[An evaluation of teacher training to promote healthy and equitable relationships: transforming or reproducing?] / Evaluación de la formación a profesorado para promover relaciones saludables y equitativas: ¿transformar o reproducir?

OBJECTIVE: To evaluate the impact of the training on teacher capacity to implement Posem el Focus, a socio-educational intervention adapted from Lights4Violence to prevent the gender-based violence during adolescence. METHOD: Evaluation study of a training using qualitative methodology in Terrassa, 2019-2021. The socio-constructionist perspective was used to understand the impact of teacher training and its translation into educational practice. A purposive sampling of teachers (n=32) was carried out. A descriptive-interpretative analysis of the discourses was carried out based on the written productions of the participants in the training and their answers to some open questions. An explanatory theoretical framework was developed. RESULTS: Teachers reported acquiring concepts, developing new skills and modifying some attitudes. Teachers stated theoretical understanding of the sex-gender system, intersectionality and explicit and implicit violence. However, they reproduced gender stereotypes, did not understand the inclusive approach and pointed out not identifying implicit violence. Teachers perceived the training as useful and felt empowered to implement the intervention. No differences were identified in discursive production with respect to gender or age. CONCLUSIONS: Teacher training ensures minimum knowledge and facilitates the acquisition of some skills, although it does not achieve in-depth changes in attitudes. It is concluded that the training enables teachers to implement Posem el Focus, although it is recommended that it be reformulated.

Social inequalities in self-perceived health in Chile, does the urban environment matter?: a cross-sectional study.

BACKGROUND: The health of a population is determined by urban factors such as the physical, social and safety environment, which can be modified by urban regeneration policies. The aim of this study was to analyze the associations of elements of the social, physical and safety environment of the neighborhood in the urban context with self-perceived health (SPH), according to axes of inequality, such as gender and educational level in Chile in 2016. METHODS: Cross-sectional study using a nationally representative population-based survey of Chile. We used data from the 2016 National Survey of Quality of Life and Health. Poor SPH in the urban population older than 25 years was analyzed in relation to social, physical and safety environment variables. Poisson multilevel regression models were estimated to obtain prevalence ratios (PR) and their respective 95% confidence intervals (95%CI). All analyses were stratified by sex and educational level. RESULTS: SPH was worse in women than in men, especially in those with a lower education level. Poor SPH was associated with lack of support networks (PR = 1.4; 95%CI = 1.1-1.7), non-participation in social organizations (PR = 1.3; 95%CI = 1.1-1.6) and perceived problems with the quality of public space (PR = 1.3; 95%CI = 1.2-1.5) in women with a medium-high educational level and with a feeling of not belonging to the neighborhood (PR = 1.5; 95%CI = 1.2-1.8) and the perception of pollution problems (PR = 1.2; 95%CI = 1.0-1.4) in women with a low educational level. A feeling of unsafety was associated with both educational levels (PR = 1.3; 95%CI = 1.0-1.5). Poor SPH was associated with the feeling of not belonging (PR = 1.7; 95%CI = 1.2-2.5), and unsafety (PR = 2.1; 95%CI = 1.8-2.4) in men with a medium-high educational level, while there were fewer associations in men with a lower education level. CONCLUSIONS: Urban interventions are recommended to improve the health of the resident population and should take into account axes of inequality.

Tackling health inequalities in a public health organization: the case of the Barcelona Public Health Agency.

