# Presentation: 028585

##  Epidemiology of solvent abuse MEXICO

**Maria Elena Medina-Mora, Jorge Villatoro; Gutiérrez R; Vega, L.**
- National Institute on Psychiatry

**Ricardo Sanchez Huesca**
- Centros de Integración Juvenil CIJ

**Patricia Cravioto**
- SISVEA General Direction of Epidemiology, SS,

## Sources of information

- 1970-1980
- First
- household
- Surveys (selected cities)

**1988**
**1st**

**1993**
**2nd **

**1998**
**3rd **

- Information Systems
- CIJ/SRID/ SISVEA
- 1974 1986  1990
- 2005

- Special populations
- 1972-2005

**2002**
**4rd**

- WHO NATIONAL HOUSEHOLD SURVEY ON PSCHIATRY EPIDEMIOLOGY *2002*

- Student surveys
- IMP/SEP
- 1976-2003

- National Household Surveys

## Underage workers in 101 Mexican cities 

- Identification of “working areas” (11,156 places):
- Streets                                    streets, avenues, etc.
- Public spaces                           markets, bus stops, etc.
- Places where they sleep            street educators
- Population count and characterization:
- observation and interview (N= 114, 497 minors)
- Selection of a sample 	         (n= 44, 454)

**Underage workers in 101 Mexican cities **

- 6 to 17 years of age; 8% in the first phase (100 cities) and 17% in Mexico City, live without parental figures; 72% to 61% males;

## Typologies of users

**Typologies of users**

- Children and adolescents that experiment with drugs
- Poly drug users that include inhalants, frequently as the drug if first use.
- Minors who’s drug of preference is inhalants who inhale every day with periods of abstinence
*These groups usually stop using solvents          upon entering adulthood.*
- Workers exposed to solvents some of whom become dependent and inhale for intoxication
- Other adults that continue using, these group shows a high degree of deterioration

- Source: Villatoro et al., 2004, 2005; Gutierrez & Vega, 2000; Stern et al., 1990; Medina.-Mora et al., 1998,

## Substances used

**Substances used**

-     Glue         	       Toluene
*“**chemo”   * 	        *“activo”*

*“**One            finishes with one self in a **few months**”*

*“**One finishes with one self in a **few years”*

- Consciousness of differential effects:

- Preferred substance: Toluene
-   greater effects and less “hangover”

- Variety of substances

- Traffic of Toluene: 98% pure, in the same places where cocaine is sold

- (Ortiz & Galván, 1998; Gutierrez & Vega, 1998, 2005

## National household surveys

- Marihuana		   2.99	     3.32       4.70       3.87        2.28
- Inhalants 	               0.76	     0.50       0.80       0.53        0.20
- Hallucinogens	  	 0.26	     0.22       0.36       0.29        0.14
- Cocaine		   0.33	     0.56       1.45       1.44        0.57
- Any drug		    3.33	     3.90       5.27       5.57        3.34

**1988**

**1993**

**1998**

**2002**

***Urban population 12 to 65 years***
***Rates of ever use***

**URBAN**

**RURAL**

**Source: SSA, CONADIC, DGE, INP**

## Drug use among patients entering for the first time to treatment CIJ

- 0

- 10

- 20

- 30

- 40

- 50

- 60

- 70

- 80

- 90

- 1990

- 1991

- 1992

- 1993

- 1994

- 1995

- 1996

- 1997

- 1998

- 1999

- 2000

- 2001

- %

- Marijuana

- Inhalants

- Cocaine

- Depressives med. use

- Heroin

- Methamphetamine

- Hallucinogens

**CIJ, 1990-2001**

_**Drug**_** use among patients entering for the first time to treatment ****CIJ**

## MAIN DRUGS OF ABUSE AMONG PATIENTS IN TREATMENT CIJ 2003

**Fuente: ****Consumo de drogas entre pacientes que ingresaron a tratamiento en Centros de Integración Juvenil en 2003.**  Dirección de Investigación y Enseñanza.

