Social inequalities in the use of physiotherapy in women diagnosed with breast cancer in Barcelona: DAMA cohort.

PURPOSE: This study aimed to analyze social inequalities in the use and access of physiotherapy service and its clinical and socio-economic determinants in women diagnosed with breast cancer in the hospital network of Barcelona. METHODS: Data from 2235 women belonging to the mixed (prospective and retrospective) DAMA Cohort were analyzed, including demographic, socio-economic, clinical, and breast cancer treatment outcomes. To determine the influence of such variables on access to physiotherapy, different Poisson regression models with robust variance (obtaining Prevalence Ratios and confidence intervals) were estimated. RESULTS: Although when experiencing different chronic and acute symptoms, only between 20 and 35% of women visited physiotherapist. Two out of 3 women reported to have received insufficient information about medical care and rehabilitation. Age of women, job occupation, education level, having a mutual or private insurance, as well as outcomes related to breast cancer, appear to be factors influencing the access to physiotherapy. CONCLUSIONS: Social and economic inequalities exist on the access to physiotherapy by women diagnosed with breast cancer, which is generally low, and may clearly impact on their functional recovery. Promoting strategies to reduce social bias, as well as improve communication and patient information regarding physiotherapy may be of interest for a better health care in breast cancer diagnosed women.

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.

Availability and promotion of alcohol across different outlet typologies and under different area-level socioeconomic status. / Disponibilidad y promoción de alcohol según la tipología de los locales y las condiciones socioeconómicas del área.

We aimed to characterize the availability and promotion of alcohol at alcohol outlets in Madrid and to compare them according to type of outlet and area-level socioeconomic status. We used the OHCITIES instrument to characterise the alcohol outlets in 42 census tracts of Madrid in 2016. We specified alcohol availability as the density of alcohol outlets and the number of alcohol outlets with extended opening hours (12 or more). We registered any type of promotion associated to alcohol outlets that could be perceived from outside the outlet. We calculated and compared proportions of availability and promotion by alcohol outlet (on- and off-premise) using chi-squared and Fisher Exact tests. We estimated the availability and promotion of alcohol densities per census tract according to area-level socioeconomic status. To assess statistical significance, we used Kruskal-Wallis tests. We recorded 324 alcohol outlets, 241 on-premise and 83 off-premise. Most of the outlets had extended opening hours (73.77%) and at least one sign promoting alcohol (89.51%). More on-premise outlets had extended opening hours and higher presence of alcohol promotion than off-premise (p < 0.001). Higher density of alcohol outlets, extended opening hours and presence of alcohol promotion were found in higher socioeconomic areas (all p < 0.001). These results were also observed for on-premise alcohol outlets. Alcohol availability and promotion were associated with alcohol outlets in Madrid. Future alcohol policies regulating the availability and promotion of alcohol should consider outlet types and area-level socioeconomic status.

El objetivo fue caracterizar la disponibilidad y promoción de alcohol asociados a los locales de venta y consumo de alcohol en Madrid, así como explorar las diferencias en su distribución en función de la tipología del local y las características socioeconómicas del área. Se utilizó el instrumento OHCITIES para caracterizar locales situados en 42 secciones censales de Madrid durante 2016. Se registró la densidad de locales y el número de locales con amplios horarios de apertura (12 o más horas). Se registró cualquier tipo de promoción asociada al local visible desde el exterior. Se compararon los porcentajes de características de disponibilidad y promoción asociada a los locales de consumo y venta de alcohol utilizando el test de chi cuadrado y la prueba exacta de Fisher. Se estimó la densidad de disponibilidad y promoción por sección censal y se exploró su distribución en función de las características socioeconómicas del área mediante el test de Kruskal-Wallis. Se registraron 324 locales, 241 de consumo y 83 de venta. La mayoría tenía un horario amplio de apertura (73,77%) y algún elemento promocional (89,51%). Los locales de consumo tenían horarios más amplios de apertura y más elementos promocionales que los de venta (p < 0,001). Se encontraron mayor densidad de locales, amplitud de horarios y elementos promocionales en áreas de nivel socioeconómico alto (todos p < 0,001). La disponibilidad y promoción estuvieron asociadas con los locales de venta y consumo de alcohol en Madrid. Futuras políticas cuyo objetivo sea la prevención del consumo de alcohol deben tener en cuenta la influencia de los tipos de locales y las características socioeconómicas del área en la distribución de la disponibilidad y promoción de alcohol.

