Mireia Jané

Evaluación de la efectividad de los programas escolares de prevención del consumo de tabaco, alcohol y cannabis: ¿Qué nos dicen los meta-análisis?

Consumption of tobacco, alcohol and illegal drugs is a major public health problem in developed countries. The aim of the study is to describe the impact and associated characteristics of preventive programs addressed at those problems in the school setting. Meta-analysis focusing on evaluations of programs focusing on smoking, alcohol and/or cannabis at the school setting are reviewed. The search was done at Cochrane Library and Medline databases of articles published between 1993 and 1999, and including as keywords programs, education, drugs prevention, prevention, smoking, alcohol, school, adolescence, teenagers, young people, evaluation, health education, effectiveness, review, meta-analysis. We found 5 meta-analysis of programs summarizing the effect of preventive programs, most of them dealing with legal and illegal drugs. However, most of the interventions reporting changes in behavior measured only smoking. More effective interventions addressed social influences, used active methodology and were implemented by teachers or peers. The importance of booster sessions, the quality of implementation and thorough evaluation is stressed. Overall, meta-analysis of evaluated programs shows a small effect, although the population impact may be relevant. Some limitations point to new areas of interest for future research.

Assessment of exposure to secondhand smoke by questionnaire and salivary cotinine in the general population of Barcelona, Spain (2004-2005).

OBJECTIVES To estimate the prevalence of self-reported exposure to secondhand smoke (SHS) in different settings and to describe salivary cotinine concentration and its determinants among non-smokers. METHODS Cross-sectional study of a representative sample (N=775) of adult non-smokers in Barcelona, Spain (years 2004-2005). We assessed exposure to SHS using a questionnaire and measurement of salivary cotinine concentration. We calculated prevalence rates of self-reported exposure and medians and geometric means of salivary cotinine concentration. We adjusted for potential confounding factors with multinomial logistic regression models. RESULTS The prevalence rate of self-reported exposure to SHS among non-smokers in any setting was 75.7% (95% CI: 72.7%-78.8%). The prevalence of exposure to SHS tended to decrease with age. The geometric mean of cotinine concentrations among non-smokers was 1.49 ng/ml (95% CI: 1.39-1.60 ng/ml) among all subjects, and 1.80 ng/ml (95% CI: 1.37-2.35 ng/ml) in subjects who reported exposure to SHS in all settings. In bivariate and multivariate analyses, the cotinine concentration increased with the number of smokers and the number of cigarettes smoked per day in the presence of non-smokers in the household. CONCLUSIONS In this population, self-reported exposure to SHS is very high. Salivary cotinine concentrations in non-smokers are associated with exposure at home.

Prevalencia del tabaquismo en Cataluña, 1982-1998: una perspectiva de género

Fundamento Describir la evolucion del habito tabaquico en la poblacion catalana entre 1982 y1998, a partir de un analisis de perspectiva de genero. Sujetos y metodo Se incluyeron datos de las encuestas llevadas a cabo por el Departament deSanitat i Seguretat Social en 1982, 1986, 1990, 1994 y 1998. Se analizaron el «status» defumador, el numero de cigarrillos diarios fumados, la edad y el sexo, asi como variables relacionadascon el tipo de tabaco fumado, la edad de inicio y la duracion del habito. Los resultadosse presentan como proporciones con sus intervalos de confianza del 95% y como medias consus desviaciones estandar. Resultados La prevalencia global del habito tabaquico en la poblacion de 15-64 anos se mantieneestable entre 1982 y 1998 (variacion porcentual de –1,1%) y se situa en un 37,5% defumadores actuales en 1998. En las mujeres, la prevalencia se incrementa un 53,5% durantedicho periodo y alcanza el 30,7% en 1998. En los varones se reduce un 23,8% y alcanza el44,4%. Entre 1994 y 1998 se rompe la tendencia decreciente que se habia producido hastaentonces en los jovenes de ambos sexos. En 1998, el 26,1% de las mujeres fuma tabaco«light» frente a un 10,4% de los varones; las mujeres fuman una media de 13,8 (8,8) cigarrillosdiarios frente a la media de 19,7 (12,6) cigarrillos que fuman los varones; la media de duraciondel habito entre las mujeres es de 13,9 (10,1) anos mientras que en los varones es de22,6 (16,0). Conclusiones Hasta el ano 1998, la prevalencia del habito tabaquico en Cataluna se mantuvoelevada a pesar de producirse una disminucion importante de la masculina. La situacion fueparticularmente desfavorable para los jovenes de ambos sexos y las mujeres, cuyo habito tabaquicopresenta caracteristicas especificas.

