Alcohol consumption patterns and adherence to the Mediterranean diet in the adult population of Spain.

PURPOSE: The objective is to evaluate the association between various indicators of alcohol consumption and the degree of adherence to the Mediterranean diet among the Spanish adult population. METHODS: A cross-sectional study including 44,834 participants ≥ 15 years of age from the 2017 National Health Survey and the 2020 European Health Survey in Spain. Alcohol patterns were defined based on (1) average intake: individuals were classified as low risk (1-20 g/day in men and 1-10 g/day in women) and high risk (> 20 g/day in men or > 10 g/day in women), (2) binge drinking, and (3) alcoholic beverage preference. Non-adherence to the Mediterranean diet was defined as scoring < 7 points on an adapted Mediterranean Diet Adherence Screener index (range 0-10). Odds ratios (OR) were estimated using logistic regression models adjusted for relevant covariates. RESULTS: Compared to non-drinkers, low and high-risk drinkers were more likely to report non-adherence to the Mediterranean diet: ORs 1.35 (95% CI 1.23; 1.49) and 1.54 (95% CI 1.34; 1.76), respectively. Similarly, reports of binge drinking less than once a month was associated with higher likelihood of non-adherence (OR 1.17; 95% CI 1.04; 1.31). Individuals reporting no preference for a specific beverage and those with a preference for beer or for spirits had lower adherence: ORs 1.18 (95% CI 1.05; 1.33), 1.31 (95% CI 1.17; 1.46), and 1.72 (95% CI 1.17; 2.54), respectively, while a preference for wine showed no association (OR 1.01; 95% CI 0.90; 1.13). CONCLUSION: Alcohol consumption, even in low amounts, is associated with lower adherence to the Mediterranean diet. Therefore, alcoholic beverages should not be included in measures that define the Mediterranean diet.

Changes in general and abdominal obesity in children at 4, 6 and 9 years of age and their association with other cardiometabolic risk factors.

Temporary changes in childhood obesity and their association with cardiometabolic risk factors have been receiving increased attention. The objective of this study was to evaluate changes in general (GO) and abdominal (AO) obesity in children from 4 to 9 years of age and their associations with cardiometabolic risk factors at 9 years of age. This study includes 1344 children from the Longitudinal Childhood Obesity Study (ELOIN). Physical examinations performed at 4, 6 and 9 years of age and a blood sample was only taken at 9 years of age. Changes in obesity from 4 to 9 years of age were estimated using Body Mass Index and waist circumference. Participants were classified into four groups according to GO and AO: (1) stable without obesity (no obesity at all three measurements); (2) remitting obesity at 9 years (obesity at 4 and/or 6 years but not at 9 years); (3) incident or recurrent obesity at 9 years (obesity only at 9 years, at 4 and 9 years or at 6 and 9 years); and (4) stable or persistent with obesity (obesity at 4, 6 and 9 years). Dyslipidemia and dysglycemia were defined by the presence of at least one altered parameter of the lipid or glycemic profile. Odds ratios (OR) were estimated using logistic regression. Compared with children without GO at all ages, those with persistent GO had an OR of 3.66 (95% CI: 2.06-6.51) for dyslipidemia, 10.61 (95% CI: 5.69-19.79) for dysglycemia and 8.35 (95% CI: 4.55-15.30) for high blood pressure. The associations were fairly similar in the case of AO, with ORs of 3.52 (95% CI: 1.96-6.34), 17.15 (95% CI: 9.09-32.34) and 8.22 (95% CI: 4.46-15.15), respectively, when comparing persistent versus stable without AO. Children with incident obesity at 9 years presented a moderate cardiometabolic risk that was nevertheless higher compared to those stable without obesity, whereas those with remitting obesity did not show any significant associations. CONCLUSION: Incident, and especially, persistent obesity, is associated with an increased cardiometabolic risk. The very early prevention of obesity, with a focus on nutrition, physical activity and sedentary behaviour, as well as tracking growth from birth to age 5, should be a priority to prevent the burden of cardiometabolic disease with consequences for adulthood. WHAT IS KNOWN: • General and abdominal obesity has been shown to be associated with other cardiometabolic risk factors such as dyslipidemia, insulin resistance and hypertension. • Temporary changes in obesity and their associations with cardiometabolic risk factors have not been sufficiently explored in childhood. WHAT IS NEW: • Children with incident, and especially persistent, general and/or abdominal obesity, had an increased risk of dyslipidemia, dysglycemia and high blood pressure. •Remitting obesity was not associated with an increased cardiometabolic risk.

