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A lo largo de las últimas décadas, la prevalencia del tabaquismo ha seguido en la Unión Europea tendencias diferentes según el sexo. Mientras que entre los varones la prevalencia ha disminuido notablemente, entre las mujeres se ha incrementado o se ha estancado. En algunos países en que estos cambios se iniciaron más precozmente, la prevalencia del tabaquismo es hoy mayor entre las mujeres que entre los varones. Este documento cuantifica estas tendencias, con referencia a la situación española. En 1995, fumaban 60 millones de hombres y 42 millones de mujeres en la Unión Europea. El 48% de las fumadoras consumían cigarrillos light, lo que supone veinte millones de mujeres que los utilizan. Hay documentos de la industria del tabaco que indican que la promoción de cigarrillos light tiene como intención tranquilizar a sus clientes y frenar a quienes se preocupan por el mantenimiento de su salud y se plantean dejar de fumar. Hay datos que confirman que esta política consigue sus objetivos y que las concepciones erróneas de los fumadores sobre los cigarrillos light puede hacerles persistir en el consumo. Existen datos que indican que el tabaco puede jugar un papel en el control del peso. Las mujeres están más preocupadas por su peso que los hombres, y para las mujeres jóvenes la imagen corporal es muy importante. Éstas tienen a menudo la percepción de tener exceso de peso. Aunque es más común el miedo al sobrepeso que el exceso de peso real, la evidencia sugiere que el temor a ganar peso puede mantener a las mujeres en el hábito de fumar, y que las consideraciones sobre cómo mantener el control del peso influyen en las mujeres jóvenes al comenzar a fumar. El consejo sobre cómo controlar el peso debería formar parte de los programas de tratamiento del tabaquismo dirigidos a las mujeres. Además, cualquier intervención preventiva sobre mujeres adolescentes fumadoras debería abordar la cuestión del aumento de peso.

This paper presents a strategic analysis of the prevention of the harm caused by alcohol in Spain. The alcohol action plan of the European Office of the WHO offers a guide for the development of the most effective control policies. Following its scheme, the current situation and the prevention policies are reviewed with data available in 2020. Strategies and key actions for the future are proposed, considering as major goals to curb the early abuse of alcohol by adolescents and to reduce the risk consumption of the population at large. Besides helping persons with abuse criteria from health services, key actions for prevention include public policies such as fiscal, marketing and availability regulations, and drink driving measures. Some have followed a favorable evolution in Spain, but for others there is wide room for improvement.

Objective: Many teenagers experiment with addictive substances such as alcohol. The objective of this study was to estimate the frequency of binge drinking among secondary school students and its relationship with sex, grade, and type of school, as well as with urban contextual factors of the school neighborhood: socioeconomic level, density of alcohol outlet premises, and tourist pressure., Methods: This was an observational cross-sectional study. The study population were the students of 8th and 10th grade (2nd and 4th year of ESO) in the city of Barcelona in 2016. Alcohol use, sex, grade, type of school and school neighborhood were taken from the FRESC survey. The wealth of the neighborhood and tourist pressure were extracted from municipal statistics. The density of alcohol outlets was obtained by direct observation with the OHCITIES instrument. We estimated the prevalence of binge drinking (consumption of five or more units on one occasion) stratifying by age, sex and ownership of the school. We calculated a robust Poisson regression model with the individual and contextual variables and analyzed the situation of those neighborhoods with the highest prevalence of binge., Results: The self-declared frequency of binge drinking in the last 30 days was 6.1% in this sample of 2,329 students, 2.2% in 8th grade and 10.3% in 10th grade. It was higher in boys (7%) than in girls (5.1%), and slightly higher in private subsidized schools (6.4%) than in public schools (5.5%). In the Poisson regression models, neither the coefficients of the three contextual variables nor the type of school reached statistical significance, contrary to those obtained with the individual variables of sex and year. The adjusted prevalence of binge in the 36 neighborhoods ranged from 0 to 18.2%. Comparing the contextual variables of the 8 neighborhoods with the lowest prevalence of binge with the others, both a greater density of local alcohol sales and higher tourism pressure were associated with a higher prevalence of binge drinking, while for wealth there were no significant differences., Conclusions: The use of alcohol in early adolescence is related to individual variables such as sex and age. Urban contextual factors such as a higher tourist pressure and the density of premises that sell alcohol may exert also some influence., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: Gambling may cause a variety of problems, both health and social, to the player, his family and his environment; Problems can be more serious for those who gamble more frequently or bet more money. Beyond the mental health gambling disorder and considering other harms derived from gambling, it is possible to develop a public health approach to the issue, including both prevention and harm reduction aspects. In recent decades gambling availability has expanded, with attempts at regulation. The objective of this paper is to provide basic information about gambling in Spain, stratifying data by Autonomous Communities (AC), from a public health perspective., Methods: A descriptive study of some aspects of gambling in Spain was carried out. The data for amounts gambled by participants, gross gaming revenue of the industry, and establishments or machines licensed for the year 2017 were extracted from the available systematic sources. Aggregated data were tabulated and stratified by AC for those presential gambling categories with the greatest compulsive gambling potential and relevant business volume. Crude results and ratios per 100,000 inhabitants were calculated., Results: Up to 41,826.8 million euros were spent gambling throughout Spain in 2017, a figure that exceeds 3.5% of the Gross Domestic Product, and the largest segment was online gambling in its various modalities (32%), followed by the national lottery and similar traditional games (27%). The supply of gambling venues (74.9 establishments per million inhabitants) was assessed by AC, showing large differences among them: their density in the region of Murcia is tenfold that of Catalonia. Gambling machines that can be installed in hospitality establishments (B machines) showed a density of 43.4 per 1,000 inhabitants, with greater homogeneity across AC than gambling premises. Regional data on the amounts spent in casinos, bingo cards, and sports betting show no homogeneous patterns., Conclusions: The volume of money spent on gambling in Spain is very important, and online gambling has become the largest business segment. The most traditional game modes and probably with less addictive potential such as lotteries and draws continue to have a relevant presence. The availability of presential gambling shows wide heterogeneity among AC, especially for licensed gambling establishments, whose density is ten times greater in the community with more supply compared to the one with less. The data by AC of some game modalities suggest that availability may be a relevant factor for gambling, but not the only one., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

