Relationship of problematic cannabis use among youth in Spain with perceived risk, environmental factors and sociodemographic factors. / Relación del consumo problemático de cannabis en la población joven de España con el riesgo percibido, los factores ambientales y los factores sociodemográficos.

The relationship of problematic cannabis consumption with perceived risk, socioenvironmental and sociodemographic factors among youth in Spain is not well known. The aims of this study are: 1) to describe the patterns of cannabis consumption (problematic and non-problematic) in Spanish youth, and 2) to explore whether problematic cannabis consumption is related to perceived risk, environmental factors and individual sociodemographic characteristics. A cross-sectional design based on data from the 2015/16 Spanish Household Survey on Alcohol and Drugs (EDADES) was performed. Individuals between 15 and 35 years old having used cannabis during the last year with a complete Cannabis Abuse Screening Test (CAST) were included (N = 1,674). Problematic consumption (CAST >= 7) was considered as dependent variable. Perceived risk, environmental factors (availability of the substance and exposure to consumption situations) and sociodemographic factors were taken as independent variables. Descriptive analyses of consumption patterns were performed and univariable and multivariable Poisson regression models were done. All analyses were stratified by gender. Problematic cannabis consumption was more frequent among men (38.9 %) than among women (23.2 %). While among men, problematic use was related to environmental factors and educational level, among women it was associated with perceived risk and unemployment. Problematic cannabis consumption among Spanish youth is associated with different types of gender-related factors. Due to its representativeness at the population level and the validity of the measures, these results might have important implications on the development of prevention strategies targeted at problematic cannabis consumption.

La relación entre el consumo problemático de cannabis, el riesgo percibido y los factores socioambientales y sociodemográficos no es clara actualmente. Los objetivos del estudio son: describir los patrones de consumo de cannabis (problemático y no problemático) en la población joven de España y explorar como el consumo problemático se relaciona con el riesgo percibido, y los factores ambientales y sociodemográficos. Se llevó a cabo un diseño transversal basado en datos de la edición de 2015/2016 de la Encuesta Domiciliaria sobre Alcohol y Drogas (EDADES). La encuesta incluyó participantes de entre 15 y 35 años que habían consumido cannabis en al menos una ocasión durante el último año y que completaron el Cannabis Abuse Screening Test (CAST) (N = 1674). Se consideró el consumo problemático (CAST >= 7) como variable dependiente. Como variables independientes se consideraron el riesgo percibido, los factores ambientales (disponibilidad de la sustancia y exposición a situaciones de consumo) y los factores sociodemográficos. Se llevaron a cabo análisis descriptivos de los patrones de consumo y se realizaron modelos univariables y multivariables de Poisson. Todos los análisis se estratificaron por género. El consumo problemático fue más frecuente en hombres (38,9 %) que en mujeres (23,2 %). Mientras en hombres el consumo problemático se relacionó con factores ambientales y nivel educativo, en mujeres se asoció con riesgo percibido y desempleo. Dada la representatividad de los datos y la validez de las medidas, estos resultados podrían tener importantes implicaciones para el desarrollo de medidas preventivas contra el consumo problemático de cannabis.

Work-related stress factors associated with problem drinking: A study of the Spanish working population.

BACKGROUND: Workers may drink to cope with stress or to overcome negative emotions arising from an aversive working context, but results of previous studies are inconclusive on the specific work features affecting alcohol use. METHODS: A cross-sectional study was designed with data on 13,005 working individuals from the Household Survey on Alcohol and Drugs in Spain (EDADES)-2007. We examined the associations between two drinking patterns and four measures of work-related stress factors. RESULTS: Moderate and high levels of exposure to a noxious working environment (OR = 2.15 [95% CI = 1.51-3.06] and OR = 2.23 [95% CI = 1.49-3.36]) and a high level of lack of social support (OR = 1.62 [95% CI = 1.16-2.28]) were associated with heavy drinking, and precariousness with binge drinking for both moderate (OR = 1.22 [95% CI = 1.01-1.46]) and high (OR = 1.33 [95% CI = 1.04-1.70]) levels (OR = 1.21; 95% CI = 1.04-1.40) in men. Significant associations among women were only found when stress factors were analyzed separately. CONCLUSIONS: Preventive practices in the workplace targeting alcohol abuse should consider specific production processes and organizational features.

