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. Author manuscript; available in PMC: 2016 Apr 1.
Published in final edited form as: Drug Alcohol Depend. 2015 Jan 25;149:55–62. doi: 10.1016/j.drugalcdep.2015.01.015

Prevalence and determinants of resistance to use drugs among adolescents who had an opportunity to use drugs*

Catalina Lopez-Quintero a, Yehuda Neumark b
PMCID: PMC4361287  NIHMSID: NIHMS661878  PMID: 25659896

Abstract

Background

As drugs remain ubiquitous and their use increasingly viewed as socially normative, vulnerable population groups such as adolescents face continued and growing risk. A better understanding of the factors that discourage individuals from initiating drug use, particularly in enabling scenarios, is therefore needed. This study aims to identify individual, interpersonal and school-contextual factors associated with resistance to using drugs in the presence of a drug use opportunity among adolescents in Bogotá, Colombia.

Methods

Data are analyzed from 724 school-attending adolescents (15.1 years, SD=1.3) who have had an opportunity to use drugs. Schools were selected in a multistage probability cluster sample. Random intercept multilevel logistic regression models were implemented to estimate the effect of individual, interpersonal and school-contextual level variables on the likelihood of resisting using drugs.

Results

Drug use resistance was observed in less than half (41.4%) of those students who experienced an opportunity to use drugs. Drug use resistance was strongly associated with having experienced a passive drug use opportunity (AOR=3.1, 95%CI=2.0, 4.9), the number of drugs offered (AOR=0.7, 95% CI=0.6, 0.8) and family factors such as not having a drug-using first-degree relative (AOR=2.3, 95%CI=1.2, 4.3) and a high degree of parental supervision (AOR=1.9, 95%CI=1.0, 3.2).

Conclusions

A large proportion of students who experienced a drug-use opportunity did not initiate drug use despite living in a context of high drug availability and social disorganization. The findings highlight the need for effective family-based drug use prevention interventions within the Colombian context.

Keywords: drug use resistance, cannabis, multilevel analyses, transition to drug use, Colombia

1. INTRODUCTION

Worldwide, drugs remain ubiquitous despite intensive military, legal and political efforts to reduce their production, trafficking and commercialization over the last decades. Today, it is estimated that globally between 167 and 375 million people aged 15 to 64 years old use drugs at least once a year (United Nations Office on Drugs and Crime, 2013). Worrisomely, the drug use phenomenon is shifting towards new markets and novel drugs, with an increasing use of drugs in developing countries and a growing demand for amphetamine-type stimulants and prescription drugs everywhere (United Nations Office on Drugs and Crime, 2013).

Globalized drug markets have primarily affected young populations (United Nations Office on Drugs and Crime, 2013). According to the World Mental Health Survey Initiative the risk of drug use initiation at any given age is consistently higher in more recent cohorts than in older cohorts (Degenhardt et al., 2008). Moreover, many of these new drug markets emerge in the context of poverty, where youth experience limited opportunities to develop, drug policy lacks scientific support, and social practices and environmental cues that enable and reinforce drug use behaviors prevail (Singer, 2008; United Nations Office on Drugs and Crime, 2013).

In Colombia, drug production, trafficking, and use pose a tremendous social burden by fueling armed conflict, transforming moral values, and promoting corruption, individualism, and mistrust (Brook et al., 2007; Ministerio de la Protección Social, 2005; Siqueira and Brook, 2003; Thoumi, 2002). Results from the first comparative study among school adolescents in nine South-American countries organized by the Inter-American Drug Abuse Control Commission showed that the rate of drug use among youth in Colombia exceeds rates observed in other Latin American countries (Inter-American Drug Abuse Control Commission, 2004). Analyses of the 2008 Colombian National Survey on Psychoactive Substance Use (Ministerio de la Protección Social and Dirección Nacional de Estupefacientes, 2008) and the 2011 National Survey on Psychoactive Substance Use in School Population (Ministerio de Justicia y del Derecho, 2011) also indicate a significant decline in the age of drug use onset. For instance, while the mean age of drug use onset was 23 years old for the 1943-1949 Colombian birth cohort, the mean age of drug use onset was 16 for the cohort born between 1985 and 1991 (Camacho et al., 2010).

Early drug use initiation and regular drug use during adolescence affects critical neurodevelopmental processes that can lead to multiple immediate and long term consequences. For example, early onset of drug use has been linked to an increased risk for development of drug dependence syndromes (Chen et al., 2009; Grant and Dawson, 1998). Furthermore, longitudinal studies have shown higher risks of cognitive impairments in adults who used drugs regularly during adolescence, compared to those who abstained or were experimental users (Meier et al., 2012). In seeking to understand the mechanisms involved in drug use initiation among adolescents, previous studies have identified factors associated with transition from experiencing a drug use opportunity to drug use onset. Such factors include: male sex, late adolescence, school drop-out, low parental monitoring, smoking, alcohol consumption, low religious devotion or lack of religious affiliation, peer drug use, type of school, and county of origin (Benjet et al., 2007a; Caris et al., 2009; Chen et al., 2004; Dormitzer et al., 2004; Pinchevsky et al., 2012; Van Etten and Anthony, 2001; Wagner and Anthony, 2002; Wells et al., 2011; Wilcox et al., 2002).

Bearing in mind the multiple socio-cultural and political forces driving the drug market and drug use in Colombia, and the pressing need to identify specific factors that contribute to drug abstinence among adolescents, the present study aims to elucidate the role that individual, interpersonal and contextual factors play in promoting drug use resistance among high school students in Bogotá, Colombia. In keeping with the comprehensive ecological model proposed by McLeroy and colleagues (1988), individual and contextual level factors evaluated in this study were organized in levels of influence. Widely recognized health behavior theories (Ajzen and Fishbein, 1980; Bandura, 1986; Jessor and Jessor, 1977) guided the selection of covariates known to predict drug use. The results of this study may enhance our understanding of the phenomenon of drug use involvement in a context of high drug availability and help establish local priorities for primary prevention and intervention.

2. METHODS

2.1. Sampling methods and study participants

We collected data from a multi-stage cluster sample of 2,279 8th–10th grade students in 23 schools in Bogota, Colombia (Lopez-Quintero and Neumark, 2010, 2011; Neumark et al., 2012). The sample was selected to reflect the socio-economic characteristics of adolescents registered in Bogotá’s school-system. In this report we analyze data from a subsample of 724 students who experienced an opportunity to use drugs such as marijuana, inhalants (e.g., gasoline, ether, glue or “boxer” as its commonly called), cocaine, bazuco (a semi-processed coca-paste mixed with other ingredients) or ecstasy.

