Elia Díez

Comportamientos relacionados con la salud en estudiantes de secundaria: relaciones sexuales y consumo de tabaco, alcohol y cannabis.

Antecedentes y objetivos: Las principales causas de mortalidad prematura entre los jovenes se asocian a comportamientos de riesgo, con frecuencia relacionados entre si, que suelen adoptarse durante la adolescencia. El objetivo del estudio es describir el patron de consumo de sustancias adictivas y de practicas sexuales entre los jovenes escolarizados en 4o de ESO, 2o BUP y 2o FP1 de Barcelona en 1996, y tambien las interrelaciones entre estos comportamientos y diversas variables sociodemograficas. Material y metodos: Estudio transversal. Muestra aleatoria de 35 aulas del ultimo curso de secundaria obligatoria y equivalentes (946 alumnos de 15,8 anos de edad media) estratificada por tipo de estudios, titularidad, nivel socioeconomico del barrio de escolarizacion y tamano del centro. El instrumento de medida es un cuestionario validado previamente. Se estudia el consumo de tabaco, alcohol, cannabis, las relaciones sexuales y el genero, la edad, el dinero semanal disponible y el nivel de instruccion de los padres. Se ha realizado un analisis bivariado mediante la prueba de *2 y multivariado mediante el ajuste de un modelo log-lineal para cada genero. Resultados: Un 27% consume tabaco a diario y un 31% consume alcohol semanalmente. El 15% ha mantenido relaciones coitales, entre los que un 79% usa siempre o casi siempre preservativos. Entre las chicas se interrelaciona el consumo de tabaco con el de alcohol (OR = 4,2), de marihuana (OR = 5,9) y el haber mantenido relaciones sexuales (OR = 3,9), y con menos intensidad la edad, el dinero y el tipo de estudios. El consumo de alcohol se asocia al de tabaco y al de marihuana (OR = 4,2). Las relaciones sexuales se relacionan con el tabaco, con la edad (OR = 3,4), con el tipo de estudios (OR = 2,4) y con el consumo de marihuana (OR = 2,8). Entre los chicos se interrelaciona el consumo de tabaco con el de alcohol (OR = 2,7), el de marihuana (OR = 7,6) y el haber mantenido relaciones sexuales (OR = 4,4), y con menos intensidad el dinero y el tipo de estudios. El consumo de alcohol se asocia al de tabaco y al de marihuana (OR = 5,5). Las relaciones sexuales se relacionan con el tabaco y con la edad (OR = 2,5). Discusion: Las conductas de riesgo entre los estudiantes de 4o de ESO y equivalentes se relacionan intensamente entre si, tanto entre los chicos como entre las chicas, y son mas frecuentes entre los mayores, entre los que disponen de mas dinero semanalmente y entre los que estudian formacion profesional.

Factors and processes influencing health inequalities in urban areas

In 2010, half of the worlds population lived in cities, reaching three quarters in Europe.1 ,2 Health inequalities tend to be more marked in urban areas because they include neighbourhoods which concentrate deprived and poor populations. A number of scholars with a long tradition in studying ‘place effects and health’,3 ,4 ‘neighbourhoods and health’5 ,6 and ‘urban areas and health’2 ,7–13 have conceptualised the determinants of health inequalities in neighbourhoods and/or urban areas. All of them have stated the importance of aspects related to the physical environment, mainly the built environment,12 and also to the socioeconomic environment. Based on these backgrounds, this editorial presents a conceptual framework of the factors and processes (determinants) influencing health inequalities in European urban areas (figure 1), which are also determinants of health behaviours, under the responsibility of municipal governments and citizens. National or international wider factors described by other authors have not been included,10 ,11 although the model may also be used for municipalities smaller than urban areas. We propose this framework as a helpful tool to analyse local policies to address inequalities in health as well as to place health equity in the political agenda of European cities. Compared with other frameworks based on urban areas, it focuses mainly on European cities, not highlighting aspects that may be more relevant for cities from other continents.2 Moreover, it includes aspects not taken into account in other approaches. The framework has been designed within the ‘Socioeconomic inequalities in mortality: evidence and policies in cities of Europe’ project (INEQ-CITIES, https://www.ucl.ac.uk/ineqcities/), funded by the European Union, which aims to analyse the different patterns of small-area health inequalities and to describe policies to reduce them in European cities. The paragraphs below detail the main sections of …

Tendencias en el consumo de tabaco, alcohol y cannabis de los escolares de Barcelona (1987-1999)