Differences in mortality in a cohort of cocaine use disorder patients with concurrent alcohol or opiates disorder.

AIMS: To study mortality in a cohort of cocaine use disorder patients, and compare results in those with concurrent alcohol or opiates disorder. DESIGN, SETTING AND PARTICIPANTS: A cohort of 10 539 cocaine use disorder individuals entering drug treatment in public out-patient centres in the city of Barcelona was followed from 1997 to 2011. Participants were divided at baseline into three groups: those with only cocaine use disorder (CUD), those with cocaine and alcohol use disorder but not opioid (CAUD) and those with cocaine and opioid use disorder (COUD). Mortality was assessed through the Spanish National Mortality Register. MEASUREMENTS: Crude mortality rates (CMR), standardized mortality ratios (SMR) and rate ratios (RR) were calculated for each group. A multivariable Cox regression model was fitted to obtain adjusted mortality hazard ratios (aHR) of CAUD and COUD with respect to CUD. Specific mortality causes were also examined. FINDINGS: The total of 716 deaths registered resulted in a CMR = 6.0/1000 person-years (PY); 95% confidence interval (CI) = 5.1-7.0 for CUD, CMR = 5.8/1000 PY (95% CI = 4.9-6.7) for CAUD and CMR = 20.7/1000 PY (95% CI = 18.8-22.8) for COUD, with no significant differences among sexes. Compared with the general population, mortality was four times higher (SMR = 4.1, 95% CI = 3.5-4.8) among CUD, more than three times among CAUD (SMR = 3.4, 95% CI = 2.9-3.9) and more than 10 times among COUD (SMR = 11.6, 95% CI = 10.5-12.8), being always higher in women. External injuries, led by overdose, accumulated the biggest percentage of deaths among the three groups, but infectious diseases showed the highest excess mortality. Some differences regarding causes of death were observed between the three groups. CONCLUSIONS: Mortality risk and excess mortality are significantly greater among those with cocaine and opiates use disorder than among people with only cocaine use disorder or cocaine and alcohol use disorder.

[Community health assessment of the programme "Barcelona Health in the Neighbourhoods". Methodology for a participatory process]. / El diagnóstico de salud del programa Barcelona Salut als Barris. Metodología para un proceso participativo.

This paper describes the methodology used for the assessment of health needs within a programme aimed at promoting health equity in disadvantaged neighbourhoods in the city of Barcelona (Spain). The assessment process involves the use of mixed methods (quantitative and qualitative) in order to obtain information regarding the health of the community, its determinants, and the availability of health-related assets. Quantitative data consists of indicators from different sources. Qualitative data collects the community's perspectives through interviews, focal groups and nominal groups. The combination of several data collection methods yields more complete information about the community, its needs and the resources available to meet them. Participation of community members in the process strengthens links between the community and the agents responsible for implementing the actions to address prioritised issues and favours community empowerment.

Gender differences in the use of alcohol and prescription drugs in relation to job insecurity. Testing a model of mediating factors.

