Xavier Bartoll

The evolution of mental health in Spain during the economic crisis

We analyse how mental health and socioeconomic inequalities in the Spanish population aged 16-64 years have changed between 2006-2007 and 2011-2012. We observed an increase in the prevalence of poor mental health among men (prevalence ratio = 1.15, 95% CI 1.04-1.26], especially among those aged 35-54 years, those with primary and secondary education, those from semi-qualified social classes and among breadwinners. None of these associations remained after adjusting for working status. The relative index of inequality by social class increased for men from 1.02 to 1.08 (P = 0.001). We observed a slight decrease in the prevalence of poor mental health among women (prevalence ratio = 0.92, 95% CI 0.87-0.98), without any significant change in health inequality.

Green spaces and General Health: Roles of mental health status, social support, and physical activity.

Green spaces are associated with improved health, but little is known about mechanisms underlying such association. We aimed to assess the association between greenness exposure and subjective general health (SGH) and to evaluate mental health status, social support, and physical activity as mediators of this association. This cross-sectional study was based on a population-based sample of 3461 adults residing in Barcelona, Spain (2011). We characterized outcome and mediators using the Health Survey of Barcelona. Objective and subjective residential proximity to green spaces and residential surrounding greenness were used to characterize greenness exposure. We followed Baron and Kennys framework to establish the mediation roles and we further quantified the relative contribution of each mediator. Residential surrounding greenness and subjective residential proximity to green spaces were associated with better SGH. We found indications for mediation of these associations by mental health status, perceived social support, and to less extent, by physical activity. These mediators altogether could explain about half of the surrounding greenness association and one-third of the association for subjective proximity to green spaces. We observed indications that mental health and perceived social support might be more relevant for men and those younger than 65years. The results for objective residential proximity to green spaces were not conclusive. In conclusion, our observed association between SGH and greenness exposure was mediated, in part, by mental health status, enhanced social support, and physical activity. There might be age and sex variations in these mediation roles.

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.

Long working hours and health status among employees in Europe: between-country differences.

OBJECTIVES This study aimed to (i) identify family responsibilities associated with moderately long working hours (41-60 hours a week); (ii) examine the relationship between moderately long working hours and three health outcomes; and (iii) analyze whether patterns differ by welfare state regimes. METHODS The sample was composed of all employees aged 16-64 years working 30-60 hours a week interviewed in the 2005 European Working Conditions Survey (9288 men and 6295 women). We fitted multiple logistic regression models separated by sex and welfare state regime typologies. RESULTS Married males were more likely to work long hours in countries with male breadwinner models whereas family responsibilities were related to long working hours among both sexes in countries with dual breadwinner models. The association between long working hours and health was (i) stronger among men in countries with male breadwinner models, primarily in Anglo-Saxon countries [adjusted odds ratio (OR adj) associated with working 51-60 hours of 6.43, 6.04 and 9.60 for work-related poor health status, stress and psychological distress, respectively); (ii) similar among both sexes in Nordic countries; and (iii) stronger among women in Eastern European countries. CONCLUSIONS In the European Union of 25 members (EU-25), working moderately long hours is associated with poor health outcomes with different patterns depending on welfare state regimes. The findings from this study suggest that the family responsibilities and breadwinner models can help explain the relationship between long working hours and health status.

Perceived Discrimination and Health among Immigrants in Europe According to National Integration Policies.

Background: Discrimination harms immigrants’ health. The objective of this study was to analyze the association between perceived discrimination and health outcomes among first and second generation immigrants from low-income countries living in Europe, while accounting for sex and the national policy on immigration. Methods: Cross-sectional study including immigrants from low-income countries aged ≥15 years in 18 European countries (European Social Survey, 2012) (sample of 1271 men and 1335 women). The dependent variables were self-reported health, symptoms of depression, and limitation of activity. The independent variables were perceived group discrimination, immigrant background and national immigrant integration policy. We tested for association between perceived group discrimination and health outcomes by fitting robust Poisson regression models. Results: We only observed significant associations between perceived group discrimination and health outcomes in first generation immigrants. For example, depression was associated with discrimination among both men and women (Prevalence Ratio-, 1.55 (95% CI: 1.16–2.07) and 1.47 (95% CI: 1.15–1.89) in the multivariate model, respectively), and mainly in countries with assimilationist immigrant integration policies. Conclusion: Perceived group discrimination is associated with poor health outcomes in first generation immigrants from low-income countries who live in European countries, but not among their descendants. These associations are more important in assimilationist countries.

