Effectiveness of a Mobile App to Increase Risk Perception of Tobacco, Alcohol, and Marijuana Use in Mexican High School Students: Quantitative Study.

BACKGROUND: Young people have the highest rate of drug use worldwide. Recent data from Mexico in this population show that the prevalence of illicit drug use doubled between 2011 and 2016 (2.9%-6.2%), with marijuana being the one with the highest increase (2.4%-5.3%), but also point out that alcohol and tobacco use have remained steady or decreased. Mexican adolescents are at high risk for drug use owing to a low perception of risk and the availability of drugs. Adolescence is an ideal period to reduce or prevent risky behaviors using evidence-based strategies. OBJECTIVE: In this study, we aimed to test the short-term effectiveness of a mobile intervention app ("What Happens if you Go Too Far?" ["¿Qué pasa si te pasas?"]) that seeks to increase risk perception of tobacco, alcohol, and marijuana use in a sample of Mexican high school students. METHODS: A nonexperimental evaluation based on pretest-posttest design was used to measure the effectiveness of a preventive intervention using a mobile app, "What Happens If You Go Too Far?" The dimensions analyzed were knowledge of drugs and their effects, life skills, self-esteem, and risk perception. The intervention was conducted on a high school campus with 356 first-year students. RESULTS: The sample included 359 first-year high school students (mean 15, SD 0.588 years; women: 224/359, 62.4% men: 135/359, 37.6%). The intervention increased the overall risk perception of tobacco (χ24=21.6; P<.001) and alcohol use (χ24=15.3; P<.001). There was no significant difference in the perception that it is dangerous to smoke 5 cigarettes, and there was a marginal difference in the perception that it is very dangerous to smoke 1 cigarette or to use alcohol or marijuana. We used a generalized estimating equation method to determine the impact of the variables on risk perception. The results showed that knowledge about smoking increased the risk perception of smoking 1 cigarette (odds ratio [OR] 1.1065, 95% CI 1.013-1.120; P=.01), and that knowledge about marijuana use (OR 1.109, 95% CI 1.138-1.185; P=.002) and self-esteem (OR 1.102, 95% CI 1.007-1.206; P=.04) produced significant increases in the risk perception of consuming 5 cigarettes. Resistance to peer pressure and assertiveness also increased the perceived risk of using tobacco and alcohol. CONCLUSIONS: The intervention has the potential to increase the perception of risk toward drug use in high school students by providing knowledge about the effects and psychosocial risks of drug use and by strengthening life skills that are associated with increased risk perception. The use of mobile technologies in intervention processes may broaden the scope of preventive work for adolescents.

[Social determinants of psychological distress and stress in men who perpetrate family violence in Mexico City]. / Determinación social del malestar psicológico y el estrés en hombres que ejercen violencia familiar en la Ciudad de México.

The social determinants of psychological distress and stress are described and analyzed in two groups of men attending reeducation programs for family violence in Mexico City. A non-experimental, descriptive, transversal study was conducted employing a qualitative methodology and an interpretive approach, in which questionnaires were utilized and focus groups were held. Symptoms of stress that were reported included muscle aches, insomnia and nightmares, headaches or dizziness, irritability or bad mood, nausea, stomach pain and indigestion. The principal issues that could be identified as the root of these symptoms included personal and family finances, their own health or that of their family members, and mental distress, among others. Differences with respect to living conditions and the effects of domestic violence were present. We argue that initiatives directed at men and their particular conditions and problems which are based on a hegemonic view of masculinity and gender are likely to be limited in their capacity to explain and modify the causes of situations generated by and experienced by men.

El objetivo es describir y analizar la determinación social del malestar psicológico y el estrés en dos grupos de hombres de la Ciudad de México que asistían a programas reeducativos por violencia familiar. Para ello, se realizó un estudio no experimental, transversal, descriptivo con metodología cualitativa y enfoque interpretativo, en el que se aplicó un cuestionario y se realizaron grupos focales. Los síntomas de estrés reportados fueron dolores musculares; insomnio y pesadillas; náuseas, dolor de estómago e indigestión; dolores de cabeza, mareos, irritabilidad o mal humor. Los principales problemas que podrían estar generando esta sintomatología serían la economía personal y familiar; la salud de ellos y sus familiares y los malestares mentales, entre otros aspectos. Existen diferencias relacionadas con las condiciones de vida y los efectos de la violencia doméstica. Los abordajes que solo consideran la masculinidad hegemónica o el género para el trabajo con varones en sus diferentes condiciones y problemáticas, sin considerar la desigualdad social y, en especial, las condiciones de vida, pueden ser insuficientes para explicar y modificar las causas de las afectaciones generadas y experimentadas por los varones.