BACKGROUND: Municipalities are important actors in the implementation of policies to tackle health inequalities, which requires political will, the availability of financial support, and technical and human resources. With the aim of aligning with local government political priorities, in 2017 the Barcelona Public Health Agency (Agència de Salut Pública de Barcelona, henceforth ASPB), which is responsible for the public health functions of the city, launched a strategy to improve the approach to tackling health inequalities in all its services. The objectives of this study were to show how social health inequalities were addressed in the ASPB from 2017 to 19 and to describe which actions were proposed after a participatory process aiming to create a plan to systematically incorporate health inequalities in ASPB actions. METHODS: The ASPB has 304 workers, 8 directors and 20 services or departments. Participatory methodologies were carried out: 1) semi-structured interviews with department heads (N = 12, 60%); 2) world cafe workshops open to a group of workers (N = 63, 37%); 3) a Quick and Colorful voting session open to a group of workers (N = 108, 63%); and 4) Hanlon matrix with 19 actions to be prioritized (N = 12 services, 60%). RESULTS: Semi-structured interviews and world cafe workshops provided 40 potential actions. After a step by step process of participatory prioritization, seven lines of action emerged: 1) to make progress in collaborative networking; 2) to promote policy evaluation; 3) to increase the ability of the ASPB to evaluate policies to reduce health inequalities; 4) to incorporate the axes of inequalities in all ASPB products; 5) to improve information on vulnerable groups; 6) to incorporate the gender perspective; and 7) to participate in an internal training plan to address health inequalities. CONCLUSIONS: The participation of ASPB public health professionals and staff allowed the organization to design a shared plan of actions to address health inequalities. This experience could be useful for other municipalities whose political agendas include tackling inequalities in health.

Effects of an urban regeneration program on related social determinants of health in Chile: A pre-post intervention study.

Urban regeneration programs, such as "Programa Quiero mi Barrio" (PQMB) that is carried out in neighborhoods with greater deprivation across Chile, can improve health and quality of life in socio-economically deprived neighborhoods. The aim of this study was to analyze the effects of this program on the physical, social, and safety environments of neighborhoods intervened between 2011 and 2018, according to gender and socioeconomic position. Four indices and six sub-indices were constructed to measure physical, social, and safety environments of the neighborhoods. We conducted a pre- and post-intervention analysis with 2095 people using linear models adjusted for repeated measurements. After the intervention, participants had an improved perception of physical, social, and safety environments, as well as the use of spaces, particularly among women and people with higher levels of education. Therefore, the PQMB program is a form of public policy that can improve the quality of life and health of people living in underprivileged areas.

[How does the employment status influence the effects of residential insecurity on health?] / ¿Cómo influye la situación laboral en los efectos de la inseguridad residencial sobre la salud?

OBJECTIVE: This study aims to analyze the effects of housing insecurity on health and if those are modified by employment status of people belonging to "Treball als Barris" program in Barcelona between 2015 and 2016. METHODS: We conducted a longitudinal study using a survey which included sociodemographic, employment and housing status information. This was administered to 469 individuals attended by "Treball als Barris" at baseline and after one year of follow-up. Then, we carried out a descriptive analysis and fitted regression models to estimate the effects of housing insecurity and employment status on health, and the interaction between them. RESULTS: Among women, we found negative effects of housing insecurity on health (PR of poor self-reported health among women who stayed under housing insecurity was 2.29 [IC95%: 1.36-3.84] compared to those who stayed secured), while, among men, main effects on health were due to employment status (PR of poor self-reported health among men who were unemployed without subsidy was 3.16 [IC95%: 1.02-6.15] compared to those who were employed after follow-up). In addition, results suggest an interaction between housing and employment status on mental health among. DISCUSSION: Housing insecurity rates have increased in last years. It produces negatives effects on health and can interact with other social determinants such as employment, mainly on men's mental health.

Trends in teenage motherhood in Ecuador: challenges and inequalities.

OBJECTIVES: To describe trends in teenage motherhood (TM), based on the socioeconomic groups teenagers belong to, and factors related to their first experience of heterosexual intercourse (FEHI). We took into consideration women aged 20-24 years, comparing three surveys from 1999, 2004, and 2012. METHODS: We obtained data from the Ecuadorian Demographic and Health Surveys about 4,696 women aged 20-24 years who had given birth as teenagers. Prevalence ratios and their confidence intervals (95% CI) were calculated to estimate changes in socioeconomic inequalities and factors related to the FEHI. RESULTS: The prevalence of TM increased from 48% in 1999 to 60% in 2012 among women with complete primary education. The social gradient among socioeconomic groups were sustained. We detected no changes in the socioeconomic inequalities characterizing TM, and in the factors related to the FEHI across the three studies in Ecuador. CONCLUSIONS: Socioeconomic inequalities in TM and disadvantageous circumstances at FEHI remained unchanged for 14 years. Some factors are vital for reducing teenage motherhood in Ecuador: gender-equitable economic development, access to comprehensive-sexual education, contraception, health services, and safe abortion.