BACKGROUND: The results of several studies suggest that economy-related stressors are less distressing for women compared with men. This study proposed to examine the relationship of perceived job insecurity with the use of licit drugs using a theoretical model that considered antecedents and mediators of this association, in order to identify differences between working men and women. METHODS: Using information from the Catalan Health Survey (2010-2014), we selected working individuals aged 16-64 who were primary providers of household income (N=5315). The outcomes were two measures of alcohol consumption (heavy drinking and binge drinking) and the use of hypnotics/sedatives. As antecedents of the exposure to job insecurity we considered the type of contractual relationship and occupational class. The mediating factors were poor mental health, household structure and the hours of housework per week. The theoretical model was assessed using path analysis where the moderating effect of gender was considered in all the associations. RESULTS: No differences in the prevalence of job insecurity were found between men and women (17%). Job insecurity (Odds ratio [OR]=1.35, 95% confidence interval [CI]=1.23-1.48) and house workload (OR=1.01, 95% CI=1.00-1.02) were positively associated with poor mental health, with no significant interactions with gender. Poor mental health was significantly associated with binge drinking (OR=1.23, 95% CI=1.13-1.33) and with the use of hypnotics/sedatives (OR=1.71, 95% CI=1.53-1.91). House workload showed a direct negative association with binge drinking (OR=0.99, 95% CI=0.98-1.00), while those in households with no children were more likely to be binge drinkers, with no significant interactions with gender. An alternative model had better fitting results for heavy drinking. CONCLUSION: No gender differences were found in the association of job insecurity with mental health nor with the use of substances among primary providers of household income, emphasising the importance of social roles when assessing differences in mental health among men and women.

Economic crisis and changes in drug use in the Spanish economically active population.

AIMS: To examine changes in the use of alcohol, cannabis and hypnotics/sedatives between two periods (before and during Spain's economic crisis), and to identify differences in the change between employed and unemployed individuals. DESIGN: Using cross-sectional data from four editions of the Spanish Household Survey on Alcohol and Drugs, we selected economically active individuals aged 16-64 years (total sample = 62 440) and defined two periods, pre-crisis [period 1 (P1) = 2005-07] and crisis (P2 = 2009-11). Poisson regression models with robust variance were fitted to obtain prevalence ratios (PR) of heavy and binge drinking and multinomial regression models to obtain relative risk ratios (RRR) of cannabis and hypnotic/sedative use between the two periods, also considering the interaction between period and employment status. FINDINGS: While the prevalence of alcohol use remained stable, heavy drinking declined in P2 in men both overall [PR = 0.73; 95% confidence interval (CI) = 0.67-0.79] and in the two age groups (16-34 and 35-64 years), and also in women overall (PR = 0.86; 95% CI = 0.75-0.99) and in the older age group. In contrast, binge drinking increased overall in P2 in men (PR = 1.17; 95% CI = 1.12-1.22) and in women (PR = 1.62; 95% CI = 1.49-1.76), and in both age groups. No differences in the change were observed between employed and unemployed individuals. Overall cannabis use remained stable in P2, but unemployed men and women of the older age group were more likely to have increased sporadic use compared to their employed counterparts (RRR = 2.24; 95% CI = 1.36-3.68 and RRR = 3.21; 95% CI = 1.30-7.93, respectively). Hypnotic/sedative use remained stable in P2 in men, but unemployed men were less likely to have increased heavy use in P2 compared with employed men (RRR = 0.69; 95% CI = 0.49-0.97). In women, heavy use increased in P2 overall and in the older age group, irrespective of employment status. CONCLUSION: During a period of economic recession in Spain, heavy drinking decreased and binge drinking increased. Sporadic cannabis use increased among older unemployed men and women. Heavy use of hypnotics/sedatives increased among employed men while older women increased use irrespective of employment status.

The relationship between labour market categories and alcohol use trajectories in midlife.

