Estimated occurrence of tobacco, alcohol, and other drug use among 12- to 18-year-old students in Panama: Results of Panama’s 1996 National Youth Survey on Alcohol and Drug Use Gonzalo B. González,1 Miguel A. Cedeño,1 Marcel Penna,1 Luis Caris,2 Jorge Delva,3 and James C. Anthony 3 ABSTRACT This report provides the first epidemiological evidence on tobacco, alcohol, and other drug use among school students in Panama, using data from a student survey completed in 1996. Specifically, we examine sex, age, grade level, type of school, and urban-rural variations in the occurrence of tobacco, alcohol, and other drug use. Estimates of lifetime prevalence and past- year use of these products were obtained using data from Panama’s 1996 National Youth Sur- vey on Alcohol and Drug Use (n = 6 477). To account for the multistage sampling design of the survey, all estimates and respective standard errors are derived by the Taylor series approx- imation method using Epi Info 6.0 CSAMPLE software. In general, more males, more older students, and more students in higher grades have used licit and illicit drugs, even though male-female differences tend to be small. Public-private school differences and urban-rural trends vary depending on the drug. The findings of this study are discussed in relation to the epidemiology and prevention of drug use in Panama. Based on these data, we seek to provide information to be used by the Government of Panama in its planning for prevention programs directed toward students in Panamanian schools. The Coalition of Panama [La Coali- the dimensions of youthful drug in- sent school-attending youths. The need ción de Panamá], organized by the First volvement in Panama, and to supply for such a survey was conveyed by the Lady of Panama, commissioned its information for the Coalition to use above coalition as a result of Panama’s Ministry of Public Health to conduct a in planning prevention programs di- drug surveillance system, which had nationwide survey of school students rected toward students in the coun- shown an increase in drug use and in order to provide new evidence on try’s schools. The purpose of this re- drug-related problems among peo- port is to present estimates about the occurrence of tobacco, alcohol, and ple seeking emergency medical care, other drug use among school-attend- among inmates in correctional facili- 1 Ministry of Health, Panama City, Panama. ties, and among people seeking sub- 2 Ministry of Health, Santiago, Chile. ing youths in Panama, as assessed in 3 The Johns Hopkins University, School of Hygiene the country’s 1996 National Youth stance abuse treatment (1). Additional and Public Health, Department of Mental Hygiene, Survey on Alcohol and Drug Use. need for a national survey also stems Baltimore, Maryland, United States of America. Submit correspondence and reprint requests to: The National Youth Survey is the from the findings of two prior surveys James C. Anthony, Ph.D., Johns Hopkins Univer- first in Panama to examine drug use conducted in Panama. A household sity, School of Hygiene and Public Health, 624 N. Broadway, 8th Floor, Baltimore, Maryland 21205 and suspected determinants of drug survey of drug use conducted in four USA. use using a sample designed to repre- urban areas in Panama in 1991 and a Rev Panam Salud Publica/Pan Am J Public Health 5(1), 1999 9 school survey in the district of Chan- from a complete list of the schools’ laboration with two of the authors, guinola in 1993 showed the percent of classrooms. Every student attending Luis Caris and James C. Anthony. Lo- lifetime cocaine use to be approxi- the sampled classrooms was recruited gistical and financial support came mately 4.4 in the early 1990s, a percent for participation. The characteristics from CICAD and the Pan American much higher than in several other of the survey respondents are shown Health Organization. Latin American countries in that same in Table 1. To ensure language and conceptual period (2, 3). Assessments were administered as equivalency, the research group trans- This apparent increase in drug use anonymous self-report questionnaires lated the DUSI into Spanish and then in recent years does not seem to be in each class by trained survey staff “back-translated” that document into unique to Panama. According to two members who first introduced the English. The resulting, final Spanish- reports on drug use in Latin America survey and answered questions. The language version of this questionnaire by the Executive Secretariat of the questionnaire was an adapted, Span- instrument has been used extensively Inter-American Drug Abuse Control ish-language version of the Drug Use during the last four years in Central Commission (CICAD) of the Organi- Screening Inventory (DUSI). The DUSI and South America. Furthermore, in zation of American States (OAS), drug was developed to assess alcohol and 1994, a