Relationship between physical activity and incidence of dementia in people aged 50 and over in Europe.

OBJECTIVE: The aim of this study was to analyse the relationship between physical activity and the incidence of dementia in a cohort of people aged 50 years or older without dementia from different countries in Europe between the years 2013 and 2015. METHODS: Prospective longitudinal design study (2013-2015) with a sample of 46,141 people without dementia in 2013 who participated in the SHARE project in waves 5 and 6, where 15 European countries participated. We defined dementia as a self-report of Alzheimer's disease, organic brain syndrome, senility, or any other serious memory impairment during follow-up. The frequency of moderate, vigorous and moderate-to-vigorous physical activity in 2013 was obtained from a validated questionnaire. Incidences of dementia by year (between 2013 and 2015) were calculated for each category of physical activity. Poisson regression models with robust variance were fitted for the association between physical activity and dementia. RESULTS: The incidence of dementia was 7.4 [95%CI = 6.8-7.9] cases per 1000 persons per year. Very frequent moderate physical activity is a protective factor for dementia independently of the frequency of vigorous physical activity and inversely. The risk of dementia was 2.36 [95%CI = 1.77-3.14] higher in people who hardly ever, or never did moderate-to-vigorous physical activity comparing to people engaged in it more than once a week independently of the baseline cognitive level. CONCLUSION: Physical activity is associated with the incidence of dementia in people aged 50 and over in both men and women in Europe.

Alcohol and educational inequalities: Hazardous drinking prevalence and all-cause mortality by hazardous drinking group in people aged 50 and older in Europe.

BACKGROUND: We examined educational inequalities in hazardous drinking prevalence among individuals aged 50 or more in 14 European countries, and explored educational inequalities in mortality in hazardous drinkers in European regions.Methods: We analyzed data from waves 4, 5 and 6 of the Survey of Health Ageing and Retirement in Europe (SHARE). We estimated age-standardized hazardous drinking prevalence, and prevalence ratios (PR) of hazardous drinking by country and educational level using Poisson regression models with robust variance. We estimated the relative index of inequality (RII) for all-cause mortality among hazardous drinkers and non-hazardous drinkers using Cox proportional hazards regression models and for each region (North, South, East and West).Results: In men, educational inequalities in hazardous drinking were not observed (PRmedium = 1.09 [95%CI: 0.98-1.21] and PRhigh = 0.99 [95%CI: 0.88-1.10], ref. low), while in they were observed in women, having the highest hazardous drinking prevalence in the highest educational levels (PRmedium = 1.28 [95%CI: 1.15-1.42] and PRhigh = 1.53 [95%CI: 1.36-1.72]). Overall, the Relative Index of Inequality (RII) in all-cause mortality among hazardous drinkers was 1.12 [95%CI: 1.03-1.22] among men and 1.10 [95%CI: 0.97-1.25] among women. Educational inequalities among hazardous drinkers were observed in Eastern Europe for both men (RIIhazardous = 1.21 [95%CI: 1.01-1.45]) and women (RIIhazardous = 1.46 [95%CI: 1.13-1.87]). Educational inequalities in mortality among non-hazardous drinkers were observed in Southern, Western and Eastern Europe among men, and in Eastern Europe among women.Conclusions: Higher educational attainment is positively associated with hazardous drinking prevalence among women, but not among men in most of the analyzed European countries. Clear educational inequalities in mortality among hazardous drinkers were only observed in Eastern Europe. Further research on the associations between alcohol use and inequalities in all-cause mortality in different regions is needed.

Understanding how alcohol environment influences youth drinking: A concept mapping study among university students. / Influencia del entorno en el consumo de alcohol en jóvenes: Un estudio utilizando concept mapping con estudiantes universitarios.

The aim of the study was to identify the environmental factors that influence alcohol consumption, according to university students, and assess the relative importance and the frequency attributed to each factor. A study using Concept Mapping methodology was performed with a sample of nursing students, who participated in two face-to-face data collection sessions. In session 1, a consensus about the environmental aspects that influence their alcohol consumption was obtained. In session 2, the statements obtained were rated according to their relative importance and frequency in alcohol use (1 = minimum; 5 = maximum). Subsequently, all data were analyzed with the RCMAP of the statistical package R 3.6.1.Approximately 60 students participated in each session. Most were women aged 20 to 24. In session 1, a total of 55 statements were obtained and classified into 7 different clusters: Advertising (9 statements); Family environment (4 statements); Social pressure (12 statements); Responsibilities/norms (4 statements); Holidays and leisure time (7 statements); Emotional situations (8 statements); Accessibility (11 statements). Factors related to social pressure, holidays and leisure time, and alcohol accessibility were considered the most important and frequent in alcohol consumption. In contrast, alcohol advertising was considered the least important (mean 2.6 out of 5) and frequent (mean 2.1 out 5) factor. In conclusion, the factors considered most relevant among nursing students match those having more resources allocated for prevention and health promotion, except for alcohol advertising, which was perceived as less important and frequent compared with the other factors.

