treat analyses did not show significant group differences in quit rates at 12 months when assuming outcome response was missing at random (23% vs. 24.1%, P = .435). Using missing=smoking imputation rule, quit rates were not different at 12 months (15.6% vs. 16.4% P = .729). Motivated smokers were more likely to quit at 6 months (17.7% vs. 9.6%, P = .03). CONCLUSIONS: Training in tobacco cessation for physicians did not improve abstinence among their unselected smoking patients.

Influence of gender role attitudes on smoking and drinking among girls from Jujuy, Argentina.

OBJECTIVE: Evaluate effect of gender role attitudes on tobacco and alcohol use among Argentinean girls. METHOD: Cross-sectional survey of 10th grade students attending 27 randomly selected schools in Jujuy, Argentina. Questions about tobacco and alcohol use were adapted from global youth surveys. Five items with 5-point response options of agreement-disagreement assessed attitude towards egalitarian (higher score) gender roles. RESULTS: 2133 girls, aged 13-18 years, 71% Indigenous, 22% mixed Indigenous/European, and 7% European responded. Of these, 60% had ever smoked, 32% were current smokers, 58% ever drinkers, 27% drank in previous month, and 13% had ≥5 drinks on one occasion. Mean response to the gender role scale was 3.49 (95% Confidence Intervals = 3.41-3.57) out of 5 tending toward egalitarian attitudes. Logistic regression models using the gender role scale score as the main predictor and adjusting for demographic and social confounders showed that egalitarian gender role was associated with ever smoking (Odds Ratio = 1.25; 95% Confidence Intervals 1.09-1.44), ever drinking (Odds Ratio = 1.24; 95% Confidence Intervals 1.10-1.40), drinking in prior month (Odds Ratio = 1.21; 95% Confidence Intervals 1.07-1.37) and ≥5 drinks on one occasion (Odds Ratio = 1.15; 95% Confidence Intervals 1.00-1.33), but was not significant for current smoking. CONCLUSION: Girls in Jujuy who reported more egalitarian gender role attitudes had higher odds of smoking or drinking.

Smoking and exposure to racial insults among multiethnic youth in Jujuy, Argentina.

PURPOSE: Exposure to racial insults among youth in Jujuy, Argentina, was examined as a factor associated with smoking behavior. METHODS: Youth sampled from eighth-grade classes in 27 randomly selected middle schools completed annual surveys in the ninth and tenth grades. Demographics, race/ethnicity (Indigenous/Amazonian, Indigenous/Andean, Indigenous unspecified group, Mixed European-Indigenous, European), cigarette smoking, and other attitudinal and behavioral factors were measured. Exposure to racial insults, measured in the ninth grade, was modeled to predict cigarette smoking in the previous 30 days (defined as current) in the tenth grade conditional on ninth grade smoking. RESULTS: Of the 3,122 respondents, 35.5% reported exposure to racial insults and 33.8% were current smokers. Factors associated with racial insults were being male, indigenous language spoken at home, ever and current smoking, smoking in a ceremonial context, exposure to second-hand smoke at home, number of friends who smoke, having low expectations for the future, low identification with conforming role models, high identification with defiant role models, and depressive symptoms. Reported exposure to racial insults increased the risk of current smoking in the 10th grade among Indigenous Amazonian respondents (OR = 3.8; 95% CI 1.4-10.4) and among the Indigenous-unspecified group (OR = 1.8; 95% CI 1.1-2.8), but not among European or Indigenous Andean youth. CONCLUSIONS: Exposure to racial insults is commonplace among youth in Jujuy. Evidence of a longitudinal effect of ninth-grade racial insults on tenth-grade smoking rates provides support for an association of racial insults with smoking behavior.

Association of media literacy with cigarette smoking among youth in Jujuy, Argentina.

INTRODUCTION: Latin America has the highest prevalence of tobacco use by youth. Higher media literacy, defined as the ability to analyze and evaluate media messages, has been associated with lower smoking among youth in the United States. The objective of this study was to determine whether media literacy related to smoking is independently associated with current smoking and susceptibility to future smoking in a sample of mostly indigenous youth in Jujuy, Argentina. METHODS: In 2006, a self-administered survey was conducted among 10th grade students sampled from 27 randomly selected urban and rural schools in Jujuy. Survey items measured smoking behavior (ever, never, and current), susceptibility to future smoking among never-smokers (definitely not accept a cigarette from a friend or to smoke in the future), 5 items assessing smoking media literacy (SML), and risk factors for smoking. RESULTS: Of the 3,470 respondents, 1,170 (34%) reported having smoked in the previous 30 days (current). Of the 1,430 students who had never smoked, 912 (64%) were susceptible to future smoking. High media literacy was present in 38%. Using multiple logistic regression, fully adjusted models showed that high media literacy was significantly associated as a protective factor of being a current smoker (odds ratio [OR] = 0.81; 95% CI = 0.67-0.97) and of being susceptible to future smoking (OR = 0.73; 95% CI = 0.58-0.92) among those who had never smoked. CONCLUSIONS: Among youth in Jujuy, higher SML was significantly associated with both lower current smoking and susceptibility to future smoking. Teaching SML may be a valuable component in a prevention intervention in this population.