Association between biomarkers of iron status and cardiometabolic risk in Spanish children aged 9-10 years. The ELOIN study.

The relationship between iron metabolism and cardiometabolic risk factors has been scarcely studied in children, and the results are controversial. The objective of this study was to evaluate the association between iron parameters and lipid, glycemic and blood pressure alterations in the pediatric population. This was a cross-sectional study of 1954 children between 9 and 10 years of age in Madrid (Spain), participants in a longitudinal study of childhood obesity. Iron metabolism parameters, i.e., serum iron (Is), ferritin (Fs), transferrin (Tf) and transferrin saturation (STf) and lipid, glycemic and blood pressure profiles were evaluated. Odds ratios (ORs) were estimated using logistic regression models adjusted for sociodemographic characteristics, diet, physical activity, C-reactive protein and body mass index. Compared with the participants in the low Is and STf tertiles, those in the upper tertiles had a lower risk of low HDL-Chol (OR: 0.34; 95%CI: 0.17; 0.67) and OR: 0.44 (95%CI: 0.23; 0.84), respectively, and children in the upper Fs tertile had an OR of 2.07 (95%CI: 1.16; 3.68) for low HDL-Chol. Children in the highest Is and STf tertiles had a lower risk of prediabetes [OR: 0.63 (95%CI: 0.41; 0.97) and OR: 0.53 (95%CI: 0.34; 0.82)] and insulin resistance (IR) (OR: 0.37; 95%CI: 0.22; 0.64), and those in the upper Tf tertile had a higher risk of IR (OR: 1.90; 95%CI: 1.16; 3.12). An increased risk of hypertension was found only in children in the upper Fs tertile (OR: 1.46; 95%CI: 1.01; 2.13). CONCLUSIONS: Biomarkers of iron metabolism are associated with cardiometabolic alterations in the pediatric population, with a variable direction and magnitude depending on the indicators used. WHAT IS KNOWN: • Iron metabolism is related to important cardiometabolic alterations such as metabolic syndrome and its components. • Association between biomarkers of iron status and cardiometabolic risk have been less explored in children. WHAT IS NEW: • Biomarkers of iron metabolism are associated with cardiometabolic alterations in the pediatric population. • Iron parameters in the pediatric population could be of great help to detect and prevent cardiometabolic abnormalities early.

Childhood obesity and risk of SARS-CoV-2 infection.

OBJECTIVE: To estimate the association between childhood obesity and the risk of SARS-CoV-2 infection in a cohort followed from 4 to 12 years of age. METHODS: The data were obtained from two independent sources: the Longitudinal Childhood Obesity Study (ELOIN) and the epidemiological surveillance system data from the Community of Madrid (Spain), which served to identify the population within the cohort with confirmed SARS-CoV-2 infection. The SARS-CoV-2 registry was cross-checked with the cohort population at 11-12 years of age. A total of 2018 eligible participants were identified in the cohort, who underwent physical examinations at 4, 6, and 9 years of age during which weight, height, and waist circumference were recorded. General obesity (GO) was determined according to the WHO-2007 criteria whereas abdominal obesity (AO) was defined based on the International Diabetes Federation (IDF) criteria. The relative risks (RRs) of infection were estimated using a Poisson regression model and adjusted by sociodemographic variables, physical activity, and perceived health reported by the parents. RESULTS: The accumulated incidence of SARS-CoV-2 infection was 8.6% (95% CI: 7.3-9.8). The estimated RR of SARS-CoV-2 infection was 2.53 (95% CI: 1.56-4.10) and 2.56 (95% CI: 1.55-4.21) for children 4-9 years old with stable GO and AO, respectively, compared with those who did not present GO. CONCLUSIONS: Childhood obesity is an independent risk factor for SARS-CoV-2 infection. This study provides new evidence that indicates that obesity increases the vulnerability of the paediatric population to infectious diseases.