Efectividad de las intervenciones en la violencia de pareja y ética / Effectiveness of Interventions in Intimate Partner Violence and Ethics / A efetividade das intervençöes na violência conjugal e a ética

Resumen Este artículo se propone identificar problemas metodológicos en el estudio de la efectividad de las intervenciones basadas en la terapia cognitivo conductual (TCC) dirigida a hombres que violentan a su pareja mujer y asisten de forma voluntaria al tratamiento. Con el método de revisión sistemática utilizado se obtuvo solo un estudio que cumplió con los criterios buscados, el cual mostró importantes limitaciones metodológicas. Luego, se realizó un comparativo con otras dos evaluaciones a fin de identificar explicaciones a tales limitaciones y la poca realización de estos estudios. Se corrobora que los estudios son escasos, con moderada o baja calidad en sus evidencias y no es posible elaborar conclusiones sobre su afectividad. Existen retos teórico-metodológicos en el diseño y la implementación de estas intervenciones que aumentan la probabilidad de resultados negativos cuando se evalúan a partir de diseños experimentales como parámetro ideal. Se identificaron evaluaciones desde una lógica experimental sobre el efecto del tratamiento, y trabajos multidisciplinarios que evalúan aspectos particulares del programa. Existen problemas teórico-metodológicos para las intervenciones y la evaluación de la efectividad, originadas en los estándares de programas con "visión restringida", así como en los estudios con diseños experimentales como parámetro ideal para conocer el impacto de las intervenciones. Es necesario incluir estos debates en la discusión ética de la salud pública.

Abstract This article intends to identify methodological problems in studying the effectiveness of Cognitive Behavior Therapy (CBT)-based interventions for men who abuse their female partners and who voluntarily attend treatment. Using the systematic review method, only one study was found that met the specified criteria but had significant methodological limitations. Subsequently, a comparison was made with two other assessments to identify explanations for such limitations and the poor conduct of these studies. We corroborated that studies are scarce, and their evidence is of moderate or low quality; thus, it is not possible to draw conclusions on their effectiveness. There are theoretical-methodological challenges in the design and implementation of these interventions that increase the probability of negative outcomes when evaluated based on experimental designs as an ideal parameter. We identified assessments of treatment effect from an experimental logic and multidisciplinary works that evaluate particular aspects of the program. There are theoretical-methodological problems in interventions and the assessment of effectiveness, arising from the standards of programs with a "restricted view," and in studies with experimental designs as an ideal parameter to know the impact of interventions. It is necessary to include these debates in the ethical discussion of public health.

Resumo Este artigo propöe-se a identificar problemas metodológicos no estudo sobre a efetividade de intervençöes baseadas na Terapia Cognitivo-Comportamental (TCC) para homens que violen tam sua parceira e que participam voluntariamente do tratamento. Com o método de revisão sistemática, obteve-se apenas um estudo que atendesse aos critérios buscados, o que apresen tou importantes limitaçöes metodológicas. Posteriormente, foi feita uma comparação com duas outras avaliaçöes para identificar explicaçöes para tais limitaçöes e o fraco desempenho desses estudos. É corroborado que os estudos são escassos, com qualidade moderada ou baixa em suas evidências e não é possível tirar conclusöes sobre sua afetividade . Existem desafios teórico-me-todológicos no desenho e implementação dessas intervençöes que aumentam a probabilidade de resultados negativos quando avaliados a partir de delineamentos experimentais como parâ metro ideal. As avaliaçöes são identificadas a partir de uma lógica experimental sobre o efeito do tratamento e trabalhos multidisciplinares que avaliam aspectos particulares do programa. Existem problemas teórico-metodológicos para as intervençöes e avaliação da efetividade, ori ginadas nos padröes de programas com "visão restrita" e nos estudos com delineamentos expe rimentais como parâmetro ideal para conhecer o impacto das intervençöes. É necessário incluir esses debates na discussão ética da saúde pública.

Malestar psicológico determinado socialmente y abuso expresivo en varones / Psychological distress socially determined and expressive abuse in men

El objetivo de este artículo es conocer y describir la experiencia subjetiva de hombres que asisten a un programa reeducativo para detener su violencia familiar, en torno al malestar psicológico determinado socialmente y su expresión por medio de actos violentos. El acercamiento metodológico de esta investigación es de tipo cualitativo y se trata de un estudio crítico con enfoque interpretativo. Participaron cinco hombres que se reúnen en un centro gubernamental especializado para la atención de la violencia familiar ubicado en una Delegación política del sur en el Distrito Federal. El malestar psicológico de la vida cotidiana se abordó a partir de instrumentos clínicos y del análisis de entrevistas grupales que exploran variables sociales. Además, se presentan los significados de los abusos realizados por los hombres con el fin de expresar el malestar. Se describió una lógica de acumulación de malestar con origen social expresado en un acto de abuso, y mediado por una razón o conflicto que justifica el ataque físico y/o verbal. La expresión de malestar, en ocasiones, se acompaña por sentimientos de culpa posteriores a los eventos violentos. Los elementos que permiten los abusos expresivos contra la pareja y otros familiares son las creencias sobre la superioridad del hombre, la inferioridad física de las mujeres e hijos, la propiedad de la persona por ser esposa, la obligación de la duración de una relación "para toda la vida" y las creencias sobre el uso de la violencia en las relaciones. En términos de intervención con esta población, se destaca la importancia de considerar el papel que juegan las determinantes sociales del malestar psicológico provenientes del nivel macro para los programas sociales e intervenciones comunitarias.

The meanings of the abuses made by men to express discomfort were explored. A logic of accumulation of discomfort with social origin expressed in an act of abuse and mediated for a reason or conflict that justified the physical and/or verbal attack was described. Sometimes, the expression of discomfort was accompanied by guilt feelings after violent events. The expressive elements that allow abuses to partners and other family members are the beliefs about the superiority of men, the physical inferiority of women and children or the belief about their inferiority, the notion that wives are a property, the perception that relationships should last a lifetime, and beliefs about the use of violence in relationships. In terms of the intervention with this population, the study highlights the importance of considering the role of social determinants of distress from the macro level to the social programs and community interventions.