Ceremonial tobacco use in the Andes: implications for smoking prevention among indigenous youth.

The purpose of this study was to identify Andean youth's beliefs regarding ceremonial tobacco use and to discuss potential applications of findings in tobacco control interventions. The study was conducted in the Province of Jujuy, Argentina among 202 boys and girls, 10 to 20 years of age, living in rural and urban areas. The world of beliefs and meanings became accessible by asking youth to focus on tangible experiences regarding the Pachamama ceremony, a ritual honoring Mother Earth. Concepts such as reciprocity, the unity of material and spiritual realms, and the complementary nature of opposite forces were linked to beliefs about ceremonial tobacco use. Three domains for understanding smoking behaviour beliefs and norms were identified including mechanisms of production, conceptual tenants and behavioural expressions. These findings suggest that tobacco control interventions based on solidarity, reciprocity, and non-rational ways of learning are more culturally appropriate for native populations in the Andes than the current individual behaviour change models and have the potential applications with other indigenous populations. The research methods also have the potential for generalized application in cross-cultural studies of health behaviours in understudied populations in middle and low-income countries.

Use of alternative tobacco products in multiethnic youth from Jujuy, Argentina.

This study examines alternative tobacco use among Latin American youth. A self-administered survey in a random sample of 27 schools was administered in 2004 in Jujuy, Argentina (N = 3218). Prevalence of alternative tobacco product use was 24.1%; 15.3% of youth used hand-rolled cigarettes, 7.8% smoked cigars, 2.3% chewed tobacco leaf and 1.6% smoked pipe. Among youth who never smoked manufactured cigarettes, alternative product use was rare (2.9%), except for chewing tobacco (22%). In multivariate logistic regression boys were more likely than girls to smoke pipe (OR = 3.1; 95% CI 1.1-8.7); indigenous language was associated with smoking hand-rolled cigarettes (OR = 1.4; 95% CI-1.1-1.9) and pipe (OR = 2.2; 95% CI 1.5-3.4). Working in tobacco sales was a risk factor for chewing tobacco (OR = 2.9; 95% CI: 1.7-4.9) and smoking hand-rolled cigarettes (OR = 1.4; 95% CI 1.1-1.8). Having friends who smoked was associated with chewing tobacco (OR = 1.8; 95% CI 1.0-3.2) and with smoking cigars (OR = 2.1; 95% CI 1.5-2.9). Current drinking and thrill-seeking orientation were associated with cigars and pipe smoking. Findings highlight the importance of surveillance of alternative tobacco products use and availability among youth and for addressing identified risk factors.

Smoking behavior and ethnicity in Jujuy, Argentina: evidence from a low-income youth sample.

Latin America is the world region with the highest rates of youth tobacco use and widest socioeconomic gaps, yet no data are available on smoking among Indigenous people, the largest disadvantaged group in the region. A self-administered survey of 3,131 8th grade youth enrolled in a random sample of 27 urban and rural schools was administered in 2004 in Jujuy, Argentina. Standard questions adapted from global surveys were used. Compared with youth of European background (11.4%; 95% CI 6.7-15.1), Indigenous (23.0%; 95% CI 21.0-25.0), and Mixed ethnicity (23%; 95% CI 18.9-27.1) youth had higher prevalence of current smoking. The odds of current smoking remained significantly elevated for Indigenous (OR 1.9; 95% CI = 1.1-3.3) and Mixed youth (OR 2.0; 95% CI 1.2-3.4) after controlling for confounders. Other risk factors that were associated with current smoking included: having any friends who smoke, repeating a grade in school, depressive symptoms in previous year, drinking any alcohol in the previous week and thrill seeking orientation. These results underscore the importance of social and cultural diversity aspects of the global tobacco epidemic.

[Problems related to alcohol drinking among youth in Jujuy, Argentina]. / Problemas relacionados con el consumo de alcohol en jóvenes de la provincia de Jujuy, Argentina.