Changes in obesity and iron deficiency between 4 and 9 years of age. Longitudinal study of childhood obesity (ELOIN).

BACKGROUND: Recent studies revealed that children who are overweight have a higher risk of iron deficiency, although the etiology of this relationship remains unclear. The aim of the study was to evaluate the association between changes in obesity status between 4 and 9 years of age and iron deficiency. SUBJECTS: This population-based cohort study included 1347 children from the ELOIN study, conducted in Madrid, Spain. Follow-up with physical examinations and a computer-assisted telephone interview were carried out at 4, 6 and 9 years of age, and a blood test was performed at 9 years. METHODS: Changes in obesity were estimated based on body mass index and waist circumference, according to the persistence or variation in obesity rates at 4, 6 and 9 years and were classified as follows: (1) Stable without obesity; (2) Remitting obesity at 9 years; (3) Incident obesity or relapse at 9 years; and (4) Stable with obesity. Iron deficiency was defined as transferrin saturation value below 16%. Odds ratios (ORs) for iron deficiency were estimated according to obesity status using logistic regression and adjusted for confounding variables, including C-reactive protein (CRP). RESULTS: The prevalence of iron deficiency in the stable general obesity (GO) and abdominal obesity (AO) groups was 38.2% and 41.2%, versus 23.6% and 23.4% in the stable without obesity groups, respectively. The ORs for iron deficiency were 1.85 (95% CI: 1.03-3.32) in the stable GO group and 2.34 (95% CI: 1.29-4.24) in the stable AO group. This association disappeared when CRP was included in the analysis. CONCLUSIONS: An extended state of obesity during the first stages of life is associated with iron deficiency, and this association may be mediated by CRP. Prevention and early detection of obesity in children should be a priority to avoid a double burden of malnutrition.

Healthy lifestyle, metabolomics and incident type 2 diabetes in a population-based cohort from Spain.

BACKGROUND: The contribution of metabolomic factors to the association of healthy lifestyle with type 2 diabetes risk is unknown. We assessed the association of a composite measure of lifestyle with plasma metabolite profiles and incident type 2 diabetes, and whether relevant metabolites can explain the prospective association between healthy lifestyle and incident type 2 diabetes. METHODS: A Healthy Lifestyle Score (HLS) (5-point scale including diet, physical activity, smoking status, alcohol consumption and BMI) was estimated in 1016 Hortega Study participants, who had targeted plasma metabolomic determinations at baseline examination in 2001-2003, and were followed-up to 2015 to ascertain incident type 2 diabetes. RESULTS: The HLS was cross-sectionally associated with 32 (out of 49) plasma metabolites (2.5% false discovery rate). In the subset of 830 participants without prevalent type 2 diabetes, the rate ratio (RR) and rate difference (RD) of incident type 2 diabetes (n cases = 51) per one-point increase in HLS was, respectively, 0.69 (95% CI, 0.51, 0.93), and - 8.23 (95% CI, - 16.34, - 0.13)/10,000 person-years. In single-metabolite models, most of the HLS-related metabolites were prospectively associated with incident type 2 diabetes. In probit Bayesian Kernel Machine Regression, these prospective associations were mostly driven by medium HDL particle concentration and phenylpropionate, followed by small LDL particle concentration, which jointly accounted for ~ 50% of the HLS-related decrease in incident type 2 diabetes. CONCLUSIONS: The HLS showed a strong inverse association with incident type 2 diabetes, which was largely explained by plasma metabolites measured years before the clinical diagnosis.

Clustering of unhealthy lifestyle behaviors, self-rated health and disability.

