The Influence of Gender Equality on Volunteering Among European Senior Citizens.

This research analyzes how gender equality influences the participation of European senior citizens in a range of volunteering activities (Social Awareness, Professional and Political, Education, and Religion). The main contribution is the simultaneous consideration of different levels of data aggregation: individual, national and welfare system. This allows conclusions to be drawn on the effects of variables linked to sociodemographic characteristics, gender equality and welfare systems. The empirical estimation utilised microdata from the World Values Survey (2005/09 and 2010/14) and the United Nations Development Programme. Results suggest that the European senior citizens appear to believe that they are more equal than the official statistics of their countries indicate. Men are more likely to participate in professional and education activities; women are more likely to be involved in religious organisations. Welfare systems influence volunteering behaviours. The promotion of macro-policies for gender equality could be important for increasing participation in non-profit organisations.

Health-related quality of life in young people: the importance of education.

BACKGROUND: The concept of health-related quality of life and education integrates the bio-psychosocial perspective of health and the multidimensional potentialities of education for wellbeing. This present work is especially relevant to young people because understanding the interaction between health and education can facilitate the design of preventive policies. The research examines the way in which the educational level of young people from an urban district in the city of Zaragoza (Casablanca) has an influence on their health-related quality of life (HRQOL). METHODS: A cross sectional survey was undertaken in the Casablanca district of Zaragoza (Spain). Participants were not randomly selected; their numbers reflected the areas where they lived with respect to age and sex distribution. It comprised 122 boys and 122 girls, aged between16 and 29, living in the neighbourhood are: Viñedo Viejo, Las Nieves and Fuentes Claras. These three residence zones are markedly different in terms of socioeconomic composition. The questionnaire included the following information: socioeconomic characteristics (sex, age, educational level, employment status, residence zone), an assessment of health (health problems, diagnosis and medication in the last 2 weeks) and HRQOL (WHOQOL-BREF dimensions: mental health; physical health; social relations; and environment). ANOVA and four regression models were used to assess the role, direction and intensity of educational level on HRQOL. RESULTS: The results show that the higher the level of education, the better the level of HRQOL. The biggest impact of education was on the mental health dimension, but this influence was modulated by sex and residence zone. The value of the interaction of education and residence zone was more significant than educational level alone. HRQOL of girls is more sensitive to education, being a student and residence zone than the HRQOL of boys. CONCLUSIONS: The dimensions of HRQOL are influenced by educational level. The influence is greatest among girls and the youngest members of the poorest area of the district. Public authorities should contemplate the development of an equitable education system from the beginning of the life cycle as a public health strategy.

Willingness to pay for a quality-adjusted life year: an evaluation of attitudes towards risk and preferences.

BACKGROUND: This paper examines the Willingness to Pay (WTP) for a quality-adjusted life year (QALY) expressed by people who attended the healthcare system as well as the association of attitude towards risk and other personal characteristics with their response. METHODS: Health-state preferences, measured by EuroQol (EQ-5D-3L), were combined with WTP for recovering a perfect health state. WTP was assessed using close-ended, iterative bidding, contingent valuation method. Data on demographic and socioeconomic characteristics, as well as usage of health services by the subjects were collected. The attitude towards risk was evaluated by collecting risky behaviors data, by the subject's self-evaluation, and through lottery games. RESULTS: Six hundred and sixty two subjects participated and 449 stated a utility inferior to 1. WTP/QALY ratios varied significantly when payments with personal money (mean €10,119; median €673) or through taxes (mean €28,187; median €915) were suggested. Family income, area income, higher education level, greater use of healthcare services, and the number of co-inhabitants were associated with greater WTP/QALY ratios. Age and female gender were associated with lower WTP/QALY ratios. Risk inclination was independently associated with a greater WTP/QALY when "out of pocket" payments were suggested. Clear discrepancies were demonstrated between linearity and neutrality towards risk assumptions and experimental results. CONCLUSIONS: WTP/QALY ratios vary noticeably based on demographic and socioeconomic characteristics of the subject, but also on their attitude towards risk. Knowing the expression of preferences by patients from this outcome measurement can be of interest for health service planning.

Human values, civic participation, and wellbeing: analysis on their relationship among older Europeans.