El objetivo del estudio fue identificar los factores del entorno que influyen en el consumo de alcohol según la perspectiva de estudiantes universitarios, y evaluar la importancia y la frecuencia atribuida a cada factor. Se utilizó la metodología del Concept Mapping con una muestra de estudiantes de enfermería, que participaron en dos sesiones de recogida de datos. En la sesión 1, se obtuvo un consenso sobre los aspectos del entorno que influyen en su consumo de alcohol. En la sesión 2, los ítems obtenidos se clasificaron en función de la importancia y la frecuencia de estos factores en el consumo de alcohol (1 = mínimo; 5 = máximo). Todos los datos se analizaron con el RCMAP del paquete estadístico R 3.6.1.Alrededor de 60 estudiantes participaron en cada sesión. La mayoría eran mujeres de 20 a 24 años. En la sesión 1, se obtuvieron un total de 55 ítems que fueron clasificados en 7 grupos: Publicidad (9 ítems); Ambiente familiar (4 ítems); Presión social (12 ítems); Responsabilidades/normas (4 ítems); Vacaciones y tiempo libre (7 ítems); Situaciones emocionales (8 ítems); Accesibilidad (11 ítems). Los factores relacionados con la presión social, las vacaciones y el tiempo libre y la accesibilidad del alcohol, fueron considerados los más importantes y frecuentes en el consumo de alcohol. Contrariamente, la publicidad del alcohol fue considerada el factor menos importante (media 2,6 sobre 5) y frecuente (media 2,1 sobre 5). En conclusión, los factores considerados más relevantes entre los estudiantes coinciden con los que se destinan más recursos para la prevención y la promoción de la salud, a excepción de la publicidad del alcohol, que se percibió como menos importante y frecuente comparado con los otros factores.

Polydrug use of tobacco and cannabis: Relationship with self-perceived health and mood state in adolescents in Central Catalonia- DESKcohort Project. / Policonsumo de tabaco y cannabis: Relación con la salud autopercibida y el estado de ánimo en adolescentes de la Catalunya Central-Proyecto DESKcohort.

The objective was to estimate the prevalence of polydrug use of tobacco and cannabis and to see its relationship with self-perceived health and mood state in adolescents from Central Catalonia in the 2019-2020 academic year. A cross-sectional study was carried out with a sample of 7,319 students, who answered a self-administered questionnaire. The dependent variables were the polydrug use of tobacco and cannabis and polydrug use of tobacco and high-risk cannabis. The main independent variables were self-perceived health status and mood state. Frequencies and percentages were analyzed for the prevalence analysis, and the Chi-square test was used. Poisson regression models were adjusted with robust variance, obtaining Prevalence Ratios. The prevalence of polydrug use of tobacco and cannabis was 3.5% and polydrug use of tobacco and high-risk cannabis was 2.5%. In boys, attending higher academic courses (4th of ESO (aPR: 3.88; 95% CI: 2.14-7.05) vs. CFGM (aPR: 8.67; CI95%: 4.51-16.67), having worse self-perceived health (aPR: 4.79; CI95%: 3.24-7.08) and worse mood state (aPR: 1.47; CI95%: 1.05-2.08) act as factors associated with polydrug use of tobacco and cannabis. The results for girls, and risky use of cannabis follow a similar pattern. Among the main conclusions we observe is that there are no differences in self-perceived health and mood state when comparing polydrug use of tobacco and cannabis and polydrug use of tobacco and high-risk cannabis, so risk reduction strategies must be applied whether the use of cannabis is occasional or problematic.

El objetivo fue estimar la prevalencia del policonsumo de tabaco y cannabis y ver su relación con la salud autopercibida y el estado de ánimo en los adolescentes escolarizados de la Catalunya Central en el curso 2019-2020. Estudio transversal con una muestra de 7.319 estudiantes, que contestaron un cuestionario auto administrado. Las variables dependientes fueron el policonsumo de tabaco y cannabis y policonsumo de tabaco y cannabis de riesgo. Las variables independientes principales fueron la salud autopercibida y el estado de ánimo. Para el análisis de prevalencia se analizaron frecuencias y porcentajes, y se usó la prueba de Chi-cuadrado. Se ajustaron modelos de regresión de Poisson con varianza robusta, obteniendo Razones de Prevalencia. La prevalencia del policonsumo de tabaco y cannabis fue de 3,5% y del policonsumo de tabaco y cannabis de riesgo 2,5%. En los chicos, cursar un curso académico superior (4º de ESO (RPa: 3,88; IC95%:2,14-7,05) vs. CFGM (RPa: 8,67; IC95%:4,51-16,67), tener peor salud autopercibida (RPa: 4,79; IC95%:3,24-7,08) y un peor estado de ánimo (RPa: 1,47; IC95%:1,05-2,08) actúan como factores asociados con el policonsumo de tabaco y cannabis. En chicas y por consumo de riesgo de cannabis siguen un patrón similar. Entre las principales conclusiones observamos que no hay diferencias en la salud autopercibida y el estado de ánimo en el policonsumo de tabaco con cannabis y con cannabis de riesgo, por lo que deben existir estrategias de reducción de riesgos tanto si el consumo de cannabis es puntual como si el consumo de cannabis es problemático.