The main objective was to identify sociodemographic characteristics of the population at risk for a greater clustering of unhealthy behaviors and to evaluate the association of such clustering with self-rated health status and disability. Data come from the 2017 Spanish National Health Survey with a sample of 21,947 participants of 15 years of age or older. Based on tobacco consumption, risk drinking, unbalanced diet, sedentarism, and body mass index <18.5/≥25 we created two indicators of risk factor clustering: 1) Number of unhealthy behaviors (0-5); and 2) Unhealthy lifestyle index (score: 0-15). Self-rated health was dichotomized into "optimal" and "suboptimal," and disability was classified as "no disability," "mild," and "severe" based on the Global Activity Limitation Index (GALI). We estimated prevalence ratios (PR) adjusted for covariates using generalized linear models using the clustering count variable, and dose-response curves using the unhealthy lifestyle index. Most participants (77.4%) reported 2 or more risk factors, with men, middle-age individuals, and those with low socioeconomic status being more likely to do so. Compared to those with 0-1 risk factors, the PR for suboptimal health was 1.26 (95% CI:1.18-1.34) for those reporting 2-3 factors, reaching 1.43 (95% CI:1.31-1.55) for 4-5 factors. The PR for severe activity limitation was 1.66 (95% CI:1.35-2.03) for those reporting 2-3 factors and 2.06 (95% CI:1.59-2.67) for 4-5 factors. The prevalence of both health indicators increased in a non-linear fashion as the unhealthy lifestyle index score increased, increasing rapidly up to 5 points, slowing down between 5 and 10 points, and plateauing afterwards.

Metal and metalloid levels in topsoil and municipal cardiovascular mortality in Spain.

The role of metals and metalloids beyond arsenic, copper, lead and cadmium in cardiovascular disease is not entirely clear. The aim of this study was to assess the association between 18 metal or metalloid levels in topsoil (upper soil horizon) with all-cause and specific cardiovascular mortality endpoints in Spain. We designed an ecological spatial study, to assess cardiovascular mortality in 7941 Spanish mainland towns from 2010 to 2014. The estimation of metals and metalloids concentration in topsoil came from the Geochemical Atlas of Spain from 13,317 soil samples. We also summarized the joint variability of the metals using principal components analysis (PCA). These components (PCs) were included in a Besag, York, and Mollié model to assess their association with cardiovascular mortality from all causes, coronary heart disease, cerebrovascular, hypertension, and conduction disorders. Our results showed, both in men and women, that at the lowest component scores range, PC2 (mainly reflecting Al, Be, Tl and U) was positively associated with coronary heart disease and cerebrovascular mortality. At medium/highest scores range, PC4 (mainly reflecting Hg) was positively associated with cerebrovascular mortality. For PC3 (reflecting Se), the association with coronary heart disease mortality was positive only in men at the highest PC scores range. For PC1 (partly reflecting metals such as Pb, As, Cu or Cd), we observed a strongly suggestive positive association with all-cause cardiovascular diseases mortality. Our ecological results are consistent with the available evidence supporting a cardiovascular role of excessive exposure to Se, Hg, Pb, As, Cu and Cd, but also identify Al, Be, Tl and U as potentially novel cardiovascular factors. Additional research is needed to confirm the biological relevance of our findings.

Smoking during pregnancy: changes and associated risk factors in Spain, 1980-2016.

BACKGROUND: Trends for maternal smoking rates have varied substantially across industrialized countries. The objective was to describe how the prevalence of maternal smoking evolved in Spain during 1980-2016. METHODS: Data came from the Spanish Collaborative Study of Congenital Malformations. Our sample consisted of 40 934 mothers of newborns with no congenital defects from hospitals all across Spain. We estimated change points in trend and the mean annual change in smoking prevalence using 'joinpoint' regression. Relevant potential factors (age, country of birth, education, parity, planned pregnancy and alcohol consumption) were examined using multivariate logistic regression. RESULTS: Maternal smoking prevalence in 1980 and 2016 were 14.3% (95% confidence interval [CI]: 11.9-17.0) and 20.4% (95% CI: 15.9-25.8). We identified four periods with distinct trends: a sharp increase during the 80s, a plateau during the 90s, a decrease starting in 2000 and a slowdown of such decrease from 2009 on. Smoking was significantly higher among young women, Spain-born, with low education, unplanned pregnancy, and alcohol consumption. CONCLUSIONS: Currently in Spain maternal smoking remains very high. Tobacco consumption trend showed an increase during the 80s, a plateau during the 90s, and a reduction in the 2000s. Several sociodemographic and behavioural factors were associated to greater likelihood of smoking.

Trends in smoking-attributable mortality in Spain: 1990-2018.