Parental consent was requested by sending letters to the parents or legal guardians explaining the study’s purpose and content and asking them to return the letter signed if they refuse the student’s participation in the survey. Regardless of parental approval, only students assenting to complete the questionnaire participated in the study. Among the total sample, twelve parents refused their child’s participation in the study, 44 students declined to participate, and 88 were absent on the day of the survey and on subsequent survey days. Eighty-two students returned incomplete questionnaires or provided incoherent or haphazard responses, or endorsed the opportunity to use a bogus drug (“Cadrina”, included as a quality control measure) and were excluded from the analyses. The research protocol was approved by university-based research committees in Colombia and Israel. The subsample of students who experienced a drug use opportunity was selected based on the question “How old were you when you first had an opportunity to try [drug]?” These drug use opportunities were further classified as “passive” or “active” by asking the students “Who provided you with the opportunity to use (drug) for the first time?“ with options that included: (1) I never had the opportunity, (2) I sought it myself, (3) a parent, (4) a sibling, (5) other family member, (6) a friend, (7) another person. Students who answered “I sought it myself” for any drug were classified as having experienced an “active” opportunity, and options 3 to 7 were classified as having experienced a “passive” opportunity. Any “active” opportunity for any of the five drugs was classified as an “active” opportunity regardless of having experienced a “passive” opportunity for the other drugs.

2.2. Data collection methods

A standardized confidential questionnaire was administered to the students during a one-hour session by a research assistant who answered students’ questions about the survey. The research assistant also read each question aloud which helped mitigate reading and literacy barriers, maintain order in the classroom, and enhance confidentiality. The questionnaire was constructed using items from the Drug Use Screening Inventory (DUSI; Tarter, 1990), the Youth Risk Behavior Survey (YRBS; Centers for Disease Control and Prevention, 2003), and particularly the questionnaire used in the multinational PACARDO research project (Dormitzer et al., 2004). Adjustments were made to the questionnaire based on the results of a pilot test and focus group sessions conducted to assess the suitability of the questionnaire with regard to duration, language appropriateness, construct comprehensiveness and answerability. YRBS test-retest reliability estimates were fair to good for self-reported life-time prevalence of legal and illegal drug-use (Κ=0.45-0.89), last-moth use (Κ=0.42-0.83), age at-first use (Κ=0.66-0.71) and offered/sold drugs on school premises (Κ=0.52) (Brener et al., 2002).

2.3. Study variables

The outcome variable, “drug use resistance”, was assessed based on the question “How old were you when you first tried (drug)?”. Response options included the age in years at which each specific drug was first used or an option that indicated that the student never used the drug. Students were classified as resistant to drug use when they indicated never having used the drug despite having had an opportunity to do so. A final “drug use resistance” variable was constructed summarizing the responses for the five individual drugs assessed (i.e., marijuana, inhalants, cocaine, bazuco and ecstasy), so that any student who indicated use of any drug given an opportunity were classified finally as non-resistant.

Numerous individual (e.g., socio-demographic, cognitive and psychosocial factors), interpersonal (e.g., family and peer factors) and contextual (e.g., school socio economic status - SES) factors were also assessed.

Socio-demographic and constructs of health behavioral theories [e.g., Theory of Reasoned Action and Planned Behavior; Ajzen and Fishbein, 1980), the Social Learning Theory (Bandura, 1986), and the Problem Behavior Theory (Jessor and Jessor, 1977)] that have been widely recognized as predictors of drug-use opportunity and drug use onset among adolescents were included as intrapersonal (socio-demographic and psychosocial and behavioral factors) and interpersonal level covariates (e.g., family and peer factors). These factors included: sex (male, female), age (<14, 14-16, >16 years), level of knowledge regarding physical and psychological harms of illegal drugs (tertiles), perceived risk of regular drug use (low/high), attitudes towards using illegal drugs (favorable/unfavorable), degree of problematic behavior (tertiles), monthly smoking in the past year (yes/no), lifetime drunkenness (yes/no), degree of parental supervision (quartiles), past-year illegal drug use among first-degree relatives (yes/no), number of drug using friends (0, 1, >1).

Level of knowledge was assessed by 6 questions [e.g., “Does illegal drug use lead to memory loss?” and analyzed in tertiles corresponding to all 6 questions answered correctly (high), 4-5 correct answers (medium) and <4 correct (low)]. Perceived risk of regular drug use was assessed by asking “To what extent do you think people risk harming themselves physically or psychologically, if they use [drug] weekly?”. “No risk” or “slight risk” responses for any given drug were recoded as “low perceived risk” and “moderate risk” and “great risk” were recoded into “high perceived risk”. Attitudes towards using illegal drugs were assessed with 5 questions such as “Do you think laws against the use of illegal drugs should be stricter?”; respondents who answered any of the questions positively were categorized as having unfavorable attitudes towards drug use. The “degree of problematic behavior” scale was composed of 9 items [(e.g., “During the last 12 months have you hit someone in a fight?”, and recoded into tertiles - low (0-2), medium (3-4) and high (5-9)]. Monthly smoking was determined if the student smoked cigarettes at least once a month every month in the past year. Degree of parental supervision was determined by 6 items [(e.g., “Are your parents or guardians often aware of where you are and what you are doing?”. The cumulative parental supervision scale was recoded in quartiles as 1st quartile or low parental supervision (0-3), 2nd (4), 3rd (5), and 4th quartile or high parental supervision (6)]. A detailed description of these scales including Cronbach alpha coefficients for internal reliability is presented as supplemental material1.

School SES, average drug use at school and exposure to school-based drug prevention programs were included as contextual (school)-level variables. School SES was determined by the Bogotá’s District Authority’s stratification (Departamento Administrativo Nacional de Estadística, 2005) and recoded as low - strata 1 and 2, medium - strata 3, and high - strata 4 to 6. Level of drug use at school was a derived variable computed by calculating the proportion of students using drugs in each school, comparing this proportion with the proportion for all participating schools, and recoded as “at/below average” or “above average”. Level of exposure to school-based drug prevention programs was a derived variable reflecting the proportion of students in each school who were exposed to drug prevention programs at school. Schools in which 75% or more of students were exposed to such programs were classified as high exposure.

