Onset of alcohol and tobacco use and transition to other drug use among students from Morelos, Mexico

Objective. To estimate the cumulative probability of occurrence of first use of alcohol and tobacco, and the risk of transition to illegal drugs (marijuana, cocaine, and heroine, among others), in adolescents and young adults, in Morelos State, Mexico. Material and Methods. A cross-sectional study was conducted during schoolyear 1998-1999, among 13 293 students aged 11-24 years, selected from public schools by probabilistic multistage sampling. Data were collected on sociodemographic, health status, and substance abuse variables, using a validated self-applied questionnaire. Data Were restructured to assemble a synthetic cohort for discrete time survival analysis. Associations were assessed with hazard rates and 95% confidence intervals obtained by means of multivariate Cox regression models. Results. Sixty percent of males started drinking alcohol at 17 years of age, and smoking tobacco at 18 years of age, on average. Women started using alcohol and tobacco one year after men. Utilization of illicit drugs occurred at 19 years of age on average in 5% of women and 13% of men. Nine out of every 100 illicit drug users started directly using illicit drugs without previous use of alcohol and/or tobacco. In general, alcohol or tobacco users were at greater risk of starting drug use than nonusers (RR=6.72; 95% confidence interval [CI]=4.13-10.93). Conclusions. Study findings suggest that interventions to decrease drug abuse should go together with efforts to delay initiation of alcohol and tobacco use. The innovative method used in this study yields epidemiologic evidence relating early use of alcohol and tobacco with initiation of illegal drugs in Mexican students. The English version of this paper is available at: http://www.insp.mx/salud/index.html.