Future intentions and beliefs about roll-your-own cigarettes in adolescents.

OBJECTIVE: To determine the predisposition to use roll-your-own (RYO) cigarettes and the beliefs about RYO cigarettes of all the students of 3°-4° of ESO during the years 2016-17 and 2018-19. A cross-sectional study. SETTING: Bisaura High School from Sant Quirze de Besora. Primary Health Care in the Catalan Health Institute, Catalunya, Spain. PARTICIPANTS: 111 3rd and 4th of ESO (14-16 years). MAIN MEASUREMENTS: Dependent variables used were future intentions of smoking and beliefs regarding RYO cigarettes. Independent variables were sex, course and ever smoked. The prevalence of the different dependent variables was described and compared according to the different independent variables with Pearson's Khi-square test. RESULTS: 26.6% of the adolescents intended to smoke in the future of which 17.4% intended to smoke RYO cigarettes and 13.8% manufactured cigarettes (MC). Around 30% of adolescents express at least one wrong belief regarding RYO cigarettes. For example, the 26.7% believed that smoking RYO cigarettes generated less addiction than MC and the 32.1% that was less harmful. Those who had smoked at some time in their life had a greater intention to smoke in the future (54.5%), to smoke MC (27.3%) and RYO cigarettes (40.9%) than those who had never smoked (7.7%, 4.6% and 1.5% respectively) (p<0.005). Some misconceptions differed depending on whether adolescents had ever smoked in life, sex and course. The boys believed that smoking RYO cigarettes was more natural than smoking MC (p<0.005). CONCLUSIONS: Educational activities to improve the information that young people have regarding RYO cigarettes are needed.

Association between negative mood states, psychoactive substances consumption and bullying in school-aged adolescents. / Asociación entre los estados de ánimo negativo, el consumo de sustancias psicoactivas y el bullying en adolescentes escolarizados.

OBJECTIVE: mental health problems during adolescence lead to increased morbidity and mortality. We intend to test the hypothesis that bullying and addictive substance use is related to negative mood states. METHODS: We carried out a cross-sectional study among high school students in Burela (Northern Spain) (n=238). "Negative mood state" was defined as experiencing the following: feeling tired, sad, out of place, bored, hopeless, nervous or lacking sleep. Independent variables were binge drinking, having smoked tobacco or cannabis, and the corresponding perceived risk of using them. The variable bullying was also measured. Poisson regression models with robust variance were estimated, and Prevalence Ratios were obtained. RESULTS: 10.5% [CI 95% (7.2-15.2)] of the students reported suffering negative mood states. Students declaring low perceived risk of cannabis use [PR = 2.6 (1.2-5.5)], having tried this addictive substance at some point [PR = 3.1 (1.1-8.9)] and having suffered bullying [PR = 4.8 (2.4-9.6)] increased the risk of experiencing negative mood states. CONCLUSION: It would be advisable to design and implement interventions aimed at improving mental health during adolescence which account for the use of addictive substances and being a victim of bullying.

Antecedentes: los problemas de salud mental durante la adolescencia suponen un aumento de la morbimortalidad y la discapacidad. Se pretende testar la hipótesis de que el bullying y el consumo de sustancias psicoactivas están asociados al estado de ánimo negativo.Métodos: estudio transversal entre estudiantes de Educación Secundaria Obligatoria (ESO) (n=238) de los institutos de Burela (Lugo). El "estado de ánimo negativo" se definió a partir de los siguientes ítems: sentirse cansado/a, triste, desplazado/a, aburrido/a, desesperanzado/a, nervioso/a o insomne. Como variables independientes se consideraron: el binge drinking, el haber fumado alguna vez tabaco o cannabis, así como sus correspondientes percepciones de peligrosidad. Además, se midió la variable bullying. Se estimaron modelos de regresión de Poisson con varianza robusta y se obtuvieron Razones de Prevalencia (RP).Resultados: el 10,5% [IC95% (7,2-15,2)] de la población encuestada presentaba estado de ánimo negativo. La nula o baja percepción de peligrosidad para el cannabis [RP=2,6 (1,2-5,5)], haber probado alguna vez esta sustancia adictiva [RP=3,1 (1,1-8,9)] y haber sufrido bullying [RP=4,8 (2,4-9,6)] se asociaban al estado de ánimo negativo.Conclusiones: sería recomendable crear intervenciones para la mejora de la salud mental durante la adolescencia que tengan en cuenta el consumo de sustancias adictivas y el hecho de haber sufrido bullying.

Considerations on the use of Odds Ratio versus Prevalence or Proportion Ratio. / Reflexiones sobre el uso de la Odds Ratio o la Razón de Prevalencias o Proporciones.

Editorial of vol. 31(4).

Editorial del vol 31(4).

The urban environment of alcohol: a study on the availability, promotion and visibility of its use in the neighborhoods of Barcelona. / Entorno urbano de alcohol: un estudio sobre disponibilidad, promoción y visibilidad del consumo en barrios de Barcelona.