2.4. Analyses

Descriptive statistics were performed to characterize the sample, and ascertain the prevalence of drug use resistance by type of drug. Cross tabulation analyses and appropriate statistical measures (chi-square, t-test) were applied to assess the relationships between resistance to use drugs and individual, interpersonal and contextual independent factors. Random intercept multilevel logistic regression models (Goldstein, 2003) were implemented to estimate the effect of individual and interpersonal characteristics at level-1 (e.g., socio-demographic, psychosocial, family and peer factors) and contextual level variables at level-2 (e.g., school SES, drug use at school) on the likelihood of resisting drug use given an opportunity. Associations are expressed as unadjusted odds ratios (OR) and adjusted odds ratios (AOR) with corresponding 95% confidence intervals (CI). Associations and correlations between independent variables and multicollinearity diagnostic statistics were examined. Tolerance values <0.1 and Variance Inflation Factor values >2.5 were regarded as indicating multicollinearity, which precluded inclusion of related independent variables in the models (Allison, 1999). The school effects on the outcomes of interest were evaluated by means of the median odds ratio (MOR), which is defined as the median value of the odds ratio between higher propensity respondents and lower propensity respondents, when randomly picking two individuals (with the same covariates) from two different clusters (e.g., schools, neighborhoods; Larsen and Merlo, 2005). The MOR converts school-level variance to the OR scale with a MOR value of 1 indicating no school variance. By contrast, the higher the MOR, the more important are the school effects for understanding the individual probability of experiencing any of the outcomes assessed. Additional details on these measures are provided elsewhere (Larsen and Merlo, 2005; Merlo et al., 2005). The analyses were performed using Stata, version 13.0 (StataCorp, 2013. College Station, TX) and MLwiN version 1.10.0007 (Centre for Multilevel Modelling, Institute of Education, London, UK).

3. RESULTS

3.1. Socio-demographic and drug use resistance related characteristics

The average age of participants was 15.1 years (SD=1.3) and nearly 60% were male. Other socio-demographic, individual, interpersonal and contextual characteristics of the study population are presented in Table 1.

Table 1.

Socio-demographic, individual, interpersonal and school-contextual characteristics of the study population (n=724), Bogotá, Colombia, 2006.

Characteristic Total
n %a
Socio-demographic
Sex
 Male 421 58.2
 Female 303 41.8
Age group (years)
 <14 60 8.3
 14-16 565 78.1
 >16 98 13.6
 Missing 1
Intrapersonal
Level of knowledge of drug use harms (tertiles)
 Low 184 36.0
 Medium 278 38.5
 High 260 25.5
 Missing 2
Perceived risk of regular drug use
 High 526 73.6
 Low 189 26.4
 Missing 9
Attitudes towards drug use
 Favorable 102 14.3
 Unfavorable 609 85.7
 Missing 13
Degree of problematic behavior (tertiles)
 High 168 34.3
 Medium 298 42.0
 Low 243 23.7
 Missing 15
Smoking monthly in the past year
 Yes 373 52.2
 No 342 47.8
 Missing 9
Ever got drunk
 Yes 571 78.9
 No 153 21.1
 Missing
Number of drugs offered (Mean, SD) 1.71 1.04
Type of drug use opportunity
 Active 161 22.2
 Passive 563 77.8
Interpersonal
Parental supervision (quartiles)
 1st (Low) 248 35.0
 2nd 186 26.3
 3rd 168 23.7
 4th (High) 106 15.0
 Missing 16
Past-year illegal drug use among first-degree relatives
 Yes 84 11.7
 No 635 88.3
 Missing 5
Number of drug using friends
 0 177 25.0
 1 95 13.3
 >1 442 61.9
 Missing 10
Contextual
School SES
 Low 334 46.1
 Medium 248 34.3
 High 142 19.6
Level of drug use at school
 At/below average 393 54.3
 Above average 331 45.7
Level of exposure to school-based drug prevention programs
 Low 168 23.2
 High 556 76.8
a

Total percentage excluding missing values

Less than half of the students (41.4%) who experienced an opportunity resisted drug use. Rates of drug use resistance varied by drug, being higher for those who experienced an opportunity to use bazuco (69.3%), followed by ecstasy (55.5%), marijuana (48.8%), cocaine (42.8%), and inhalants (40.4%). Significant sex differences in drug use resistance were noted only for marijuana (Table 2).

Table 2.

Drug use resistance rates by sex and type of drug use opportunity among school adolescents who experienced an opportunity to use drugs (N=724), Bogotá, Colombia, 2006.

% Drug Use Resistance
Total Males Females p-value Given an Active opportunity Given a Passive opportunity

Marijuana 48.8 44.3 55.7 0.02 15.2 51.6
Inhalants 40.4 37.8 43.9 0.2 32.0 45.1
Cocaine 42.8 41.0 47.5 0.5 33.3 43.4
Bazuco 69.3 66.0 75.0 0.4 40.0 71.4
Ecstasy 55.5 51.8 60.0 0.2 50.0 55.8
Any drug 41.4 38.5 45.4 0.1 23.8 46.4

Rates of drug use resistance were two-fold higher among students who experienced a passive drug-use opportunity (46.4%) than among those who experienced an active opportunity (23.8%; Table 2). The rate of drug use resistance given an active opportunity was highest for ecstasy (50.0%) and lowest for marijuana (15.2%). The rate of drug use resistance given a passive opportunity was highest for bazuco (71.4%) and lowest for cocaine (43.4%). Most transitions from opportunity to use occurred within the same year an opportunity presented itself (79.9% for inhalants and to 91.7% for Bazuco).

3.2. Factors associated with drug use resistance

3.2.1 Individual-level factors

As shown in Table 3, multiple cognitive and behavioral factors showed to be associated with drug use resistance after controlling for confounding effects. For instance, those students who experienced a passive drug use opportunity were more likely to resist using drugs than those who experienced an active drug use opportunity (AOR=3.1, 95% CI=2.0,4.9). As the number of drugs offered increased the likelihood to resist using drugs decreased (AOR=0.7, 95% CI=0.6,0.8). Also, students perceiving the regular use of drugs as a highly risky behavior were more likely to resist using drugs given an opportunity (AOR=1.8, 95% CI=1.2,2.7) as were non-smoking students compared with students who smoked (AOR=1.7, 95% CI=1.2.,2.5). Compared with students reporting a high degree of problematic behavior, those students reporting a low degree of problematic behavior also had a two-fold greater likelihood to resist drug use given an opportunity (AOR=2.3, 95%CI=1.3,4.1).

Table 3.

Intrapersonal, interpersonal, and contextual factors associated with resistance to use drugs. Results from random intercept multilevel logistic regression models. Bogotá, Colombia, 2006.