Evolución de las desigualdades sociales en salud en Cataluña

Resumen El objetivo de este articulo es analizar la evolucion de las desigualdades segun la clase social en hombres y mujeres en el estado de salud, en las conductas relacionadas con la salud y en la utilizacion de servicios sanitarios en Cataluna entre los anos 1994 y 2006. Es un estudio de tendencias basado en el analisis de la Encuesta de Salud de Cataluna. Se ajustaron modelos de regresion de Poisson robusta para examinar la asociacion entre las 12 variables dependientes y la clase social en cada encuesta. Las personas de clases manuales son las que presentaban peores indicadores. Las desigualdades en el estado de salud y uso de servicios tendian a mantenerse constantes a lo largo de los anos o a disminuir (realizacion de cribado de cancer de mama). Por el contrario, las desigualdades en el consumo de tabaco aumentaron. En Cataluna existen desigualdades en salud segun la clase social, tanto en hombres como en mujeres, que tienden a mantenerse estables a lo largo de los anos.

Long working hours and health in Europe: Gender and welfare state differences in a context of economic crisis.

This article examines the relationship between moderately long working hours and health status in Europe. A cross-sectional study based on data from the 2010 European Working Conditions Survey (13,518 men and 9381 women) was performed. Working moderately long hours was consistently associated with poor health status and poor psychological wellbeing in countries with traditional family models, in both sexes in Liberal countries and primarily among women in Continental and Southern European countries. A combination of economic vulnerability, increasing labour market deregulation and work overload related to the combination of job and domestic work could explain these findings.

Veinticinco años de informes de salud en Barcelona: una apuesta por la transparencia y un instrumento para la acción

After a quarter century of annual health reports in the city of Barcelona, this study documents the experience and draws some elements that may be useful in other contexts, specifying the analysis on the Health Report of 2008. We show the conceptual framework, the process of preparing the report, sources of information used and the contents. We evaluate the dissemination of the health report, both at the political level, as well as the media, professionals and the public. Furthermore, we examine the impact of the report as a tool for social change and planning.After a quarter century of annual health reports in the city of Barcelona, this study documents the experience and draws some elements that may be useful in other contexts, specifying the analysis on the Health Report of 2008. We show the conceptual framework, the process of preparing the report, sources of information used and the contents. We evaluate the dissemination of the health report, both at the political level, as well as the media, professionals and the public. Furthermore, we examine the impact of the report as a tool for social change and planning.

Food consumption frequency and excess body weight in adolescents in the context of financial crisis in Barcelona (Spain).

OBJECTIVES To describe food consumption frequency in adolescents in the context of the financial crisis in 2012, and to analyse potential fluctuations in excess body weight between 2008 and 2012. METHOD A cross-sectional study of eating habits and excess body weight was conducted in adolescents aged 13 to 19 years old from public, subsidised and private secondary schools in Barcelona, Spain. The FRESC lifestyle risk factors survey was used, and food frequency consumption, food recommendations and body mass index were analysed according to gender, year of education and socioeconomic status. RESULTS Girls ate vegetables and fruits more frequently than boys, while the prevalence of junk food consumption was higher in boys. The prevalence of compliance with food recommendations was lower than 50% for all foods, and gender and socioeconomic differences were found for eggs, red meat and soft drinks. Regarding excess body weight, boys had a higher prevalence than girls in the 2 years analysed. Furthermore, a reduction in excess body weight was observed among girls in secondary education in the highest socioeconomic groups (28.7% [95% CI: 24.8-32.6%] in 2008 to 20.5% [95% CI: 17.1-23.8%] in 2012). CONCLUSIONS The prevalence of adolescents following food recommendations is low, and gender differences were found in terms of food consumption frequency, even in the context of financial crisis. There is a need to promote programmes and policies to reduce inequalities related to eating habits and excess body weight in adolescents.

Trends in smoking in an urban population over recent decades

Introduction The objective of this study is to describe the distribution of smoking in the population and to assess changes and trends over recent decades.