How does a targeted active labour market program impact on the well-being of the unemployed? A concept mapping study on Barcelona "Employment in the Neighbourhoods".

BACKGROUND: The "Employment in the neighbourhoods" program is an innovative, tailor-made Active Labour Market Program that has been implemented in 12 neighbourhoods in Barcelona (Spain). Its goal is to get people from deprived, high-unemployment neighbourhoods back to work. The aim of this study was to describe the effects of the program on participants' quality of life, and identify the mechanisms underlying these effects, according to their own perception and the perception of technical staff who assisted them. METHODS: We used Concept Mapping, a mixed methods approach combining qualitative and quantitative analysis, to develop a conceptual map of the participants' and technical staffs' perceptions about changes in the participants' quality of life. Data collection occurred within the generation and structuring steps where participants brainstormed answers to a focus question, and then rated and sorted the responses. To create maps, we used Concept Systems Incorporated software, which conducted two main forms of analysis, a multidimensional scaling analysis, and a hierarchical cluster analysis. RESULTS: Study participants reported several positive effects on mental health and emotional wellbeing, including self-esteem and empowerment, and considered that this was achieved through strengthened social networks, skills acquisition, emotional coaching, and personalized technical assistance. They also described some negative impacts, mainly related to the labour market situation. We observed marked gender differences in the discourses of program participants. CONCLUSIONS: The results obtained have allowed us to identify different perceived effects and mechanisms by which the "Employment in the Neighbourhoods" Active Labour Market Programme can influence quality of life of participants from the most deprived areas of Barcelona.

The impact of Active Labour Market Policies on health outcomes: a Scoping review.

BACKGROUND: Since the last Western great recession of 2008, an increasing interest on the effects of Active Labour Market Policies (ALMPs) on improving health has emerged. The aim of our review is to synthesize evidence on the effectiveness of ALMPs and whether some types of ALMP are more effective. METHODS: Using the Scoping review methodology, we conducted a literature review in PubMed/MEDLINE, Scopus and Web of Science and selected articles published between 1990 and 2017 in high income countries. We applied four sequential phases of document screening to the list of retrieved articles. RESULTS: Of the 416 documents detected in the search, 36 documents were finally selected. Most of them focused on mental health and related components (72.2%) and found positive results at least in one outcome (80.6%). The ALMPs reported mainly attempt to build capacity through job search assistance (31.6%) with a component on mental health, showing positive results on health; some offer job training (16.7%) and few subsidized employment (8.3%), showing more controversial results, although mostly positive. The rest include a combination of different types of ALMPs. CONCLUSIONS: This review shows that ALMPs have a positive impact on health and quality of life. There are relatively few studies of the impact of ALMPs on general health, and most of the studies found are focused on Anglo-Saxon and Nordic countries. The most significant knowledge gaps are the mechanisms involved in achieving this improvement, and above all the differential health impacts according to axes of inequality and welfare state.

Employment in the neighborhoods of Barcelona: health effects of an active labor market program in Southern Europe.

BACKGROUND: The aim of this study was to analyze the changes in self-perceived health status and mental health among participants in an active labour market policy (ALMP) of Barcelona, and to assess whether the results differed according to the participants' social characteristics and their program trajectories. METHODS: A pre-post intervention study was designed, including unemployed people participating in a return-to-work ALMP in 13 deprived neighborhoods of Barcelona; using one survey upon entering the program (pre), and another 1 year later (post). We assessed the prevalence of poor self-perceived health status and poor mental health (Goldberg-12 questionnaire) in both periods of time. We fit five Poisson regression models using generalized estimating equations (GEE) to measure changes in self-perceived health and mental health between pre- and post-intervention. RESULTS: About 696 individuals (48% women) participated in the study, mainly manual workers. In both sexes, mental health improved (prevalence ratio [PR]-comparing post- and pre-periods for women: 0.49, 95% confidence interval [CI]: 0.39-0.61 and men: PR: 0.41, 95% CI: 0.32-0.53), whereas self-perceived health status remained stable or worsened. Men who remained unemployed reported poorer self-perceived health status, while no such association was observed among women. CONCLUSIONS: This study shows a mental health improvement among male and female participants.