Indicadores de salud reproductiva y perinatal en mujeres inmigrantes y autóctonas residentes en Cataluña y en la Comunitat Valenciana (2005-2006)

OBJECTIVES To determine the prevalence of teenage maternity, preterm birth and low birth weight in Spanish and immigrant mothers from Latin America, eastern Europe, Maghreb and sub-Saharan Africa resident in Catalonia and Valencia from 2005 and 2006. METHODS Using data from congenital metabolic disorders registers in both regions, proportions and 95% confidence intervals were obtained for the following: 1) mothers aged less than 20 years; 2) preterm (<37 weeks) and very preterm (<32 weeks) births; and 3) low birth weight (<2500g) and very low birth weight (<1500g) neonates. The calculations were performed for mothers from each of the geographical areas of origin (Spain, Latin America, Eastern Europe, Maghreb and Sub-Sahara). These proportions were compared in Spanish-born and immigrant women and the significance of differences was assessed using chi-squared tests. RESULTS The prevalence of teenage mothers was between three and five times higher in immigrants than in Spanish women, the highest rate being found in women from eastern Europe. Preterm births, very preterm births and very low birth weight were more frequent in eastern European women than in Spanish women. The prevalence of prematurity and very low birth weight was higher in sub-Saharan mothers than in Spanish women. CONCLUSIONS The number of births in teenage mothers was higher in immigrant mothers from all origins than in Spanish women. The highest rates of low birth weight and preterm births were found in women from eastern Europe and sub-Saharan Africa.

Caesarean section rates in immigrant and native women in Spain: the importance of geographical origin and type of hospital for delivery.

BACKGROUND Spain has become a principal destination for immigrants and delivery is the major reason for hospitalization in this population. However, research about inequities between native and immigrant women regarding the quality of the care received during pregnancy and delivery is still scarce. One of the indicators used to evaluate the quality of the obstetric care is the rate of caesarean sections (CSs). METHODS A cross-sectional study of 215 379 single deliveries from Spanish and immigrant women from Latin America, East Europe and Maghreb was carried out in Spain in 2005-06. Prevalence of CS according to maternal and neonatal characteristics was calculated by geographical origin. Two associations were explored by means of multiple logistic regression analysis. First, the association between geographical origin and the risk of CS in public or private hospitals separately, and, second, the risk of CS for women from the same geographical origin depending on whether they delivered at public or private hospitals. RESULTS Overall, the risk of CS was lower for immigrants as a whole than for native women (odds ratio (OR) = 0.83 95% confidence interval (CI) = 0.80-0.85), but the risk varied markedly by area of origin, being higher for Latin Americans (OR = 1.09 95% CI = 1.05-1.13) and lower for East Europeans (OR = 0.61 95% CI = 0.57-0.66) and Maghrebians (OR = 0.60 95% CI =0.57-0.63). Public hospitals followed the overall pattern of risk. CS risk was higher in private than in public hospitals for all groups. However, the increase in risk was higher for immigrant than for natives. CONCLUSION Immigrants in Spain are a heterogeneous population regarding the risk of CS. Geographical origin and type of hospital are key aspects underlying such a risk.

Recent Immigration and Adverse Pregnancy Outcomes in an Urban Setting in Spain

To describe social and economic inequalities in non-fatal pregnancy outcomes (low birth weight, preterm birth and small for gestational age births) in the neighbourhoods of the city of Barcelona (Spain), according to maternal age and maternal country of origin, between 1991 and 2005. A cross-sectional ecological study was carried out using the 38 neighbourhoods of Barcelona as the unit of analysis. The study population comprises the 192,921 live births to resident women aged 12–49 residing from 1991 to 2005. Information was gathered from births registry. Prevalence of low birth-weight, preterm birth and small for gestational age, was calculated for each of the 38 neighbourhoods of mothers’ residence, stratifying results by maternal age and country of origin. The indicator of neighbourhood socio-economic level was the unemployment rate. Quartile maps along with Spearman correlation coefficients and linear regression were performed between indicators. The present study reports socio-economic inequalities in pregnancy outcomes among neighbourhoods in Barcelona (Spain): the more disadvantaged neighbourhoods have worse pregnancy outcomes (low birth weight, preterm birth and small for gestational age births) in all women age groups. These inequalities do not exist among immigrant women, and some groups of foreign mothers even have lower rates of low birth weight, pretem birth, and small for gestational age births than autochthonous women. The existing inequalities suggest that policy efforts to reduce these inequalities are not entirely successful and should focus on improving pregnancy and delivery care in less privileged women in a country with universal access to health care.