Introduction: So far, both for the general and older population, research on human values and wellbeing mainly shows correlational associations but does not inquire about the direction of this relationship. This is also true for values and civic participation. Therefore, our objective is to identify the directional association between civic participation and Schwartz values, and between values and wellbeing, among older Europeans. Methods: A pseudo-panel was created from the cross-sectional data of the European Social Survey (ESS 2002-2018), controlling for gender, age-group, country and level of studies (n = 3926). The data analysis was performed using a cross-lagged model, applying both random-effects and fixed-effects models. Results: On the one hand, the relationship between participation and values is bidirectional, but the effect of civic participation on values is more significant since participating stimulates the development of certain values. On the other hand, although the relationship between values and wellbeing is also bidirectional, the effect of wellbeing on values is stronger since a given level of wellbeing favors the development of particular values. Discussion: We conclude that civic participation should be promoted within the older population since it directly increases wellbeing, and moreover reinforces those (Growth-oriented) values that positively influence the health, happiness and life satisfaction of older people.

Household social characteristics of the demand for alcoholic beverages among Spanish students.

This paper studies how household social capital affects adolescents' demand for alcoholic drinks. To that end, we focus on a theoretical framework that combines elements from the Model of Rational Addiction and the Model of Social Economics. For the empirical framework, we use a simultaneous Type II Tobit model, with data drawn from the Spanish National Survey on Drug Use in the School Population (2000, 2002, and 2004). The sample is comprised of 12,627 students aged 17 years old. Our results confirm that parents' decisions about drinking are even more decisive in their children's behavior than socioeconomic variables, such as parents' educative levels or working status. Parental responsibilities go beyond the endowment of health and educational goods and services; so, these results suggest the importance of designing family-drug use prevention programs. The study's limitations are noted.

[Health, sport and socioeconomic vulnerability in an urban community]. / Salud, deporte y vulnerabilidad socioeconómica en una comunidad urbana.

OBJECTIVE: To analyse the association between perceived and diagnosed health, sport practice, and the belonging to a vulnerable socioeconomic group. DESIGN: Observational study. Questionnaire. SETTING: Casablanca neighbourhood. Primary Health Care Area in the city of Zaragoza (Spain). PARTICIPANTS: 1032 residents aged over 15 years. MAIN MEASUREMENTS: a) Perceived health using the Health Perception Questionnaire of Davis and Ware; b) diagnosed morbidity; c) sport practice using the Healthy Lifestyles questionnaire-94 of Herrero, Musitu and Gracia, and d) socioeconomic vulnerability based on the occupational, educational and economic conditions of the family unit. RESULTS: Socioeconomic vulnerability had a statistically significant association with diagnosed health, self-perceived health, and sport practice. Vulnerability and exercise showed a higher influence over self-perceived health than over diagnosed health. In the analysis stratified by gender, the association could only be observed in men. CONCLUSIONS: The impact of health social factors is modulated by gender. Social stratification and lifestyles, such as sport practice, are predictors of self-perceived health and, thus, of the relationship between the population and the use of health services.

Stress impact of COVID-19 in nurse managers.

Background: The COVID-19 pandemic has directly affected specially nurses, not only those on the front lines but also nurse managers. Aims: To assess and compare stress levels of nurse managers before and during the pandemic, and to identify predictive factors. Method: Cross-sectional studies were carried out in two moments, before and during pandemic. 102 manager nurses were recruited before the sanitary crisis (2018) and 87 during the health crisis (2020). Perceived stress was measured with the Perceived Stress Scale-14 and quality of professional life, job demands, motivation and managerial support were assessed with the Professional Quality of Life Questionnaire. Socio-demographic and job-related variables were also analysed. Statistical analysis was performed using student's t-test, correlations and multiple regression analysis. Results: The majority of nurse managers were women, married, who worked the morning shift. 78.2% managed nursing personnel who worked with COVID patients. They suffered a significant increase in both job demands and perceived stress level in the pandemic. Job demands, working in shifts morning, being young and being unmotivated were predictors of perceived stress level according to multiple linear regression analysis. Conclusion: Perceived stress was greatest during the COVID-19 pandemic. Both, before and during the pandemic, job demands are central predictors of nurse managers' general perceived stress. It is necessary to adapt the workplace to personal characteristics of the nurse manager and increase actions to enhance their motivation and reduce their job demands to prevent stress.

Civic Participation as a Promoter of Well-Being: Comparative Analysis among European Countries.

