Sandro Baldissera

Depressive symptoms and behavior-related risk factors, Italian population-based surveillance system, 2013

Introduction Depression may increase the likelihood of adopting behaviors risky to health. Population studies investigating the association between depressive symptoms and behavior-related risk factors are lacking in Italy. The aim of this study was to estimate the prevalence of various self-reported behavior-related risk factors and to study their associations with current depressive symptoms in the Italian adult general population. Methods Data collected in 2013 from people aged 18 to 69 years participating in the Italian behavioral risk factor surveillance system were used for the analysis. Indicators of no leisure-time physical activity, obesity, cigarette smoking, and excessive alcohol consumption were investigated. Depressive symptoms were explored through the Patient Health Questionnaire-2. Results In the survey sample of 39,463 participants, 34.4% of adults engaged in no leisure-time physical activity, 26.2% were cigarette smokers, 11.5% were excessive alcohol consumers, and 10.3% were obese. The prevalence of depressive symptoms was 6.2%. People with depressive symptoms were more likely to be physically inactive (adjusted prevalence ratio [APR], 1.13), cigarette smokers (APR, 1.34), obese (APR, 1.27) and excessive alcohol consumers (APR, 1.43) than those without depressive symptoms. Conclusion The contribution of this study to the existing evidence lies not just in confirming the association between depression and behavior-related risk factors in the Italian context but also in suggesting that programs for simultaneously improving people’s mental and physical health should be developed and implemented.

Epidemiology of chronic respiratory diseases and associated factors in the adult Italian population

Background Detailed epidemiology of Chronic Respiratory Diseases (CRDs) and of their risk and protective factors is needed to plan preventive interventions to reduce the burden of CRDs on population health. This study determines the prevalence of doctor-diagnosed CRDs and its associated factors in the adult Italian population. Methods Data was collected from adults participating in the ongoing cross-sectional Italian Behavioural Risk Factor Surveillance System (PASSI) between 2013 and 2015. Results Among 108 705 respondents, 7.0% reported a CRD (3.4% asthma, 2.6% COPD, 1.0% Asthma-COPD Overlap Syndrome). Current smoking was more frequent in the group with CRD compared to those without (30.8% vs. 25.2%, P < 0.001), as was physical inactivity (41.9% vs. 36.4%, P 0.009) and overweight/obesity (52.4% vs. 41.4%, P 0.009). Adults with CRDs also reported appropriate perception of insufficient physical activity and excessive body weight, adopted protective behaviours and received preventive interventions more often than those without CRDs. Conclusions Italian adults with CRDs are more likely to be exposed to aggravating factors but are also knowledgeable of their condition and amenable to behaviour change. Since effective interventions for modifying these factors are available, there is an opportunity to reduce the significant disease burden of CRDs through specifically targeted health promotion interventions.

Self-reported influenza vaccination uptake in people with chronic diseases: data from Progressi delle Aziende Sanitarie per la Salute in Italia (PASSI)

Abstract Background Influenza is an important public health problem, with potential severe consequences among people with chronic diseases. The aim of this study was to obtain reliable measures of seasonal influenza vaccine uptake in this population, otherwise not available in Italy. Methods Progressi delle Aziende Sanitarie per la Salute in Italia (PASSI) is a nationwide surveillance system of health-related behaviours and acceptance of preventive interventions (including influenza immunisation) offered by the Italian National Health Service. Data are collected with telephone interviews at local health unit level for supporting local activities. The survey sample is randomly selected from local health unit lists of adult residents. The trend of annual vaccine coverage since 2008 was estimated for people aged 18–64 years who reported having at least one chronic disease. To obtain a sufficient sample size in subgroups, we analysed the characteristics of vaccinated people in the 2010–13 cumulative dataset. Univariate, multivariate, and logistic regression analyses were undertaken. Findings In 2008–13, 13 659 individuals with at least one chronic disease were interviewed. Vaccination coverage fell significantly from 29·7% (95% CI 27·2–32·4) in 2007–08 to 19·9% (18·0–22·1) in 2012–13. During 2010–13, the overall proportion of vaccinated people with a chronic disease was 25·6% (24·5–26·7). Vaccine coverage of people with diabetes (34·3%, 31·7–36·9) or cardiovascular diseases (31·8%, 29·6–34·2) was greater than that of people affected by renal failure, respiratory diseases, tumours, or chronic liver diseases (26·5% [22·5–30·7], 24·9% [23·2–26·7], 22·2% [20·0–24·6], and 20·6% [17·5–24·6], respectively). Vaccination coverage increased with age (from 13·1% [11·0–15·5] in the 18–34 year age group to 33·4% [31·9–35·1] in people aged 50–64 years); it was higher among people with a low educational level than among those with a high educational level, higher in those having economic difficulties than in those with no economic difficulties, and higher among Italian citizens than among non-citizens. Interpretation In the past few years, prevalence of influenza vaccination in Italian adults with at least one chronic disease was well below the Ministry of Healths goal (75% minimum) and showed a downward trend. A major reason of this evolution is probably the changing public perception of the benefits and risks of vaccines. PASSI is a source of useful data not otherwise available for public health intervention. Funding Italian Ministry of Health.

P1-293 Involving local community: testing models for communicating surveillance data. From planning to elaborating and evaluating effective communicative tools to specific target groups at local level

Introduction When monitoring population health-related behaviours it is important to assess the effectiveness of delivering health related information to specific target groups such that any need for improved communication can be identified. The Italian Behavioural Risk Factors Surveillance System Passi is conducted through Local Health Units (LHUs) personnel interviewing a random sample of 18–69 year olds monthly. PinC, the Programme of Information and Communication for Gaining Health, promoted a training project for Passi care workers the aim of which was to achieve competency in communication using methods that were pre-tested and effective. Methods Forty operators from 25 LHUs participated in the six-monthly-training: three one day meetings (22 April 2010, 24 June 2010, 11 November 2010) and two rounds of two-monthly-activities in the field. A password-protected portal was used for exchanging materials among participants at a distance. Results The seven inter-regional Working Groups planned communication, performed and tested materials using surveillance results for specific target groups at a local level. The need for effective approaches to communication was highlighted. Draft materials (leaflets for older women, posters for young people, charts for GPs, papers for policy makers/stakeholders) were tested on selected target groups. The two lay target populations (women, children) evaluated the tools positively, critiquing images, recommending clear and essential messages, clarifying what should be done to improve health. The professional groups suggested editing of text and space for graphs/tables. Materials will be modified accordingly and delivered. Conclusion Surveillance systems are valuable tools for advocacy at a local level. Communication is fundamental for knowledge, awareness and empowerment processes in specific target groups, professional and lay. To be effective, materials must be carefully planned and tested.