Early alcohol or tobacco onset and transition to other drug use among students in the state of Morelos, Mexico.

UNLABELLED: In this study, we explored if patterns in the transition from alcohol/tobacco in the Mexican State of Morelos, Mexico are similar to those observed in other countries. METHODS: The data were from a representative sample of youth age 11-21 years (n = 13,105), who participated in a paper-and-pencil survey in middle schools, high schools, and colleges in the State of Morelos, Mexico. Drug use was assessed via the standardized instrument mostly used in Mexican student surveys. Cox's models for discrete time-survival analyses, stratified by school and age group were used to estimate the risk of drug use in relation to age of alcohol and tobacco use initiation by gender, while accommodating the complex survey design. RESULTS: About 5% of the students were estimated to have used drugs in their life. Male early users of alcohol or tobacco were more likely to use other drugs, compared to students who did not have an early alcohol or tobacco onset. COMMENT: Further studies on social mechanisms might help to account for observed similarities in patterns of drug involvement in different countries, even in the context of important differences in rates of drug use.

Mortality from cervical carcinoma in Mexico: impact of screening, 1980-1990.

OBJECTIVE: To determine the temporal mortality trends of uterine cervical cancer in Mexico for the period 1980-1990. STUDY DESIGN: In Mexico, data from death certificates are collected in a national repository at the National Institute of Statistics, Geography and Informatics. These data were analyzed to obtain mortality trends, and regional variations were obtained for the same period using a Poisson regression model. RESULTS: The official mortality figure for cervical cancer for the study period was 37,982 cases. Subregistration due to misclassification was evident, particularly in the first five years of the study period; however, poor quality of information was proportionally distributed across the different age groups. A standardized analysis by quinquennia showed a steady mortality trend during the last 10 years, with slightly upward significant trends within some age groups (beta=0, P<.05). High regional variations in cervical cancer mortality risks were found using a Poisson regression model. Twenty-four states in Mexico showed an increased mortality risk when compared with Mexico City; seven states showed a steady or downward trend. CONCLUSION: The results show the ineffectiveness of the cancer screening program, underscoring the need to ensure access to and the quality of the cervical cancer screening program in order to decrease mortality rates.

Technology evaluation of a USA-Mexico health information system for epidemiological surveillance of Mexican migrant workers.

From 1994 through 1996, federal, state, and nongovernmental organizations in Mexico and in the United States of America developed and piloted a Binational Health Information System for Epidemiological Surveillance of Mexican migrant workers. The system allowed data exchange for epidemiological surveillance between the state of Guanajuato in Mexico and the Commonwealth (state) of Pennsylvania in the United States, for case detection, prevention, and treatment, through shared contact investigation and case management of communicable diseases. The target population consisted of migrant workers traveling between Guanajuato and Pennsylvania to work mainly in the mushroom industry, and their sexual partners in their Mexican communities of origin. Computerized migrant health information modules were set up in Guanajuato and in Pennsylvania. Patient information and epidemiological surveillance data were encrypted and communicated electronically between the modules, using the WONDER communications system of the U.S. Centers for Disease Control and Prevention. Evaluation of the Guanajuato-Pennsylvania Binational Health Information System showed that major barriers to binational epidemiological surveillance and control are: a) lack of communication binationally; b) interrupted medical care due to migration; c) inconsistent diagnosis and treatment criteria between the two countries; d) lack of referral clinical records from one country to the other; and e) deficient legal regulations concerning binational clinical data transfer. To our knowledge, this is the first project that has successfully demonstrated the technological feasibility of a binational disease control system linking a state in the interior of one country with a state in the interior of another country, rather than just states in the border region. The project also advanced the understanding of health service organizational issues that facilitate or hinder communication, outreach, disease prevention, and organization of health care services for migrant workers in both Mexico and the United States. Despite the unprecedented success and potential bilateral benefits demonstrated by this project, serious structural and organizational deficits in the public health systems of both countries must be addressed before epidemiological surveillance can be achieved binationally.