Previous research on the direction of the relationship between civic participation and well-being has evidenced that civic participation is a promoter of well-being among older adults in Europe. Accordingly, the objective of the present study is to identify and analyze the differences between European welfare systems regarding both civic participation and well-being. For this purpose, a logistic multilevel regression analysis was performed as an empirical strategy, using the cross-sectional data from the 9 waves of the European Social Survey (2002-2018). Significant differences in well-being were observed, with Anglo-Saxon elders being the healthiest, and the Nordic the happiest and most satisfied with their lives. In contrast, Eastern European seniors reported the lowest levels of well-being. Also, Nordic countries are the most civically engaged, followed by the Continental and Anglo-Saxon, while Mediterranean and Eastern countries engage the least. However, the impact of civic participation on well-being is strongest for the Mediterranean countries, while its impact on satisfaction and happiness is weakest for the Nordic countries. The 3 models of the multilevel analysis indicate that civic participation has a positive impact on health, happiness and life satisfaction, and that this effect is quite robust. Also, by adding country-level macro variables to the model, it is possible to reduce the random effects and hence to better explain these international differences. Concisely, the impact of civic participation on the well-being of the elderly differs across nations and should therefore be considered by policy makers.

Gender Gap in Self-Rated Health: A Cohort Perspective in Eastern European Countries.

BACKGROUND: The relationship between self-rated health and gender differs across countries and generations. The aim of this study is to analyze the effect of socioeconomic conditions on self-rated health from a generational perspective, its differential effect on gender, and its influence on the gender gap in order to explore health diversity using a multidisciplinary approach and considering policy implications in Eastern European countries. METHODS: We used data drawn from the European Health Interview Survey for eight Eastern European countries and EUROSTAT from 2006 through to 2009. We conducted multilevel analyses to understand the individual and national health determinants of self-rated health by gender and to determine whether national differences remain after controlling for micro variables. In order to analyze the role of equity (Gini quartile) in gender differences, Oaxaca analyses were used. RESULTS: The self-rated health gender gap increases with age. Individual characteristics, such as educational level or smoking, influence citizens' perceived health, and have a stronger effect on women than on men. Knowing both the characteristics (endowment effects) and the effects of individual characteristics (coefficient effects) on health is important in order to understand gender gaps among people from the silent generation. CONCLUSIONS: Our research indicates that random effects are greater for men than for women. Moreover, random effects might be explained to a certain extent by economic equity (Gini index). The combined effects of gender, cohort, and geographical differences on self-rated health have to be taken into account to develop public health policies.

Corporate social responsibility and workplace health promotion: A systematic review.

The complex situation that global society is facing as a result of COVID-19 has highlighted the importance of companies committing to the principles of social responsibility. Among the internal initiatives, those related to the health of workers are, obviously, highly topical. The objective of our research is to provide concise knowledge of the relationship between workplace health promotion (WHP) and corporate social responsibility (CSR) so that the relevant specialized research was gathered in a single document that lays the foundations of its applicability. A systematic review, following the PRISMA method, has been carried out. Twenty-seven articles have been selected from the main scientific databases. Their qualitative analysis concludes that CSR and WHP are linked, have beneficial reciprocal effects, need committed leadership respectful of autonomy and voluntariness, and require the establishment of specific goals within the framework of the organizations' sustainability policies. Future studies should establish the impact of the pandemic on these aspects.

A study of the user's perception of economic value in nursing visits to primary care by the method of contingent valuation.

BACKGROUND: The identification of the attribution of economic value that users of a health system assign to a health service could be useful in planning these services. The method of contingent valuation can provide information about the user's perception of value in monetary terms, and therefore comparable between services of a very different nature. This study attempts to extract the economic value that the subject, user of primary care nursing services in a public health system, attributes to this service by the method of contingent valuation, based on the perspectives of Willingness to Pay (WTP) and Willingness to Accept [Compensation] (WTA). METHODS/DESIGN: This is an economic study with a transversal design. The contingent valuation method will be used to estimate the user's willingness to pay (WTP) for the care received from the primary care nurse and the willingness to accept [compensation] (WTA), were this service eliminated. A survey that meets the requisites of the contingent valuation method will be constructed and pilot-tested. Subsequently, 600 interviews will be performed with subjects chosen by systematic randomized sampling from among those who visit nursing at twenty health centers with different socioeconomic characteristics in the Community of Madrid. The characteristics of the subject and of the care received that can explain the variations in WTP, WTA and in the WTP/WTA ratio expressed will be studied. A theoretical validation of contingent valuation will be performed constructing two explanatory multivariate mixed models in which the dependent variable will be WTP, and the WTP/WTA relationship, respectively. DISCUSSION: The identification of the attribution of economic value to a health service that does not have a direct price at the time of use, such as a visit to primary care nursing, and the definition of a profile of "loss aversion" in reference to the service evaluated, can be relevant elements in planning, enabling incorporating patient preferences to health policy decision-making.