BACKGROUND: This study sought to analyse the trend in smoking-attributable mortality (SAM) in Spain among the population aged ≥35 years across the period 1990-2018. METHODS: SAM was estimated by applying a prevalence-independent method, which uses lung cancer (LC) mortality as a proxy of tobacco consumption. We sourced observed mortality from the National Institute of Statistics (Spain), LC mortality rates in smokers and never smokers from the Cancer Prevention Study I-II, and relative risks from 5 US cohorts. Estimates of annual SAM by cause of death, sex and age are shown, along with crude and annual standardised SAM rates. The trend in standardised all-cause and LC rates was analysed using a joinpoint regression model. RESULTS: Tobacco caused 1 717 150 deaths in Spain in the period 1990-2018. Among men, cancers replaced cardiovascular diseases-diabetes mellitus (CVD-DM) as the leading group of tobacco-related cause of death in 1994. Among women, CVD-DM remained the leading cause of death throughout the period. Trend analysis of standardised SAM rates due to all causes and LC showed a decrease in men and an increase in women. CONCLUSIONS: The tobacco epidemic in Spain across the period 1990-2018 has had an important impact on mortality and has evolved differently in both genders. SAM is expected to increase dramatically in women in the coming years. SAM data highlight the importance of including a gender perspective in SAM analyses, in designing more effective and comprehensive public health interventions and in developing gender-specific tobacco control policies to curb tobacco consumption.

Tracking and risk of abdominal and general obesity in children between 4 and 9 years of age. The Longitudinal Childhood Obesity Study (ELOIN).

BACKGROUND: Studies have shown that overweight and obesity conditions tend to be stable from childhood and adolescence to adulthood. Unfortunately, little is known about the evolution of abdominal obesity during childhood. The aim of this study was to evaluate the temporal variations and risk of general and abdominal obesity between 4, 6, and 9 years of age. METHODS: Measurements of children in the ELOIN study taken at the three follow-ups of 4, 6, and 9 years of age were included (N = 1,902). Body mass index and waist circumference were recorded via physical examination. General obesity was determined according to the criteria of the World Health Organization (WHO) and abdominal obesity according to the cut-off points proposed by the International Diabetes Federation (IDF). Prevalence ratios (PRs) were estimated by sex and family affluence using generalized estimating equation models and relative risks (RRs) of obesity were obtained via Poisson regression. RESULTS: The prevalence of general obesity was 5.1%, 9.1%, and 15.6% at 4, 6, and 9 years, respectively, yielding a PR of 3.05 (95%CI: 2.55-3.60) (9 years old relative to 4 years). The prevalence of abdominal obesity was 6.8%, 8.4%, 14.5% at 4, 6, and 9 years, respectively, and the PR was 2.14 (95%CI: 1.82-2.51) (9 years old relative to 4 years). An inverse correlation was observed between both general and abdominal obesity and socioeconomic status. Among participants with general or abdominal obesity at 4 years of age, 77.3% and 63.6% remained in their obesity classification at 9 years, respectively, and 3.4% and 3.5% presented general or abdominal obesity also at 6 and 9 years of age, respectively. The RRs of general and abdominal obesity at 9 years were 4.61 (95%CI: 2.76-7.72) and 4.14 (95%CI: 2.65-6.48) for children classified with obesity at 4 years of age, increased to 9.36 (95%CI: 7.72-11.35) and 9.56 (95%CI: 7.79-11.74) for children who had obesity at 6 years, and up to 10.27 (95%CI: 8.52-12.37) and 9.88 (95%CI: 8.07-12.11) for children with obesity at both 4 and 6 years, respectively. CONCLUSIONS: General and abdominal obesity begin at an early age and increase over time, showing an inverse correlation with socioeconomic status. In addition, general and abdominal obesity at 9 years are strongly associated with being classified with obesity at 4 and 6 years, so preventive interventions should be established at very early ages.

Validity of the Global Activity Limitation Indicator (GALI) to evaluate severity of disability.