BACKGROUND AND AIMS: Studies on the role of labour market position and change in alcohol use during midlife are scarce and their results are inconclusive mainly due to their failure to define comprehensive and distinct labour market groups and the short periods of time studied. In this study we used different activity categories for men and women to examine alcohol use trajectories in midlife covering a period of 17 years. METHODS: Using data from four sweeps of the National Child Development Study covering ages 33-50 (N=9960), we used multilevel growth models to study the association between labour market categories and longitudinal changes in weekly units of alcohol consumed. RESULTS: In the reference group of full-time employed men alcohol trajectory decreased over the follow-up period (ß=-0.14; 95% CI -0.18 to -0.11) while in the reference group of employed women it increased (ß=0.06; 95% CI 0.04 to 0.08). Men and women who were 'mainly sick' had significantly steeper declines in their alcohol consumption trajectory. Women who became employed after being homemakers had the steepest increase in alcohol use (ß=0.05; 95% CI 0.01 to 0.09). CONCLUSIONS: Being employed is a strong determinant of alcohol use for men and women in midlife, making the workplace a good target for health promotion programmes and policies aimed at reducing alcohol use. Caution is needed when interpreting the health effects of alcohol consumption as low alcohol users may have previously been heavy drinkers.

[Prevalence of the use of hypnotics and sedatives among the working population and associated work-related stress factors]. / Prevalencia de consumo de hipnosedantes en población ocupada y factores de estrés laboral asociados.

OBJECTIVE: To explore the prevalence of the use of hypnotics and sedatives in a sample of the Spanish working population and to examine its association with certain work-related stress factors. METHODS: Using data from the 2007 Spanish Household Survey on Alcohol and Drugs (Encuesta Domiciliaria sobre Alcohol y Drogas en España [EDADES]), we analyzed the distribution of the use of hypnotics and sedatives in the previous month in the working population aged 16 to 64 years old (n=13,005). Associations with exposure to certain work-related stress factors (noxious working environment, precariousness, workload, and social support) were examined using logistic regression modelling. RESULTS: The prevalence of the use of hypnotics and sedatives among women in the previous month doubled that of men (6.5% and 3.3%, respectively), while use among the oldest age group was twice that of the youngest group in both sexes (10.2% in women and 5.5% in men older than 45 years), and was four times higher among those reporting poor health (18.9% in women and 11% in men). Concerning work-related stress, exposure to moderate (OR: 1.96; 95%CI: 1.31-2.92) and high (OR: 1.95; 95%CI: 1.14-3.34) levels of precariousness in men and moderate levels in women (OR: 1.43; 95%CI: 1.03-1.99) was associated with the use of hypnotics and sedatives. CONCLUSIONS: The prevalence of the use of hypnotics and sedatives was high in women and in workers older than 45 years. Further research is needed on the relationship between the use of hypnotics and sedatives and workers' health, and on the role that work-related stress factors play in this association.

Sex differences in the cumulative incidence of substance use by birth cohort.

BACKGROUND: Men present higher overall rates of substance use and abuse than women; yet, evidence suggests that an increase of substance use by the younger cohorts of women in recent decades is narrowing this gap in western societies. Moreover, younger cohorts may also be reporting earlier initiation of substance use, representing an increased risk for developing substance-related problems. With this study we intend to identify changes in the patterns of substance use of men and women in Spain for public health policy, planning and intervention. METHODS: Sex differences in the cumulative incidence of alcohol, tobacco, cannabis and cocaine were examined by birth cohort using a combined sample of individuals aged 15-64 years from eight editions of the Spanish National Survey on Drugs (1995-2009). RESULTS: Initiation of substance use in Spain is progressively taking place at younger ages, particularly among women. The gender-gap of life-time occurrence of substance use is narrowing (cannabis and cocaine) almost closing (alcohol) and even reversing (tobacco) in the youngest cohort. CONCLUSION: These results reflect the particular evolution and trends of Spanish society regarding substance use. Women's increased use of substances and the earlier age of initiation of substance use by both sexes present particular challenges for prevention and treatment of future substance-related problems. The trends registered for legal and illegal substances would require re-evaluation of existing prevention policies.

[Exploration and validation of working conditions questionnaire items included in the Spanish Household Survey on Alcohol and Drugs (EDADES)]. / Exploración y validación de las preguntas relacionadas con las condiciones de empleo y trabajo incluidas en la Encuesta Domiciliaria sobre Alcohol y Drogas en España (EDADES).