Decline in fertility induced by economic recession in Spain.

OBJECTIVE: To describe trends in fertility in Spain before (pre-recession; 1998-2008) and during (recession period; 2009-2013) the economic crisis of 2008, taking into account women's age and regional unemployment in 2010. METHOD: The study consisted of a panel design including cross-sectional ecological data for the 17 regions of Spain. We describe fertility trends in Spain in two time periods, pre-recession (1998-2008) and recession (2009-2013). We used a cross-sectional, ecological study of Spanish-born women to calculate changes in fertility rates for each period using a linear regression model adjusted for year, period, and interaction between them. RESULTS: We found that compared to the pre-recession period, the fertility rate in Spain generally decreased during the economic recession. However, in some regions, such as the Canary Islands, this decrease began before the onset of the recession, while in other regions, such as the Basque country, the fertility rate continued to grow until 2011. The effects of the recession on the fertility rate are clearly observed in women aged 30-34 years. CONCLUSIONS: The current economic recession has disrupted the positive trend in fertility that began at the start of this century. Since Spain already had very low fertility rates, the further decline caused by the economic recession could jeopardize the sustainability of welfare-state systems.

Is Being Employed Always Better for Mental Wellbeing Than Being Unemployed? Exploring the Role of Gender and Welfare State Regimes during the Economic Crisis.

The growth of poor jobs related to economic crisis adds to its increase since the mid-1970s as a result of new forms of flexible employment. In Europe, there is no clear evidence on whether working in a poor-quality job is better for mental wellbeing than being unemployed. The objectives of this study were to compare mental wellbeing between the unemployed and those working in jobs with different quality levels and to examine gender and welfare state differences in Europe. We selected 8324 men and 7496 women from the European Social Survey, 2010. Hierarchical multiple logistic regression models were fitted, separated by sex and country group. No significant differences in mental wellbeing were shown between unemployed-non-active, unemployed-active, and those working in low-quality jobs in either sex. Only men from Conservative countries in low-quality jobs had better mental wellbeing than unemployed (non-active) men. Only having a good-quality job reduced the likelihood of poor mental wellbeing compared with being unemployed (non-active) among men in all countries (except Social-Democratic) and among women in Eastern and Southern European countries. No differences were observed among men or women in Social-Democratic countries, while strong gender differences were found in Conservative and Liberal countries. Our study indicates the need to take job quality into account, in addition to creating jobs during economic crises. The main mechanisms to explain the strong gender and welfare state differences identified could be social protection for unemployed, labor market regulations, and family models.

Inequalities in health and health behaviours between couple and lone mothers before and during the financial crisis in Spain (2003-2012).

Lone mothers report worse health and adopt more risky health behaviours than couple mothers, as largely documented in several European countries, but not deeply in Spain. The primary aim of this study was to identify the possible existence of inequalities in health and health behaviours between couple and lone mothers in Spain by occupational social class and employment status. A second aim was to explore whether any inequalities were influenced by the economic crisis beginning in 2008, analysing changes in inequalities between 2003-2004 and 2011-2012. Two waves of the cross-sectional Spanish National Health Survey data were used. Analyses were restricted to mothers aged 16-64 years, with at least one child aged 18 years or younger. The sample consisted of 2982 mothers in 2003-2004 and 3070 in 2011-2012, representing more than 80% of couple mothers. Two health outcomes and two health behaviour measurements were used. Robust Poisson regression was run to estimate inequalities between couple and lone mothers, calculating prevalence ratios adjusted by age and stratified by social class and employment status. We found inequalities in health and health behaviours between couple and lone mothers in Spain amongst the manual social class, with lone mothers reporting a more than 30% higher prevalence of poor self-perceived health and being smoker in both time points of study compared with couple mothers. Furthermore, lone mothers were at 50% higher risk of having at least one selected chronic condition and 86% higher probability of sleeping less than 6 hours/day in 2011-2012 This study could not confirm that inequalities between couple and lone mothers changed in Spain during the study period, although some patterns were noticeable. Inequalities pointed towards an increase amongst mothers in the manual social class with paid employment, while inequalities amongst unemployed mothers (both manual and non-manual social class) pointed towards a decrease.

