Materials and Methodology

This current study was of transversal type and had a quantitative approach with a descriptive scope. The studied population consisted of Jesús Jiménez School’s sixth grade teenagers, through February to July 2011. Youngsters were ten years old or above, who were current students of sixth grade and had an informed consent from the parents; and those who didn’t wish to be part of the research, or were absent in the questionnaire application date were excluded. To participate in the research, an informed consent must be signed by the parents and an informed assent from the teenagers was requested. The study was approved by the Local Bioethics Committee of Hospital Max Peralta.

The data recollection was made through the followed questionnaires: Risk Screening from the PAIA and Family APGAR. Both instruments were applied in a group formation but each teenager answered the questions individually and confidentially.

Before obtaining the analysis information, a review of each questionnaire was made, to detect which adolescents presented risks factors, with the purpose of sending them on time for an adequate attention by professionals in psychology, social work and family medicine of Cartago Health Center.

Thereafter, the data was tabbed and depurated in an Excel 2007 program. Simple frequencies of all variables were made, and the prevalence with its respective 95% confidence indexes was estimated. For the quantitative variables, measures of central tendency and dispersion were calculated. Statistical association tests between independent variables (family’s functionality perception) and dependent variables (biopsycosocial risk factors) were made; this comparison was made using the Chi square test. The statistical analysis was made with EPIDAT3.1 and SPSS17. The confidence level was 95% and the statistical significance level was p<0.05.

Results

The total of students in sixth grade from this center was 164. There were 30 parents who didn’t sign the informed consent. Ten teenagers that have the informed consent of their parents were exluded, six of these teenagers decided not to sign the informed assent and the other four, were absent during the questionnaire application date. Thus, only 124 teenagers were part of this study.

According to age, 46% (CI95% 36,8-55,1) of the population consisted of male, and 54% (CI95% 44,9-63,2), of female. The ages were between 11-14 years old, with an average of 11.66 years old, with a standard deviation of 0.75 and a variation coefficient of 6.43%. According to residence, almost half of the teenagers lived in zones that belonged to EBAIS El Carmen, Manuel de Jesús Jiménez and La Pitahaya, all attached to Cartago Health Center.

According to the score obtained on PAIA’s Risk Screening, each partaker in this research was classify according to the level of biopsycosocial risk, in three groups: low (0-8 points), intermediate (9-13 points) and high (14 points or higher). The average score was 3.07 with a standard deviation (SD) of 2.6 and a variation coefficient of 84.62% (Table 1).

The prevalence of biopsycosocial risk factors was obtained through PAIA detection instrument, using dichotomous closed questions, to determined if the teenager presented a risk factor, according to his/her recent behavior (Figure 1).

Discussion

In relation to the prevalence of biopsycosocial risk groups, the study showed a high percentage of low risk teenagers, indicating that this group is susceptible to receive primary prevention measures for risk behaviors.

The absence of a confident had the highest prevalence among biopsycosocial risk groups, presenting in more than one third of the teenagers among sixth graders. This fact increases the probability for teenagers to fall into risk behaviors due to the lack of social support, as analyzed in a 2007’s Spanish study.⁷

The prevalence of teenagers involved in fights was of 12.1%; also the prevalence for the use of weapons among sixth graders had a prevalence of 1.6%; both factors represent a severe problem in schools. As manifested by PAHO (Pan American Health Organization), violence is one of the greatest difficulties of public health worldwide, so it is important to worked on school, community and family settings to stimulate teenagers to acquired preventive abilities against violent behaviors.¹⁰

The prevalence of driving or asking for rides/lifts was of 2.4% in both cases. These behaviors are life threatening for this population and other people as wells. The consequences of this risk behaviors are shown in United States statistics, where accidents (included those related to reckless driving of vehicles) are the main cause of death among teenagers.¹¹

In relation to drug use, the prevalence for active tobacco smoking was of 0.8%, also 0.8% for alcohol drinking in the last semester and 0.8% for other drugs. Comparing this data, IAFA’s 2006 national research had a prevalence of active tobacco smoking of 4.2%, alcohol drinking in the last 12 months of 20% and other drugs in 6.6% among seventh graders.¹²

In 2006’s national study, the onset age reported for alcohol drinking was 12.85 years old in males, and 13.01 years old in females; and the age onset for tobacco smoking was 12.38 years old for males and 12.88 years old for females.¹² The average age for the studied population was 11.66 years old, this number is below the age onset for tobacco smoking and alcohol drinking nationwide, justifying that the prevalence found in national statistics is lower.