Our aim was to estimate the validity of the Global Activity Limitation Indicator (GALI) when measuring the severity level of disability. Data came from 153 residents of Spain, who requested an evaluation of their degree of disability. We compared disability classifications (severe vs. non-severe) from GALI against those from the 36-item questionnaire WHODAS 2.0, the current gold standard measure of disability. The sensitivity of GALI to detect severe disability was 58.3% [95% confidence interval (CI):43.2-72.4], and the specificity was 84.8% (95% CI: 76.4-91.0). Thus, the validity of GALI to accurately categorize the degree of severity of an individual's disability is not high, this in great part due to its limited sensitivity.

Individual and Contextual Factors Associated With Hazardous Drinking in Spain: Evidence From a National Population-Based Study.

BACKGROUND: Heavy drinking (HD) and binge drinking (BD) exhibit marked differences in their relationships with contextual-level factors imbedded in geographical areas of residence. The objective is to identify sociodemographic factors, both at the individual and at the contextual level, associated with these 2 main hazardous consumption patterns. METHODS: Cross-sectional study using data from the 2011 to 2012 National Health Survey in Spain. The sample included 21,007 individuals ≥15 years of age. HD was defined as an alcohol intake of ≥40 g/d in men and ≥24 g/d in women. BD was defined as the consumption in the previous month of ≥6 alcoholic drinks (men) or ≥5 drinks (women) within 4 to 6 hours. Individual-level variables included sociodemographic factors, urban/rural residence, smoking, and perceived social support. Contextual-level variables covered percentage of population with no schooling, unemployment rate, and hospitality industry-related economic activity, all at the census tract level. We analyzed data using multilevel logistic regression and calculated areas under the curve (AUC). RESULTS: Being male, smoking, high-income, and low perceived social support were associated with both hazardous drinking patterns. Younger individuals were at higher risk for BD but at lower risk for HD. BD was more common among rural than urban dwellers (odds ratios [OR] = 1.35; 95% CI: 1.05 to 1.72), whereas HD was less likely in participants residing in areas with high unemployment rates (OR = 0.62; 95% CI: 0.41 to 0.93). HD was more likely in census tracts with higher levels of hospitality industry activity (OR = 1.74; 95% CI: 1.20 to 2.54). The AUC increased substantially for both HD and BD when the census tract variable was entered in the respective models (reaching 89.5 and 93.3%, respectively). CONCLUSIONS: Except for age, both drinking patterns have similar associations with individual-level variables but disparate links to contextual-level indicators. In both cases, accounting for area of residence substantially increased the ability to discriminate between high-risk drinkers from nonhazardous alcohol consumers.

Parental perception of child health status and quality of life associated with overweight and obesity in early childhood.

PURPOSE: The aim was to assess perceived health status and health-related quality of life (HRQL) according to persistence of and variation in weight status among children from the age of 4 to 6 years. METHODS: Longitudinal study of 1883 participants in the ELOIN cohort (Madrid Region, Spain), with physical examination at ages 4 and 6 years. Perceived health status and HRQL were assessed using parent-reported Kidscreen-10 scores, with excess weight being defined on the basis of body mass index (BMI) using the WHO reference tables (z-BMI > 1 standard deviation), and abdominal obesity being defined on the basis of waist circumference (percentile ≥ 90) using the tables proposed by Fernández et al. Variation in these two parameters at age 6 years was associated with incident cases of suboptimal health by logistic regression, and with HRQL by linear regression. RESULTS: Compared to children without excess weight or abdominal obesity in both periods, incident cases of excess weight or abdominal obesity had odds ratios (ORs) of suboptimal health of 2.41 (95% CI 1.21 to 4.80) and 2.99 (95% CI 1.31 to 6.84) respectively. In terms of HRQL, children with remission of excess weight had a higher Kidscreen-10 score: ß coefficient = 2.02 (95% CI 0.36 to 3.68), whereas new cases of abdominal obesity had a lower Kidscreen-10 score: ß = - 2.22 (95% CI - 4.40 to - 0.03). CONCLUSIONS: Incident cases of excess weight and abdominal obesity had a higher risk of suboptimal health. Incident cases of abdominal obesity were also associated with worse HRQL.

Changes in Alcohol Intake During Pregnancy in Spain, 1980 to 2014.