INTRODUCTION: This paper describes the presence of alcohol in the public space, assessing establishments that offer it, its advertising, and signs of consumption, as factors that may influence its consumption. METHOD: Descriptive observational study based on cluster sampling with two-step selection. Results are described, and the spatial association between variables is assessed. RESULTS: In the 20 census tracts studied, 306 premises were identified that offered alcoholic beverages: 204 were on-premises and 102 were off-premises, mainly supermarkets and food retail stores. Their spatial distribution was uneven, concentrated in two central districts. We identified 72 publicity items, mostly sponsorship of musical events. There were many promotional items linked to on- premises, especially in their terraces. Five people were detected promoting consumption or selling alcohol in the Old Town. In each time slot, between 39 and 51 signs of consumption on the public space were observed (mostly abandoned beer cans), more frequent at night and in the Old Town. There is an association between the presence of establishments that offer alcohol and advertising. There is no relationship between these variables and signs of consumption in the public space; these are concentrated in the Old Town, which has greater presence of tourism. CONCLUSIONS: The urban environment is characterized by elements that stimulate alcohol use and its distribution is uneven, with a strong influence of tourism-related activities. Further regulation of alcohol promotion, availability and consumption in the public space may change its social image and decrease its use.

Introducción. Se describe la presencia de alcohol en el espacio público, valorando los establecimientos que lo ofrecen, la publicidad, y los indicios de consumo, como factores que pueden inducir el consumo. Método. Estudio observacional descriptivo basado en un muestreo por conglomerados con selección bietápica. Se describen los resultados, y se valora la asociación espacial entre variables. Resultados. En las 20 secciones censales estudiadas se identificaron 306 establecimientos que ofrecían bebidas alcohólicas: 204 de venta y consumo y 102 de venta sin consumo, básicamente supermercados y comercio alimentario. Su distribución territorial fue desigual, concentrada en dos distritos céntricos. Se identificaron 72 elementos de promoción y publicidad destacando el patrocinio de actividades musicales. Se observan elementos promocionales vinculados a los locales de venta y consumo, sobre todo en sus terrazas. Se detectaron cinco personas realizando venta ambulante o promoción del consumo en el casco antiguo. En cada franja horaria se apreciaron entre 39 y 51 indicios de consumo en la vía pública (mayoritariamente envases de cerveza abandonados), más frecuentes de noche y en el casco antiguo. Hay una asociación entre la presencia de establecimientos que ofrecen alcohol y la de elementos de publicidad. No se aprecia relación entre estas variables y los indicios de consumo en el espacio público; éstos se concentran en el casco antiguo, con mayor presencia del turismo. Conclusiones. El medio urbano se caracteriza por elementos que estimulan el consumo de alcohol y su distribución es desigual, muy influida por las actividades orientadas al turismo. Mejorar la regulación de su promoción, disponibilidad y consumo en el espacio público puede contribuir a cambiar su imagen social y disminuir su uso.

Individual and contextual factors related to binge drinking among adolescents in Spain: a multilevel approach. / Factores individuales y contextuales relacionados con el binge drinking en adolescentes españoles: un enfoque multinivel.

The aim of this study was to estimate the prevalence of binge drinking by regions in Spain and assess the effect of individual and contextual factors related to this drinking pattern in adolescents. A cross-sectional study was performed with data from the 2014 Spanish School Survey on Drug Use (ESTUDES) in students aged 14-18 years (N = 34,259). The outcome was binge drinking in adolescents during the last 30 days. Individual independent variables were socioeconomic variables and variables related to access to alcohol and its availability. Contextual variables consisted of adult alcohol consumption, public policies on alcohol, and socioeconomic factors. Multilevel Poisson regression models with robust variance were estimated, obtaining prevalence ratios (PR) and their 95% confidence intervals.  The results showed that the prevalence of youth binge drinking by region of residence was similar for both sexes (r = 0.72). At the individual level, binge drinking was mainly associated with the perception of easy access to alcohol (PR: 1.38; 95% CI: 1.23-1.55), consumption in open areas [(PR: 3.82; 95% CI: 3.44-4.24) < once a month and (PR: 6.57; 95% CI: 5.85-7.37) ≥ once a month], at least one parent allowing alcohol consumption (PR: 1.42; 95% CI: 1.37-1.47), and receiving >30 euros weekly (PR :1.51; 95% CI: 1.37-1.67). Contextual variables were not associated with youth binge drinking when individual variables were considered. In conclusion, youth binge drinking was associated with individual variables related to high alcohol accessibility and availability, regardless of contextual variables. These variables explained the variability in binge drinking among Spanish regions.