Characteristic Drug Use Resistance
n %a OR 95%C.I. AOR 95%C.I.
Sex
Male 166 39.1 1 1
Female 137 45.8 1.4 0.9-1.8 1.2 0.8-1.7
Age group (years)
<14 34 56.7 2.7 1.4-5.4 1.5 0.7-2.0
14-16 232 41.1 1.4 0.9-2.3 1.2 0.7-2.0
>16 32 32.7 1 1
Level of knowledge of drug use harms (tertiles)
Low 63 34.2 1 1
Medium 117 42.1 1.4 0.9-2.1 1.3 0.8-2.0
High 118 45.4 1.6 1.1-2.4 1.6 1.0-2.5
Perceived risk of regular drug use
Low 50 26.5 1 1
High 244 46.4 2.4 1.7-3.5 1.8 1.2-2.7
Attitudes towards drug use
Favorable 228 37.4 1 1
Unfavorable 63 61.8 2.7 1.8-4.2 1.2 0.7-2.1
Degree of problematic behavior (tertiles)
High 38 22.6 1 1 1
Medium 117 39.3 2.2 1.4-3.4 1.5 0.9-2.5
Low 136 56.0 4.4 2.8-6.8 2.2 1.2-3.8
Smoked monthly in the past year
Yes 109 29.2 1 1
No 186 54.4 2.9 2.1-4.0 1.7 1.2-2.5
Ever got drunk
Yes 208 36.4 1 1
No 91 59.5 2.6 1.8-3.7 1.3 0.8-2.1
Number of drugs offered (mean, SD) 1.4 0.8 0.6 0.5-0.7 0.7 0.6-0.8
Type of drug use opportunity
Active 38 23.6 1 1
Passive 261 46.4 2.9 1.9-4.3 3.1 2.0-4.9
Parental supervision (quartiles)
1st (Low) 86 34.7 1 1
2nd 68 36.6 1.1 0.8-1.6 0.9 0.6-1.4
3rd 70 41.7 1.4 0.9-2.1 0.8 0.5-1.3
4th (High) 66 62.3 3.2 2.0-5.2 1.9 1.0-3.2
Past-year illegal drug use among first-degree relatives
Yes 17 20.2 1 1
No 277 43.6 3.0 1.7-5.3 2.3 1.2-4.3
Number of drug using friends
>1 157 35.5 1 1 1
1 43 45.3 1.5 0.9-2.4 1.3 0.8-2.2
0 94 53.1 2.1 1.4-2.9 1.1 0.7-1.8
School SES
Low 145 43.4 1 1
Medium 91 36.7 0.8 0.5-1.1 0.8 0.5-1.2
High 63 44.4 1.1 0.7-1.7 1.1 0.7-1.9
Level of drug use at school
At/below the average 147 37.4 1 1
Above the average 152 45.9 1.4 1.1-1.9 1.2 0.9-1.8
Level of exposure to school-based drug prevention programs
Low 62 36.9 1 1
High 237 42.6 1.3 0.9-1.9 1.7 1.1-2.7
σ2 SE σ2 SE
Between-school variance components 0.03 0.18 0.02 0.15
Median Odds Ratio (MOR) 1.2 1.1
a

Row percentages

AOR= Adjusted Odds Ratio, 95%C.I.= 95% Confidence Interval

3.2.2 Interpersonal-level factors

Not having any first-degree relatives who use drugs was strongly associated with drug use resistance given an opportunity (AOR=2.3, 95%CI=1.2,4.3; Table 3). Parental supervision was also strongly associated with drug use resistance. Specifically, the adjusted model reveals that compared with students in the lowest (1st) quartile of parental supervision, those in the highest (4st) quartile were more likely to resist using drugs given an opportunity (AOR=1.9, 95%CI=1.0,3.2; Table 3).

3.2.3 Contextual level factors

Students from schools in which ≥75% of students were exposed to drug prevention education were more likely to resist using drugs given an opportunity (AOR=1.7, 95%CI=1.1,2.7) than students from schools in which <75% of the students received drug prevention education, as shown in the adjusted models presented in Table 3. Neither school SES nor level of drug use at the school were found to be associated with drug use resistance.

A median odds ratio (MOR) of 1.2 was observed in the null model and inclusion in the models of individual (MOR=1.1), interpersonal (MOR=1.3) and school-level covariates (MOR=1.3) moderately strengthened the size of these between-schools variations (Table 3). The results indicate that if a student moves to another school with a higher probability of resisting using drugs given an opportunity, his/her likelihood of resisting drug use will (in median) increase by 10% to 30%.

4. DISCUSSION

This study on the early stages of drug use involvement reveals that drug use resistance was observed in less than half (41.4%) of those students who experienced an opportunity to use drugs. The rate of marijuana use resistance observed in Bogotá, was comparable to the rate observed among school adolescents in Guatemala (40%) and adolescents in the general population in Mexico (38%; Benjet et al., 2007b; Dormitzer et al., 2004); lower than the drug use resistance rate found among school adolescents in Costa Rica (47%), Nicaragua (54%), Dominican Republic (71%) and Honduras (73%) and among adolescents in the general population in the US (60%; Dormitzer et al., 2004; Van Etten and Anthony, 2001); and higher than the drug use resistance rates found among school adolescents in El Salvador (22%), Panama (25%), and Chile (30%; Caris et al., 2009; Dormitzer et al., 2004).

Compared with students who experienced an active drug use opportunity, those who experienced a passive opportunity were more likely to resist using drugs. The number or opportunities experienced also showed to be associated with drug use resistance. Deciding whether to use a drug or not once an opportunity to do so presents itself has been explained based on principles of psycho-social theories that focus on the process of decision-making among adolescents (Dillon et al., 2007), such as the self-regulatory theory (Kanfer and Karoly, 1972; Karoly, 1993) and the self-efficacy theory (Bandura, 1986). According to the self-regulatory theory, internal and external processes motivate individuals to select, plan and evaluate goal-focused actions and consequently inhibit or acquire new behaviors in order to achieve these goals (Karoly, 1993). Thus, adolescents may refuse using drugs given one or multiple drug-use opportunities if they perceive drug use as incompatible with their goals. Alternatively, based on self-efficacy theory, adolescents with strong beliefs about their capabilities of putting their decision not to use drugs into practice (strong sense of self-efficacy), who are assertive, and who possess functional problem-solving skills, can more easily refuse to use drugs even under peer pressure, and accurately judge the consequences of using drugs. Among those students who experienced an active opportunity, a small, but significant proportion (23.6%) did not initiate drug use, perhaps due to social or environmental pressures preventing them from starting to use the drug (e.g., presence of adults, affordability of the drug) or self-regulatory mechanisms. This finding emphasizes the importance of investigating the acquisition and development of neurocognitive skills and abilities within an ecological framework. Research on the practical implications of the self-regulatory and the self-efficacy theories emphasizes the importance of providing adolescents with accurate, credible and updated information and strengthening their life-skills in order to help them achieve life goals and develop a strong sense of self-efficacy (Dillon et al., 2007).

