Social Inequalities in Mental Health and Self-Perceived Health in the First Wave of COVID-19 Lockdown in Latin America and Spain: Results of an Online Observational Study.

COVID-19 lockdowns greatly affected the mental health of populations and collectives. This study compares the mental health and self-perceived health in five countries of Latin America and Spain, during the first wave of COVID 19 lockdown, according to social axes of inequality. This was a cross-sectional study using an online, self-managed survey in Brazil, Chile, Ecuador, Mexico, Peru, and Spain. Self-perceived health (SPH), anxiety (measured through GAD-7) and depression (measured through PHQ-9) were measured along with lockdown, COVID-19, and social variables. The prevalence of poor SPH, anxiety, and depression was calculated. The analyses were stratified by gender (men = M; women = W) and country. The data from 39,006 people were analyzed (W = 71.9%). There was a higher prevalence of poor SPH and bad mental health in women in all countries studied. Peru had the worst SPH results, while Chile and Ecuador had the worst mental health indicators. Spain had the lowest prevalence of poor SPH and mental health. The prevalence of anxiety and depression decreased as age increased. Unemployment, poor working conditions, inadequate housing, and the highest unpaid workload were associated with worse mental health and poor SPH, especially in women. In future policies, worldwide public measures should consider the great social inequalities in health present between and within countries in order to tackle health emergencies while reducing the health breach between populations.

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.

Study Protocol for the Evaluation of the Health Effects of Superblocks in Barcelona: The "Salut Als Carrers" (Health in the Streets) Project.

Superblocks are currently being introduced in Barcelona to respond to the city's scarcity of green spaces and high levels of air pollution, traffic injuries, and sedentariness. The aim is to calm the streets by reducing the number of square meters dedicated to private vehicles and to reclaim part of this public space for people. Salut als Carrers (Health in the Streets) is a project to evaluate the potential environmental and health effects of the superblock model with an equity perspective in Barcelona. This study aims to explain the various interventions implemented in different neighborhoods in Barcelona and the methods that will be used to evaluate them in a quasi-experimental and health impact assessment (HIA) approaches. Given the complexity of the intervention evaluated, the project employs mixed methodologies. Quantitative methods include: (a) a pre-post health survey of 1200 people randomly selected from the municipal register asked about self-perceived health and quality of life, social support, mental health, mobility, physical activity, neighborhood characteristics, and housing; (b) pre-post environmental measurements, mainly of nitrogen dioxide (NO2), particulate matter of less than 10 µm (PM10), and particulate matter of less than 2.5 µm (PM2.5) and black carbon; (c) pre-post environmental walkability measures using the Microscale Audit of Pedestrian Streetscapes (MAPS) tool; (d) use of public space and physical activity levels using the System for Observing Play and Recreation in Communities (SOPARC), a validated observation tool; (e) pre-post traffic injury measures with a comparison group; and (f) the comparison and integration of pre-post assessment with previous HIAs and the improvement of future HIAs. Qualitative studies will be performed to analyze residents' perception of these effects by using: (a) various focus groups according to different participant characteristics who are more or less likely to use the superblocks; and (b) a guerrilla ethnography, which is a method that combines ethnographic observation and semi-structured interviews. This study, which evaluates the impact of an ambitious urban-renewal program on health, will help to assess the effectiveness of public policy in terms of health and health inequalities.

Social Inequalities in Fertility in Women Residing in Urban Neighbourhoods in Spain: A Multilevel Approach.

BACKGROUND: Reproductive health inequalities tend to be more marked in large cities because they include neighbourhoods with unequal social and community networks, resources and opportunities. The aim was to describe social inequalities in fertility patterns among women who gave birth between 2007 and 2016 in the city of Barcelona (Spain) by jointly evaluating the effect of individual and socioeconomic neighbourhood characteristics. METHODS: We conducted a multilevel study of women's individual characteristics (age, educational attainment, and country of origin) and neighbourhood characteristics (disposable household income, percentage of unemployment and percentage of foreigners). RESULTS: Multilevel modelling revealed significant variability in fertility across neighbourhoods after adjustment for individual explanatory variables. The fertility rate (FR) was higher in better educated women (adjusted relative risk: aRR 2.76), those aged 30-39 years (aRR 2.13), and in those born in Spain in relation to their respective reference groups. The FR was lowest in women with upper to post-secondary, non-tertiary education (aRR 0.86) who were born in high income countries (aRR 0.57). Women living in neighbourhoods with a low income (aRR 1.46) and with a higher unemployment (aRR 1.33) were more likely to have children. In contrast, women living in neighbourhoods with a lower percentage of foreigners had the lowest FR (aRR 0.81). CONCLUSIONS: The neighbourhood's characteristics played an important role in fertility patterns, independently of women's individual characteristics. At the contextual level, the highest FR was found in the poorest settings, highlighting inequalities. At the individual level, the FR was highest among women with higher education and in their thirties.

Effects of Superblocks on health and health inequities: a proposed evaluation framework.

The following essay outlines the intervention and presents a framework that will serve as a guide in the evaluation of the different effects of the Superblocks. Superblocks consist of amalgamations of blocks throughout the city, with the goal of improving the habitability of public spaces, advancing sustainable mobility, increasing urban green, and promoting residents' participation and coresponsibility, while ultimately influencing residents' health and health inequities. The evaluation framework considers the following aspects: the interventions implemented in the Superblock strategy, the changes that occur at neighbourhood and individual level and the population turnover as intermediate factors and finally the health outcomes. Inequity dimensions are also considered.

Bayesian smoothed small-areas analysis of urban inequalities in fertility across 1999-2013.

BACKGROUND: Since the 2008 economic crisis in Spain, overall fertility has continued to decrease, while urban inequalities have increased. There is a general lack of studies of fertility patterns in small-areas of Spanish cities. We explored the effects of the economic crisis on fertility during three time periods in urban settings in Spain. METHODS: We studied the distribution of fertility rates among women (15-49 years) from Spain and low-middle income countries (LIC) who were living in 13 Spanish cities. We mapped fertility and the MEDEA socioeconomic deprivation index in small-areas, and analyzed age-related trends in fertility rates. We performed an ecological regression analysis of fertility and the deprivation index in two pre-crisis periods (1999-2003 and 2004-2008) and one crisis period (2009-2013). Fertility rates were calculated and smoothed using the hierarchical Bayesian model (BYM). RESULTS: Higher fertility was generally associated with socioeconomic deprivation, with adjustment for the mothers' age and nationality. While Spanish citizens tended to delay childbearing throughout the three study periods, fertility increased among Spanish adolescents from deprived urban areas during the economic crisis. There was a general decline in fertility among immigrants after the crisis, especially in southern cities. Overall, fertility appeared to be stable, with higher fertility in more deprived areas. CONCLUSION: Increased unemployment and changes to government family policies may have contributed to delayed childbearing in Spain. For immigrants, more restrictive immigration policies may have played a crucial role in decreasing fertility rates. Reforming such policies will be key for better reproductive rights and improved fertility rates across all population cohorts in Spain.