Jaime Pinilla

Factores predictores del inicio y consolidación del consumo de tabaco en adolescentes

Objetivo: Analizar los factores que determinan la adquisicion y posterior consolidacion del consumo de tabaco en los jovenes adolescentes. Material y metodo: Estudio longitudinal de 3 anos de duracion (2000-2002) sobre jovenes estudiantes de ensenanza obligatoria, con una edad al inicio del estudio de 13-14 anos. Los datos fueron recogidos mediante encuesta individual, cuyo ambito de estudio era la isla de Gran Canaria, con una muestra final de 745 individuos. Se estimaron modelos de eleccion binaria condicional de efectos fijos para datos longitudinales, para determinar la probabilidad de probar por primera vez el tabaco («modelo de inicio»), asi como sobre la probabilidad de ser fumador ocasional o habitual («modelo de experimentacion»). Resultados: En el ultimo ano, el 57% de los adolescentes encuestados ha tenido contacto con el tabaco alguna vez, un 25% mas que en el primer ano, algunos de ellos (el 9%) de forma diaria. En el «modelo de inicio» los determinantes del consumo de tabaco son el interes por el colegio (odds ratio [OR] = 0,27; intervalo de confianza [IC] del 95%, 0,08-0,87, y OR = 0,14; IC del 95%, 0,03-0,58 para los que manifestaron bastante y mucho interes por el colegio, respectivamente), el consumo de tabaco por parte del mejor amigo (OR = 7,44; IC del 95%, 2,59-21,4), el consumo de alcohol (OR = 11,82; IC del 95%, 4,96-28,2, y OR = 15,42; IC del 95%, 4,68-50,7 para los que beben alcohol de manera ocasional o frecuente, respectivamente), y el dinero disponible (euros semanales) (OR = 1,13; IC del 95%, 1,07-1,19). Para el «modelo de experimentacion», el consumo de tabaco por parte del mejor amigo (OR = 7,01; IC del 95%, 2,96-16,5), el consumo de alcohol (OR = 5,71; IC del 95%, 1,98-16,4, y OR = 5,22; IC del 95%, 1,56-17,5 para los que beben alcohol de manera ocasional o frecuente, respectivamente) y los anos que lleva como fumador (OR = 1,44; IC del 95%, 1,11-1,86). Conclusiones: El estudio destaca, principalmente, los efectos del grupo de amigos, el consumo de bebidas alcoholicas y el poco interes por los estudios como factores asociados al consumo de tabaco.

Willingness to pay for alternative policies for patients with Alzheimer's Disease.

This paper focuses on eliciting the willingness to pay (WTP) for policy measures aimed at improving the health care offered to patients suffering from Alzheimers disease (AD). We utilize a discrete choice experiment (DCE) approach for the elicitation of the preferences of the general population for three alternative policies: home care, day care centres, and medium or long-stay centres. The results show that these policies are significantly valued across the surveyed population. The monthly WTP per hour of home care is estimated as 4 euros per individual, while the monthly WTP values for full population coverage in day centres and medium-long-stay centres are estimated as 0.43 euros and 0.42 euros respectively. We compare the results of classical and Bayesian estimation methods, and conclude that the latter provide a better representation of the heterogeneity in the sample. The results are significant for health care, as they enable policymakers to identify the social demand for such services, as well as the relative economic values placed on the alternative policy measures.

Equity in specialist waiting times by socioeconomic groups: evidence from Spain

In countries with publicly financed health care systems, waiting time—rather than price—is the rationing mechanism for access to health care services. The normative statement underlying such a rationing device is that patients should wait according to need and irrespective of socioeconomic status or other non-need characteristics. The aim of this paper is to test empirically that waiting times for publicly funded specialist care do not depend on patients’ socioeconomic status. Waiting times for specialist care can vary according to the type of medical specialty, type of consultation (review or diagnosis) and the region where patients’ reside. In order to take into account such variability, we use Bayesian random parameter models to explain waiting times for specialist care in terms of need and non-need variables. We find that individuals with lower education and income levels wait significantly more time than their counterparts.

Young Adolescents, Tobacco Advertising, and Smoking.

Background: In adolescents aged 12–14, we measured attitudes to tobacco advertising. Our purpose is to understand the relation of these attitudes to tobacco use and identify the groups most influenced by the advertising. Methods: Survey of adolescents on Gran Canaria Island, Spain, about aspects of family, school, peers, tobacco consumption, and tobacco advertising. The subjects of the double-stratified cluster sample were 1910 students at the same grade level in 33 schools; 86.6% were 13 or 14 years old, and 51.2% were boys. We generated measures for attitudes to tobacco advertising from replies to seven questions with ordinal scales by an analysis of categorical principal components. To relate attitude to tobacco advertising and the profiles of these adolescents, we used multiple regression and logistic regression models. Results: Attitudes to tobacco advertising are related to some home and school factors, but most significantly to tobacco and alcohol consumption, to amount of time at home without adults, and to peer influence. Conclusions: It is possible to draw up profiles of the students most vulnerable to tobacco advertising, and to cluster them in two groups, the “vitalists” and the “credulous.” The effect of cigarette ads is different between these groups. This study can help to orientate smoking prevention.