Objetivo: Describir las tendencias en el consumo de tabaco, alcohol y cannabis entre los adolescentes escolarizados entre 1987 y 1999 de la ciudad de Barcelona. Metodos: Encuestas transversales realizadas a muestras representativas de escolares de segundo curso de Educacion Secundaria Obligatoria (ESO) entre 1987 y 1999. Los cuestionarios eran anonimos y autocontestados. Se dispone de datos de 5.013 escolares de la ciudad de Barcelona que participan en alguna de las 5 encuestas. Resultados: Tras disminuir de forma uniforme entre 1987 y 1996, en 1999 se observa un aumento del 13,4% en el consumo regular (diario o semanal) de tabaco y del 38,7% en el consumo experimental de tabaco, respecto a las prevalencias observadas en 1996. Con respecto al consumo de alcohol, se observa una disminucion global del 14% de los escolares que ha bebido al menos medio vaso de alcohol entre 1987 y 1999. El consumo problematico de alcohol se iguala en ambos sexos, y la proporcion que declara haberse emborrachado alguna vez es en 1999 superior en las chicas (14,0%) que en los chicos (10,5%). Mientras en 1996 un 6,9% declaraba haber probado cannabis, la proporcion en 1999, sin diferencias entre sexos, era del 7,3% de la poblacion estudiada. Conclusiones: En el periodo estudiado se observa un aumento del consumo regular de tabaco, una disminucion del consumo de alcohol y una estabilizacion del consumo de cannabis. Las diferencias entre ambos sexos tienden a desaparecer.

Substance use among road traffic casualties admitted to emergency departments

Objective: To describe the prevalence of recent psychoactive substance use and associated factors among road traffic casualties admitted to emergency departments. Methods: A cross-sectional study was carried out, including adults injured in road traffic crashes admitted to the emergency department (ED) of eight hospitals in Catalonia (Spain), during three cross-sections, each of 4 days duration (2005–2006). Information sources were an interview, an oral fluid specimen and the patient’s clinical record. Dependent variables were presence of alcohol, cannabis, cocaine, ecstasy, opiates or benzodiazepines. Independent variables were socioeconomic characteristics and circumstances of the injuries and admission. Prevalence and exact 95% confidence intervals were estimated for men and women. Bivariate analyses and multivariate binomial regression modelling were carried out to study factors associated with substance use in male drivers and pedestrians. Results: The prevalence of substance use was higher in men (n = 226) than in women (n = 161) for any substance (34.4% and 16.2%), any illegal substance (19.3% and 7.6%), alcohol (18.5% and 9.2%) and cannabis (17.0% and 3.8%), respectively. In male drivers and pedestrians, alcohol use was associated with being in the 25–30-year age group, being injured at night and the weekend, and arriving at the ED by ambulance; cannabis use was only associated with being in the 18–30-year age group. Conclusions: A high prevalence of recent psychoactive substance use, especially alcohol, cannabis and cocaine, was observed in all age groups. The results indicate the need to screen for substance use and to give simple advice to casualties at EDs.

Socioeconomic inequalities in cause-specific mortality in 15 European cities

Background Socioeconomic inequalities are increasingly recognised as an important public health issue, although their role in the leading causes of mortality in urban areas in Europe has not been fully evaluated. In this study, we used data from the INEQ-CITIES study to analyse inequalities in cause-specific mortality in 15 European cities at the beginning of the 21st century. Methods A cross-sectional ecological study was carried out to analyse 9 of the leading specific causes of death in small areas from 15 European cities. Using a hierarchical Bayesian spatial model, we estimated smoothed Standardized Mortality Ratios, relative risks and 95% credible intervals for cause-specific mortality in relation to a socioeconomic deprivation index, separately for men and women. Results We detected spatial socioeconomic inequalities for most causes of mortality studied, although these inequalities differed markedly between cities, being more pronounced in Northern and Central-Eastern Europe. In the majority of cities, most of these causes of death were positively associated with deprivation among men, with the exception of prostatic cancer. Among women, diabetes, ischaemic heart disease, chronic liver diseases and respiratory diseases were also positively associated with deprivation in most cities. Lung cancer mortality was positively associated with deprivation in Northern European cities and in Kosice, but this association was non-existent or even negative in Southern European cities. Finally, breast cancer risk was inversely associated with deprivation in three Southern European cities. Conclusions The results confirm the existence of socioeconomic inequalities in many of the main causes of mortality, and reveal variations in their magnitude between different European cities.

Social and health policies or interventions to tackle health inequalities in European cities: a scoping review

BackgroundHealth inequalities can be tackled with appropriate health and social policies, involving all community groups and governments, from local to global. The objective of this study was to carry out a scoping review on social and health policies or interventions to tackle health inequalities in European cities published in scientific journals.MethodsScoping review. The search was done in “PubMed” and the “Sociological Abstracts” database and was limited to articles published between 1995 and 2011. The inclusion criteria were: interventions had to take place in European cities and they had to state the reduction of health inequalities among their objectives.ResultsA total of 54 papers were included, of which 35.2% used an experimental design, and 74.1% were carried out in the United Kingdom. The whole city was the setting in 27.8% of them and 44.4% were based on promoting healthy behaviours. Adults and children were the most frequent target population and half of the interventions had a universal approach and the other half a selective one. Half of the interventions were evaluated and showed positive results.ConclusionsAlthough health behaviours are not the main determinants of health inequalities, the majority of the selected documents were based on evaluations of interventions focusing on them.