Resisting austerity measures to social policies: multiple explanatory case studies.

Since Margaret Thatcher reached power in the United Kingdom, European governments have increasingly turned to neoliberal forms of policy-making, focusing, especially after the 2008 Great Recession on 'austerity policies' rather than investing in social protection policies. We applied a multiple explanatory case studies methodology to examine how and why challenges and resistance to these austerity measures are successful or not in four settings for three different social policy issues: using a gender lens in state budgeting in Andalusia (Spain), maintaining unemployment benefits in Italy and cuts to fuel poverty reduction programs in Northern Ireland and England. In particular, we intended to learn about whether resistance strategies are shared across disparate cases or whether there are unique activities that lead to successful resistance to austerity policies. As our approach drew from realist philosophy of science, we started with initial theories concerning collective action, political ideology and political power of affected populations. Our findings suggest that there are similarities between the cases we studied despite differences in political and policy contexts. We found that joint action between advocacy groups was effective in resisting cuts to social spending. Evidence also indicates that the social construction of target populations is important in resisting changes to social programmes. This was observed in both England and Northern Ireland where pensioners held significant political clout.

Trends in cancer mortality in Spain: the influence of the financial crisis.

OBJECTIVE: To determine if the onset of the economic crisis in Spain affected cancer mortality and mortality trends. METHOD: We conducted a longitudinal ecological study based on all cancer-related deaths and on specific types of cancer (lung, colon, breast and prostate) in Spain between 2000 and 2013. We computed age-standardised mortality rates in men and women, and fit mixed Poisson models to analyse the effect of the crisis on cancer mortality and trends therein. RESULTS: After the onset of the economic crisis, cancer mortality continued to decline, but with a significant slowing of the yearly rate of decline (men: RR = 0.987, 95%CI = 0.985-0.990, before the crisis, and RR = 0.993, 95%CI = 0.991-0.996, afterwards; women: RR = 0.990, 95%CI = 0.988-0.993, before, and RR = 1.002, 95%CI = 0.998-1.006, afterwards). In men, lung cancer mortality was reduced, continuing the trend observed in the pre-crisis period; the trend in colon cancer mortality did not change significantly and continued to increase; and the yearly decline in prostate cancer mortality slowed significantly. In women, lung cancer mortality continued to increase each year, as before the crisis; colon cancer continued to decease; and the previous yearly downward trend in breast cancer mortality slowed down following the onset of the crisis. CONCLUSIONS: Since the onset of the economic crisis in Spain the rate of decline in cancer mortality has slowed significantly, and this situation could be exacerbated by the current austerity measures in healthcare.

Social and material determinants of health in participants in an active labor market program in Barcelona.

