Recomendaciones sobre el estilo de vida / Recommendations on life style

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Factors associated with problematic alcohol consumption in schoolchildren.

PURPOSE: To describe the factors, including the role of anticipated results, which explain progression of problematic alcohol consumption in a sample of schoolchildren attending primary and secondary school and vocational training. METHOD: A self-administrated questionnaire on lifestyle habits was carried out in 1992 among a sample of 2140 students (mean age 15.4 years) in six schools of Barcelona and Lleida. One year later the same questionnaire was administered to the 1496 students remaining in the school. A total of 1236 follow-up questionnaires could be matched through a personal code. Problematic consumption was defined according to a score composed of several indicators of alcohol consumption. A self-administrated questionnaire on alcohol attitudes and consumption and a short version of the Alcohol Expectancy Questionnaire-Adolescent was used. RESULTS: At the baseline survey 28% of males and 25% of females reported having gotten drunk at least once in the last six months. Fifty-two percent of boys and 39% of girls had drunk four or more drinks in a row at least once. The strongest predictors of problematic alcohol consumption after 1 year were to have drinking friends (OR 3.1), to be regular smoker (OR 2.5), to show favorable alcohol-related expectancies (OR 1.8), to be boy (OR 1.6) and to be older than 15 years (OR 1.6), by order of importance. CONCLUSIONS: As has been found in other studies around the world, peer consumption of alcohol and expectancies regarding alcohol remained the most important predictive factors for problematic drinking among Spanish adolescents.

[The reliability of a self-administered questionnaire for investigation of the level of exercise, smoking habit and alcohol intake in school children]. / Fiabilidad de un cuestionario autoadministrado para investigar el nivel de ejercicio y el consumo de tabaco y de alcohol entre escolares.

BACKGROUND: The validity of self-administered questionnaires used to study habits during adolescence is often put into doubt. The aim of this study was to analyze the reliability and the aspects of validity of the presentation of a self-administered questionnaire concerning smoking habits, alcohol intake and degree of exercise. MATERIAL AND METHODS: A descriptive transversal study was undertaken in 1990 in 846 primary school children in Lleida (Spain) (444 of 6th course and 402 from 8th course). The children were randomly selected by conglomerates (unit = class) and stratified according to the type of school. The degree of exercise, smoking habits and alcohol intake of each student and the consumption perceived within the environment as well as the attitudes and beliefs related to the three habits were studied. Another test was performed in a subsample at two months to study the reliability and aspects related to validity were analyzed by concordance of interrelated questions. RESULTS: The reliability of the second test regarding the degree of exercise was found to have a correlation higher than 0.69. For the main variables related to alcohol consumption, the percentage of agreement was greater than 70% being 78% for the smoking habit. The results did not allow conclusions concerning the reliability of the variables for quantifying consumption and the age of initiation of the same to be obtained. The reliability concerning the attitudes regarding smoking (0.79-0.82) was higher that for alcohol (0.66-0.72) and exercise (0.36-0.54). CONCLUSIONS: The reliability of the variables of the questionnaires on habits of alcohol intake, smoking and degree of exercise within the environment and the attitudes is acceptable. The questionnaire studied was considered useful for studying these habits in school children.

[Mid-term evaluation of a help program for smokers]. / Evaluación a medio plazo de un programa de ayuda a los fumadores.

BACKGROUND: Medical counsel to smokers is an intervention that has proved useful to motivate smokers to stop smoking. This study pretends evaluate the long-term impact (2 years and 9 months) of systematic and structured health counsel on the smoke habit from the primary health care. MATERIAL AND METHODS: In April 1990, in four primary care centers from Barcelona and Zaragoza, Spain, a program of systematic counselling to stop smoking with an offer of subsequent follow-up was initiated in all adult smokers (15-65 years of age). According to the answer, every patient was classified on one of seven established categories that allowed a individualized follow-up. Data from the total population included in the program from the beginning till January 1993, are analyzed. RESULTS: From 683 known smokers (59.2% males and 40.8% women), 20 were excluded for different reasons and 343 were included in the program (56.4% cover). Average age of included smokers was 35.1 years (SE = 0.6) and average number of visits of 5.3 (SE = 0.2) which was significantly higher than those not included in the program (33.4; SE = 0.6, and 2.7; SE = 0.1). An average follow-up of 14.3 months (SE = 0.5) and of 2.6 (SE = 0.1) interventions on each individual were done. The average daily number of cigarettes was 18.4 (SE = 0.6) in the initial period and 13.3 (SE = 0.6) on the last program evaluation. The final answers showed a 18.1% of quitters and a decrease of more than 50% on the initial consume on 32.6%. In 12% the answer was negative. CONCLUSIONS: Programs of systematic help for smokers show a higher level of favourable responses than does normal counselling.

[Alcohol consumption in schoolchildren]. / Consumo de alcohol en escolares.

BACKGROUND: The onset of alcohol consumption begins very early in the Spanish society; generally, at the school age. The target of this study is to identify the factors that are linked to alcohol use and abuse, at this age. METHODS: A survey was designed and carried out among 1,816 students of 6 schools of Barcelona and Lleida, Spain (97.5% response rate) between 13 and 18 years old included, through a questionnaire filled-in in the classroom. RESULTS: 85.5% had ever consumed alcoholic drinks, 7.3% reported to drink alcohol every day and 39.6% said that they had drunk four or more glasses of an alcoholic beverage at least once. The multivariate analysis showed that smoking habitually, with an odds ratio (OR) of 9.7; having a larger amount of own money to buy alcohol (OR = 1.5); and the expectations that alcohol helps to enjoy and get along with friends (OR = 2.4) were the most important factors identified as associated with problematic alcohol consumption. CONCLUSIONS: The study points to several factors related to the habit of smoking, the influence of the environment of schoolchildren and the expectations associated to alcohol consumption are related with the consumption of alcoholic drinks, especially from the beginning in the high school.