Interpersonal factors, such as no drug use among first-degree relatives and parental supervision were found to be the most important interpersonal factors associated with drug use resistance given an opportunity. Students experiencing low levels of parental supervision were less likely to resist using drugs given an opportunity than those experiencing higher levels of parental supervision. Emerging evidence suggests that parental supervision decreases the likelihood of experiencing a drug use opportunity (Chen et al., 2005; Neumark et al., 2012), drug use onset (Chilcoat and Anthony, 1996; Denton and Kampfe, 1994; Graves et al., 2005; Mulhall et al., 1996), and level of drug use (Graves et al., 2005; Kung and Farrell, 2000). Children and adolescents whose parents are less involved in their care tend to associate with deviant or drug-using peers, be less informed about the hazardous effects of drugs, normalize drug-taking behavior, adopt favorable drug use attitudes, or to have drugs readily available (Burlew et al., 2009; Chilcoat and Anthony, 1996; Hawkins and Fitzgibbon, 1993; Kung and Farrell, 2000; Kerr and Stattin, 2000; Lloyd and Anthony, 2003; Montgomery et al., 2008). By restricting the analyses to a sub-sample of adolescents who already had experienced a drug-use opportunity, this study was able to confirm an association between parental supervision and drug use onset that goes beyond the social and environmental influences of parental supervision on experiencing an opportunity to use drugs. These results suggest that emotional connections and cognitive processes within the family dynamics that manifest themselves through parental involvement in their children’s lives from early stages of psychological development to adolescence (Erikson, 1993; Piaget, 1970), might contribute to reduce the likelihood that the adolescent will transition from opportunity to use. The rapid shift from a traditional agricultural-based lifestyle to an urban industrial lifestyle, the entry of women into the labor market, and other macro-social shifts, have brought about a change in family structure and child-rearing practices in Colombia (Echeverry-Angel, 2004), with potential effects on adolescents’ behaviors. Moreover, the weakening of traditional family values, and the rise in the proportion of single and stepparent families might have resulted in decreased parental time and consequently lower levels of parental supervision (Gauthier et al., 2004). The findings highlight the need to explore the effectiveness of family-based interventions to prevent drug use among Colombian adolescents. In this regard, one intervention of particular relevance for the Colombian context is “Familias Unidas”, an eco-developmental family-based program designed to increase positive parenting, family support of the adolescent, parental involvement, general parent-adolescent communication and parent-adolescent communication specific to substance use, and to prevent unsafe sexual behavior and HIV (Pantin et al., 2004). This intervention has demonstrated its efficacy in preventing both substance use and unprotected sexual behavior among Hispanic youth (including Colombian immigrant adolescents; Prado and Pantin, 2011).

Our finding that perception of regular drug use as a high risk behavior increased the likelihood to resist using drugs is consistent with previous studies assessing the role or risk perception on drug use initiation (Johnston et al., 2005; Morrell et al., 2010). Experimental and population based studies indicate that perception of risk is affected by knowledge (e.g., of hazardous effects), vicarious learning, and experience, and that risk perception beliefs originating from vicarious learning are less strong, less stable over time, and less influential over behavior performance (Agostinelli et al., 1995, Ajzen, 2001, Morrell et al., 2010). Thus, to avoid cognitive dissonance, individuals who initiate drug use tend to modify their risk perception beliefs by using mechanisms such as denial, normalization of the risk, reinterpretation of the negative information and/or attribution of the consequences to factors beyond their own control (Agostinelli et al., 1995, Gerrard et al., 1996, Halpern-Felsher et al., 2004; Wolfson, 2000).

Results of this study also reveal that a high degree of exposure to school-based drug use prevention programs increased the likelihood of resistance to use drugs. This finding highlights the important role of schools in shaping adolescent’s attitudes and behaviors and the need to develop a culture of drug use prevention. Converging evidence provides support of the effectiveness of school-based preventive strategies to deter drug use onset and progression along the drug use continuum among adolescents and young adults in North-America and Europe (Agostinelli et al., 1995; Botvin, 2004; Botvin and Griffin, 2007; Faggiano et al., 2005; Tobler, 1997). The extent to which such preventive strategies may be effective in other settings remains to be demonstrated. Implementation of intervention trials and translational public health research (Ogilvie et al., 2009) in Colombia is urgently needed.

MOR values observed in the null and adjusted models indicate that inclusion of intrapersonal, interpersonal and school-level covariates moderately increases the between-schools variations. A large proportion of the total variance in drug use resistance can be attributed to intrapersonal and interpersonal factors, rather than to school level factors.

4.1 Study limitations

The above findings should be interpreted in light of the following limitations: 1) Assessment of drug use is based on self-report, which is highly prone to social desirability bias (Anthony et al., 2000). Thus, we anticipate that any bias in the reporting of drug use would be toward under-reporting. 2) The results are not generalizable to all adolescents in Bogotá, but only to those currently enrolled in the school system and who likely represent the least problematic population with regards to drug use. Absenteeism rates observed in this study were probably slightly higher than in previous years, due to the city-wide public school renovation program that caused disruption in academic activities of many schools during the data collection phase. 3) A more comprehensive approach in the conceptual assessment of drug use resistance (for instance with regards to the frequency and context in which drug use opportunities occur) is needed to capture the complexity of this phenomenon. 4) The study did not investigate the role of personality traits, impulsivity, and response inhibition on resistance to use drugs given an opportunity. Future studies should address the role of these and other indicators of disinhibiting behaviors on the likelihood to resist using drugs. 5) This baseline survey addressed risk perception at the time the questionnaire was applied and not at the time of the first or last drug use opportunity nor at the time of first drug use, We believe that recalling a particular risk perception at the time at which each of those events occurred may not be accurate, especially if time had passed between events. A longitudinal study design would be needed to better assess the associations between event-specific risk perception and drug use resistance.

4.2 Conclusions

Despite these possible limitations, our results extend the current level of knowledge about the epidemiology of drug use involvement among school-attending adolescents and provide important information for the design of drug use prevention interventions for adolescents in a context where drugs are widely available. This paper focuses on the process of drug involvement among adolescents in Bogota, Colombia, yet we believe our results are relevant for other communities where drug production and trafficking represent a significant social threat. By analyzing data from a representative sample of school adolescents in Bogotá, we found that a large proportion of students (41.3%) who experienced a drug-use opportunity did not initiate drug use despite living in a context of social disorganization and high drug availability. Type and number of drug use opportunities experienced, as well as degree of parental supervision and no drug use among relatives were the strongest determinants of drug use resistance. Testing the effectiveness and efficacy of family-based drug use prevention interventions that employ interactive teaching strategies and concentrate on normative re-education strategies, training in refusal, development of parent-child interaction, communication, child management and family management skills is a priority strategy for decreasing the impact of drug use among youth in high risk context.

Supplementary Material

supplement

Highlights.

  • A large proportion of school adolescents who experience a drug-use opportunity do not initiate drug use despite living in a context of high drug availability and social disorganization, such as the Colombian context.

  • Rates of drug use resistance varied by drug, being higher for those who experienced an opportunity to use bazuco (69.3%), followed by ecstasy (55.5%), marijuana (48.8%), cocaine (42.8%), and inhalants (40.4%).

  • Drug use resistance was strongly associated with having experienced a passive drug use opportunity (AOR=3.1, 95%CI=2.0, 4.9) and the number of drugs offered (AOR=0.7, 95% CI=0.6, 0.8).