In relation to sexual intercourse, the prevalence among sixth graders was 0%. In comparison with Santander and colleagues study, developed in Chilean schools, a prevalence of 14.3% was found in teenagers under age 13. ³ On national level, 2010’s Sexual and Reproductive Health poll, stages for sexual intercourse, an average of onset age of 15 for males and 16 for females. So, a 0% prevalence of sexual intercourse in a school population with an average age of 11.66 years old is according to Costa Rica’s reality. This indicates that preventive interventions for teenagers must be started, inside the National Sexuality Policy, recently acknowledge by the Ministry of Health.¹³

The prevalence of the family’s functionality perception on this study demonstrated that 68.6% had a good family function, differing totally from a 2008’s Chilean study that reported that 66.5% of teenagers perceived their families as dysfunctional;³ however, there are important similarities with a 2009’s Spanish study, where teenagers reporting a good family function was presented in 77% of cases.¹⁴ The prevalence of family dysfunction is 31.4% in this study, similar to statistics among general populations from different studies, with a family dysfunction between 16 and 35%.⁷

The fact that sixth graders perceived their families as functional is a beneficial factor; it is known that the family system is responsible for the teenager growth, fulfilling their tasks to acquired emotional maturity and that a functional family is and will always be for a teenager’s health, the best preventive agent.¹⁵

The perception of a good family function showed a relation with the presence of low biopsycosocial risks (p=0,011). This association stands that a good family function can be a protective factor against risk behaviors among teenagers; instead, a family dysfunction would be related to a higher biopsycosocial risk, as demonstrated in Roustit and colleagues study; that defined an association between family disruption and psycosocial maladjustment in teenagers.¹⁶

The absence of feeling depressed as a risk factor had been linked to the perception of good family function (p=0,002). So, a functional family can be a protective factor against development of depression. In comparison, Pérez-Milena and colleagues study in Spain, found an association between family dysfunction and presence of depression symptoms, proposing that family dysfunction could be a predisposing factor for depression;⁷ similar to Santander and colleagues study in Chile, where the risk to present emotional symptoms was slightly superior in families perceived as dysfunctional.³

In other variable crossing, a good family function was associated with the absence of suicide attempts (p=0,003), showing that a functional family could be a protective factor against suicides in adolescents. This is an important finding, since the IV State for Children and Adolescents Rights, indicates suicide as one of the greatest problems among teenagers.⁹

With the obtained data in this research, the association between perception of a good family function and the absence of suicide ideas (p=0,000) was found, referring to a protective relation against suicide ideas in teenagers with functional families. The above agrees with the study results related to depression and suicide attempts references received by the Hospital Calderón Guardia’s Adolescent Clinic, where family dysfunction was a crisis triggers.¹⁷

Also, a relation between perception of family as functional and constant communication with parents (p=0,000) was defined. This association confirms what Santander and colleagues described about teenagers belonging to functional families were the ones with better communication with their parents.³

Finally, it is recommended that future studies make a cohort or case-control design, based on this research, to analyze deeper the relationship of causality between the variables studied. In addition, it is necessary that the Caja Costarricense de Seguro Social continue with the routine application of screening and risk assessment of family functioning of adolescents, both in schools and in the EBAIS, to ensure comprehensive care of this population.

Conflict of Interests: the author reports none.

Thanks: We thank MSc. Mayra Cartín Brenes for her valuable advice.