[The annual evaluation of a program to aid the smoker]. / Evaluación anual de un programa de ayuda al fumador.

OBJECTIVE: To evaluate the impact over a year of a systematic, structured intervention with smokers, called the Smokers' Aid Project (SAP), at a primary care centre in Barcelona. DESIGN: Observational study with a descriptive intervention. SETTING: Urban primary care centre. PATIENTS AND OTHERS PARTICIPANTS: Between April, 1990, and March, 1991, every adult (over 15) who smoked more than one cigarette a day was counselled verbally and/or in writing. The different replies were placed into eight groups and a personal follow-up was made for each category. The groups were: winner, reduction, alone, with help, doubtful, backslider, negative and pending. MEASUREMENTS AND MAIN RESULTS: There was a follow-up on 178 people. Among those monitored, the initial cigarette average was 15.0 (SD 11.4) and the final, 12.45 (SD 11.45). The response was favorable (winner or reduction) in 35.4%, with 10.6% showing a favorable attitude (alone and with help) and 16.3% showing a negative response. A follow-up programme of 7.5 months (SD 3.5) was implemented, with an average of 1.82 (SD 1.05) interventions for each individual. CONCLUSIONS: Programmes of systematic help to the smoker appear to provide more favorable responses than isolated counselling. The SAP can be put into practice within our Primary Care system, although effectiveness will have to be assessed over longer-term follow-ups.

[Evolution of adolescent fertility and its association with evolution of income in the Spanish provinces during the period 1975-1985]. / Evolución de la fecundidad adolescente y su asociación con la evolución de la renta en las provincias Españolas en el periodo 1975-1985.

BACKGROUND: Fertility rates in women under 21, during the period 1975-1985 in Spain, have analyzed, as well as their association with the evolution of the socioeconomic indicators in order to study the distribution and associated factors to adolescent maternity in our environment. METHODS: The fertility rates have been elaborated from the Official Demographic Statistics. The socioeconomic indicators have been obtained from the Statistics Year Book of the National Institute of Statistics and from other complementary sources. The method of weighted linear regression has been used to analyze the association between the indicators and the rates at the provincial level. RESULTS: The fertility rates have decreased a 16% in mothers from 15 to 19 years old in Spain, between 1975 and 1985. The highest accumulated rates belong to the Communities of Canarias (42.8 births by 1000 women of 15 to 19, Galicia (38.1) Murcia (33.7) and Andalucía (30.3). In the regression analysis, the income evolution shows an association with the fertility evolution in the group from 15 to 19 years old, and this association remains when we take into account unemployment, index of provincial development and birth rate, which allows to explain a 49% of the variance. Fertility of adolescent under 15 is only associated with the income evolution, with a determination coefficient of 0.29. CONCLUSIONS: Results indicate that early maternity has decreased in Spain, although there are geographical differences, which cam, in some measure, be related with social-economic factors.

[Early use of tobacco by students]. / Consumo precoz de tabaco en escolares.

We present the results concerning smoking prevalence and related factors from a wider cross sectional survey of a representative sample of 5th and 8th grade schoolchildren (10-11 and 13-14 years old respectively) in the city of Barcelona, Spain. The survey was done in the 1986-87 school year. During this period of life there is an increase in the presence of smoking in the social environment and a rise in use of tobacco by schoolchildren, paralleled by a modification of their personal attitudes, radically opposed to smoking in the younger ages. The construction of a model to separate smokers and non smokers on the basis of predictive variables is attempted through discriminant analysis. Results suggest the most important factors are socioeconomic (lower socioeconomic status, higher amounts of pocket money), environmental (having siblings or friends who smoke), attitudinal (agreeing with certain sentences such as "smoking makes you feel good", "smoking is not as harmful as they say", "smokers are not more interesting persons", "I like the smell of tobacco" and "I'll probably smoke in the future") and related to other health associated behaviors (lower physical activity levels, having got drunk). These data will help in the design of school health programs addressing smoking prevention and provide baseline information for their evaluation.

[Review of the effectiveness of medical counseling in quitting smoking in primary care]. / Revisión de la efectividad del consejo médico para dejar de fumar en atención primaria.

After recognizing smoking habit as a relevant problem in our media, the complex implications of this type of lifestyle are commented. After revising the main obstacles for achieving primary health care preventive measures not only for the patient, who frequently looks for a "treatment", but also for the professional who generally desires immediate therapeutic success, we describe the evolution of medical advice as a treatment for controlling smoking habit. Studies done on this topic during the last 20 years have made possible the identification of the basic factors associated with the success of this procedure, such as complementing medical advice with graphic support, establishing a date for dropping the habit, programming follow-up visits, individualization of risks and the use of alternative resources such as nicotine chewing gum. We conclude that intervention of primary health care professionals is usefull and necessary and using the information available is a good way to start.

[Effectiveness of the physician's advice to quit smoking: evaluation of the impact a year after the fact]. / Efectividad del consejo médico para dejar de fumar: evaluación del impacto al año de la intervención.

The results of a physician-based intervention on smoking done by general practitioners in Barcelona (Spain) are described one month and one year after its inception. Among the 208 smokers in the intervention group there were more attempts to quit, and they were more successful than in the 216 smokers in the control group. The proportions of quitters after a year was 5.3% and 2.3% in each group (p less than 0.05). Among the variables related to success in quitting are self-reliance, the willingness to reduce or quit smoking, the intensity of the habit and the family environment.