Health-Related Quality of Life and Physical Activity in a Community Setting.

This article analyses how physical activity reinforces each of the dimensions (mental, physical, social, etc.) of the health-related quality of life concept. To that end, we determined whether this relationship is moderated by educational level and area of residence. The empirical part was based on data obtained from a cross-sectional survey carried out in the Casablanca neighbourhood (Zaragoza, Spain). The sample comprised 1083 participants aged between 25 and 84 years residing in the three residential areas of this neighbourhood: Viñedo Viejo, Las Nieves and Fuentes Claras. These three areas exhibit significant socio-economic differences in their population. The self-reported questionnaire included the following key information for this study: socio-economic characteristics (sex, age, educational level and area of residence) and health-related quality of life (WHOQOL-Brief: mental health, physical health, social relations and environment). The main results obtained from the descriptive statistics and regression systems were added. Playing a sport or undertaking some physical activity brings many health benefits, both physical and mental. The educational level and area of residence affect this relationship, such that the effects of physical activity are greater for those residents of Casablanca who have a higher educational level and/or live in more favoured areas of this neighbourhood. The results have also been discussed by sex and age group. Investing in innovative programmes in educational institutions and communities to acquire healthy habits and behaviour patterns that take into account socioeconomic differences in the population would be an advisable public health strategy.

The Quality of the Supervisor-Nurse Relationship and Its Influence on Nurses' Job Satisfaction.

BACKGROUND: Leader-Member Exchange theory provides strategic information about how to improve the leader's role and nurses' satisfaction on healthcare organizations. OBJECTIVES: The main objective of this research was to study the quality of the supervisor-nurse relationship in relation to the nurses' job satisfaction. This research also analyses how the relationship between Leader-Member exchanges and nurse job satisfaction could be moderated by other variables, such as nurse psychological empowerment, nurse-perceived organizational support and Leader-Leader Exchange. METHODS: The sample comprises of 2541 registered nurses who work in public hospitals in the Autonomous Region of Aragon (Spain). Regression analyses were conducted. RESULTS: The statistically significant results demonstrate the influence that the supervisor's leadership exerts on the job satisfaction of the nurse. CONCLUSIONS: The moderating variables (Empowerment, Perceived Organizational Support and Leader-Leader relationship) play an important role explaining the job satisfaction of the nurse. Deepening in these relationships could help us implement precise strategies to improve the nurse organizational commitment and the quality of health care performance.

Reply to Learning by Doing .Errors! Comment on Gil-Lacruz, M.; Gracia-Pérez, M.L.; Gil-Lacruz, A.I. Learning by Doing and Training Satisfaction: An Evaluation by Health Care Professionals. Int. J. Environ. Res. Public Health 2019, 16, 1397.

We would like to thank the reviewer for the positive and constructive comments on our work and offer the following response: [...].

Learning by Doing and Training Satisfaction: An Evaluation by Health Care Professionals.

As one of the training methodologies employed in the health care context, 'Learning by Doing' prioritizes the transference of competence, control, and workplace motivation. However, there are few published works that consider the opinions of health care professionals in relation to the effects of this kind of training on their workplace competence. The goal of this research was to evaluate the level of satisfaction and impact on quality of care, as perceived by the health care professionals that participated in this training program (Formative Focus). The evaluation utilized an online questionnaire that assessed professional satisfaction through five dimensions: The training methodology; the training program; its economic impact; perceived improvement in professional competence; and, perceived improvement in quality of care. A total of 364 health professionals took part in the training course and were asked to complete an online questionnaire. The variables that contemplated satisfaction were related to quality of care and preferences regarding the training methodology. Participants preferred interactive methods for learning with emphasis on practical contents. In terms of application of learning to their jobs, health care professionals found Learning by Doing skills more useful to transfer to their workplace. This experience of Learning by Doing training indicates an interesting potential for impact on improvement: Quality of health care, health care competence of professionals, and organizational development.

Self-rated health in Europe and its determinants: Does generation matter?