BACKGROUND: Unemployment affects the physical and mental health of affected individuals, which can be explained by its direct effect on worsening finances due to the lack of income as well as by its negative psychosocial effects. "Employment in the Neighborhoods" return to work program was implemented in Barcelona specifically in the neighborhoods characterized with a greater economic deprivation and by high unemployment to improve personal and occupational abilities and skills of the participants to reintegrate them into the workforce. The aim of this study is to determine the association between the lack of economic resources and psychosocial factors with respect to mental health and self-rated health in unemployed persons participating in the program "Employment in the Neighborhoods". METHODS: Cross-sectional study. Data collected from a self-administered questionnaire. Generalized linear models were constructed, adjusted by age and social class, to estimate prevalence ratios and analyze any possible association between economic resources, psychosocial factors and poor self-rated health and mental health. RESULTS: Nine hundred forty-eight persons of 2763 participants in the "Employment in the Neighborhoods" program completed the questionnaire. 46.9% were women. 72.5% of women and 61.9% of men were at risk of poor mental health and 25.5% of women and 21.1% of men reported poor self-rated health. Low self-esteem [women: PR 1.88 95%CI (1.24-2.84); men: PR 2.51 95%CI (1.57-4.02)] and medium social support [2.01 (1.30-3.09)], in men, and low social support [1.74 (1.13-2.68)] in women are associated with worsening of self-rated health. In men, low self-esteem [1.40 (1.19-1.64)] and delay in paying bills [1.38 (1.17-1.64)] were associated with the risk of poor mental health; in women were associated low self-esteem [1.27 (1.11-1.44)] and received a non-contributory allowance [1.37 (1.09-1.74)]. CONCLUSIONS: Economic resources, self-esteem and social support are necessary for good general and mental health among unemployed persons. The high prevalence of poor mental health among persons participating in the active labor market program "Employment in the Neighborhoods" could be due to a substantial deficit in these factors.

Trends in small-for-gestational age before and after the economic crisis in Spain.

The aim of this study was to evaluate trends in small-for-gestational age covering the period before and after the Spanish economic crisis, taking into account mother's age, nationality and the autonomous community where she resides. We performed a trend study including children born to fertile women in Spain between 2002 and 2013. Poisson mixed models showed that the prevalence of small-for-gestational age increased following the onset of the crisis, and that a previous downward trend was interrupted.

The mental health of unemployed Brussels youth: the role of social and material resources.

BACKGROUND: In the aftermath of the 2008 Great Recession, youth unemployment rates in the Brussels Capital Region (BCR) increased. The aim of this study is firstly to investigate the evolution of the mental health gap between employed and unemployed youth and secondly to examine the association of material and social resources with mental health of youth entering the labour market in the BCR. METHODS: Two data sources are used to answer the research questions: the Belgian Health Interview Survey (HIS) data (1997 to 2013; 18- to 29-year-olds; N = 5,562), and the authors' own primary data collection among Brussels youth in the transition from education to employment (2015; 18- to 29-year-olds; N = 1,151; BCR-sample). Prevalence ratios, bivariate and multivariate logistic regression analyses are used to explore mental distress and possible mental disorder amongst this particular group of youth. RESULTS: The results show a consistent tendency towards increasing mental health problems for unemployed, compared to employed youth in the 1997-2013 period in the three Belgian Regions. Both social support and the living arrangements of men are related to mental distress and a possible mental disorder. The perception of a poor financial situation is related to a possible mental disorder. Our study also found that escape-avoidance behaviour is important in explaining both adverse mental health outcomes amongst women. CONCLUSIONS: This study suggests that the mental health gap between employed and unemployed youth increases and demonstrates the importance of material and social resources for the mental health of unemployed youth. These results can contribute to discussions on unemployment policies targeting vulnerable youth.

Gender Policies and Gender Inequalities in Health in Europe: Results of the SOPHIE Project.

The aim of this article is to explain the results of the SOPHIE project regarding the effect of gender policies on gender inequalities in health in Europe. We start with the results of a systematic review on how gender regimes and gender equality policies at the country level impact women's health and gender inequalities in health. Then, we report on three empirical analyses on the relationship between different family policy models existing in Europe and gender inequalities in health. Finally we present four case studies on specific examples of gender policies or determinants of gender inequalities in health. The results show that policies that support women's participation in the labor force and decrease their burden of care, such as public services and support for families and entitlements for fathers, are related to lower levels of gender inequality in terms of health. In addition, public services and benefits for disabled and dependent people can reduce the burden placed on family caregivers and hence improve their health. In the context of the current economic crisis, gender equality policies should be maintained or improved.