Urban and social determinants of alcohol and tobacco consumption among adolescents in Madrid.

OBJECTIVE: This study aims to describe the accessibility to and promotion of alcohol and tobacco around secondary schools in Madrid and its distribution in relation with area-level socioeconomic deprivation; analyze the relationship between this exposure and individual consumption characteristics of students between 14 and 18 years old; and explore other facilitators of this consumption. METHOD: Mixed-methods study conducted in three phases: 1) we collected data on accessibility to and promotion of alcohol and tobacco in the environment using systematic social observation around 55 secondary schools; 2) we administered 2287 questionnaires among the students in these centers to gather information about characteristics and determinants of consumption; and 3) we conducted 20 semi-structured interviews and one discussion group to deepen in the results obtained in surveys and systematic social observation. We will use Geographic Information Systems to integrate and analyze the data from a spatial perspective.

Trends and determinants of social inequities in cardiovascular risk factors in Spain: a mixed-methods study.

This sequential mixed-methods study aims to: 1) assess spatial and temporal trends in cardiovascular risk factors by socioeconomic position from 2001 to 2020 in Spain; 2) explore public health professionals' perspectives regarding interventions that might have impacted these inequities; and 3) analyze determinants on social inequities in cardiovascular risk factors. First, we will measure the change in absolute and relative social inequities in eight cardiovascular risk factors through time trend analysis using repeated cross-sectional data from both National and European Health Surveys for Spain from 2001 to 2020. Second, we will interview key informants -both at the regional and national level-, to contextualize data obtained in phase 1 and capture the content and variation of policies across regions. Third, we will use econometric methods to analyze how these identified interventions have impacted these social inequities within and across regions.

Residents perceptions of the alcohol environment: A participatory photovoice project in two districts with different socio-economic status in a large city.

The purpose of this study was to present the alcohol environment as perceived by its residents in two districts of Madrid using the Photovoice participatory methodology. Secondly, we compared the results according to the socio-economic status of the districts. The study was conducted in the city of Madrid, Spain, in two districts with different socio-economic status. A total of 26 people participated, who took and discussed photographs about their alcohol environment. They grouped them into 33 final categories, such as the socialising role of alcohol or the alcohol advertising. Co-authors further grouped participants final categories into seven general areas. The participants in the Photovoice project have helped to deepen the understanding of the alcohol urban environment. These results may help to design more effective policies to prevent hazardous alcohol consumption.

How the choice of ethnic indicator influences ethnicity-based inequities in maternal health care in four Latin American countries: who is indigenous?

BACKGROUND: The current focus on monitoring health inequalities and the complexity around ethnicity requires careful consideration of how ethnic disparities are measured and presented. This paper aims to determine how inequalities in maternal healthcare by ethnicity change according to different criteria used to classify indigenous populations. METHODS: Nationally representative demographic surveys from Bolivia, Guatemala, Mexico, and Peru (2008-2016) were used to explore coverage gaps across maternal health care by ethnicity using different criteria. Women were classified as indigenous through self-identification (SI), spoken indigenous language (SIL), or indigenous household (IH). We compared the gaps through measuring coverage ratios (CR) with adjusted Poisson regression models. RESULTS: Proportions of indigenous women changed significantly according to the identification criterion (Bolivia:SI-63.1%/SIL-37.7%; Guatemala:SI-49.7%/SIL-28.2%; Peru:SI-34%/SIL-6.3% & Mexico:SI-29.7%/SIL-6.9%). Indigenous in all countries, regardless of their identification, had less coverage. Gaps in care between indigenous and non-indigenous populations changed, for all indicators and countries, depending on the criterion used (e.g., Bolivia CR for contraceptive-use SI = 0.70, SIL = 0.89; Guatemala CR for skilled-birth-attendant SI = 0.77, SIL = 0.59). The heterogeneity persists when the reference groups are modified and compare just to non-indigenous (e.g., Bolivia CR for contraceptive-use under SI = 0.64, SIL = 0.70; Guatemala CR for Skilled-birth-attendant under SI = 0.77, SIL = 0.57). CONCLUSIONS: The indigenous identification criteria could have an impact on the measurement of inequalities in the coverage of maternal health care. Given the complexity and diversity observed, it is not possible to provide a definitive direction on the best way to define indigenous populations to measure inequalities. In practice, the categorization will depend on the information available. Our results call for greater care in the analysis of ethnicity-based inequalities. A greater understanding on how the indigenous are classified when assessing inequalities by ethnicity can help stakeholders to deliver interventions responsive to the needs of these groups.

Obstacles and opportunities for monitoring ethnicity-based inequalities in maternal health care: Lessons from Mexico.

BACKGROUND: Monitoring and reducing inequalities in health care has become more relevant since the adoption of the Sustainable Development Goals (SDGs). The SDGs bring an opportunity to put the assessment of inequalities by ethnicity on the agenda of decision-makers. The objective of this qualitative study is to know how current monitoring is carried out and to identify what factors influence the process in order to incorporate indicators that allow the evaluation of inequalities by ethnicity. METHODS: We conducted 17 semi-structured interviews with key informants from the health ministry, monitoring observatories, research centers, and international organizations, involved in maternal health care monitoring in Mexico. Our analysis was interpretative-phenomenological and focused on examining experiences about monitoring maternal health care in order to achieve a full picture of the current context in which it takes place and the factors that influence it. RESULTS: The obstacles and opportunities pointed out from the participants emerge from the limitations or advantages associated with the accuracy of evaluation, availability of information and resources, and effective management and decision-making. Technicians, coordinators, researchers or decision-makers are not only aware of the inequalities but also of its importance. However, this does not lead to political decisions permitting an indicator to be developed for monitoring it. As for opportunities, the role of international organizations and their links with the countries is crucial to carry out monitoring, due to political and technical support. CONCLUSIONS: The success of a monitoring system to help decision-makers reduce inequalities in health care depends not only on accurate evaluations but also on the context in which it is implemented. Understanding the operation, obstacles and opportunities for monitoring could be a key issue if the countries want to advance towards assessing inequalities and reducing health inequities with the aid of concrete policies and initiatives.