El objetivo de este estudio era estimar la prevalencia de binge drinking por provincias en España y estimar el efecto de variables individuales y contextuales relacionadas con dicho consumo en adolescentes españoles. Se realizó un estudio transversal con datos de la Encuesta sobre uso de drogas en Enseñanzas Secundarias en España (ESTUDES 2014) a estudiantes de 14 a 18 años (N = 34.259). La variable dependiente fue binge drinking en adolescentes durante los últimos 30 días. Las variables independientes individuales fueron variables socioeconómicas y variables relacionadas con el acceso y la disponibilidad de alcohol. Las variables contextuales fueron el consumo de alcohol en adultos, políticas públicas relacionadas con el alcohol y factores socioeconómicos. Se ajustaron modelos de regresión de Poisson multinivel con variancia robusta, obteniendo razones de prevalencia (RP) y sus intervalos de confianza al 95%. Los resultados muestran que la prevalencia de binge drinking en estudiantes españoles en función de la provincia era similar para ambos sexos (r = 0,72). A nivel individual, el binge drinking se asociaba principalmente a una percepción de acceso fácil al alcohol (RP: 1,38; IC 95%: 1,23-1,55), a su consumo en zonas abiertas [(RP: 3,82; IC 95%: 3,44-4,24) < una vez al mes y (RP: 6,57; IC 95%: 5,85-7,37) ≥ una vez al mes], a tener uno de los dos padres que permite beber (RP: 1,42; IC 95%: 1,37-1,47), y a disponer de más de 30 euros semanales (RP: 1,51; IC 95%: 1,37-1,67). Las variables contextuales no se asociaban al binge drinking cuando se consideraban las variables individuales. En conclusión, el binge drinking se asociaba con variables individuales relacionadas con una alta accesibilidad y disponibilidad de alcohol independientemente de las variables contextuales. Estas variables explicaban la variabilidad de el binge drinking entre las provincias.

Cancer and Alcohol Consumption in People Aged 50 Years or More in Europe.

AIMS: To estimate the prevalence of hazardous drinking in individuals aged 50 and older who had or had had cancer in 17 European countries and Israel and to analyze the factors associated with their consumption. METHODS: Cross-sectional study based on data from 2011 to 2013 SHARE surveys. A total of 69,509 individuals aged 50 or more from 17 European countries and Israel participated in the study. Prevalence of hazardous drinking in people with cancer was estimated (adapting the SHARE questionnaire to the AUDIT-C). To ascertain whether type of cancer or time since diagnosis were associated with hazardous drinking, Poisson regression models with robust variance were estimated, obtaining prevalence ratios (PR). RESULTS: Overall, 5.4% of participants reported having been diagnosed with cancer. Prevalence of hazardous drinking in people with cancer was 18% in women and 23% in men. After adjusting for various socioeconomic and health variables, no significant differences were observed between hazardous drinking and type of cancer [PR = 0.99 (95% confidence interval (95% CI) = 0.83-1.17) in people with alcohol-related cancers compared to non-alcohol related cancers] and time since diagnosis [PR = 1.01 (95% CI = 0.82-1.25) in people with a cancer diagnosed >5 years ago compared to those diagnosed ≤5 years ago]. Significant differences were found between hazardous drinking and smoking status and self-perceived health. CONCLUSION: In total, 20% of people diagnosed with cancer were hazardous drinkers, despite the known relationship between alcohol use and a worse prognosis of the disease and an increased likelihood of recurrence. SHORT SUMMARY: Overall, 20% of people diagnosed with cancer were hazardous drinkers. There were no significant differences in the prevalence of hazardous drinking depending on the type of cancer (alcohol-related versus non-alcohol related cancers). Highest prevalence of hazardous drinking in people with cancer is found in smokers and people with good self-perceived health.

Hazardous drinking in people aged 50 years or older: a cross-sectional picture of Europe, 2011-2013.

OBJECTIVE: To assess gender and age differences in hazardous drinking and to analyse and compare the factors associated with it in men versus women, and in 50 to 64-year-old versus ≥65-year-old people in Europe. METHODS: Cross-sectional study with data from 65,955 people aged ≥50 years from 18 countries (SHARE project, 2011-2013). The outcome variable, hazardous drinking, was calculated using an adaptation of the AUDIT-C test. Several individual (sociodemographic, life-style and health factors) and contextual variables (country socioeconomic indicators and alcohol policies) were analysed. The prevalence of hazardous drinking was estimated by each exposure variable. To estimate associations, multilevel Poisson regression models with robust variance were fit, yielding prevalence ratios and their 95% confidence intervals (95%CI). RESULTS: Overall, the prevalence of hazardous drinking was 21.5% (95%CI = 21.1-22.0), with substantial differences between countries. The proportion of hazardous drinking was higher in men than in women [26.3%(95%CI = 25.6-27.1); 17.5%(95%CI = 17.0-18.0), respectively], as well as in middle-aged people than in older people [23.6%(95%CI = 23.0-24.3); 19.2%(95%CI = 18.6-19.8), respectively]. At the individual level, associations were found for migrant background, marital status, educational level, tobacco smoking, depression and self-perceived health. At the contextual level, hazardous drinking was associated with gender inequalities in society (only in women) and alcohol advertising regulations (both genders). CONCLUSIONS: One in five people aged ≥50 years in the countries studied is a hazardous drinker, with large differences by countries, gender and age group. Interventions and policies aimed at preventing or reducing alcohol use in this population should account for country, gender and age differences, as well as individual characteristics. Copyright © 2016 John Wiley & Sons, Ltd.

Adolescent alcohol use and parental and adolescent socioeconomic position in six European cities.