OBJECTIVE: To examine drinking patterns and alcohol-related problems among youth in Jujuy, Argentina. MATERIAL AND METHODS: A survey was conducted in 2005 with a representative sample of 9th grade youth (12 to 17 years old) including sociodemographic and consumption data, and the AUDIT-C test. RESULTS: Nine percent of girls and 11% of boys reported hazardous drinking; 12% of girls and 19% of boys reported dependence symptoms. The odds ratio for dependence symptoms (adjusted OR 0.7; 95%CI: 0.6-0.8) and for hazardous drinking (adjusted OR 0.7; 95%CI: 0.6-0.8) was significantly lower for girls compared with boys. Older age, working, and attending night school were risk factors for hazardous drinking, dependence symptoms, and harmful drinking. CONCLUSIONS: A significant proportion of youth reported problematic patterns of alcohol drinking, highlighting the need to implement prevention and treatment interventions tailored to the adolescent population.

Problemas relacionados con el consumo de alcohol en jóvenes de la provincia de Jujuy, Argentina / Problems related to alcohol drinking among youth in Jujuy, Argentina

OBJETIVO: Examinar los patrones de consumo y los problemas relacionados con el alcohol en jóvenes de la provincia de Jujuy, Argentina. MATERIAL Y MÉTODOS: En el año 2005 se aplicó una encuesta a una muestra representativa de 2924 jóvenes de noveno grado (12-17 años), incluidas la información sociodemográfica y de consumo y la prueba AUDIT-C. RESULTADOS: Hasta 9 por ciento de las mujeres y 11 por ciento de los varones refirieron consumo de riesgo; asimismo, 12 por ciento de las mujeres y 19 por ciento de los varones notificaron síntomas de dependencia. Las mujeres presentaban menor probabilidad que los varones de experimentar síntomas de dependencia (RM ajustada 0.7; IC95 por ciento 0.6-0.8) o de consumo perjudicial (RM ajustada 0.7; IC95 por ciento 0.6-0.8). Tener mayor edad, trabajar y asistir al turno nocturno fueron factores de riesgo para el consumo de riesgo, síntomas de dependencia y consumo perjudicial. CONCLUSIONES: Los resultados ponen de relieve la importancia de instituir intervenciones de prevención y tratamiento para los adolescentes.

OBJECTIVE: To examine drinking patterns and alcohol-related problems among youth in Jujuy, Argentina. MATERIAL AND METHODS: A survey was conducted in 2005 with a representative sample of 9th grade youth (12 to 17 years old) including sociodemographic and consumption data, and the AUDIT-C test. RESULTS: Nine percent of girls and 11 percent of boys reported hazardous drinking; 12 percent of girls and 19 percent of boys reported dependence symptoms. The odds ratio for dependence symptoms (adjusted OR 0.7; 95 percentCI: 0.6-0.8) and for hazardous drinking (adjusted OR 0.7; 95 percentCI: 0.6-0.8) was significantly lower for girls compared with boys. Older age, working, and attending night school were risk factors for hazardous drinking, dependence symptoms, and harmful drinking. CONCLUSIONS: A significant proportion of youth reported problematic patterns of alcohol drinking, highlighting the need to implement prevention and treatment interventions tailored to the adolescent population.

[Alcohol consumption in the emergency room]. / Consumo de alcohol en la consulta de una sala de emergencia.

We examined patterns of alcohol consumption and blood alcohol levels in emergency room patients. The study was conducted in a public hospital of the province of Jujuy, Argentina. A survey was conducted among all patients during the 24 hours of 4 consecutive days (N = 500) using the Alcohol Use Disorders Identification Test, short version (AUDIT-C). Blood samples were collected in 84% of participants. Results showed that 37% were hazardous drinkers (men 50% vs. women 23%), 29% had symptoms of dependence (men 48% vs. women 11%); 17% of men and 3% of women had high blood alcohol levels, equal or greater than 50 mg/dl. In multivariate logistic regression models men had increased likelihood of hazardous drinking (Adjusted OR 3.2; 95% CI 2.1-5.0), symptoms of dependence (Adjusted OR 7.5; 95% CI 4.4-12.7) and increased blood alcohol levels (Adjusted OR 8.0; 95% CI 2.2-28.8), compared with women. Patients admitted due to accidents, violence, or drug use, had increased likelihood of hazardous drinking (Adjusted OR 2.4; 95% CI 1.5-3.9), dependence symptoms (Adjusted OR 2.0; 95% CI 1.2-3.3) and increased blood alcohol levels (Adjusted OR 7.7; 95% CI 3.0-19.8), compared with those admitted for other reasons. Alcoholism has a significant impact on the occurrence of injuries and on the demand imposed on health services. Prevention programs can potentially reduce the negative health and social impact of alcoholism.