BACKGROUND: Even small amounts of alcohol consumed during pregnancy can have adverse effects on the embryo and the fetus. We estimated how alcohol intake among pregnant women in Spain changed between 1980 and 2014, and identified factors associated with alcohol use. METHODS: Data came from the Spanish Collaborative Study of Congenital Malformations (ECEMC). The sample includes ECEMC's control mothers, 40,268 pregnant women from all regions of Spain. We classified alcohol consumption during pregnancy into 3 categories: no consumption; sporadic consumption of small amounts of alcohol; and regular consumption, or sporadic but in large quantities including drunkenness. Independent variables included sociodemographic factors, planned/unplanned pregnancy, maternal chronic diseases, gestational diabetes, and tobacco and illegal drug use during pregnancy. Trend analyses were performed using data from 1980 to 2014. The multinomial logistic regression models designed to identify associated factors differentiated between 2 periods: 1994 to 2004 and 2005 to 2014. RESULTS: Prevalence of alcohol consumption declined from 29.6% (95% CI: 27.1 to 32.2) in 1980 to 5.4% (95% CI: 3.7 to 7.6) in 2014, mostly due to the reduction in regular intake. This decline was especially acute between 1980 and 1994. Sporadic and regular consumption increased among women working outside the home, born outside Spain, those whose pregnancy was unplanned, and those reporting using tobacco or other drugs. Comparing 1994 to 2004 versus 2005 to 2014, a stronger association was observed between regular alcohol consumption and tobacco consumption in the latter period (interaction p = 0.003). CONCLUSIONS: Alcohol consumption among expectant mothers has declined substantially in the last 35 years. However, it is worth highlighting the significant and substantial associations between alcohol use and consumption of tobacco, which have become stronger in the most recent years.

Correlation between tobacco control policies and preterm births and low birth weight in Europe.

OBJECTIVE: To assess the correlation between tobacco control policies- particularly smoking bans in work and public places-and the prevalence of preterm births and low birth weight in the European countries. METHODS: This is an ecological study and the unit of analysis set at the country level. Tobacco control data in Europe were obtained for the years 2010 and 2013 as measured by the Tobacco Control Scale (TCS), which reflects the level of implementation of tobacco control policies. Prevalence data for preterm births and low birth weight were obtained from two sources: the European Perinatal Health Report (EPHR), which provides data for 2010, and the Eurostat data, which includes the years 2013 and 2014. We analyzed the correlation between the TCS score and the prevalence of preterm birth and low birth weight in the European countries by means of Spearman (rsp) rank-correlation coefficients and their 95% confidence intervals (95%CI). RESULTS: The 2010 TCS was negatively correlated with the prevalence of preterm births before week 37 (rsp = -0.51; 95% CI: -0.77, -0.15; p = 0.006) and week 32 (rsp = -0.42; 95%CI: -0.73, -0.01; p = 0.030) and with the prevalence of the low birth weight (< 2500g, (rsp = -0.42; 95% CI: -0.66, -0.09; p = 0.028) in European countries in 2010. We found a statistically significant inverse correlation between the level of restrictions on smoking in public places and the prevalence of low birth weight (< 2500g rsp: -0.54; 95%CI: -0.72, -0.10; p = 0.017). CONCLUSION: The level of smoke-free legislation in European countries correlates with lower preterm birth prevalence rates at the ecological level. Given the important negative effects of premature births for the public health system, these data support greater implementation of smoke-free policies and tend to support the implementation of tobacco control policies, but more research is needed.

Intersection of neighborhood dynamics and socioeconomic status in small-area walkability: the Heart Healthy Hoods project.

