Community-Based Interventions to Reduce Alcohol Consumption and Alcohol-Related Harm in Adults.

Alcohol consumption was associated with 3 million deaths worldwide in 2016. Although community action has proven to be effective and has become a priority area of the global strategy to reduce alcohol consumption, there is a gap in the knowledge of community interventions to reduce alcohol use among adults. This study aims to analyze the evidence on effective community-based interventions to reduce alcohol consumption and harm among adults and to identify their components and underlying theories. Search strategy involved five databases (January 2000-March 2020). We included multicomponent, evaluated, and community interventions addressing to adults in urban settings of high-income countries. Furthermore, two conceptual frameworks were adapted to identify the social determinants of alcohol related harms and modifiable factors through community interventions. The initial search yielded 164 articles. The final sample included eight primary studies. Six of them were effective and shared three components (community mobilization; law enforcement and media campaigns), they combined approaches at individual and environmental levels addressing structural determinants of health and some cultural aspects related to consumption. Health outcomes focused mainly on reducing consumption, modifying patterns and acute effects on health. Few studies addressed social problems arising from harmful consumption. This review has identified several effective community-based interventions to reduce harmful use of alcohol among adults as well as some mechanisms and theories supporting them. It also provides a framework to guide new designs, with potential evidence of factors, as well as possible combinations of methods to improve health at community level across different settings and contexts.

[A public health surveillance system applied to climate change for cities]. / Un sistema de vigilancia de salud pública para el cambio climático en las ciudades.

This paper makes a first proposal for a public health surveillance system for climate change in cities, and describes the process that led to its definition. After several years of monitoring different aspects related to climate change and its impact, the public health services of Barcelona made a preliminary proposal and gathered a working group of experts to discuss and review it. Four categories of components were defined: climate data, health impacts of climate change and its determinants, contributions of the city to mitigation (especially those with health co-benefits), and actions to reduce vulnerability to extreme events. They were broken in twelve components, with indicators for each. The proposal was further refined with subsequent reviews, and is being used by the city public health services involved in this field.

Climate Change and Health in Urban Areas with a Mediterranean Climate: A Conceptual Framework with a Social and Climate Justice Approach.

The consequences of climate change are becoming increasingly evident and highlight the important interdependence between the well-being of people and ecosystems. Although climate change is a global phenomenon, its causes and consequences vary dramatically across territories and population groups. Among settings particularly susceptible to health impacts from climate change are cities with a Mediterranean climate. Here, impacts will put additional pressure on already-stressed ecosystems and vulnerable economies and societies, increasing health inequalities. Therefore, this article presents and discusses a conceptual framework for understanding the complex relationship between climate change and health in the context of cities with Mediterranean climate from a social and climate justice approach. The different elements that integrate the conceptual framework are: (1) the determinants of climate change; (2) its environmental and social consequences; (3) its direct and indirect impacts on health; and (4) the role of mitigation and adaptation policies. The model places special emphasis on the associated social and health inequalities through (1) the recognition of the role of systems of privilege and oppression; (2) the distinction between structural and intermediate determinants of climate change at the root of health inequalities; (3) the role of individual and collective vulnerability in mediating the effects of climate change on health; and (4) the need to act from a climate justice perspective to reverse health inequities.

[Innovating the service management of public health: the experience of the Barcelona Public Health Agency (Spain)]. / Innovar en la gestión de servicios de salud pública: la experiencia de la Agencia de Salud Pública de Barcelona.

We describe the evolution of the organization of public health services in the city of Barcelona (Catalonia, Spain) until the creation of the Barcelona Public Health Agency. This Agency is a consortium created by the Barcelona City Council and the Government of Catalonia as the sole entity responsible for regional and local public health services in the city. The underlying logic for the Agency's design, as well as its mission, vision and value statements, strategy, services' portfolio, and the role of leadership in the process, are analyzed. Aspects related to the Agency's quality and communication plans, as well as the design of its processes, and its policy in terms of alliances for research and training in public health, are discussed. Finally, the main challenges for the future are described.