pilot test of the DUSI was con- use appears to be increasing, particu- other drug use, school adjustment, and ducted in Panama with 524 students larly among young persons (4, 5). Re- behavioral and psychological prob- aged 12–19 years; questions the stu- cent increases in cocaine use in Central lems among youths in the United dents found to be unclear or confusing America is a case in point (5). Recently States (9). The DUSI was translated were revised in preparation for the na- documented increases in marijuana and adapted by investigators of the tional survey. use in Chile, as well as the high inci- Ministry of Health in Panama in col- A total of 39 assessors were trained dence of smoking of pasta base (un- for a period of one week before they processed cocaine) in the northern conducted the assessments. Supervi- cities of the country, are additional ex- sors closely monitored the fieldwork amples of the complex drug problem throughout the entire data collection found in Latin America (6–8). TABLE 1. Demographic characteristics of period. For quality control, regional students 12–18 years old participating The results of the national survey supervisors edited completed surveys in National Survey of Alcohol and Other in Panama are intended to guide the Drug Use, Panama, 1996 before forwarding them to the national allocation of resources to facilitate the field office. This work entailed no development, implementation, and n = 6 477 changes in students’ answers, but pro- evaluation of preventive intervention No.a % vided monitoring and rapid detection programs targeted towards the young Characteristic (unweighted) (weighted) of missing data and unclear responses. population of the country. This is an This information then was provided as b important task in view of the increas- Sex feedback to assessors so they would Male 2 788 50.2 ing use of alcohol and other drugs, Female 3 073 49.8 have uniform specifications about how and related health and psychosocial to answer students’ questions. problems. Age Informed consent procedures in- 12 1 399 22.2 13 1 869 29.1 volved notifying parents and allowing 14 1 668 25.8 either students or parents to withdraw MATERIALS AND METHODS 15 1 007 15.4 or to skip questions. Assurances of 16 368 5.3 anonymity were provided. Though The Panama population under study 17 117 1.5 parents might have kept their children 18 49 0.7 was all school-attending youths 12–18 home on the day of the survey in order years old in 1996, except those who Grade level to avoid study participation, to our 1 2 612 40.5 had progressed to postsecondary edu- 2 2 148 33.8 knowledge no parent or student re- cation, that is, to the university level. 3 1 713 25.7 fused participation in the survey. The sample consisted of 6 477 students Missing 4 — Some students skipped sensitive ques- selected via multistage probability School Type tions, as seems to be common for sur- sampling from 154 public and private Public 5 307 83.7 veys of this type. Furthermore, stu- schools, chosen to represent the urban Private 1 170 16.3 dents were told that they could decline and rural areas of the entire country. Location of School to participate at any time without fear- There is no 100% list of youths ages Urban 5 003 78.9 ing retaliation. 12–18 attending school in Panama, Rural 1 474 21.1 To measure the occurrence of drug from which a strictly random sample a Numbers (No.) are unweighted. Percents are weighted use, students were asked the following might be drawn. Hence, schools were and poststratified to reflect the population of school stu- question regarding drug use: “¿Has con- dents in Panama. sampled from a complete list of b Based on the 5 861 students who reported their sex sumido (nombre de la droga) alguna vez en schools, and classrooms were sampled (male versus female). la vida?” [“Have you ever used (name 10 González et al. • Occurrence of tobacco, alcohol, and other drug use among students in Panama of drug)?”], as well as follow-up ques- respective 95-percent confidence inter- reported using marijuana, cocaine hy- tions, such as to assess recency of use. vals (95% CI) were derived by the Tay- drochloride, crack cocaine, pasta base The lifetime experience question was lor series approximation method using (coca paste), hallucinogens, and heroin. asked for tobacco, alcohol, marijuana, Epi Info 6.0 CSAMPLE software (10). Table 3 shows estimates for recent tranquilizers, inhalants, stimulants, co- This method allows for variation in use of tobacco, alcohol, and other caine hydrochloride (cocaine in pow- sampling weights; poststratification drugs. An estimated 33.6% of students der form), crack cocaine (the form that adjustment to such known school pop- used alcohol in the year prior to as- can be smoked), pasta base (coca paste), ulation characteristics as age, sex, re- sessment (95% CI = 30.2 to 37.1), and hallucinogens, and heroin.