This paper presents a strategic analysis of the prevention of smoking in Spain. After a review of the situation of the epidemic and of the current prevention policies with the data available in 2019, it identifies the main problems to improve the prevention of smoking, while proposing strategies and key actions for the future. Considering as major objectives reducing the initiation of smoking and helping smokers quit, the different strategies of action and the key actions to be developed. In addition to helping smokers to stop smoking from the health services, key preventive actions include several public policies including taxation, banning advertising and other forms of promotion, the regulation of tobacco packaging, the expansion of smoke-free spaces, and information to the public on its effects. Some of them have followed a positive path for prevention in Spain but for others there is wide room for improvement. The MPOWER strategy of the WHO offers a guide for the development of the most effective tobacco control policies. In its light it is recommended to put emphasis on actions related to expanding smoke-free areas, to develop distance support services to stop smoking, to periodically carry out advertising campaigns of wide coverage to encourage quitting, to reinforce support for quitting in health care services, to finance pharmacological treatments, to expand the advertising ban to electronic devices that release nicotine, and to increase the tax burden on tobacco and other products delivering nicotine.

Objective: The health system in Spain rests mostly in the Autonomous Communities (similar to the states in the US). The public health activities of many local governments are little studied. The objective of this work was to bring knowledge about the public health activities of the municipalities, providing information obtained from a recent survey in Catalonia., Methods: Descriptive study based on a survey to public health officers in the 119 municipalities above 10,000 population in Catalonia, excluding the city of Barcelona. The survey was conducted between May and October 2016, with 103 municipalities (86.6%) reporting on their services in 2015, prior to the survey. Data were collected and descriptive analyses performed., Results: A consolidation of both political and professional public health structures of the municipalities was observed. Most frequent activities in health protection were related to legionella control, the control of urban pests and the management of complaints and requests by citizens. Most frequent activities in the field of health promotion were related to physical activity and health, prevention in tobacco and alcohol, food and nutrition. There were relatively few changes reported in public health structures and their officers, as well as in human resources., Conclusions: In Catalonia, municipalities above 10,000 population have a remarkable level of activity in public health. Both the areas of health protection (with mandatory minimum services for local governments) and of health promotion show high levels of activity. The system seems stable regarding political changes and budget constraints. There are opportunities for improvement in the training of professionals and service accreditation. It would be desirable to find ways to improve coordination among these services., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

The impact on health of alcohol in a given society is mainly related with the volume and pattern of drinking, and these are related with individual factors, but also with environmental factors, among which public policies are important determinants. Public policies may favour or reduce alcohol use, and thus have a substantial preventive capacity. The effectiveness of policies to prevent the harm caused by alcohol has been reviewed in recent documents, which provide evidence to extract recommendations. This paper reviews the most effective policies to reduce the harm caused by alcohol, with an emphasis in the use of taxes to increase its cost, availability regulation, and policies on drinking and driving. The regulation of alcohol promotion and publicity is also assessed, as well as the detection and treatment of alcohol abuse and dependence. The state of alcohol related policies in Spain is analysed, as well as the obstacles, for the adoption of policies more prone to prevention, and recommendations for the future are made.

Background: The National Plan for Drugs in Spain (PNSD) fostered the prevention and treatment of illegal drug use disorders, and now also covers alcohol use disorders. The goal of this paper is to estimate the number of persons in specialized treatment because of alcohol in public services., Methods: Review of the key documents of the PNSD, the drug information system of Catalonia, and the Barcelona drug information system. For Catalonia and Barcelona data from 1991 to 2010 are presented., Results: In recent years, there has been more information available for Spain as a whole, of varying validity and comprehensiveness. In Catalonia, the number of reported admissions to treatment for alcohol use disorders has risen: alcohol causes yearly over 40% of all admissions in the drug addiction treatment network; mean age is 44 years, and 23% are women. In Barcelona, admissions to treatment due to alcohol are more than 2.000 each year, relative frequency is 217 by 100.000 residents over 15 years for men and 67 for women., Conclusions: Available data shows that for alcohol, the drug information system needs further development in Spain, solving methodological issues. Available data for Catalonia suggests that the network of drug treatment centres has improved treatment for alcohol use disorders along with that of illegal drugs. This information is relevant, as there is almost no population based treatment data. This information should be completed for other Regional Administrations.