BACKGROUND: Many risk behaviours in adolescence are socially patterned. However, it is unclear to what extent socioeconomic position (SEP) influences adolescent drinking in various parts of Europe. We examined how alcohol consumption is associated with parental SEP and adolescents' own SEP among students aged 14-17 years. METHODS: Cross-sectional data were collected in the 2013 SILNE study. Participants were 8705 students aged 14-17 years from 6 European cities. The dependent variable was weekly binge drinking. Main independent variables were parental SEP (parental education level and family affluence) and adolescents' own SEP (student weekly income and academic achievement). Multilevel Poisson regression models with robust variance and random intercept were fitted to estimate the association between adolescent drinking and SEP. RESULTS: Prevalence of weekly binge drinking was 4.2% (95%CI = 3.8-4.6). Weekly binge drinking was not associated with parental education or family affluence. However, weekly binge drinking was less prevalent in adolescents with high academic achievement than those with low achievement (PR = 0.34; 95%CI = 0.14-0.87), and more prevalent in adolescents with >€50 weekly income compared to those with ≤€5/week (PR = 3.14; 95%CI = 2.23-4.42). These associations were found to vary according to country, but not according to gender or age group. CONCLUSIONS: Across the six European cities, adolescent drinking was associated with adolescents' own SEP, but not with parental SEP. Socio-economic inequalities in adolescent drinking seem to stem from adolescents' own situation rather than that of their family.

Changes in alcohol consumption in the 50- to 64-year-old European economically active population during an economic crisis.

Background: The aim was to compare alcohol drinking patterns in economically active people aged 50-64 years before the last economic crisis (2006) and during the crisis (2013). Methods: Cross-sectional study with data from 25 479 economically active people aged 50-64 years resident in 11 European countries who participated in wave 2 or wave 5 of the SHARE project (2006 and 2013). The outcome variables were hazardous drinking, abstention in previous 3 months and the weekly average number of drinks per drinker. The prevalence ratios of hazardous drinking and abstention, comparing the prevalence in 2013 vs. 2006, were estimated with Poisson regression models with robust variance, and the changes in the number of drinks per week with Poisson regression models. Results: The prevalence of hazardous drinking decreased among both men (PR = 0.75; 95%CI = 0.63-0.92) and women (PR = 0.91; 95%CI = 0.72-1.15), although the latter decrease was smaller and not statistically significant. The proportion of abstainers increased among both men (PR = 1.11; 95%CI = 0.99-1.29) and women (PR = 1.18; 95%CI = 1.07-1.30), although the former increase was smaller and not statistically significant. The weekly average number of drinks per drinker decreased in men and women. The decreases in consumption were larger in Italy and Spain. Conclusion: From 2006 to 2013, the amount of alcohol consumed by late working age drinkers decreased in Europe, with more pronounced declines in the countries hardest hit by the economic crisis.

Binge drinking and well-being in European older adults: do gender and region matter?

Background: We aimed to describe gender and region differences in the prevalence of binge drinking and in the association between binge drinking and well-being, among older adult Europeans. Methods: This is a cross-sectional study using the Survey of Health, Ageing and Retirement in Europe (SHARE) wave 4, conducted between 2011 and 2012, including 58 489 individuals aged 50 years or older. Sixteen European countries were grouped in four drinking culture regions: South, Central, North and East. We categorized drinking patterns as: never, former, no-binge and binge drinkers. We used the CASP-12 questionnaire to measure well-being. To assess the association between binge drinking and well-being, we fitted two-level mixed effects linear models. Results: The highest percentage of binge drinkers was found in Central Europe (17.25% in men and 5.05% in women) and the lowest in Southern Europe (9.74% in men and 2.34% in women). Former, never and binge drinkers had a significant negative association with well-being as compared with no-binge drinkers. There was a significant interaction in this association by gender and region. Overall, associations were generally stronger in women and in Southern and Eastern Europe. The negative association of binge drinking with well-being was especially strong in Southern European women (ß = -3.80, 95% CI: -5.16 to - 2.44, P value <0.001). Conclusion: In Southern and Eastern European countries the association between binge drinking and well-being is stronger, especially in women, compared with Northern and Central Europe. Cultural factors (such as tolerance to drunkenness) should be further explored.

Applied Prevalence Ratio estimation with different Regression models: An example from a cross-national study on substance use research. / Estimación de la Razón de Prevalencia con distintos modelos de Regresión: Ejemplo de un estudio internacional en investigación de las adicciones.

OBJECTIVE: To examine the differences between Prevalence Ratio (PR) and Odds Ratio (OR) in a cross-sectional study and to provide tools to calculate PR using two statistical packages widely used in substance use research (STATA and R). METHODS: We used cross-sectional data from 41,263 participants of 16 European countries participating in the Survey on Health, Ageing and Retirement in Europe (SHARE). The dependent variable, hazardous drinking, was calculated using the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C). The main independent variable was gender. Other variables used were: age, educational level and country of residence. PR of hazardous drinking in men with relation to women was estimated using Mantel-Haenszel method, log-binomial regression models and poisson regression models with robust variance. These estimations were compared to the OR calculated using logistic regression models. RESULTS: Prevalence of hazardous drinkers varied among countries. Generally, men have higher prevalence of hazardous drinking than women [PR=1.43 (1.38-1.47)]. Estimated PR was identical independently of the method and the statistical package used. However, OR overestimated PR, depending on the prevalence of hazardous drinking in the country. CONCLUSIONS: In cross-sectional studies, where comparisons between countries with differences in the prevalence of the disease or condition are made, it is advisable to use PR instead of OR.