BACKGROUND: Previous studies found a complex relationship between area-level socioeconomic status (SES) and walkability. These studies did not include neighborhood dynamics. Our aim was to study the association between area-level SES and walkability in the city of Madrid (Spain) evaluating the potential effect modification of neighborhood dynamics. METHODS: All census sections of the city of Madrid (n = 2415) were included. Area-level SES was measured using a composite index of 7 indicators in 4 domains (education, wealth, occupation and living conditions). Two neighborhood dynamics factors were computed: gentrification, proxied by change in education levels in the previous 10 years, and neighborhood age, proxied by median year of construction of housing units in the area. Walkability was measured using a composite index of 4 indicators (Residential Density, Population Density, Retail Destinations and Street Connectivity). We modeled the association using linear mixed models with random intercepts. RESULTS: Area-level SES and walkability were inversely and significantly associated. Areas with lower SES showed the highest walkability. This pattern did not hold for areas with an increase in education level, where the association was flat (no decrease in walkability with higher SES). Moreover, the association was attenuated in newly built areas: the association was stronger in areas built before 1975, weaker in areas built between 1975 and 1990 and flat in areas built from 1990 on. CONCLUSION: Areas with higher neighborhood socioeconomic status had lower walkability in Madrid. This disadvantage in walkability was not present in recently built or gentrified areas.

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.

Exposure to secondhand smoke in the home and mental health in children: a population-based study.

OBJECTIVES: To examine the association between exposure to secondhand smoke (SHS) in the home and mental health among children. METHODS: Cross-sectional study of 2357 children representative of the Spanish population aged 4-12 years in 2011-2012. Duration of SHS exposure in children was reported by parents. Probable mental disorder was defined as a score>90th centile in the parental version of the Strengths and Difficulties Questionnaire (SDQ). Statistical analysis was performed with logistic regression and adjusted for sociodemographic variables, lifestyle, neighbourhood environment and family characteristics, including parental mental health. RESULTS: Among study participants, 6.9% (95% CI 5.7% to 8.0%) were exposed to SHS in the home for <1 h/day and 4.5% (95% CI 3.5% to 5.5%) for ≥1 h/day. Compared to children not habitually exposed to SHS, the multivariate ORs for probable mental disorder were 1.49 (95% CI 0.85 to 2.62) for SHS exposure<1 h/day and 2.73 (95% CI 1.38 to 5.41) for SHS exposure≥1 h/day (p for linear trend=0.002). The corresponding ORs for attention-deficit and hyperactivity disorder (ADHD) were 2.18 (95% CI 1.30 to 3.64) for <1 h/day exposure and 3.14 (95% CI 1.63 to 6.04) for ≥1 h/day exposure (p for linear trend<0.001). No association was found between SHS and the rest of the components of the SDQ. CONCLUSIONS: Among children, SHS exposure in the home during ≥1 h/day is associated with a higher frequency of mental disorder. This association was mostly due to the impact of SHS on ADHD.

Binge drinking in Spain, 2008-2010.

BACKGROUND: Most alcohol-related research has focused on northern and eastern Europe and the United States. Data on Mediterranean countries point to drinking patterns approaching the sporadic and excessive patterns found in northern and eastern Europe. This is the first study to estimate the prevalence of binge drinking (BD) and the joint distribution of BD, regular heavy alcohol consumption, and alcohol abuse or dependence (AAD) in a nationally representative sample of the adult population of Spain. METHODS: Cross-sectional study conducted in 2008 to 2010 with 9,130 persons aged 18 to 64 years. BD was defined as intake of ≥80 g of alcohol in men (≥60 g in women) during any drinking occasion in the previous month, with ≥3 BD episodes discriminating between frequent and sporadic BD. Regular alcohol consumption was measured with a validated diet history, and the threshold between moderate and heavy drinking was ≥40 g of alcohol/d in men (≥24 g in women). AAD was defined by a CAGE score ≥2. RESULTS: BD prevalence was 10% (95% confidence interval [CI]: 8.8 to 11.2) in men and 4.2% (95% CI: 3.5 to 4.8) in women, and proved highest among 18- to 24-year-olds (19.5% in men and 10.3% in women). During the latest BD episode, men consumed a mean of 114 g of alcohol versus 85.3 g in women; spirits accounted for 65.2 and 66.2% of total intake, respectively. The mean number of monthly BD episodes was 2.3 in men and 2 in women. Among binge drinkers, 61% were 18- to 34-year-olds, over 80% had regular moderate drinking, 25% reported frequent BD, and 22.8% reported AAD. In multivariate analyses, sporadic BD and frequent BD were associated with AAD independently of regular alcohol intake. CONCLUSIONS: Prevalence of BD in Spain is moderately high. Prevention interventions should consider that the majority of binge drinkers are young men with regular moderate consumption and no AAD traits.