Background: The Drugs Advice Service (SOD in its Catalan acronym) in Barcelona (Catalonia, Spain) provides an Information and Guidance Program (IGP) for teenagers, and an Alternative Measures Program (AMP) targeting minors fined for consumption / possession of illegal drugs in public spaces. This study describes these programs and compares the profiles of their users., Methods: Cross-sectional descriptive study of 1,010 people discharged from the two SOD programs in 2008-10 after screening for psychiatric disorders and addiction and an extended brief intervention for subjects without pathology. The profiles of the users were compared, and age-specific rates of AMP use were calculated., Results: Cannabis causes 89.9% of entries in the SOD. The proportion of IGP users with high risk criteria for cannabis is 13.3% and with risk for alcohol 11.3%, while in AMP it is 8.9%, and 4%. Criteria for substance dependence or abuse or another psychiatric disorder caused referral of 6% of AMP users and 38% of IGP users., Conclusions: Adolescents in the AMP had a pattern of cannabis use (and often of alcohol) of low or moderate risk, compared to IGP. Beyond the value of the indicated prevention intervention, the programmes facilitate the early detection and referral of problematic substance use and mental disorders in early stages.

After a quarter century of annual health reports in the city of Barcelona, this study documents the experience and draws some elements that may be useful in other contexts, specifying the analysis on the Health Report of 2008. We show the conceptual framework, the process of preparing the report, sources of information used and the contents. We evaluate the dissemination of the health report, both at the political level, as well as the media, professionals and the public. Furthermore, we examine the impact of the report as a tool for social change and planning.

This paper concentrates on the port folio of public health services in the National Health System, with an inventory of those provided by the central level of government in the currently decentralized context of Spain. There is an important activity in public health, with some dispersion among different bodies and organisations. Most of the current activities of the central level of government concentrate in monitoring health levels and their determinants, managing information systems and health alerts and warnings, but with an involvement in policy development, both as a counterpart of the European Union and as an active agent with both regional levels of government and other organisations influencing public health. Besides, this level of government assures some essential services with little visibility for the general population as they are mostly delivered to other public administrations or to professional groups.

The implementation in 2006 of the law 28/2006 for smoking prevention was a milestone for modern public health in Spain. This law regulated three aspects: it banned the direct and indirect tobacco publicity and sponsorship, it reduced points of sale, and it banned smoking in enclosed workplaces and public spaces, with exemptions concentrating in the restaurant and hospitality sector. As it was implemented, other changes with preventive capacity were adopted: taxes on cigarettes were raised, and there were more resources for prevention and treatment, besides information campaigns and an intensive social debate on smoking. To evaluate the isolated effect of the law is complex, but in this paper we make an attempt by reviewing all the available information, despite its heterogeneity. More than three years after its implementation there are elements suggesting a positive impact on smoking prevalence among teens, in the general consumption of cigarettes and in acute myocardial infarction morbidity. Public policies are important for smoking prevention and to improve population s health, as they create a context conducive to smoking cessation. To reach further progress in smoking prevention in Spain, the current exemption for bars and restaurants in the smoking ban should be removed, and the taxation of tobacco products should be increased.

The prevention movement has been the key agent involved in smoking control policies. This study describes the context and the process in which Law 28/2005 was passed in Spain with a synthesis of its substance. It provides the background of the events leading up to Spain's current smoking control law in addition to an analysis of the role played by the different social actors in the process and the arguments and strategies employed in opposition by the tobacco industry. A review is also provided of the political agents, highlighting that decentralized countries have further problems in enforcing regulations. This case offers lessons for the future.

In the year 2004 the government of Catalonia undertook a process to reform its public health services. In this context, it created a working groupinvolving experts from diverse backgrounds to analyse the reforms to be undertaken, the Scientific Committee for the Reform of Public Health in Catalonia. Its members produced eight documents on specific aspects of public health, from which a global report of the Committee was compiled by the end of 2005. This paper makes a synthesis of their production, and includes as an annex their recommendations and proposals. Public health policies should be structured around three main goal: the reduction of health inequalities, the control and removal of social and environmental risks, and effective improvements in quality of life. To reach them, common criteria are defined as main directions. These are based in favouring decentralization of public health services and their administration, linking public health activities with health care services, designing interventions with a population perspective, and reinforcing cross-sectional implications of public health. The work of this Committee is produced in the context of an international debate on the future of public health services and the disproportion between its contribution to health and well being and its resources and visibility. The Committee produced proposals and recommendations which can he grouped in five facets: consolidating a solid and coherent system, developing an organizational reform, defining a port-folio of services, adopting improvements in management, and taking into account cross sectional aspects relating to public health.