OBJECTIVE: To identify and validate a factor structure from items on working conditions included in the 2007 edition of Spanish Household Survey on Alcohol and Drugs (EDADES-2007) for use in research on consumption of addictive substances with this survey. METHODS: We performed a factor analysis of the questionnaire items using a cross-validation technique with a subsample of EDADES 2007 (N=13,005). Exploratory factor analysis with half of this sample yielded a latent factor structure. This structure was subsequently validated via confirmatory factor analysis with the remaining half of the sample. Standard criteria were used to test the model's goodness of fit, and a model-based internal consistency index was used to test the reliability of the structure. RESULTS: The structure obtained showed an adequate confirmatory fit and involved four factors related to the dimensions environmental conditions (F1), workload (F2), precariousness (F3) and social support (F4). The internal consistency index confirmed the reliability for the total structure (0.755) as well as for each of the factors (F1=0.755, F2=0.661, F3=0.529 and F4=0.680). CONCLUSIONS: The structure obtained represents a valid tool for assessing the relationship between use of addictive substances and certain work and employment conditions in the context of the EDADES survey. However, the inclusion of a more comprehensive and validated tool for the measurement of these conditions should be considered in future editions of the survey.

OBJETIVO: Identificar y validar una estructura de factores a partir de las preguntas sobre condiciones de empleo y trabajo incluidas en la edición 2007 de la Encuesta Domiciliaria sobre Alcohol y Drogas en España (EDADES-2007) para su utilización en estudios relacionados con el consumo de sustancias adictivas basados en esta encuesta. MÉTODOS: Se realizó un análisis factorial de las preguntas mediante un proceso de validación cruzada utilizando una submuestra de EDADES-2007 (N=13.005). A partir de un análisis exploratorio con la mitad de esta muestra se obtuvo una estructura de factores latentes. Posteriormente esta estructura se validó con la otra mitad de la muestra mediante un análisis confirmatorio. Se utilizaron criterios de ajuste estándar para evaluar la bondad general del modelo, y un índice de consistencia interna basado en el modelo para valorar la fiabilidad de la estructura. RESULTADOS: La estructura obtenida presentaba un ajuste confirmatorio adecuado e incluyó cuatro factores relacionados con las dimensiones condiciones ambientales (F1), carga de trabajo (F2), precariedad (F3), y apoyo social (F4). El índice de consistencia interna confirmó la fiabilidad tanto de la estructura total (0,755) como para cada uno de los factores (F1=0,755, F2=0,661, F3=0,529 y F4=0,680). CONCLUSIONES: La estructura obtenida representa una herramienta válida para examinar el consumo de sustancias adictivas en relación con determinadas condiciones de empleo y trabajo en el marco de la encuesta EDADES, si bien en próximas ediciones de la encuesta se debería valorar incluir una herramienta más completa y validada para medir estos factores.

El diagnóstico de salud del programa Barcelona Salut als Barris. Metodología para un proceso participativo / Community health assessment of the programme "Barcelona Health in the Neighbourhoods". Methodology for a participatory proces

Se describe la metodología usada en el diagnóstico de salud de un programa orientado a mejorar la salud en los barrios más desfavorecidos de la ciudad de Barcelona. En el proceso de diagnóstico se utiliza una metodología mixta (cuantitativa y cualitativa) para obtenera información sobre el estado de salud de la comunidad, sus determinantes y los recursos disponibles relacionados con la salud. Los datos cuantitativos corresponden a indicadores elaborados a partir de registros de diversas fuentes. La información cualitativa recoge las perspectivas de la comunidad mediante entrevistas, grupos focales y grupos nominales. Las diferentes formas de recogida de datos proporcionan una información más completa de la salud de la comunidad, de sus necesidades y de los recursos disponibles para afrontarlas. La participación comunitaria en el proceso fortalece los lazos entre la comunidad y los agentes implicados en las acciones para abordar los temas priorizados, y favorece su empoderamiento