[Smoke-free areas: persuasion and enforcement]. / Espacios sin humo: persuasión y obligación.

This paper presents the actions taken by the public health services in the city of Barcelona (Catalonia, Spain) to improve compliance with the requirements of the new 28/2005 tobacco control law. These were essentially informative at first, with a second phase where authority enforcement mechanisms were activated. In workplaces, educational settings and transport the law was incorporated without incidents nor relevant complaints, except for isolated incidents in some university or mass transport settings. In food establishments the process has been more complex. Estimating the frequency of related events, there are 17.5 formal citizen complaints for 100,000 person-years. Inspections generated by citizen complaints resulted in 3.3 administrative proceedings for 100,000 person-years, mostly for incurring in serious violations. Effectively enforcing the law required active information and communication policies, as well as the real enforcement by health authority. This caused an important workload to the public health services.

[Smoking in Spain, 1945-1995. A retrospective analysis based on the Spanish National Health Interview Surveys]. / Prevalencia del consumo de tabaco en España entre 1945 y 1995. Reconstrucción a partir de las Encuestas Nacionales de Salud.

BACKGROUND AND OBJECTIVE: To analyse trends in cigarette consumption in Spain between 1945 and 1995. MATERIAL AND METHODS: Prevalence rates of daily cigarette smoking were derived from the individual information collected in the Spanish National Health Interview Surveys (1993, 1995 and 1997) for the period 1945-1995. RESULTS: In males, the prevalence rate in 1945 was 42.4% (95% confidence interval [CI], 40,1-44,7%), increased till 59.1% in 1975 (95% CI, 58,0-60,2%), levelled-off during the decade 1975-1985, and decreased till 48.9% in 1995 (95% CI, 48,1-49,7%). In females, the prevalence rate of cigarette smoking was less than 5% till the 1970s, and it begun to steadily increase till the end of the study period (22,5%; 95% CI, 21,9-23,1%). CONCLUSIONS: This analysis shows the different dynamics of the smoking epidemic among men and women in Spain.

[Tobacco use by adolescents in Barcelona (Spain) and trends in the last 20 years]. / Consumo de tabaco de los adolescentes en Barcelona y tendencias a lo largo de 20 años.

OBJECTIVES: Smoking is a preventable cause of early death and the habit starts in adolescence. The aim of this study was to describe tobacco consumption in secondary school students in 2008 and trends in the last 20 years in Barcelona. MATERIAL AND METHODS: We analyzed the trend in tobacco consumption by comparing data from 8 surveys carried out between 1987 and 2008 in the 8th (2nd year of Compulsory Secondary Education), 10th (4th year of Compulsory Secondary Education) and 12th (2nd year of Compulsory Secondary Education) years of secondary school. The FRESC questionnaire was used. Data on regular and daily consumption and associated factors in 2008 were gathered and compared with those corresponding to the previous studies. Percentages of annual change were calculated with Joinpoint regression and data were stratified by sex and year of education. RESULTS: In 2008, 6.1% of boys and 4.5% of girls in the 8th year, 15.8% and 20.4% of those in the 10th year, respectively, and 26.1% and 33.1% of those in the 12th year, respectively, were regular smokers. A strong association was noted between regular smoking and cannabis consumption in three school years, as well as with having friends who were smokers and poor school performance. At 15-16 years old, the average annual decrease from 1996 to 2008 was 6.8% in girls and 6.1% in boys. CONCLUSIONS: Adolescent smoking has been decreasing in the last few years in Barcelona. There is a strong association between tobacco use and cannabis consumption.

La recomendación del consumo de alcohol en las «Guías Alimentarias para la población española». Un mensaje demasiado ambiguo / Alcohol consumption recommendations in the dietary guidelines for the Spanish population. A very ambiguous message

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[Who is against prevention? A map of policy actors favoring smoking in Spain]. / ¿Quién se opone a la prevención? Un mapa de los actores pro tabaco en España.