Breastfeeding initiation in immigrant and non-immigrant women in Spain

Research about inequities between native and immigrant women regarding the quality of health care is still scarce. Initiation of breastfeeding in hospital is considered a quality care indicator. In this study, we explore the association between the geographical origin of the women and the establishment of breastfeeding in Spanish hospitals. Prevalence of breastfeeding initiation is higher for women from Latin America, Eastern Europe, Maghreb or sub-Saharan Africa than for Spanish women, and lower for Chinese women. Compared with Spanish women the odds of not breastfeeding in hospital were lower in all these immigrant groups but more than five times higher for Chinese immigrants. Culturally adapted health services are necessary to maintain breastfeeding rates in most immigrant groups. Moreover, it seems urgent to identify the factors influencing patterns of breastfeeding in Chinese immigrants and to develop innovative strategies to encourage breastfeeding initiation in hospital.

Calidad de los datos utilizados para el cálculo de indicadores de salud reproductiva y perinatal en población autóctona e inmigrante

OBJECTIVE To assess the quality of data on births in the Natural Population Movement (NPM) and congenital metabolic disorders registers with regard to calculation of reproductive and perinatal health indicators. METHODS The following comparisons between registers were made: (1) the total number of births to mothers living in Catalonia and Valencia from 2005 to 2006, (2) the percentage of missing data on the mothers geographical origin, (3) the percentage of missing data on the mothers age and the infants birthweight and gestational age according to maternal origin. RESULTS The congenital metabolic disorders registers exhaustively collected the total number of births gathered in the NPM. The percentages of missing data on material origin and age were higher in the congenital metabolic disorders registers, although the proportion of births by maternal origin and the mean maternal age in each ethnic group was fairly similar to that in the NPM. The percentages of missing data on birthweight and gestational age were much higher in the NPM data than in the congenital metabolic disorders registers, especially among births registered in Catalonia and births to foreign mothers. CONCLUSIONS Our results suggest some limitations in the quality of the data on gestational age and birthweight provided by NPM data, especially for comparisons of preterm and low birthweight indicators in the Spanish-born and immigrant populations. Moreover, the results point to the quality of the congenital metabolic disorders registers as a source to compare reproductive and perinatal health indicators.

Construction of the birth weight by gestational age population reference curves of Catalonia (Spain): Methods and development

Infant size at birth is a useful indicator to evaluate fetal growth in relation to gestational age. There is no standard model to create anthropometric reference curves in neonates, but the method chosen could determine the reference values estimated. We describe the methods used to construct population-based reference curves of birth weight for gestational age in Catalonia, Spain. These methods included detection of implausible values of birth weight for gestational age by a probabilistic cluster model, utilization of the Generalized Additive Model for Location and Scale method to obtain smoothed percentiles and z-scores, and calculation of 95% confidence intervals by bootstrapping. To our knowledge, these are the first reference curves in neonates constructed through a method allowing asymmetric distributions with kurtosis to be modelled. Estimation of confidence intervals is useful to determine which reference intervals can be employed to assess newborn size.

Gender differences in sexual risk behaviour among adolescents in Catalonia, Spain

OBJECTIVE To analyze the factors associated with sexual risk behavior in adolescent girls and boys in order to plan future school health interventions. METHODS A cross-sectional study with two-stage cluster sampling that included 97 schools and 9,340 students aged between 14 and 16 years old was carried out in 2005-2006 in Catalonia (Spain). For the survey, a self-administered paper-based questionnaire was used. The questionnaire contained items on sociodemographic variables, use of addictive substances and mood states, among other items. These variables were tested as risk factors for unsafe sexual behavior. RESULTS This study included 4,653 boys and 4,687 girls with a mean age of 15 years. A total of 38.7% of students had had sexual relations at least once and 82.3% of boys and 63.0% of girls were engaged in sexual risk behaviors. The prevalence of sexual relations and risk behaviors was generally higher in boys than in girls, independently of the variables analyzed. Boys had more sexual partners (P<.001) and used condoms as a contraceptive method less frequently than girls (P<.001). Foreign origin was related to unsafe sexual activity in both genders. Alcohol consumption was also a risk factor in boys. CONCLUSIONS Sexual risk behaviors among adolescents in Catalonia are higher in boys than in girls. Factors related to unsafe sexual activity in boys were foreign origin and alcohol consumption. In girls only foreign origin was a significant risk factor.