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.

Women who inject drugs and violence: Need for an integrated response. / Mujeres que usan drogas inyectadas y violencia: Necesidad de una respuesta integrada.

The aim of this study was to describe the prevalence of physical and/or sexual violence experienced by women who inject drugs (WWID) and identify associated factors. A cross-sectional study was conducted among 120 WWID in a network of harm reduction centres using an anonymous questionnaire. Oral fluid samples were also collected to estimate the prevalence of HIV and hepatitis C. Univariate and multivariate Poisson regression models with robust variance were performed to identify the factors associated with experiencing violence, obtaining prevalence ratios (PR) and their 95% confidence intervals. The results showed that the prevalence of violence reported by WWID in the last 12 months was 45.8% (42.2% physical and 11.9% sexual aggression). In multivariate analysis, variables associated with experiencing violence were homelessness (PR = 1.59; CI: 1.07-2.38), reporting exchanges of sex for money or drugs (PR = 1.65; CI: 1.19-2.29), reporting a previous sexually transmitted infection (PR = 1.49; CI: 1.04-2.15) and/or injecting drugs less frequently than daily (RP = 2.29; CI: 1.49-3.54). This study highlights the importance of establishing detection protocols and systems of referral to the network of attention to women suffering violence, within the centres of the drug addiction care network, as well as the development of multilevel strategies that take into account not only individual factors but also other social and/or structural aspects that may be playing a relevant role in addressing this problem.

El objetivo de este estudio fue describir la prevalencia de violencia física y/o sexual experimentada por mujeres que usan drogas por vía inyectada (MUDVI) e identificar factores asociados. Se realizó un estudio transversal en 120 MUDVI usuarias de centros de reducción de daños mediante un cuestionario anónimo y recogida de muestras de fluido oral para estimar la prevalencia del VIH y de la hepatitis C. Los factores asociados a la presencia de violencia se analizaron mediante un modelo de regresión de Poisson con varianza robusta univariante y multivariante, obteniendo razones de prevalencia (RP) y sus intervalos de confianza al 95%. Los resultados muestran que la prevalencia de  agresiones en los últimos 12 meses fue del 45,8% (42,2% agresiones físicas y 11,9% agresiones sexuales). A nivel multivariante, las variables asociadas a la presencia de violencia fueron estar sin domicilio fijo (RP=1,59; IC: 1,07-2,38), ejercer el trabajo sexual (RP=1,65; IC: 1,19-2,29), haber sufrido alguna infección de transmisión sexual (RP=1,49; IC: 1,04-2,15) y/o inyectarse drogas no de forma diaria (RP=2,29; IC: 1,49-3,54). Este estudio pone de manifiesto la importancia de establecer protocolos de detección, y derivación a la red de atención a la violencia de género, dentro de los centros de la red de atención a las drogodependencias, así como el desarrollo de estrategias multinivel que tengan en cuenta no solamente factores individuales sino también otros aspectos sociales y/o estructurales que pueden estar jugando un papel relevante a la hora de abordar este problema.

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.

The Experience of Implementing Urban HEART Barcelona: a Tool for Action.

Urban Health Equity Assessment and Response Tool (HEART) is a tool developed by the World Health Organization whose objective is to provide evidence on urban health inequalities so as to help to decide the best interventions aimed to promote urban health equity. The aim of this paper is to describe the experience of implementing Urban HEART in Barcelona city, both the adaptation of Urban HEART to the city of Barcelona, its use as a means of identifying and monitoring health inequalities among city neighbourhoods, and the difficulties and barriers encountered throughout the process. Although ASPB public health technicians participated in the Urban HEART Advisory Group, had large experience in health inequalities analysis and research and showed interest in implementing the tool, it was not until 2015, when the city council was governed by a new left-wing party for which reducing health inequalities was a priority that Urban HEART could be used. A provisional matrix was developed, including both health and health determinant indicators, which allowed to show how some neighbourhoods in the city systematically fare worse for most of the indicators while others systematically fare better. It also allowed to identify 18 neighbourhoods-those which fared worse in most indicators-which were considered a priority for intervention, which entered the Health in the Barcelona Neighbourhoods programme and the Neighbourhoods Plan. This provisional version was reviewed and improved by the Urban HEART Barcelona Working Group. Technicians with experience in public health and/or in indicator and database management were asked to indicate suitability and relevance from a list of potential indicators. The definitive Urban HEART Barcelona version included 15 indicators from the five Urban HEART domains and improved the previous version in several requirements. Several barriers were encountered, such as having to estimate indicators in scarcely populated areas or finding adequate indicators for the physical context domain. In conclusion, the Urban HEART tool allowed to identify urban inequalities in the city of Barcelona and to include health inequalities in the public debate. It also allowed to reinforce the community health programme Health in the Barcelona Neighbourhoods as well as other city programmes aimed at reducing health inequalities. A strong political will is essential to place health inequalities in the political agenda and implement policies to tackle them.