OBJECTIVES: For a comprehensive approach to policies on smoking, the map of actors related to tobacco and their political ties needs to be identified. The present article constitutes the first attempt at this task in Spain. METHODOLOGY: Analysis of the press, industry publications, and interviews with key people. Active actors favoring smoking in Spain were identified and classified according to their characteristics, the sphere in which they act, and their preferred territorial arena. RESULTS: We identified tobacco companies (Altadis and Philip Morris dominate the market), tobacco trade organizations (tobacconists), front-line organizations created by the tobacco industry (The Smokers for Tolerance Club), organizations of tobacco growers, and processing companies. Distribution to retailers is dominated by Logista, owned by Altadis. Other sectors to take into account are vending companies and those manufacturing related products (cigarette paper, matches or lighters). The contacts of these actors with the public administration are reviewed, notable among which are the role of the Commissioner for the Tobacco Market, the Ministry of Agriculture, the Ministry of Finance and the Ministry of the Economy. Ties were also found with employers' organizations, some political parties, and unions, as well as with other sectors with social influence such as the media and advertising sectors. CONCLUSIONS: The map of actors favoring smoking in Spain is complex and goes beyond the confines of the tobacco industry. Understanding this web is crucial to promoting comprehensive prevention policies.

Espacios sin humo: persuasión y obligación / Smoke-free areas: persuasion and enforcement

Se presentan las acciones de los servicios de salud públicaen Barcelona para conseguir un mejor cumplimiento de laLey 28/2005 de medidas sanitarias frente al tabaquismo. Éstasse concentran en una primera fase informativa y una segundaen la que se activan los mecanismos de ejercicio de la autoridadsanitaria.La implantación de la Ley en centros de trabajo, educativosy medios de transporte se saldó sin incidentes relevantes salvosucesos aislados en algún centro universitario o medio de transporte.En el sector alimentario el proceso ha sido más complejo.Se calculan 17,5 denuncias ciudadanas por 100.000 personas-año. Las inspecciones desencadenadas por denunciasciudadanas provocaron la apertura de 3,3 expedientes sancionadorespor 100.000 personas-año, en general por incluiral menos una falta grave.La implantación de la Ley ha precisado políticas activas decomunicación y el ejercicio real de la autoridad sanitaria. Estoha comportado una notable carga de trabajo para los serviciosde salud pública(AU)

This paper presents the actions taken by the public healthservices in the city of Barcelona (Catalonia, Spain) to improvecompliance with the requirements of the new 28/2005 tobaccocontrol law. These were essentially informative at first,with a second phase where authority enforcement mechanismswere activated.In workplaces, educational settings and transport the law wasincorporated without incidents nor relevant complaints, exceptfor isolated incidents in some university or mass transport settings.In food establishments the process has been more complex.Estimating the frequency of related events, there are 17.5formal citizen complaints for 100,000 person-years. Inspectionsgenerated by citizen complaints resulted in 3.3 administrativeproceedings for 100,000 person-years, mostly for incurringin serious violations.Effectively enforcing the law required active information andcommunication policies, as well as the real enforcement byhealth authority. This caused an important workload to the publichealth services(AU)

Prevalencia del consumo de tabaco en España entre 1945 y 1995. Reconstrucción a partir de las Encuestas Nacionales de Salud / A retrospective analysis based on the Spanish National Health Interview Surveys

FUNDAMENTO Y OBJETIVO: Analizar la evolución del consumo de cigarrillos en España entre 1945 y 1995. MATERIAL Y MÉTODO: A partir de la información individual sobre consumo de tabaco recogida en las Encuestas de Salud de España de 1993, 1995 y 1997 se ha reconstruido la prevalencia de fumadores de cigarrillos diarios para el período 1945-1995. RESULTADOS: En los varones, la prevalencia de tabaquismo en 1945 fue del 42,4 per cent (intervalo de confianza [IC] del 95 per cent, 40,1-44,7 per cent), aumentó hasta llegar al 59,1 per cent en 1975 (IC del 95 per cent, 58,0-60,2 per cent), se estabilizó a continuación durante la década 1975-1985 y disminuyó hasta la actualidad hasta el 48,9 per cent (IC del 95 per cent, 48,1-49,7 per cent) en 1995. En las mujeres, la prevalencia de tabaquismo fue inferior al 5 per cent hasta la década de los setenta, momento en que empieza a aumentar de manera sostenida hasta el final del período de estudio, con una prevalencia en 1995 del 22,5 per cent (IC del 95 per cent, 21,9-23,1 per cent). CONCLUSIONES: Este análisis permite apreciar la diferente dinámica de la epidemia de tabaquismo entre varones y mujeres en España (AU)