The Impact of Medical Technology on Health : A Longitudinal Analysis of Ischemic Heart Disease

OBJECTIVES This article estimates the costs and benefits of changes in ischemic heart disease (IHD) care in Spain from 1980 to 2003. METHODS We use joinpoint regression to identify trends in the standardized rates of mortality and hospitalization for IHD in general and acute myocardial infarction (AMI) in particular. We estimate also logistic regression models for the probability of in-hospital death of patients admitted for AMI. To measure costs and benefits between 1980 and 2003 we use the microdata from Spanish Hospital Morbidity Survey, and the reports of the Cardiac Catheterization and Coronary Intervention Registry of the Spanish Society of Cardiology. RESULTS Mortality from IHD in Spain has been substantially reduced in the past 25 years. Medical advances have saved lives of many patients admitted to hospitals. If the patients with AMI admitted in 2003 had been treated with 1980 procedures the rate of hospital mortality for AMI would have doubled. The estimated benefits in 2003 are the lives of the 5326 patients saved. The unit real costs have increased from euro2143 to euro4550 per AMI admission. If this cost increase is applied to the 57,842 Spanish AMI inpatients admitted in 2003, one could say that advances in medical technology from 1980 to 2003 carry a cost of euro26,140 per life saved. CONCLUSIONS In Spain advances in hospital technology for the treatment of IHD since 1980 are well worth the cost.

Aproximación a los pesos de calidad de vida de los «años de vida ajustados por calidad» mediante el estado de salud autopercibido

Objectives: To estimate quality of life weights in Spain for 1987, 1993 and 2001, based on self-assessed health status reported in the National Health Survey. Material and methods: Quality of life weights were estimated using an ordered probit model. In this model, self-assessed health status was related to the presence of chronic diseases, demographic characteristics, and a random error. Quality of life weights were derived by normalizing the regressors obtained. Results: Quality of life values related to chronic diseases varied depending on the diseases. Pain, limitations, and diseases in the previous 12 months had a greater negative impact on quality of life than did chronic diseases. Quality of life decreased as age increased, and increased as educational level increased. For the same disease and adjusted for age, sex, and educational level, quality of life weights were greater for 1993 and 2001 than for 1987. Conclusions: The proposed methodology allows quality of life weights to be calculated from health survey data, which has direct application in economic assessment, analysis of socioeconomic health inequalities, and health capital estimation.

The evolution of health status and chronic conditions in Catalonia, 1994-2006: the paradox of health revisited using the Blinder - Oaxaca decomposition

BackgroundThe paradox of health refers to the improvement in objective measures of health and the increase in the reported prevalence of chronic conditions. The objective of this paper is to test the paradox of health in Catalonia from 1994 to 2006.MethodsLongitudinal cross-sectional study using the Catalonia Health Interview Survey of 1994 and 2006. The approach used was the three-fold Blinder - Oaxaca decomposition, separating the part of the differential in mean visual analogue scale value (VAS) due to group differences in the predictors (prevalence effect), due to differences in the coefficients (severity effect), and an interaction term. Variables included were the VAS value, education level, labour status, marital status, all common chronic conditions over the two cross-sections, and a variable for non-common chronic conditions and other conditions. Sample weights have been applied.ResultsResults show that there is an increase in mean VAS for men aged 15-44, and a decrease in mean VAS for women aged 65-74 and 75 and more. The increase in mean VAS for men aged 15-44 could be explained by a decrease in the severity effect, which offsets the increase in the prevalence effect. The decrease in mean VAS for women aged 65-74 and 75 and more could be explained by an increase in the prevalence effect, which does not offset the decrease in the severity effect.ConclusionsThe results of the present analysis corroborate the paradox of health hypothesis for the population of Catalonia, and highlight the need to be careful when measuring population health over time, as well as their usefulness to detect populations perceptions.

Utilización y tiempos de espera: dos vertientes inseparables del análisis de la equidad en el acceso al sistema sanitario público

El objetivo de esta investigacion consiste en analizar si existe equidad en el acceso a los servicios sanitarios publicos por niveles socioeconomicos. Se analiza conjuntamente la probabilidad de utilizar los servicios sanitarios y los tiempos de espera hasta ser atendidos, corrigiendose asi el sesgo de seleccion que se derivaria de su estudio separado, tal y como se evidencia en esta investigacion. Se propone una aproximacion bayesiana y se hace uso de la informacion a nivel individual sobre la utilizacion sanitaria, tiempos de espera, nivel socioeconomico, necesidad sanitaria y otras variables sociodemograficas contenidas en la En-cuesta nacional de salud (2006). Los resultados muestran que hay inequidad en el acceso a los servicios especializados y hospitalarios (tanto en utilizacion como en tiempos de espera) que perjudica a los niveles socioeconomicos inferiores. En los servicios de medicina general, si bien la utilizacion beneficia relativa-mente mas a los grupos de menor nivel socioeconomico, los tiempos de espera perjudican a los de menor nivel educativo.

Attitudes of Teenagers Towards Cigarettes and Smoking Initiation

This paper contributes to the empirical knowledge of determinants of smoking initiation in adolescents. The instrument we used was a structural equation model, which is a powerful tool to analyze causal relationships in nonexperimental studies. We used a school-based sample of 1198 teenagers from Spain. We measured the attitude of the adolescents towards tobacco. Attitudes and smoking status are related. Attitudes become more favorable to smoking, as experimentation with cigarettes progresses and pupils become older. Teenagers who have tried at least one cigarette are on average more favorable to smoking than those who had never smoked. The studys limitations were noted.

Why are Some Spanish Regions so Much More Efficient than Others

This article investigates the main sources of heterogeneity in regional efficiency. We estimate a translog stochastic frontier production function in the analysis of Spanish regions in the period 1964-1996, to attempt to measure and explain changes in technical efficiency. Our results confirm that regional inefficiency is significantly and positively correlated with the ratio of public capital to private capital. The proportion of service industries in the private capital, the proportion of public capital devoted to transport infrastructures, the industrial specialization, and spatial spillovers from transport infrastructures in neighbouring regions significantly contributed to improve regional efficiency.