USE AND ABUSE OF DRUGS AMONG STUDENTS AND ITS RELATIONSHIP WITH CHILD MALTREATMENT IN A UNIVERSITY OF LEON, NICARAGUA

Quantitative exploratory study that examines the relationship between drug use and abuse during childhood among university students in Leon, Nicaragua. A cross-sectional study was designed with a bio-ecological perspective. The sample includes 368 students, where 48.4 % (178) were men and 51.6% (190) were women. The results highlighted that the negligence was found in 54.6% of participants, without gender differences (56.2% men and 53.2% women). Psychological abuse accounted for 40.5% of the students with small gender differences (39.3% men and 41.6% female). Moreover, 54.1% of participants had separated parents, 44.3% live or lived at some point in their life with an alcoholic, 28.8% have witnessed abuse to their mother or caretaker, 26.1% have lived or live with a family member with mental illness, while 21.2% lived with a drug addict. It can be concluded that child maltreatment is common and that negligence is an everyday event among participants. DESCRIPTORS: Narcotics. Child abuse. Students. University . USO E ABUSO DE DROGAS E SUA RELAÇÃO COM MAUS-TRATOS NA INFÂNCIA EM UM UNIVERSIDADE DE LEON, NA NICARAGUA RESUMO: Estudo exploratório quantitativo que examinou a relação entre uso de drogas e maus-tratos durante a infância, entre estudantes universitários em Leon, Nicarágua. O estudo transversal foi desenhado em uma perspectiva bioecológica. A amostra incluiu 368 estudantes, dos quais 48,4% (178) são homens e 51,6% são mulheres. Os resultados ressaltam que a negligência esteve presente em 54,6% dos estudantes, sem diferenças entre os sexos (56,2% homens e 53,2% mulheres). Maus-tratos psicológicos responderam por 40,5% dos estudantes com pequena diferença entre os sexos (39,3% homens e 41,6% mulheres). Além disso, 54,1% dos participantes tinham pais separados, 44,3% vive ou viveram em algum momento da vida com alcoolista, 28,8% testemunharam abuso a suas mães ou empregadas, 26,1% vivem ou viveram com familiares com doença mental e 21,2% viveram com dependente químico. Conclui-se que maus-tratos na infância é comum e que negligência é um evento cotidiano entre os estudantes avaliados. DESCRITORES: Entorpecentes. Maus-tratos infantis. Estudantes. Universidades. 75 Http://dx.doi.org/10.1590/0104-07072015001090014


INTRODUCTION
Violence against children and adolescents is a common issue in Nicaragua.The use of physical force, like violence against women, seems to be part of the culture, values, and beliefs that guide practices and interrelations in the family and in the community.Violence against children is defined as maltreatment that causes physical and psychological damage to them, and girls are more frequently abused than boys. 1 There is considerable important evidence linking drug abuse and child maltreatment.The factors related to child maltreatment include the characteristics of the parents, children, family, and culture where these are inserted.The parents' characteristics associated with child maltreatment include psychological disorders and substance dependence. 2 One survey found that child maltreatment is related to parents or caregivers who use alcohol and drugs; when both parents are drug users, maltreatment tends to be severe, 3 and high levels of drug consumption by caregivers are related to more severe abuse and abandonment of the child. 2 It has been found that child maltreatment bears strong links with drug use and abuse, [4][5] and girls are much more likely to be abused than boys, but both report similar effects from suffering abuse. 6The negative results are associated with the development of coping strategies as a result of maltreatment. 5Youngsters who have been maltreated are more likely to consume drugs as a means to cope with the trauma of having been abused. 7The impact of psychological abuse is a challenging field of study as there is no generally accepted definition of psychological abuse.This kind of abuse tends to take place together with other forms or kinds of maltreatment, thus hin-dering the measurement of its impact. 8he study aims at analyzing the relation between drug use among students of a university in Léon, Nicaragua and maltreatment in childhood.

