Esther Colell

Sex differences in the cumulative incidence of substance use by birth cohort

BACKGROUND Men present higher overall rates of substance use and abuse than women; yet, evidence suggests that an increase of substance use by the younger cohorts of women in recent decades is narrowing this gap in western societies. Moreover, younger cohorts may also be reporting earlier initiation of substance use, representing an increased risk for developing substance-related problems. With this study we intend to identify changes in the patterns of substance use of men and women in Spain for public health policy, planning and intervention. METHODS Sex differences in the cumulative incidence of alcohol, tobacco, cannabis and cocaine were examined by birth cohort using a combined sample of individuals aged 15-64 years from eight editions of the Spanish National Survey on Drugs (1995-2009). RESULTS Initiation of substance use in Spain is progressively taking place at younger ages, particularly among women. The gender-gap of life-time occurrence of substance use is narrowing (cannabis and cocaine) almost closing (alcohol) and even reversing (tobacco) in the youngest cohort. CONCLUSION These results reflect the particular evolution and trends of Spanish society regarding substance use. Womens increased use of substances and the earlier age of initiation of substance use by both sexes present particular challenges for prevention and treatment of future substance-related problems. The trends registered for legal and illegal substances would require re-evaluation of existing prevention policies.

Economic crisis and changes in drug use in the Spanish economically active population.

AIMS To examine changes in the use of alcohol, cannabis and hypnotics/sedatives between two periods (before and during Spains economic crisis), and to identify differences in the change between employed and unemployed individuals. DESIGN Using cross-sectional data from four editions of the Spanish Household Survey on Alcohol and Drugs, we selected economically active individuals aged 16-64 years (total sample = 62 440) and defined two periods, pre-crisis [period 1 (P1) = 2005-07] and crisis (P2 = 2009-11). Poisson regression models with robust variance were fitted to obtain prevalence ratios (PR) of heavy and binge drinking and multinomial regression models to obtain relative risk ratios (RRR) of cannabis and hypnotic/sedative use between the two periods, also considering the interaction between period and employment status. FINDINGS While the prevalence of alcohol use remained stable, heavy drinking declined in P2 in men both overall [PR = 0.73; 95% confidence interval (CI) = 0.67-0.79] and in the two age groups (16-34 and 35-64 years), and also in women overall (PR = 0.86; 95% CI = 0.75-0.99) and in the older age group. In contrast, binge drinking increased overall in P2 in men (PR = 1.17; 95% CI = 1.12-1.22) and in women (PR = 1.62; 95% CI = 1.49-1.76), and in both age groups. No differences in the change were observed between employed and unemployed individuals. Overall cannabis use remained stable in P2, but unemployed men and women of the older age group were more likely to have increased sporadic use compared to their employed counterparts (RRR = 2.24; 95% CI = 1.36-3.68 and RRR = 3.21; 95% CI = 1.30-7.93, respectively). Hypnotic/sedative use remained stable in P2 in men, but unemployed men were less likely to have increased heavy use in P2 compared with employed men (RRR = 0.69; 95% CI = 0.49-0.97). In women, heavy use increased in P2 overall and in the older age group, irrespective of employment status. CONCLUSION During a period of economic recession in Spain, heavy drinking decreased and binge drinking increased. Sporadic cannabis use increased among older unemployed men and women. Heavy use of hypnotics/sedatives increased among employed men while older women increased use irrespective of employment status.

Work-related stress factors associated with problem drinking: A study of the Spanish working population

BACKGROUND Workers may drink to cope with stress or to overcome negative emotions arising from an aversive working context, but results of previous studies are inconclusive on the specific work features affecting alcohol use. METHODS A cross-sectional study was designed with data on 13,005 working individuals from the Household Survey on Alcohol and Drugs in Spain (EDADES)-2007. We examined the associations between two drinking patterns and four measures of work-related stress factors. RESULTS Moderate and high levels of exposure to a noxious working environment (OR = 2.15 [95% CI = 1.51-3.06] and OR = 2.23 [95% CI = 1.49-3.36]) and a high level of lack of social support (OR = 1.62 [95% CI = 1.16-2.28]) were associated with heavy drinking, and precariousness with binge drinking for both moderate (OR = 1.22 [95% CI = 1.01-1.46]) and high (OR = 1.33 [95% CI = 1.04-1.70]) levels (OR = 1.21; 95% CI = 1.04-1.40) in men. Significant associations among women were only found when stress factors were analyzed separately. CONCLUSIONS Preventive practices in the workplace targeting alcohol abuse should consider specific production processes and organizational features.

The relationship between labour market categories and alcohol use trajectories in midlife

Background and aims Studies on the role of labour market position and change in alcohol use during midlife are scarce and their results are inconclusive mainly due to their failure to define comprehensive and distinct labour market groups and the short periods of time studied. In this study we used different activity categories for men and women to examine alcohol use trajectories in midlife covering a period of 17 years. Methods Using data from four sweeps of the National Child Development Study covering ages 33–50 (N=9960), we used multilevel growth models to study the association between labour market categories and longitudinal changes in weekly units of alcohol consumed. Results In the reference group of full-time employed men alcohol trajectory decreased over the follow-up period (β=−0.14; 95% CI −0.18 to −0.11) while in the reference group of employed women it increased (β=0.06; 95% CI 0.04 to 0.08). Men and women who were ‘mainly sick’ had significantly steeper declines in their alcohol consumption trajectory. Women who became employed after being homemakers had the steepest increase in alcohol use (β=0.05; 95% CI 0.01 to 0.09). Conclusions Being employed is a strong determinant of alcohol use for men and women in midlife, making the workplace a good target for health promotion programmes and policies aimed at reducing alcohol use. Caution is needed when interpreting the health effects of alcohol consumption as low alcohol users may have previously been heavy drinkers.