  • Drug use resistance is also strongly associated with not having a drug-using first-degree relative (AOR=2.3, 95%CI=1.2, 4.3) and a high degree of parental supervision (AOR=1.9, 95%CI=1.0, 3.2).

  • A large proportion of the total variance in drug use resistance among school adolescents can be attributed to intrapersonal and interpersonal factors, rather than to school level factors.

Acknowledgments

The authors wish to acknowledge the cooperation of the schools and students who participated in the survey and the local health authorities.

Role of funding sources

The preparation, development of this work was funded by a Milstein Doctoral Training Fellowship to C. Lopez-Quintero at the Hebrew University-Hadassah Braun School of Public Health and Community Medicine. The preparation of this manuscript was also supported by the National Institute on Drug Abuse, grants T32DA021129 to C. Lopez-Quintero (PI: J.C. Anthony), and by Michigan State University. The funding sources had no further role in the study design; in the collection, analysis and interpretation of data; in the writing of the report or in the decision to submit the paper for publication.

Footnotes

Contributors

Lopez-Quintero C and Neumark Y designed the study and wrote the first draft of the manuscript, Lopez-Quintero C undertook the statistical analyses. All authors read and approved the final version of the manuscript.

Conflict of Interest

The authors declare that they have no conflicts of interest.

*

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References

  1. Agostinelli G, Brown JM, Miller WR. Effects of normative feedback on consumption among heavy drinking college students. J Drug Educ. 1995;25:31–40. doi: 10.2190/XD56-D6WR-7195-EAL3. [DOI] [PubMed] [Google Scholar]
  2. Ajzen I, Fishbein M. Understanding Attitudes And Predicting Social Behaviour. Prentice-Hall; Englewood Cliffs, NJ: 1980. [Google Scholar]
  3. Ajzen I. Nature and operation of attitudes. Annu Rev Psychol. 2001;52:27–58. doi: 10.1146/annurev.psych.52.1.27. [DOI] [PubMed] [Google Scholar]
  4. Allison P. Logistic Regression Using the SAS System: Theory and Application. SAS; Cary, North Carolina: 1999. [Google Scholar]
  5. Anthony JC, Neumark Y, Van Etten ML. Do I do what I say? A perspective on self-report methods in drug dependence epidemiology. In: Stone A, Turkan JS, Bachrach CA, Jobe JB, Kurtzman HS, Cain VS, editors. The Science of Self-Report: Implications for Research and Practice. Lawrence Erlbaum Associates; New Jersey: 2000. pp. 175–198. [Google Scholar]
  6. Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice Hall; 1986. [Google Scholar]
  7. Benjet C, Borges G, Medina-Mora ME, Blanco J, Zambrano J, Orozco R, Fleiz C, Rojas E. Drug use opportunities and the transition to drug use among adolescents from the Mexico City Metropolitan Area. Drug Alcohol Depend. 2007a;90:128–134. doi: 10.1016/j.drugalcdep.2007.02.018. [DOI] [PubMed] [Google Scholar]
  8. Benjet C, Borges G, Medina-Mora ME, Fleiz C, Blanco J, Zambrano J, Rojas E, Ramirez M. Prevalence and socio-demographic correlates of drug use among adolescents: results from the Mexican Adolescent Mental Health Survey. Addiction. 2007b;102:1261–1268. doi: 10.1111/j.1360-0443.2007.01888.x. [DOI] [PubMed] [Google Scholar]
  9. Botvin GJ. Advancing prevention science and practice: challenges, critical issues, and future directions. Prev Sci. 2004;5:69–72. doi: 10.1023/b:prev.0000013984.83251.8b. [DOI] [PubMed] [Google Scholar]
  10. Botvin GJ, Griffin KW. School-based programmes to prevent alcohol, tobacco and other drug use. Int Rev Psychiatry. 2007;19:607–615. doi: 10.1080/09540260701797753. [DOI] [PubMed] [Google Scholar]
  11. Brener ND, Kann L, McManus T, Kinchen SA, Sundberg EC, Ross JG. Reliability of the 1999 youth risk behavior survey questionnaire. J Adolesc Health. 2002;31:336–342. doi: 10.1016/s1054-139x(02)00339-7. [DOI] [PubMed] [Google Scholar]
  12. Brook JS, Brook DW, Whiteman M. Growing up in a violent society: longitudinal predictors of violence in Colombian adolescents. Am J Community Psychol. 2007;40:82–95. doi: 10.1007/s10464-007-9126-z. [DOI] [PubMed] [Google Scholar]
  13. Burlew AK, Johnson CS, Flowers AM, Peteet BJ, Griffith-Henry KD, Buchanan ND. Neighborhood risk, parental supervision and the onset of substance use among African American adolescents. J Child Fam Stud. 2009;18:680–689. [Google Scholar]
  14. Camacho A, Gaviria A, Rodríguez C. El consumo de droga en Colombia. Bogotá, DC: Centro de Estudios sobre Desarrollo Económico, Universidad de los Andes; 2010. [Google Scholar]
  15. Caris L, Wagner FA, Ríos-Bedoya CF, Anthony JC. Opportunities to use drugs and stages of drug involvement outside the United States: evidence from the Republic of Chile. Drug Alcohol Depend. 2009;102:30–34. doi: 10.1016/j.drugalcdep.2008.12.004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Centers for Disease Control and Prevention (CDC) Handbook for conducting Youth Risk Behavior Surveys. US Department of Health and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion; Atlanta, GA: 2003. [Google Scholar]
  17. Chen CY, Dormitzer CM, Bejarano J, Anthony JC. Religiosity and the earliest stages of adolescent drug involvement in seven countries of Latin America. Am J Epidemiol. 2004;159:1180–1188. doi: 10.1093/aje/kwh151. [DOI] [PubMed] [Google Scholar]
  18. Chen CY, Storr CL, Anthony JC. Influences of parenting practices on the risk of having a chance to try cannabis. Pediatrics. 2005;115:1631–1639. doi: 10.1542/peds.2004-1926. [DOI] [PubMed] [Google Scholar]
  19. Chen CY, Storr CL, Anthony JC. Early-onset drug use and risk for drug dependence problems. Addict Behav. 2009;34:319–322. doi: 10.1016/j.addbeh.2008.10.021. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Chilcoat HD, Anthony JC. Impact of parent monitoring on initiation of drug use through late childhood. J Am Acad Child Adolesc Psychiatry. 1996;35:91–100. doi: 10.1097/00004583-199601000-00017. [DOI] [PubMed] [Google Scholar]