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.

Long-Term Opioid Agonist Treatment Participation after First Treatment Entry is Similar across 4 European Regions but Lower in Non-Nationals.

Heroin users in opioid agonist treatment (OAT) show markedly reduced heroin consumption, less crime and a lower mortality rate. However, the extent of long-term OAT participation over subsequent treatment episodes remains unclear. We analysed the annual proportion of patients in treatment (at least 1 day) since the start of first OAT in 4 European regions: Barcelona (BA) 1996-2012: 8,602 patients; Czech -Republic (CZ) 2000-2014: 4,377 patients; Netherlands (NL) 1994-2014: 33,235 patients, Zurich (ZU) 1992-2015: 11,795. We estimated the long-term decline of treatment need due to mortality or abstinence and also a "nuisance" short-term decline until the equilibrium level of cycling in and out of OAT is reached to obtain the adjusted treatment participation value. The adjusted treatment participation was around 50% (BA: 47.4-51.4%; CZ: 49.8-53.9%; NL: 52.3-54.0%; ZU: 46.4-49.3%), and the annual decline of treatment need was close to 4%. Non-nationals (NL patients with a migrant background) showed substantial lower adjusted treatment participation (rate ratio BA: 0.059-0.343; NL: 0.710-0.751; ZU: 0.681-0.797; CZ: n.a.). Our method may provide a policy-relevant indicator of long-term provision, quality and access to OAT following first treatment.

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.

Estimating average alcohol consumption in the population using multiple sources: the case of Spain.

BACKGROUND: National estimates on per capita alcohol consumption are provided regularly by various sources and may have validity problems, so corrections are needed for monitoring and assessment purposes. Our objectives were to compare different alcohol availability estimates for Spain, to build the best estimate (actual consumption), characterize its time trend during 2001-2011, and quantify the extent to which other estimates (coverage) approximated actual consumption. METHODS: Estimates were: alcohol availability from the Spanish Tax Agency (Tax Agency availability), World Health Organization (WHO availability) and other international agencies, self-reported purchases from the Spanish Food Consumption Panel, and self-reported consumption from population surveys. Analyses included calculating: between-agency discrepancy in availability, multisource availability (correcting Tax Agency availability by underestimation of wine and cider), actual consumption (adjusting multisource availability by unrecorded alcohol consumption/purchases and alcohol losses), and coverage of selected estimates. Sensitivity analyses were undertaken. Time trends were characterized by joinpoint regression. RESULTS: Between-agency discrepancy in alcohol availability remained high in 2011, mainly because of wine and spirits, although some decrease was observed during the study period. The actual consumption was 9.5 l of pure alcohol/person-year in 2011, decreasing 2.3 % annually, mainly due to wine and spirits. 2011 coverage of WHO availability, Tax Agency availability, self-reported purchases, and self-reported consumption was 99.5, 99.5, 66.3, and 28.0 %, respectively, generally with downward trends (last three estimates, especially self-reported consumption). The multisource availability overestimated actual consumption by 12.3 %, mainly due to tourism imbalance. CONCLUSIONS: Spanish estimates of per capita alcohol consumption show considerable weaknesses. Using uncorrected estimates, especially self-reported consumption, for monitoring or other purposes is misleading. To obtain conservative estimates of alcohol-attributable disease burden or heavy drinking prevalence, self-reported consumption should be shifted upwards by more than 85 % (91 % in 2011) of Tax Agency or WHO availability figures. The weaknesses identified can probably also be found worldwide, thus much empirical work remains to be done to improve estimates of per capita alcohol consumption.