Gender differences in the use of alcohol and prescription drugs in relation to job insecurity. Testing a model of mediating factors

BACKGROUND The results of several studies suggest that economy-related stressors are less distressing for women compared with men. This study proposed to examine the relationship of perceived job insecurity with the use of licit drugs using a theoretical model that considered antecedents and mediators of this association, in order to identify differences between working men and women. METHODS Using information from the Catalan Health Survey (2010-2014), we selected working individuals aged 16-64 who were primary providers of household income (N=5315). The outcomes were two measures of alcohol consumption (heavy drinking and binge drinking) and the use of hypnotics/sedatives. As antecedents of the exposure to job insecurity we considered the type of contractual relationship and occupational class. The mediating factors were poor mental health, household structure and the hours of housework per week. The theoretical model was assessed using path analysis where the moderating effect of gender was considered in all the associations. RESULTS No differences in the prevalence of job insecurity were found between men and women (17%). Job insecurity (Odds ratio [OR]=1.35, 95% confidence interval [CI]=1.23-1.48) and house workload (OR=1.01, 95% CI=1.00-1.02) were positively associated with poor mental health, with no significant interactions with gender. Poor mental health was significantly associated with binge drinking (OR=1.23, 95% CI=1.13-1.33) and with the use of hypnotics/sedatives (OR=1.71, 95% CI=1.53-1.91). House workload showed a direct negative association with binge drinking (OR=0.99, 95% CI=0.98-1.00), while those in households with no children were more likely to be binge drinkers, with no significant interactions with gender. An alternative model had better fitting results for heavy drinking. CONCLUSION No gender differences were found in the association of job insecurity with mental health nor with the use of substances among primary providers of household income, emphasising the importance of social roles when assessing differences in mental health among men and women.

Impact of smoke-free regulations on smoking prevalence trends in Spain.

Background: Studies assessing Spanish smoke-free laws have found a decrease in second-hand smoke exposure, but the impact of such laws on general smoking trends is not clear. This study proposes to analyse trends in the prevalence of smoking in Spain, including changes by educational level, following the implementation of smoke-free regulations (2005 and 2010). Methods: Seven editions of the Spanish Household Survey on Alcohol and Drugs from 1999 to 2011 were used to analyse the standardised prevalence of daily smokers, the proportion of ex-daily smokers, and the average cigarettes smoked daily in both sexes and by educational level, among the population aged 15–64. The annual percentage of change (APC), and Poisson and linear multiple regressions were used to identify differences in terms of years and educational levels. Results: The overall prevalence of Spanish daily smokers decreased from 33.5% in 1999 to 30.2% in 2011 (APC = −1.7% for men, APC = −1.0% for women). Differences between low and high educational levels in the prevalence of daily smokers and ex-daily smokers increased. For both sexes, the prevalence ratio (PR) of daily smokers was positive for the years before 2005 and negative afterwards. Conversely, for ex-daily smokers the PR in all years was lower than in 2005. The mean number of cigarettes decreased from 17.6 cig/day in 1999 to 14.2 in 2011 [APC= day 1.8 (95% confidence interval: day 2.2, day 1.3)]. Conclusion: Six years after the national smoke-free regulation was implemented, previously reported decreasing trends of smoking for both men and women persisted, while inequalities between educational levels increased in both sexes.

Exploration and validation of working conditions questionnaire items included in the Spanish Household Survey on Alcohol and Drugs (EDADES)

OBJECTIVE To identify and validate a factor structure from items on working conditions included in the 2007 edition of Spanish Household Survey on Alcohol and Drugs (EDADES-2007) for use in research on consumption of addictive substances with this survey. METHODS We performed a factor analysis of the questionnaire items using a cross-validation technique with a subsample of EDADES 2007 (N=13,005). Exploratory factor analysis with half of this sample yielded a latent factor structure. This structure was subsequently validated via confirmatory factor analysis with the remaining half of the sample. Standard criteria were used to test the models goodness of fit, and a model-based internal consistency index was used to test the reliability of the structure. RESULTS The structure obtained showed an adequate confirmatory fit and involved four factors related to the dimensions environmental conditions (F1), workload (F2), precariousness (F3) and social support (F4). The internal consistency index confirmed the reliability for the total structure (0.755) as well as for each of the factors (F1=0.755, F2=0.661, F3=0.529 and F4=0.680). CONCLUSIONS The structure obtained represents a valid tool for assessing the relationship between use of addictive substances and certain work and employment conditions in the context of the EDADES survey. However, the inclusion of a more comprehensive and validated tool for the measurement of these conditions should be considered in future editions of the survey.