METHODOLOGY
The study was cross-sectional and, from a bioecological perspective, it defined whether students reporting to be drug users and abusers had a higher possibility of having experienced maltreatment in childhood than those who did not use drugs.Following were some types of maltreatment surveyed: neglect; physical abuse; emotional abuse; and sexual abuse.Sampling was randomly selected.Information was collected using the ACE tool, and K10 was used to evaluate psychological distress.
Sampling consisted of 368 university students (178 men and 190 women) randomly selected; all participants were 18 years of age or older and attended a university in León.The non-probabilistic sampling technique was used to facilitate sampling selection.Sampling comprised the university as a whole, and the researchers randomly selected three colleges; then two courses from each college (the College of Medicine, College of Economic Sciences, and College of Law) were randomly selected.The analyses performed the prevalence calculation for the main variables, seeking some association measures.The protocol was approved by the Commission of Ethics in Research of the Center of Addictions and Mental Health (CAMH) and by the Ethical Commission of the university in León, Nicaragua.
The statistical test to compare the percentage of men and women for each type of maltreatment disclosed no significant difference between estimators.Regarding family experiences in childhood, 54.1% of the students stated that they were the children of parents who were separated; 44.3% live or had lived with an alcoholic; 28.8% reported having witnessed the abuse of their mother or female caregiver; 26.1% live or had lived with a family member suffering from mental disease; and 21.2% had lived with someone who was drug addicted.Moreover, 18.2% of the students reported having a family member who had attempted to commit suicide, while 13.9% knew a family member who had been imprisoned (Table 2).Regarding the levels of psychological distress reported, 50% of the students displayed minimum distress, 19.8% a medium level of distress, 16.0% a severe level, and 14.1% a moderate level.Among women, 24.2% were diagnosed with a medium level of distress, whereas for students with a moderate level of distress, 15.2% were men and 13.2% were women.The highest percentages of severe distress were found among women (17.9%) compared to 14.0% among men, although there were no significant differences in this level of distress, p=0.68 (Tabla 3).The prevalence of consumption of any kind of drug (legal or illegal) at any point in life was estimated in 50.0% of those surveyed, with a 95% probability that actual prevalence ranges were between 44.8% and 55.2%.

DISCUSSION
This paper suggests that psychological maltreatment and neglect are hardly distinguishable as these typically occur simultaneously, and participants stated having experienced some sort of maltreatment in childhood.Therefore, psychoactive substances are used on a daily basis as a means to cope with the trauma suffered in childhood.
On the other hand, neglect is perceived and understood as a product of the environment where youngsters were raised, because in Nicaragua children face a challenging quality of life of and difficulties with access to care.It was shown 9 that in several households children take care of themselves, and thus are more vulnerable to growing Peñalba S, Mann R, Hamilton H, Erickson P, Brands B, Giesbrecht N, et al.
up in adverse situations.The living standard of youth is not optimal, as many of them come from broken families where they are exposed to all kinds of maltreatment.Other studies have proved that sexual abuse, for example, is an usual phenomenon in Nicaragua. 10Migration to Costa Rica, the United States, and Spain is very relevant, as children's care is left under the responsibility of grandparents, uncles, or aunts.Many times we believe children will be educated at schools, but true education about moral values and principles is delivered by the family unit.That is when youngsters state to have experienced neglect by their relatives, mainly their parents.
Psychological maltreatment is more frequent than other kinds of maltreatment due to many risk factors occurring in the youths' everyday lives, mainly when they come from broken families and separation is considered to be normal, or when adolescents reject one of the parents, as these are evidence of a lack of affection and care in childhood.That is why these youngsters suffer from depression when using some sort of psychoactive substance, as this is a way of confessing that their experiences in childhood have caused them to do that.³Moreover, one or both of the parents having been a user of any kind of substance is another influencing factor, as children follow their examples.Adolescents are typically rebellious; however, when maltreatment is added to the picture, the possibility that they will start consuming some kind of psychoactive substance is increased. 4oung university students from other towns enjoy unlimited freedom, as the role of their parents is limited to giving them money to ensure their livelihood in the university.¹¹The authors were able to observe that many youngsters who did not use alcohol, tobacco, or marijuana started consuming these substances when they entered university, and that consumption became part of their daily lives, imitating others who already use these substances.

CONCLUSIONS
More than half of the students participating in the survey reported a minimum level of distress, while the medium, severe, and moderate levels were significantly lower.On the other hand, women were more subjected to psychological maltreatment than men, but different levels of psychological distress were found: minimum; medium; moderate; and severe.The minimum level prevailed among men, while among women the severe level prevailed, evidencing that psychological distress is frequent and closely linked with the use of psychoactive substances among university students.
Participants mentioned having suffered neglect in childhood as a consequence of lack of care from their parents and caregivers, which culminated in the use of drugs in adolescence.

Limitations
Data gathered are valid only for the colleges selected and cannot be expanded to the 34 courses offered by the university.As a cross-sectional study, it is subject to variations along time, because data herein represent only the period when the survey was carried out.

Recommendations
It is recommended to provide psychosocial assistance to students who have undergone some kind of maltreatment in childhood, and to provide them with access to the psychological care programs offered by the university.The phenomenon of drugs should be approached from the legal, social, and public health perspectives in the several courses offered by the university.