Propuesta marco de reorganización de la salud pública en Cataluña / Proposal for the reorganization of public health in Catalonia, Spain

La reforma de la salud pública está aún pendiente y es necesario avanzar en una propuesta organizativa que permita dar una respuesta correcta a las necesidades actuales. En este artículo un grupo de profesionales que desarrollan su trabajo en diferentes instituciones relacionadas con la salud pública en Cataluña dan su opinión y reflexiones sobre esta reestructuración. Se analiza lo que hace la salud pública y qué tiene hoy, para llegar a una propuesta marco de reorganización: qué debería tener. Se definen 17 actividades básicas de salud pública y se enumeran algunas características organizativas. Se han contemplado cuatro niveles básicos de actuación (país, regional, local y atención primaria). De la interrelación de los tres componentes del modelo (actividades, organizaciones y niveles) surge una propuesta organizativa de salud pública con definición de actividades y recursos para cada grupo y nivel. La propuesta respeta el marco jurídico vigente. Cataluña contaría con una institución de salud pública a nivel central y con 8 instituciones regionales. Las instituciones regionales podrían integrar una veintena de organizaciones locales de salud pública, todas ellas integradas en red y financiadas por el sistema sanitario público. Barcelona ciudad aparece como una realidad específica. Los equipos de atención primaria deberían simultanear la dimensión asistencial y la de salud pública. Esta organización comporta que el gerente de región ostente la responsabilidad de las actividades de salud pública que se lleven a cabo en el territorio, como ya tiene hoy la responsabilidad de las actividades asistenciales. Se estima que en Cataluña alrededor de 1.500 profesionales a tiempo completo desarrollan tareas de salud pública directamente, y unos 500 más trabajan en tareas subcontratadas relacionadas con la garantía de servicios. Estos recursos representan aproximadamente un profesional/3.000 habitantes. Partiendo de estos recursos, se formula una propuesta orientadora de volumen de recursos técnicos que deberían dedicarse a la prestación de la salud pública en Cataluña. La definición de una cartera de servicios y la relación contractual con el Servei Català de la Salut se consideran elementos necesarios para alcanzar un trabajo homogéneo en el territorio (AU)

Public health reform is still pending and an organizational proposal that would provide an appropriate response in needed. In this article, a group of health professionals working in various public health institutions in Catalonia (Spain) express their opinion on this restructuring. We analyze what public health does, what is currently has at its disposal and what us should have to achieve a proposed reorganizational framework. Seventeen basic public health activities are defined and some organizational characteristics are described. Four basic levels of activity are envisaged (national, regional, local and primary care). The interrelation between the model's three components (activities, organizations and levels) forms the basis of the proposal for public health oeganization in which the activities and resources for each group and level are defined. The proposal respects the legal framework currently in force. Catalonia would have a central public health institution with eight regional institutions. The regional institutions could integrate approximately twenty local public health organizations, all of which would be integrated into the network and financed by the public health system. The city of Barcelona would be a specific entity. Primary care centers should combine health care and public health functions. In this organizational model the regional director, in addition to being responsible for health care activities (the current situation),would also be responsible for the public health activities performed in the region. In Catalonia, approximately 1,500 full-time health professionals are directly engaged in public health activities related to the guarantee of services. These resources represent approximately 1 health care professional/3,000 inhabitants. Based on these resources, we formulate a suggested proposal for the volume of technical resources that shouls be devoted to the provision of public health in Catalonia. The definition of a portfolio of services and the contractual relationship with the Catalan health systems are considered essential elements to achieve homogeneous work in the region (AU)