This paper describes the methodology used for the assessment of health needs within a programme aimed at promoting health equity in disadvantaged neighbourhoods in the city of Barcelona (Spain). The assessment process involves the use of mixed methods (quantitative and qualitative) in order to obtain information regarding the health of the community, its determinants, and the availability of health-related assets. Quantitative data consists of indicators from different sources. Qualitative data collects the community's perspectives through interviews, focal groups and nominal groups. The combination of several data collection methods yields more complete information about the community, its needs and the resources available to meet them. Participation of community members in the process strengthens links between the community and the agents responsible for implementing the actions to address prioritised issues and favours community empowerment

Exploración y validación de las preguntas relacionadas con las condiciones de empleo y trabajo incluidas en la Encuesta Domiciliaria sobre Alcohol y Drogas en España (EDADES) / Exploration and validation of working conditions questionnaire items included in the Spanish household survey on alcohol and drugs (edades)

Objetivo: Identificar y validar una estructura de factores a partir de las preguntas sobre condiciones de empleo y trabajo incluidas en la edición 2007 de la Encuesta Domiciliaria sobre Alcohol y Drogas en España (EDADES-2007) para su utilización en estudios relacionados con el consumo de sustancias adictivas basados en esta encuesta. Métodos: Se realizó un análisis factorial de las preguntas mediante un proceso de validación cruzada utilizando una submuestra de EDADES-2007 (N=13.005). A partir de un análisis exploratorio con la mitad de esta muestra se obtuvo una estructura de factores latentes. Posteriormente esta estructura se validó con la otra mitad de la muestra mediante un análisis confirmatorio. Se utilizaron criterios de ajuste estándar para evaluar la bondad general del modelo, y un índice de consistencia interna basado en el modelo para valorar la fiabilidad de la estructura. Resultados: La estructura obtenida presentaba un ajuste confirmatorio adecuado e incluyó cuatro factores relacionados con las dimensiones condiciones ambientales (F1), carga de trabajo (F2), precariedad (F3), y apoyo social (F4). El índice de consistencia interna confirmó la fiabilidad tanto de la estructura total (0,755) como para cada uno de los factores (F1=0,755,F2=0,661, F3=0,529 y F4=0,680).Conclusiones: La estructura obtenida representa una herramienta válida para examinar el consumo de sustancias adictivas en relación con determinadas condiciones de empleo y trabajo en el marco de la encuesta EDADES, si bien en próximas ediciones de la encuesta se debería valorar incluir una herramienta más completa y validada para medir estos factores (AU)

Objective: To identify and validate a factor structure from items on working conditions included in the 2007 edition of Spanish Household Survey on Alcohol and Drugs (EDADES-2007) for use in research on consumption of addictive substances with this survey. Methods: We performed a factor analysis of the questionnaire items using a cross-validation technique with a subsample of EDADES 2007 (N=13,005). Exploratory factor analysis with half of this sample yielded a latent factor structure. This structure was subsequently validated via confirmatory factor analysis with the remaining half of the sample. Standard criteria were used to test the model’s goodness of fit, and a model-based internal consistency index was used to test the reliability of the structure. Results: The structure obtained showed an adequate confirmatory fit and involved four factors related to the dimensions environmental conditions (F1), workload (F2), precariousness (F3) and social support (F4). The internal consistency index confirmed the reliability for the total structure (0.755) as well as for each of the factors (F1=0.755, F2=0.661, F3=0.529 and F4=0.680). Conclusions: The structure obtained represents a valid tool for assessing the relationship between use of addictive substances and certain work and employment conditions in the context of the EDADES survey. However, the inclusion of a more comprehensive and validated tool for the measurement of these conditions should be considered in future editions of the survey (AU)