  21. Degenhardt L, Chiu WT, Sampson N, Kessler RC, Anthony JC, Angermeyer M, Bruffaerts R, de Girolamo G, Gureje O, Huang Y, Karam A, Kostyuchenko S, Lepine JP, Medina Mora ME, Neumark Y, Ormel H, Pinto-Meza A, Posada-Villa J, Stein DJ, Takeshima T, Wells JE. Toward a global view of alcohol, tobacco, cannabis, and cocaine use: findings from the WHO World Mental Health Surveys. PLoS Med. 2008;5:1053–1067. doi: 10.1371/journal.pmed.0050141. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Denton RE, Kampfe CM. The relationship between family variables and adolescent substance abuse: a literature review. Adolescence. 1994;29:475–495. [PubMed] [Google Scholar]
  23. Departamento Administrativo Nacional de Estadística. La estratificación en Bogotá y estudios relacionados - 1983–2004. Bogotá D.C: Alcaldía Mayor de Bogotá D.C, Departamento Administrativo de Planeación Distrital; 2005. [Google Scholar]
  24. Dormitzer CM, Gonzalez GB, Penna M, Bejarano J, Obando P, Sanchez M, Vittetoe K, Gutierrez U, Alfaro J, Meneses G, Bolivar Diaz J, Herrera M, Hasbun J, Chisman A, Caris L, Chen CY, Anthony JC. The PACARDO research project: youthful drug involvement in Central America and the Dominican Republic. Rev Panam Salud Publica. 2004;15:400–416. doi: 10.1590/s1020-49892004000600006. [DOI] [PubMed] [Google Scholar]
  25. Dillon L, Chivite-Matthews N, Grewal I, Brown R, Webster S, Weddell E, Brown G, Smith N. Risk, Protective Factors And Resilience To Drug Use: Identifying Resilient Young People And Learning From Their Experiences. Home Office, the Qualitative Research Unit at the National Centre for Social Research (NatCen) and the British Market Research Bureau (BMRB); London: 2007. [Google Scholar]
  26. Echeverry Angel L. Maestros y Maestras piensan a Colombia. Centro de Estudios Sociales; Bogotá: 2004. La familia en Colombia transformaciones y prospectiva. [Google Scholar]
  27. Erikson EH. Childhood and Society. W.W. Norton and Company; New York: 1993. [Google Scholar]
  28. Faggiano F, Vigna-Taglianti FD, Versino E, Zambon A, Borraccino A, Lemma P. School-based prevention for illicit drugs’ use. Cochrane Database Syst Rev. 2005;2:1–69. doi: 10.1002/14651858.CD003020.pub2. [DOI] [PubMed] [Google Scholar]
  29. Gauthier AH, Smeeding TM, Furstenberg FF. Are parents investing less time in children? Trends in selected industrialized countries. Popul Dev Rev. 2004;30:647–672. [Google Scholar]
  30. Gerrard M, Gibbons FX, Benthin AC, Hessling RM. A longitudinal study of the reciprocal nature of risk behaviors and cognitions in adolescents: what you do shapes what you think, and vice versa. Health Psychol. 1996;15:344–354. doi: 10.1037//0278-6133.15.5.344. [DOI] [PubMed] [Google Scholar]
  31. Goldstein H. Multilevel Statistical Models. 3. Arnold; London: 2003. [Google Scholar]
  32. Grant BF, Dawson DA. Age of onset of drug use and its association with DSM-IV drug abuse and dependence: results from the National Longitudinal Alcohol Epidemiologic Survey. J Subst Abuse. 1998;10:163–173. doi: 10.1016/s0899-3289(99)80131-x. [DOI] [PubMed] [Google Scholar]
  33. Graves KN, Fernandez ME, Shelton TL, Frabutt JM, Williford AP. Risk and protective factors associated with alcohol, cigarette, and marijuana use during adolescence. J Youth Adolesc. 2005;34:379–387. [Google Scholar]
  34. Halpern-Felsher BL, Biehl M, Kropp RY, Rubinstein ML. Perceived risks and benefits of smoking: differences among adolescents with different smoking experiences and intentions. Prev Med. 2004;39:559–667. doi: 10.1016/j.ypmed.2004.02.017. [DOI] [PubMed] [Google Scholar]
  35. Hawkins JD, Fitzgibbon JJ. Risk factors and risk behaviors in prevention of adolescent substance abuse. Adolesc Med. 1993;4:249–262. [PubMed] [Google Scholar]
  36. Inter-American Drug Abuse Control Commission. First comparative study of drug use in the secondary school student population in Argentina, Bolivia, Brazil, Colombia, Chile, Ecuador, Paraguay, Peru and Uruguay. Organization of American States; Lima: 2004. [Google Scholar]
  37. Jessor R, Jessor SL. Problem Behavior And Psychosocial Development: A Longitudinal Study Of Youth. Academic Press; New York: 1977. [Google Scholar]
  38. Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. Monitoring The Future National Survey Results On Drug Use, 1975-2004: Secondary School Students. I. National Institute On Drug Abuse; Bethesda, MD: 2005. [Google Scholar]
  39. Kanfer FH, Karoly P. Self-control: abehavioristic excursion into the lion’s den. Behav Therapy. 1972;3:398–416. [Google Scholar]
  40. Karoly P. Mechanisms of self-regulation: a systems view. Annu Rev Psychol. 1993;44:23–52. [Google Scholar]
  41. Kerr M, Stattin H. What parents know, how they know it, and several forms of adolescent adjustment: further support for a reinterpretation of monitoring. Dev Psychol. 2000;36:366–380. [PubMed] [Google Scholar]
  42. Kung EM, Farrell AD. The role of parents and peers in early adolescent substance use: an examination of mediating and moderating effects. J Child Fam Stud. 2000;9:509–528. [Google Scholar]
  43. Larsen K, Merlo J. Appropriate assessment of neighborhood effects on individual health: integrating random and fixed effects in multilevel logistic regression. Am J Epidemiol. 2005;161:81–88. doi: 10.1093/aje/kwi017. [DOI] [PubMed] [Google Scholar]
  44. Lloyd JJ, Anthony JC. Hanging out with the wrong crowd: how much difference can parents make in an urban environment? J Urban Health. 2003;80:383–399. doi: 10.1093/jurban/jtg043. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Lopez-Quintero C, Neumark Y. Effects of risk perception of marijuana use on marijuana use and intentions to use among adolescents in Bogotá, Colombia. Drug Alcohol Depend. 2010;109:65–72. doi: 10.1016/j.drugalcdep.2009.12.011. [DOI] [PubMed] [Google Scholar]
  46. Lopez-Quintero C, Neumark Y. The epidemiology of volatile substance misuse among school children in Bogotá, Colombia. Subst Use Misuse. 2011;46:50–56. doi: 10.3109/10826084.2011.580209. [DOI] [PubMed] [Google Scholar]
  47. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Behav. 1988;15:351–377. doi: 10.1177/109019818801500401. [DOI] [PubMed] [Google Scholar]
