Socioeconomic disparities in diet and physical activity in children: evidence from well-child visit electronic health records in the Canary Islands, Spain.

BACKGROUND: Diet and physical activity (PA) in childhood are heavily influenced by the living environment. While diet quality follows a socioeconomic pattern, limited evidence is available in relation to PA in children. We assessed the effect of socioeconomic status at the individual (SES) and neighbourhood (NSES) levels on diet and PA among children from the general population of the Canary Islands, Spain. METHODS: In this cross-sectional study, patients aged 6-14 years from the Canary Health Service in 2018 were included (n=89 953). Diet and PA surveys from the electronic health records of the well-child visit programme were used. A healthy habits (HH) score was defined to assess the level of adherence to the dietary and leisure time PA guidelines. We modelled the association between the HH score, SES and NSES using a stepwise multilevel linear regression analysis, differentiating between specific and general contextual observational effects. RESULTS: A strong positive association between SES and the HH score was found, as children living in more affluent families were more likely to follow a healthy diet and being physically active. Differences in the HH score between geographical areas were of minor relevance (variance partition coefficient=1.8%) and the general contextual effects were not substantially mediated by NSES (proportional change in variance=3.5%). However, the HH score was significantly lower in children from areas with a higher percentage of annual incomes below the €18 000 threshold. CONCLUSION: HH followed a socioeconomic gradient at the individual and the neighbourhood level. In the study population, the geographical component of the inequalities found were low.

Una escala para valorar el riesgo de embarazo adolescente no planificado / A scale to assess the risk of unplanned adolescent pregnancy

Objetivo: Diseñar y validar un cuestionario para valorar el riesgo de embarazo adolescente no planificado (EANP). Método: Diseño de un cuestionario para valorar el riesgo de EANP a partir de todos los factores relacionados descritos en la literatura. Se validó posteriormente sobre una muestra de adolescentes de La Palma clasificadas como EANP y no EANP con estimación de fiabilidad por test-retest. Resultados: El cuestionario partía de 36 ítems. Con la finalidad de validar la apariencia y el contenido de este cuestionario inicial, se constituyó un grupo de expertos y otro de adolescentes con EANP. La muestra de validación la conformaron 148 adolescentes, con una media de edad ± desviación estándar de 21 ± 2 años, entre las que figuraba un 36% de EANP. Se eliminaron 27 ítems por no tener relación con el EANP. Su coeficiente alfa de Cronbach alcanzó un valor de 0,78 con la eliminación de un ítem redundante, por lo que el cuestionario final quedó conformado por 8 ítems. La validez de constructo mediante análisis factorial confirmatorio ratificó la estructura de 5 dimensiones, con un 76% de variabilidad de respuestas explicada. Se establecieron reglas cualitativas de afectación de ítems, dimensiones y de salida global del cuestionario. La validez de criterio mostró una sensibilidad de 0,87 (intervalo de confianza [IC] del 95%: 0,81-0,93) y un valor predictivo de resultado negativo de 0,86 (IC del 95%: 0,80-0,92). La fiabilidad presentó un índice kappa de 0,77 (IC del 95%: 0,70-0,84). Todos estos parámetros alcanzaron un valor de p <0,001. Conclusión: Las propiedades métricas del cuestionario obtenido (Instrumento de valoración del Riesgo de Embarazo No Esperado [IRENE]), junto con su facilidad y rapidez de administración, lo convierten en un medio adecuado de cribado para detectar a una adolescente en situación de riesgo de embarazo no planificado y valorar sobre qué aspectos podemos incidir para intentar reducirlo

Objective: Design and validate a questionnaire to assess the risk of unplanned adolescent pregnancy (UAP). Method: The design of a questionnaire to assess the risk of UAP from all the related factors described in the literature. It is subsequently validated on a sample of adolescents from La Palma classified as UAP and not UAP with reliability estimation by test-retest. Results: The questionnaire starts from 36 items. An expert group and another group of teenagers with UAP carry out their validity of appearance and content. The validation sample is made up of 148 adolescents aged 21 ± 2 years with 36% of UAP. 27 items are eliminated because they are not related to the UAP. The Cronbach alpha reaches 0.78 with an elimination of a redundant item, the final questionnaire was formed by 8 items. The construct validity by confirmatory factor analysis confirms the 5-dimensional structure with 76% variability of responses explained. Qualitative rules of affectation of items, dimensions and global exit of the questionnaire are established. The criterion validity shows 0.87 (95% CI: 0.81-0.93) of sensitivity and 0.86 (95% CI: 0.80-0.92) of predictive value of negative result. Reliability presents a kappa index of 0.77 (95% CI: 0.70-0.84). All these parameters achieve p <0.001. Conclusion: The metric properties of the questionnaire obtained (Unexpected Pregnancy Risk Assessment Instrument [IRENE]), together with its ease and speed of administration, make it an adequate means of screening to detect a teenager at risk of unplanned pregnancy and assess what aspects we can influence to try to reduce it