Understanding Urban Health Inequalities: Methods and Design of the Heart Health Hoods Qualitative Project.

OBJECTIVE: Qualitative methods may help to understand features related to health urban inequalities as a way to include citizens' perceptions of their neighbourhoods in relation to their health-related behaviours. The aim of this article is to describe the methods and design of a qualitative urban health study. METHODS: The Heart Healthy Hoods (HHH) analyses cardiovascular health in an urban environment using mixed methods: electronic health records, quantitative individual questionnaires, physical examination, semi-structured Interviews (SSIs), focus groups (FGs) and participatory technics such as photovoice. This article focuses on the HHH qualitative methods and design. A case study was used to select three neighbourhoods in Madrid with different socioeconomic levels: low, medium, and high. The selection process for these three neighbourhoods was as follows: classification of all Madrid's neighbourhoods (128) according to their socioeconomic level; after ranking this classification, nine neighbourhoods, three by socioeconomic level, were short-listed; different urban sociology criteria and non-participant observation were used for the final selection of three neighbourhoods. After selecting the three neighbourhoods, thirty SSIs were held with residents and six SSIs were held with key informants. Finally, twenty-nine FGs will be conducted over the course of 8 months, between May and December of 2018. CONCLUSIONS: Systematization in the selection of neighbourhoods and the use of adequate techniques are essential for the qualitative study of urban health inequalities.

Creating a Collaborative Platform for the Development of Community Interventions to Prevent Non-Communicable Diseases.

Chronic diseases, also known as non-communicable diseases (NCD) are one of the most important public health problems of our time. Many of these diseases can be reduced by achieving healthy lifestyles. Community interventions are very useful in reducing these types of diseases since they have a direct impact over daily conditions and are adjustable to the complex situations that they carry. This article describes the process of the creation of a collaborative platform for the design and implementation of community interventions to prevent NCDs. This platform includes six non-governmental organizations who have aligned their prevention and health promotion objectives to develop joint community interventions. The intervention levels approach, based on the socio-ecological model has been the basic model to structure the working groups of the platform. Dealing with institutional differences, complexity and variability of contexts, defining the roles and responsibilities and managing the resources are key elements to have in mind to achieve good relations and functional partnerships to design and implement effective community interventions at different levels. Institutional recognition, support and planning based on local priorities are also key elements for these kinds of platforms to be successful, sustainable and, therefore, have an impact on people's health.

Shortening of gestational length among native-born and immigrants in Spain (1997-2008).

During the last decade there have been significant socio-demographic changes in Spain with potential impact on gestational length. The aim of the study was to describe the evolution of gestational age during 1997-2008, separately for native-born and immigrant population, in order to assess their contribution to the overall pattern of gestational length. A cross-sectional study of 5,018,229 singleton births born between 1997 and 2008 was carried out. The annual mean of gestational age was calculated and compared by means of ANOVA test, globally and also separately for natives and immigrants. Proportions of deliveries by gestational age and maternal characteristics were calculated in 4 periods and compared by means of Chi-square tests. Crude and adjusted multinomial logistic regression models were fitted separately for native-born and immigrant women. Our results show that in the last 12 years a progressive shortening in the mean gestational age has taken place in Spain. While the overall decrease of gestational length along the period was 1.5 days, closer to that in Spanish women (1.3 days), it was 2.3 days among immigrants. In both groups this shortening was mainly due to an increase in the proportion of 37-39 weeks deliveries at the expense of a substantial decrease in those with 40 weeks. These trends remained after controlling for known confounding variables such as maternal age, parity and occupation. Further analysis of its causes and public health implications are recommended.

[Health Impact Assessment: assessing the effectiveness of policies in population health]. / Evaluación de impacto en salud: valorando la efectividad de las políticas en la salud de las poblaciones.

Health Impact Assessment is a comprehensive methodology proposed by the World Health Organization to determine the impact on health of projects, policies and strategies that are no originally specifically health-related but that could have on effect on health. This work aims to review the methodological approaches to Health Impact Assessment, and determine its value in Public Health. Health Impact Assessment is a multidisciplinary process that combines both qualitative and quantitative evidence in a decision-making frame. It is based on a model of health that includes the economic, political, social, psychological, and environmental determinants of health. If interventions with a real impact on the population s health require a comprehensive and structural approach, with Public Health measures taken at political level, those responsible for implementing such measures have to engage in the decision-making process and in the assessment of its effectiveness. To conduct Health Impact Assessment it is necessary to facilitate the integration of the existing data in order to perform the initial diagnosis and be able to investigate the late effects of the policy measures implemented. This way it will be possible to systematically monitor the effects on health of the actions which derive from Health Impact Assessment, thus maximizing potential positive effects on health and preventing the potential adverse effects.