  48. Meier MH, Caspi A, Ambler A, Harrington H, Houts R, Keefe RS, McDonald K, Ward A, Poulton R, Moffitt TE. Persistent cannabis users show neuropsychological decline from childhood to midlife. Proc Natl Acad Sci U S A. 2012;109:E2657–E2664. doi: 10.1073/pnas.1206820109. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Merlo J, Chaix B, Yang M, Lynch J, Råstam L. A brief conceptual tutorial of multilevel analysis in social epidemiology: linking the statistical concept of clustering to the idea of contextual phenomenon. J Epidemiol Community Health. 2005;59:443–449. doi: 10.1136/jech.2004.023473. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. National Survey on Psychoactive Substance Use in School Population. Bogotá, DC: MJD, MEN, MSPS; 2011. Ministerio de Justicia y del Derecho (MJD) (Observatorio de Drogas de Colombia), Ministerio de Educación Nacional (MEN), Ministerio de Salud y Protección Social (MSPS) [Google Scholar]
  51. Ministerio de la Protección Social. Estudio Nacional de Salud Mental 2003. Bogotá, D.C.: Ministerio de la Protección Social and Fundación FES Social; 2005. [Google Scholar]
  52. Estudio Nacional de Consumo de Sustancias Psicoactivas en. Colombia Bogotá, D.C.: MPS, DNE; 2008. Ministerio de la Protección Social (MPS), Dirección Nacional de Estupefacientes (DNE) [Google Scholar]
  53. Montgomery C, Fisk JE, Craig L. The effects of perceived parenting style on the propensity for illicit drug use: the importance of parental warmth and control. Drug Alcohol Rev. 2008;27:640–649. doi: 10.1080/09595230802392790. [DOI] [PubMed] [Google Scholar]
  54. Morrell HE, Song AV, Halpern-Felsher BL. Predicting adolescent perceptions of the risks and benefits of cigarette smoking: a longitudinal investigation. Health Psychol. 2010;29:610–617. doi: 10.1037/a0021237. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Mulhall P, Stone D, Stone B. Home alone: is it a risk factor for middle school youth and drug use? J Drug Educ. 1996;26:39–48. doi: 10.2190/HJB5-0X30-0RH5-764A. [DOI] [PubMed] [Google Scholar]
  56. Neumark Y, Lopez-Quintero C, Bobashev G. Drug use opportunities as opportunities for drug use prevention: Bogotá, Colombia a case in point. Drug Alcohol Depend. 2012;12:127–134. doi: 10.1016/j.drugalcdep.2011.09.022. [DOI] [PubMed] [Google Scholar]
  57. Ogilvie D, Craig P, Griffin S, Macintyre S, Wareham NJ. A translational framework for public health research. BMC Public Health. 2009;9:116. doi: 10.1186/1471-2458-9-116. [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. Pantin H, Schwartz SJ, Sullivan S, Prado G, Szapocznik J. Ecodevelopmental HIV prevention programs for Hispanic adolescents. Am J Orthopsychiatry. 2004;74:545–558. doi: 10.1037/0002-9432.74.4.545. [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Piaget J. Science of Education And The Psychology Of The Child. Orion Press; New York: 1970. [Google Scholar]
  60. Prado G, Pantin H. Reducing substance use and HIV health disparities among Hispanic youth in the USA: the Familias Unidas program of research. Interv Psicosoc. 2011;20:63–73. doi: 10.5093/in2011v20n1a6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. Pinchevsky GM, Arria AM, Caldeira KM, Garnier-Dykstra LM, Vincent KB, O’Grady KE. Marijuana exposure opportunity and initiation during college: parent and peer influences. Prev Sci. 2012;13:43–54. doi: 10.1007/s11121-011-0243-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  62. Singer M. Drugs and development: the global impact of drug use and trafficking on social and economic development. Int J Drug Policy. 2008;19:467–478. doi: 10.1016/j.drugpo.2006.12.007. [DOI] [PubMed] [Google Scholar]
  63. Siqueira LM, Brook JS. Tobacco use as a predictor of illicit drug use and drug-related problems in Colombian youth. J Adolesc Health. 2003;32:50–57. doi: 10.1016/s1054-139x(02)00534-7. [DOI] [PubMed] [Google Scholar]
  64. Tarter RE. Evaluation and treatment of adolescent substance abuse: a decision tree method. Am J Drug Alcohol Abuse. 1990;16:1–46. doi: 10.3109/00952999009001570. [DOI] [PubMed] [Google Scholar]
  65. Thoumi FE. Illegal drugs in Colombia: from illegal economic boom to social crisis. Ann Am Acad Polit Soc Sci. 2002;582:102–116. [Google Scholar]
  66. Tobler NS. Meta-analysis of adolescent drug prevention programs: results of the 1993 meta-analysis. NIDA Res Monogr. 1997;170:5–68. [PubMed] [Google Scholar]
  67. United Nations Office on Drugs and Crime (UNODC) World Drug Report 2013. UNODC; New York: 2013. [Google Scholar]
  68. Van Etten ML, Anthony JC. Male-female differences in transitions from first drug opportunity to first use: searching for subgroup variation by age, race, region, and urban status. J Womens Health Gend Based Med. 2001;10:797–804. doi: 10.1089/15246090152636550. [DOI] [PubMed] [Google Scholar]
  69. Wagner FA, Anthony JC. Into the world of illegal drug use: exposure opportunity and other mechanisms linking the use of alcohol, tobacco, marijuana, and cocaine. Am J Epidemiol. 2002;155:918–925. doi: 10.1093/aje/155.10.918. [DOI] [PubMed] [Google Scholar]
  70. Wells JE, Haro JM, Karam E, Lee S, Lepine JP, Medina-Mora ME, Nakane H, Posada J, Anthony JC, Cheng H, Degenhardt L, Angermeyer M, Bruffaerts R, de Girolamo G, de Graaf R, Glantz M, Gureje O. Cross-national comparisons of sex differences in opportunities to use alcohol or drugs, and the transitions to use. Subst Use Misuse. 2011;46:1169–1178. doi: 10.3109/10826084.2011.553659. [DOI] [PMC free article] [PubMed] [Google Scholar]
  71. Wilcox HC, Wagner FA, Anthony JC. Exposure opportunity as a mechanism linking youth marijuana use to hallucinogen use. Drug Alcohol Depend. 2002;66:127–135. doi: 10.1016/s0376-8716(01)00191-0. [DOI] [PubMed] [Google Scholar]
  72. Wolfson S. Students’ estimates of the prevalence of drug use: evidence for a false consensus effect. Psychol Addict Behav. 2000;14:295–298. doi: 10.1037//0893-164x.14.3.295. [DOI] [PubMed] [Google Scholar]

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