OBJECTIVES: To analyse the influence of micro- and macro-factors on self-rated health, and the role of generation on this relationship. METHODS: Cross-sectional study using data from European Health Interview Surveys from 14 European countries. Individuals were divided into four generations ("silent generation", "baby boomers", and "generation X" and "Y"). We conducted multilevel analyses for each generation to study the influence of individual and national explanatory variables on self-rated health. RESULTS: Age showed an exponential effect in older generations. Education and employment presented the strongest association with low self-rated health, especially in "baby boomers" and women (low education: OR 3.5; 95% CI 3.2-3.9). Tobacco showed a negative effect in younger generations. Overweight and low physical activity were negatively associated with self-rated health regardless of generation. Countries from the Eastern welfare system showed the highest risk of low self-rated health and this association was higher in men for "silent generation" (OR 4.7; 95% CI 3.0-7.6). CONCLUSIONS: The influence of individual and national factors on self-rated health varies regarding generation. The target generation and the demographic structure of a country should be taken into account to develop more accurate health policies.

"Gaining or losing": The importance of the perspective in primary care health services valuation.

RATIONALE AND OBJECTIVES: Economic theory classifies an intervention as socially beneficial if the total Willingness to Pay (WTP) of those who gain exceeds the total Willingness to accept (WTA) of those who are harmed. This paper examines the differences in health system users' valuation of a health care service in primary care setting based on the WTP and WTA perspectives, discussing the impact of personal and service variables, including risk attitudes, on these disparities. METHOD: Six hundred and sixty two subjects who asked for care in health centres in the Region of Madrid (Spain) were interviewed, using the contingent valuation method to estimate WTP and WTA. Patient sociodemographic characteristics, health needs, satisfaction with the service and risk attitude and behaviour under risk (measured by self-reported scales and lottery games respectively) were collected. Generalised Linear Models were used to estimate the association between the explanatory variables and the WTA/WTP ratio. RESULTS: We obtained the WTA/WTP ratio for 570 subjects (mean 1.66 CI 95%: 1.53-1.79; median 1, interquartile range 1-2). People with higher education or in high social groups expressed WTA values closest to WTP. The opposite occurred in patients with the greatest health needs or who were born abroad. Self-reported expression of risk aversion appeared also related to increases in the WTA/WTP ratio. Satisfaction with the service evaluated was the most influential factor in the WTA/WTP ratio. CONCLUSION: Health need, difficulty in obtaining substitutes and satisfaction with the service could serve for profiling people averse to loss for health care services in primary care setting. Self-reported expression of risk aversion could also be related to increases in the WTA/WTP ratio. This would mean that these characteristics should be taken into account both in the design and implementation of new healthcare interventions, as in the making decision for disinvestment.

Risk-Taking Attitudes of Patients who Seek Health Care: An Exploratory Approach through Lottery Games. / La valoración de la actitud ante el riesgo en personas que demandan cuidados en salud: una aproximación mediante juegos de loterías utilizando generalized estimating equations.

BACKGROUND: The characterization of the risk-taking attitude of individuals may be useful for planning health care interventions. It has been attempted to study expressions of risk-taking attitude and evaluate characteristics of a standard lottery game in a population that seeks health care to elicit these attitudes. METHODS: Multicentric cross-sectional study. Demographic and socioeconomic characteristics, quality of life (EuroQol-5D), and health risk behaviors were collected from 662 users of 23 health centers selected by random sampling. Risk-taking attitude was evaluated by means of a self-evaluation scale and two lottery games, (L1 and L2; L2 included the possibility of economic losses). Generalized estimating equations (GEE) explicative models were used to evaluate the variability of risk-taking attitude. RESULTS: Nineteen percent out of interviewed people (CI95%: 15.6-22.6%) expressed a high risk appetite, but only 10.0% (CI95% 7.0 to 13.0) were classified as risk-seeking by L2. It was found association between increased risk appetite and having a better perception of health status (0.110, CI95%: 0,007-0,212) or a higher income (0.010, CI95%: 0.017- 0.123) or smoking status (0.059, CI95%: 0.004- 0.114). Being Spanish was associated with lower risk appetite (-0.105, CI95%: -0.005 --0.205), as being over 65 (-0.031, CI95%:- 0.061- -0.001) or a woman (-0.038, CI95%:-0.064- -0.012). The intraclass correlation coefficient for self-evaluation scale was 0.511 (95% CI: 0.372 to 0.629), 0.571 (95% CI: 0.441 to 0.678) for L1 and 0.349 (95% CI: 0.186-0.493) to L2. CONCLUSIONS: People who seek health care express certain inclination to risk, but this feature is attenuated when methodologies involving losses are used. Risk appetite seems greater in young people, males, people with better health, or more income, and in immigrants. Lottery games such as the proposed ones are a simple and useful tool to estimate individuals' inclination to risk.