**N= 20,179**

**Notes:**

Para ilustrar y comparar la diseminación del uso de cocaína en 1990-1994,
se estimó primero la prevalencia total promedio del uso de cocaína
en el lapso 1990-1997, la cual asciende a 31.4%

Una vez establecida esta media,
en el mapa se muestran los sitios donde se registraron, entre 1990 y 1994,
 tasas de prevalencia superiores a la misma; sitios que, en
general, coinciden con las rutas del tráfico ilegal de sustancias

## Rates of drug use - Mexico City

- Inhalants
- Marihuana
- Cocaine

*House   Street*

- %

*   **House   Street*

-  3.9	     73.6
-     2.0       35.8
-  1.6	     18.9

-       2.4      69.6
-       1.0      30.4
-       1.0      17.4

- Inhalants
- Marihuana
- Cocaine

- HOSE-HOLD SURVEY*

- 1.08
- 2.47
- 0.99

- 0.20
- 0.45
- 0.22

- STREET WORKERS

- *SSA,IMP:  ENA 1 998

- DIF-DF/UNICEF

**Rates of drug use - Mexico City**
*(12-17 years of age)*

## Age of first use*

**Age of first use***

**%**

- *% from total users of each drug

## Boys and Girls Between 6 and 17 Years of Age 

*Boys and Girls Between 6 and 17 Years of Age** *

**Living with parental figures is correlated to school attendance** (0.58)
- School enrolment is a protective factor for
-  **Working in a high risk environment** (-0.76)
**Drug use**  (-0.32)
**Early sexual intercourse** (-0.73)
-   **Years worked** (-0.47)

**Medina-Mora, Robles, Villatoro, Ruz, Fleiz, 1999**

**STRUCTURAL EQUATION MODEL FOR MINORS THAT WORK IN THE STREETS**

**DIF/UNICEF/UNDCP**

## STRUCTURAL EQUATION MODEL FOR MINORS THAT WORK IN THE STREETS   GENDER DIFERENCES 12 -17 YEARS OF AGE 

**STRUCTURAL EQUATION MODEL FOR MINORS THAT WORK IN THE STREETS **** ***** ****GENDER DIFERENCES 12 -17 YEARS OF AGE*

-               School enrolment              Living in a house with
-  							         1 or 2
-            Parents *reduce the risk of working in a dangerous                                                                                                            environment*
**The place of work is an important factor**
** ****for drug abuse*****  ***
***And for sexual abuse***
- Problems with the police increase with:
-               **The use of drugs -  The working place**

**Medina-Mora, Robles, Villatoro, Ruz, Fleiz, 1999**

## Impact: Inhalant abusers vs. non users  High school students (n=7,874)

- Social maladjustment 	   	     1.28 (1.00-1.64)
- Stress  				     1.22 (1.03-1.45)
- Suicidality			                1.17 (1.06-1.29)
- Sexual abuse	                           1.83 (1.21-2.75)
- Antisocial behavior		      2.25 (1.66-3.06)
-    *(severe)*

- Logistic regression models

- Villatoro, Medina-Mora et al., 2005

## Inhalant abusers vs. users of other drugs  

- Attending secondary school 	     1.87 (1.40-2.49)
- Parents have lower school status  1.38 (1.22-1.56)
- Lower perception of risk		      2.22 (1.63-3.03)
- More antisocial behavior:
-                           Low severity	      1.63 (1.18-2.24)
-                           High severity	      1.79  (1.26-2.54)

**Impact**
**I****nhalant abusers vs. non users**

- Friends use		 	     2.91 (2.28-3.71)
- Family members use		     2.22 (1.66-2.98)

## Pregnancy and exposure to solvents

- Gutierrez y Vega, 1998

- Girls are exposed to violence & sexual abuse in their families of origin and in the streets
- They inhale more frequently by themselves or get involve with one partner to avoid being sexually used
- Have little information about their reproductive health and pregnancy and infectious risks.
- Females inhale while pregnant
- Babies are exposed since birth when parents and others inhale in close environments

- Matlapa, 2005

## Implications for policy, prevention and treatment

- Efforts to control availability for minors
- Programs established to protect these children require support for the treatment of health conditions including mental disorders, cognitive impairment and substance dependence.
- Support for street educators is also required
- Widen scope of specialized treatment programs to include vulnerable populations

- Support research aimed at developing and testing intervention models tailored to the needs of vulnerable populations & evaluation of programs

## Problems reported – research needs

- Mortality and Morbidity
- Lack vaccination schemes
- Malnourished
- Sleep in unsafe conditions
- Exposed to violence and accidents related to their work
- Exposed to violence and accidents while intoxicated
- Pregnancy, fetal exposure and during the perinatal period
- Cognitive impairment
- Distorted sleep cycles

**Life styles, exposure to solvents, individual vulnerabilities**

## NATIONAL INSTITUTE OF PSYCHIATRYInformation Center on Mental Health and Addictions

- 56552811 or 56552816, ext. 196 and 157
-  cisma@imp.edu.mx
- www.inprfm.org.mx