Consumo de alcohol en la consulta de una sala de emergencia / Alcohol consumption in the emergency room

Se examinaron patrones de consumo de alcohol y alcoholemia en sala de emergencia del hospital público de referencia para traumatismos en la provincia de Jujuy aplicando el Instrumento de Evaluación para los Trastornos Debidos al Consumo de Alcohol, versión corta (AUDIT-C). Se entrevistaron pacientes durante las 24 horas de 4 días (N=500) y se obtuvieron muestras para prueba de alcoholemia en el 84%. El 37% presentaba consumo de riesgo (hombres 50% vs. mujeres 23%) y el 29% tenía síntomas de dependencia (hombres 48% vs. mujeres 11%). El 17% de los hombres y el 3% de las mujeres tenían un nivel de alcoholemia igual o mayor a 50 mg/dl. En modelos de regresión logística multivariados la razón de posibilidades para los hombres de ser consumidores de riesgo (OR ajustado 3.2; IC 95% 2.1-5.0), tener síntomas de dependencia (OR ajustado 7.5; IC 95% 4.4-12.7) o niveles elevados de alcoholemia (OR ajustado 8.0; IC 95% 2.2-28.8), fue mayor que para las mujeres. Para ingresos por accidentes, situaciones de violencia o uso de drogas, la razón de posibilidades de ser consumidores de riesgo (OR ajustado 2.4; IC 95% 1.5-3.9), presentar síntomas de dependencia (OR ajustado 2.0; IC 95% 1.2-3.3), o alcoholemia (OR ajustado 7.7; IC 95% 3.0-19.8) fue mayor comparados con ingresos por otras causas. El alcoholismo tiene un impacto significativo en la ocurrencia de lesiones e influye sobre la demanda de atención médica. La implementación de programas de prevención podría ser una herramienta efectiva para reducir el impacto negativo del alcoholismo.

We examined patterns of alcohol consumption and blood alcohol levels in emergency room patients. The study was conducted in a public hospital of the province of Jujuy, Argentina. A survey was conducted among all patients during the 24 hours of 4 consecutive days (N=500) using the Alcohol Use Disorders Identification Test, short version (AUDIT-C). Blood samples were collected in 84% of participants. Results showed that 37% were hazardous drinkers (men 50% vs. women 23%), 29% had symptoms of dependence (men 48% vs. women 11%); 17% of men and 3% of women had high blood alcohol levels, equal or greater than 50 mg/dl. In multivariate logistic regression models men had increased likelihood of hazardous drinking (Adjusted OR 3.2; 95% CI 2.1-5.0), symptoms of dependence (Adjusted OR 7.5; 95% CI 4.4-12.7) and increased blood alcohol levels (Adjusted OR 8.0; 95% CI 2.2-28.8), compared with women. Patients admitted due to accidents, violence, or drug use, had increased likelihood of hazardous drinking (Adjusted OR 2.4; 95% CI 1.5-3.9), dependence symptoms (Adjusted OR 2.0; 95% CI 1.2-3.3) and increased blood alcohol levels (Adjusted OR 7.7; 95% CI 3.0-19.8), compared with those admitted for other reasons. Alcoholism has a significant impact on the occurrence of injuries and on the demand imposed on health services. Prevention programs can potentially reduce the negative health and social impact of alcoholism.

Depressive symptoms among women with an abnormal mammogram.

An abnormal mammography finding constitutes a stressful event that may increase vulnerability by developing or intensifying pre-existing psychological morbidity. We evaluated depressive symptoms using the Composite International Diagnostic Interview among women of four ethnic groups who had an abnormal mammography result controlling for the effect of demographic, psychosocial and medical factors on recent onset of depressive symptoms. Telephone surveys were conducted among women aged 40-80 years recruited from four clinical sites in the San Francisco Bay Area after receiving a screening mammography result that was classified as abnormal but probably benign, suspicious or highly suspicious, or indeterminate using standard criteria. Among the 910 women who completed the interview, mean age was 56 (S.D.=10), 42% were White, 19% Latina, 25% African American, and 14% Asian. Prevalence of lifetime depressive symptoms was 44%, and 11% of women had symptoms in the previous month. Multivariate logistic regression models showed that Asian ethnicity, annual income >$10 000 and weekly attendance at religious services were significantly associated with decreased depressive symptoms. Having an indeterminate result on mammography and being on disability were significantly associated with more depressive symptoms. Reporting a first episode of depression more than a year before the interview was associated with significant increase in depressive symptoms in the month prior to the interview regardless of mammography result. Women with an indeterminate interpretation on mammography were at greater risk of depressive episode in the month prior to the interview compared to women with probably benign results (odds ratio=2.41; 95% CI=1.09-5.31) or with a suspicious finding. Clinicians need to consider depression as a possible consequence after an abnormal mammography result.