OBJETIVO: La caracterización de la actitud ante el riesgo puede ser útil en la planificación de las intervenciones sanitarias. El objetivo fue estudiar la actitud ante el riesgo de una población que demanda cuidados de salud y evaluar la capacidad de un juego de loterías para evidenciar dicha actitud. METODOS: Estudio multicéntrico transversal. Se recogieron características demográficas, socioeconómicas, de calidad de vida y conductas de riesgo en salud de 662 personas usuarias de 23 centros de salud seleccionadas mediante muestreo aleatorio. La actitud ante el riesgo se evaluó mediante una escala subjetiva y mediante dos juegos de azar (L1 y L2; L2 incluía la posibilidad de pérdidas económicas). Se realizaron modelos explicativos para valorar la variabilidad de la propensión al riesgo utilizando Generalized Estimating Equations (GEE). RESULTADOS: El 19,1% (IC95%:15,6-22,6%) de los sujetos expresaron una propensión al riesgo alta, el 10,0% (IC95%:7,0-13,0) fueron clasificados como propensos al riesgo con L2. Se encontró asociación entre una mayor propensión al riesgo y tener mejor percepción del estado de salud (0,110; IC95%:0,007- 0,212) o mayor renta (0,010; IC95%: 0,017- 0,123) o ser fumador (0,059; IC95%: 0,004-0,114). Ser español se relacionaba con menor propensión al riesgo (-0,105; IC95%: -0,205- -0,005), al igual que ser mayor de 65 años (-0,031; IC95%:-0,061- -0,001) o ser mujer (-0,038, IC95%:-0,064- -0,012). El coeficiente de correlación intraclase para la escala subjetiva fue 0,511 (IC95%:0,372-0,629), 0,571 (IC95%:0,441-0,678) para L1 y 0,349 (IC95%:0,186-0,493) para L2. CONCLUSIONES: Las personas que demandan cuidados de salud presentan con frecuencia propensión al riesgo, la cual se atenúa cuando se caracteriza mediante metodologías que implican pérdidas. La propensión al riesgo parece mayor en personas jóvenes, varones, con mejor estado de salud, con mayor renta y en inmigrantes.

Women and smoking­prices and health warning messages: evidence from Spain.

OBJECTIVE: In Spain, fewer men are smoking every year yet the number of women smokers remains relatively high. This paper examines the impact of two anti-smoking policies (increased prices and obligatory pictorial health warning labels) on womens smoking decisions; generation cohorts are used to elucidate the determinants of those decisions. DATA SOURCE: We have drawn 48,755 observations of women living in Spain from the Spanish National Health Surveys of 2001, 2003, 2006 and 2011. DATA SYNTHESIS: Among the main results, we highlight that belonging to a particular generation modulates the manner in which individual characteristics and tobacco policies determine smoking decisions. For example, women's smoking was not considered as socially acceptable until the 1960s and therefore older women have lower smoking rates. However, for the younger female cohorts (generations X and Y) smoking was seen as an act of rebellion and modernity, so women belonging to these groups, irrespective of educational level, are more likely to smoke. CONCLUSIONS: The price of cigarettes and pictorial health warning labels on cigarette packets also influence the smoking behaviour of Spanish women.

Female preventive practices: breast and smear tests.

Breast cancer and cervical cancer are the most common female cancers in Spain and in many developed countries. The main goal of this paper is to identify the determinants of individual decisions on breast screening and smear testing, that is to say, the decision to take a test for the first time and the decision to test with suitable regularity. To that end, we have combined analyses of micro and macro data (the Spanish National Health Survey and Spanish Regional Social Indicators) and employed multilevel estimation models. Among the main results, we highlight the fact that regional public screening programmes improve individual decisions on screening (more women testing for the first time and more women testing regularly) and, furthermore, they generate positive synergies; for example, regional public programmes for smear testing improve individual decisions on both cervical and breast cancer screening. In addition, we conclude that it is not only important to know if the numbers of women undergoing breast screening and smear testing are increasing, it is also important to know if they are testing regularly.