Objetivo: Examinar las diferencias entre la Razón de Prevalencia (RP) y la Odds Ratio (OR) en un estudio transversal y proporcionar herramientas para calcular la RP usando dos paquetes estadísticos ampliamente utilizados en la investigación de adicciones (STATA y R). Métodos: Se utilizaron los datos de un estudio transversal de 41.263 participantes de 16 países de Europa que participaron en la Encuesta sobre Salud y Envejecimiento en Europa (SHARE). La variable dependiente, consumo de riesgo de alcohol, se calculó a partir del Alcohol Use Disorders Identification Test ­ Consumption (AUDIT-C). Como principal variable independiente se utilizó el género. Otras variables fueron la edad, el nivel de estudios y el país de residencia. Las RP de consumo de riesgo de alcohol entre hombres y mujeres se estimaron a partir del método de Mantel Haenzel, de modelos de regresión log-binomial y de modelos de regresión de Poisson con varianza robusta. Estas estimaciones fueron comparadas con las OR obtenidas a partir de modelos de regresión logística. Resultados: La prevalencia de consumidores de riesgo de alcohol varía según país. En general los hombres tienen un mayor consumo de riesgo que las mujeres [RP=1.43 (1.38-1.47)]. La RP estimada no varía, independientemente del método o paquete estadístico utilizado. Sin embargo, dependiendo de la prevalencia del consumo de riesgo del país, la OR entre los consumidores de riesgo y el género sobrestima la RP. Conclusiones: En estudios transversales en los que se comparan distintos países con diferente prevalencia de una determinada enfermedad o condición es recomendable utilizar la RP en lugar de la OR.

Gender differences in hazardous drinking among middle-aged in Europe: the role of social context and women's empowerment.

BACKGROUND: The aim of this study was to estimate the magnitude of gender differences in hazardous drinking among middle-aged people and to analyse whether these differences are associated with contextual factors, such as public policies or socioeconomic factors. METHODS: Cross-sectional design. The study population included 50- to 64-year-old residents of 16 European countries who participated in the Survey of Health, Ageing and Retirement in Europe project conducted in 2010-12 (n = 26 017). We estimated gender differences in hazardous drinking in each country. To determine whether different social context or women's empowerment variables were associated with gender differences in hazardous drinking, we fitted multilevel Poisson regression models adjusted for various individual and country-level variables, which yielded prevalence ratios and their 95% confidence intervals (95% CI). RESULTS: Prevalence of hazardous drinking was significantly higher in men than women [30.2% (95% CI: 29.1-31.4%) and 18.6% (95% CI: 17.7-19.4%), respectively] in most countries, although the extent of these differences varied between countries. Among individuals aged 50-64 years in Europe, risk of becoming a hazardous drinker was 1.69 times higher (95% CI: 1.45-1.97) in men, after controlling for individual and country-level variables. We also found that lower values of the gender empowerment measure and higher unemployment rates were associated with higher gender differences in hazardous drinking. CONCLUSION: Countries with the greatest gender differences in hazardous drinking were those with the most restrictions on women's behaviour, and the greatest gender inequalities in daily life. Lower gender differences in hazardous drinking seem to be related to higher consumption among women.

Enforcing regulations on alcohol sales and use as universal environmental prevention.

The informal social control over alcohol consumption that was traditional in Southern European countries has weakened. At the same time there is an increase in binge drinking and drunkenness among young people in Spain. To mitigate this problem, regulations on alcohol and driving and restrictions on the sale and consumption of alcohol have been adopted. This paper documents the current regulations in the city of Barcelona and describes efforts to enforce them and their outcomes. Data from the municipal information systems on infringements reported for the period 2008-13 are provided. There is an increasing pressure of municipal services to enforce the rules in two areas: a) alcohol sales at night (retailers); and b) consumption in the public space (citizens). An increase in the controls of drink-driving has also taken place, and the proportion above legal limits has decreased. The largest relative increase occurred in the control of retailers. In Barcelona interventions are made to limit the supply and consumption of alcohol at low cost and during the night, and of driving under the influence of alcohol. There have been no documented episodes of massive drinking in public spaces (known as 'botellón') in the city. These actions, which complement other preventive efforts based on health education, can change the social perceptions of alcohol by minors in a direction less favorable to consumption, promoting environmental prevention.

