This report sheds new light on adolescent drug experiences in Panama, the five Spanish-heritage countries of Central America, and the Dominican Republic, and presents the first estimates of school-level clustering of youthful drug involvement in these seven countries. Placed in relation to school survey findings from North America and Europe, these estimates indicate lower levels of drug involvement in these seven countries of the Americas. For example, in the United States of America 70% of surveyed youths had tried alcohol and 59% had smoked tobacco. By comparison, in these seven countries, only 51% have tried alcohol and only 29% have smoked tobacco. Future research will help to clarify explanations for the observed variations across different countries of the world. In the meantime, strengthening of school-based and other prevention efforts in the seven-country PACARDO area may help these countries slow the spread of youthful drug involvement, reduce school-level clustering, and avoid the periodic epidemics of illegal drug use that have been experienced in North America.

In recent evidence from the United States, there generally are no male-female differences in the probability of drug use among persons who report an opportunity to try the drugs. This is an important observation that might help us understand male-female differences in later drug use and dependence, but the observation needs to be replicated elsewhere. We begin this replication process using data from a 1996 national school survey of drug involvement among 6,477 students age 12-18 in Panama. We first examine the occurrence of an opportunity to use drugs by grade. We then follow these analyses with an examination of male-female differences in drug opportunity patterns. We found opportunities to use drugs and actual drug use to be greater at higher grade levels. Also, we found the probability of making a transition to use, given an opportunity, to be more likely among upper-grade students. Consistent with results observed in the United States, we found males in Panama to be more likely to have an opportunity to use marijuana, crack-cocaine, and other forms of cocaine, but not more likely than females to make a transition into drug use once an opportunity had occurred to try each drug. These findings are discussed in relation to the epidemiology and prevention of drug use in Panama and elsewhere, and future research on male-female differences in drug involvement.

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 Survey 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 approximation 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.

number of published studies on "cost effectiveness" have increased by more than 30%. There is a large variability in CERs for same drugs for different indications, in some cases also varying by biomarkers. Primary care drugs had lower and less variable CERs than specialty drugs. Variations also exist in methodology used by different groups in modeling cost effectiveness, especially for time horizon and comparator. Majority of primary care drugs were modeled for a time horizon of 35-40 years or lifetime to demonstrate cost effectiveness. CONCLUSIONS: This analysis shows the range, variability and methods used for calculation of ICER values for these high budget impact drugs and provides lessons for executives and policy makers.