The effects of an urban renewal project on health and health inequalities: a quasi-experimental study in Barcelona

Background In the last decade, the Neighbourhoods Law in Catalonia (Spain) funded municipalities that presented urban renewal projects within disadvantaged neighbourhoods focusing on physical, social and economic improvements. The objective of the study was to evaluate the effects of this law on the health and health inequalities of residents in the intervened neighbourhoods in the city of Barcelona. Methods A quasi-experimental predesign and postdesign was used to compare adult residents in five intervened neighbourhoods with eight non-intervened comparison neighbourhoods with similar socioeconomic characteristics. The Barcelona Health Survey was used for studying self-rated and mental health in pre (2001, 2006) and post (2011) years. Poisson regression models stratified by sex were used to compute prevalence ratios comparing 2011 with 2006, and later stratified by social class, to study health inequalities. Results The intervened neighbourhoods had a significant decrease in poor self-rated health in both sexes while no significant changes occurred in the comparison group. When stratified by social class, a significant improvement was observed in poor self-rated health in the manual group of the intervened neighbourhoods in both sexes, resulting in a decrease in self-rated health inequalities. Similar results were observed in poor mental health of women, while in men, poor mental health worsens in both neighbourhood groups but mostly in the comparison group. Conclusions The Neighbourhoods Law had a positive effect on self-rated health and seems to prevent poor mental health increases in both sexes and especially among manual social classes.

Socioeconomic inequalities in mortality in 16 European cities

Aims: To explore inequalities in total mortality between small areas of 16 European cities for men and women, as well as to analyse the relationship between these geographical inequalities and their socioeconomic indicators. Methods: A cross-sectional ecological design was used to analyse small areas in 16 European cities (26,229,104 inhabitants). Most cities had mortality data for a period between 2000 and 2008 and population size data for the same period. Socioeconomic indicators included an index of socioeconomic deprivation, unemployment, and educational level. We estimated standardised mortality ratios and controlled for their variability using Bayesian models. We estimated relative risk of mortality and excess number of deaths according to socioeconomic indicators. Results: We observed a consistent pattern of inequality in mortality in almost all cities, with mortality increasing in parallel with socioeconomic deprivation. Socioeconomic inequalities in mortality were more pronounced for men than women, and relative inequalities were greater in Eastern and Northern European cities, and lower in some Western (men) and Southern (women) European cities. The pattern of excess number of deaths was slightly different, with greater inequality in some Western and Northern European cities and also in Budapest, and lower among women in Madrid and Barcelona. Conclusions: In this study, we report a consistent pattern of socioeconomic inequalities in mortality in 16 European cities. Future studies should further explore specific causes of death, in order to determine whether the general pattern observed is consistent for each cause of death.

Substance use among non-fatally injured patients attended at emergency departments in Spain

AIMS To describe the prevalence of recent use of alcohol, medication, and illegal drugs among patients who attended emergency departments (EDs) as a result of suffering an injury due to any external mechanism and to identify factors associated with alcohol and drug use. METHODS A cross-sectional study was conducted in eight university hospitals in Spain. Participants were adult patients admitted to a trauma ED. Oral fluid was used to test for psychoactive substances analyzed by gas chromatography-mass spectrometry. Socio-demographic data and information on circumstances of the injury were collected through interviews. RESULTS The analysis included 1579 patients admitted to the EDs (56.4% men). Among young people (< 40 years), 21.4% of men and 8.5% of women were positive for any illegal substance, primarily cannabinoids or cocaine; 24.7% of men and 14.8% of women were positive for alcohol. Among patients > or = 40 years, 7.4% of men and 1.6% of women were positive for any illegal substance, and 16.3% and 11.0% respectively for alcohol. Prevalence of substance detected varied across mechanism of injury, gender and age group. Night-time injury was associated with substance use. CONCLUSIONS A high proportion of injured patients who were treated in an EDs tested positive for psychoactive drugs. Routine testing at trauma departments would maximize the identification of patients who may benefit from referral to specialized addiction treatment centers, or brief interventions.

Desigualdades en salud materno-infantil: impacto de una intervención.

Resumen Se evalua en terminos del impacto poblacional una intervencion sociosanitaria materno-infantil en un area urbana de Barcelona (el distrito de Ciutat Vella ) de renta familiar baja. La intervencion se baso en facilitar el acceso a los servicios sociales y sanitarios a embarazadas y recien nacidos. Eldiseno del estudio es cuasiexperimental con un grupo de control no equivalente y medidas multiples en el tiempo. Se comparan las tasas de mortalidad infantil y perinatal acumuladas del distrito de Ciutat Vella con las del resto de la ciudad antes (1983-86) y despues de la intervencion (1987-89, 1990-92). Los resultados muestran que las diferencias iniciales existentes entre las tasas de mortalidad de las dos poblaciones desaparecen despues del desarrollo del programa. La mortalidad infantil en Ciutat Vella paso de 17,7/1.000 nacimientos en 1983-86 a 13,1/1.000 nacimientos en 1987-89 y a a 13,4/1.000 nacimientos en 1990-92, mientras que en el resto de la ciudad las tasas pasan de 9,5 a 8, 8 y 7,7/1.000 nacimientos, respectivamente. Se concluye que los programas sociosanitarios integrados en zonas urbanas pequenas de baja renta familiar pueden contribuir a la reduccion de las desigualdades en salud materno-infantil.