El control social informal sobre el consumo de alcohol, tradicional en los países del Sur de Europa, se ha debilitado. Este cambio ha ido acompañado de un incremento de los episodios de consumo intensivo y borracheras en jóvenes en España. Para mitigar este problema, se han adoptado regulaciones sobre alcohol y conducción, y otras que restringen la venta y el consumo de alcohol. Este trabajo documenta las regulaciones vigentes y describe los esfuerzos realizados en la ciudad de Barcelona en este campo y sus resultados. Asimismo, se recopilan datos de infracciones denunciadas en los sistemas de información municipal para el período 2008-13.Se observa un incremento de la presión de los servicios municipales para hacer cumplir las normas en dos aspectos: a) la venta en horario nocturno (establecimientos); y b) el consumo en la vía pública (ciudadanía). Por otra parte, también se aprecia un aumento en la actividad de control de la alcoholemia de los conductores, mientras que la proporción que superan los límites legales descendió. El mayor incremento relativo se ha producido en las acciones sobre establecimientos.En Barcelona se realizan intervenciones para limitar la oferta y consumo de alcohol a bajo coste y en horario nocturno, así como la conducción bajo la influencia del alcohol. En la ciudad no se han documentado episodios de botellón masivo en espacios públicos. Estas acciones, que complementan otros esfuerzos preventivos basados en la educación para la salud, pueden modificar la percepción social del alcohol por los menores en un sentido menos favorable al consumo, contribuyendo a crear un entorno de prevención ambiental.

Short report: Effectiveness of a universal preschool-based program for emotional education in 3- to 5-year-old children with autism spectrum conditions.

LAY ABSTRACT: There are numerous programs and interventions to improve social and emotional skills that expressly target children with autism spectrum conditions. However, there is less knowledge about the impact of universal (directed to all children) school programs of emotional education specifically on these children. In this context, the aim of our study was to evaluate the impact of the "1,2,3,emoció!" universal school program on them. The results show that children with autism spectrum conditions participating in the program improved their emotional competence more than the ones who did not participate. Therefore, we conclude that the "1,2,3,emoció!" universal program is effective in children with autism spectrum conditions. This promising outcome gives the opportunity to these children to benefit from group learning in an inclusive school setting, by complementing individual interventions with a universal program.

Relationship between Diet Quality and Socioeconomic and Health-Related Factors in Adolescents by Gender.

Adolescence is a key period for consolidating heathy lifestyles and proper eating habits that can last into adulthood. To analyze the diet quality of Spanish adolescents and its association with socioeconomic factors and health behaviors by gender, a cross-sectional study was conducted using data from the DESKcohort project, consisting of a biannual panel survey on health, health behaviors, and associated determinants, collected in secondary education centers. The study population consisted of 7319 students aged 12 to 18 years. Data were collected from October 2019 to March 2020. The dependent variable was diet quality score according to the Spanish adaptation of the Healthy Eating Index (S-HEI). The independent variables included were socioeconomic factors and health behaviors. We conducted linear regression separately by gender. Diet quality score was significantly higher for girls than for boys (68 and 65, respectively, p < 0.001). For both genders, poorer diet quality was associated with a low level of physical activity [-0.9 (95% CI = -1.6:-0.2) in boys, -1.2 (95% CI = -1.9:-0.4) in girls], alcohol use [-2.5 (95% CI = -3.7:-1.3) in boys, -1.0 (95% CI = -1.9:0.0) in girls], poor self-perceived health [-1.1 (95% CI = -2.4:0.2) in boys, -3.5 (95% CI = -4.6:-2.4) in girls], and having attended Intermediate Level Training Cycles [-2.9 (95% CI = -4.3:-1.5) in boys, -1.9 (95% CI = -3.5:-0.3) in girls]. In girls, poorer diet quality also was associated with low mood [-1.1 (95% CI = -1.9:-0.3)]. The variance was 9% in boys and 12% in girls. Our results highlight the need to consider socioeconomic and health-related factors, as well as gender, when conducting interventions to promote healthy eating among adolescents.

Gender inequalities in the prevalence of low mood and related factors in schooled adolescents during the 2019-2020 school year: DESKcohort project.

BACKGROUND: Mood disorders are the second most prevalent mental disorders in childhood and adolescence. Many undiagnosed people manifest subthreshold symptoms, like low mood, and present worse prognoses than asymptomatic healthy subjects. The aim of this study was to estimate the prevalence of low mood, gender inequalities, and associated factors, in 12- to 18-year-old adolescents in the rural and medium-sized urban areas of Central Catalonia during the 2019-2020 academic year. METHODS: Cross-sectional study with data from a cohort of high-schooled students (2019-2020), with a convenience sample of 6428 adolescents from the Central region of Catalonia (48.3 % boys and 51.7 % girls). Prevalence of low mood was estimated by gender and exposure variables, and ratios were obtained using Poisson regression models, adjusting for several exposure variables one by one, and for all of them jointly. RESULTS: The prevalence of low mood was 18.6 %, with statistically significant differences between genders (11.6 %, 95 % CI: 10.5-12.8 in boys and 25.1 %, 95 % CI: 23.7-26.6 in girls). Being an immigrant, dieting, and daily tobacco smoking were only associated with low mood in girls, whereas risky alcohol consumption was only associated in boys. Sexual violence was found to account for 36.2 % of low mood problems in girls. LIMITATIONS: The main limitation of the study is its cross-sectional design, which means that no casual relationships can be extracted of this study. CONCLUSIONS: The prevalence of low mood varies between the sexes, highlighting the importance of developing gender-specific interventions to reduce its incidence in young people, considering the factors associated with this condition.