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Evidence-based interventions recommended in the Framework Convention on Tobacco Control of the World Health Organization (WHO FCTC) are subject to implementation factors that might affect their actual effectiveness. The Colombian law enacting key commitments from WHO’s FCTC was signed in 2009. This study aims at evaluating the potential impact of the enactment and implementation of these WHO FCTC on four outcomes for tobacco consumption (last-year cigarette smoking prevalence, prevalence of heavy smokers, prevalence of lower-intensity smokers and monthly smoking incidence). We used data from the National Psychoactive Substances Consumption Survey (NPSCS) in 2008 (n = 29 164) and 2013 (n = 32 605), and assessed changes in these four outcomes WHO FCTC using propensity score matching (PSM). Propensity scores were obtained using key socio-demographic variables and by matching through a ‘Kernel’ estimation. Matching quality tests were performed. The common support for both survey samples was 60 793. Sub-analyses were conducted using a governance index to assess the effect of heterogeneous governance levels, proxying implementation, over the country. We found that cigarette year-prevalence and cigarette month-incidence decreased after matching around 8 and 1.2 percentage points between 2008 and 2013, respectively. Consumption might have shifted, at least partially, from heavy smoking towards lower-intensity smoking. Departments with a higher governance index showed larger reductions of tobacco use, possibly associated to a stronger WHO FCTC implementation. This study highlights the impact that the WHO FCTC had on tobacco consumption in a middle-income country and shows the importance of governance strength as a mediating mechanism for WHO FCTC impact. These results advance current knowledge on the effectiveness of WHO FCTC and shed light on the relevance of governance as a key factor in the WHO FCTC implementation.

Public health surveys deployed through automated mobile phone calls raise a set of ethical challenges, including succinctly communicating information necessary to obtain respondent informed consent. This study aimed to capture the perspectives of key stakeholders, both experts and community members, on consent processes and preferences for participation in automated mobile phone surveys (MPS) of non-communicable disease risk factors in Colombia. We conducted semi-structured interviews with ethics and digital health experts and focus group discussions with community representatives. There was meaningful disagreement within both groups regarding the necessity of consent, when the purpose of a survey is to contribute to the formulation of public policies. Respondents who favored consent emphasized that consent communications ought to promote understanding and voluntariness, and implicitly suggested that information disclosure conform to a reasonable person standard. Given the automated and unsolicited nature of the phone calls and concerns regarding fraud, trust building was emphasized as important, especially for national MPS deployment. Community sensitization campaigns that provide relevant contextual information (such as the name of the administering institution) were thought to support trust-building. Additional ways to achieve the goals of consent while building trust in automated MPS for disease surveillance should be evaluated in order to inform ethical and effective practice.

In Bogotá, Colombia, motorcyclists represent a concern as the proportion of motorcycle users between 2013 and 2018 has increased from 18% to 35%. Despite available risk reduction strategies, the fatality rates are also growing, notably in young adults (15-29 years old). This study aims at identifying correct helmet use patterns and its relationship with official records of injuries and casualties in the city over time.Between 2015 and 2018, semiannual observational studies of motorcycle users in six randomly selected sites in Bogotá were conducted. Data was collected and analyzed on the number of occupants per vehicle (driver and passengers), gender, approximate age, type of helmet, and whether it was correctly used (strapped) or not. Bivariate and multivariate analyses were performed to identify the determinants of correct helmet use. Additionally, a spatial analysis was conducted to estimate the relationship between motorcycle's casualties and correct use of the helmet (full-face helmet use) prevalence.A total of 77,932 motorcycles were observed, showing a high prevalence of helmet use (99% for drivers and passengers), but only 88% use it correctly (89% drivers and 82% passengers). The presence of enforcement (camera or police personnel) increases the correct use of the helmet, especially in principal roads. Female, adults, and single riders are more likely to correctly wear the helmet. Finally, there is a relationship between the concentration of the fatalities and the incorrect helmet use in 80% of the observational sites.Incorrect helmet use has been found by the study to be related to higher mortality among motorcycle occupants in Bogotá. Our data shows that enforcement increases correct helmet use with the potential to reduce deaths among motorcycle occupants.

Background Data collection on noncommunicable disease (NCD) behavioral risk factors has traditionally been carried out through face-to-face surveys. However, its high costs and logistical difficulties can lead to lack of timely statistics for planning, particularly in low and middle-income countries. Mobile phone surveys (MPS) have the potential to fill these gaps. Objective This study explores perceptions, feasibility and strategies to increase the acceptability and response rate of health surveys administered through MPS using interactive voice response in Colombia. Method A sequential multimodal exploratory design was used. We conducted key informant interviews (KII) with stakeholders from government and academia; focus group discussions (FGDs) and user-group tests (UGTs) with young adults and elderly people living in rural and urban settings (men and women). The KII and FGDs explored perceptions of using mobile phones for NCD surveys. In the UGTs, participants were administered an IVR survey, and they provided feedback on its usability and potential improvement. Results Between February and November 2017, we conducted 7 KII, 6 FGDs (n = 54) and 4 UGTs (n = 34). Most participants consider MPS is a novel way to explore risk factors in NCDs. They also recognize challenges for their implementation including security issues, technological literacy and telecommunications coverage, especially in rural areas. It was recommended to promote the survey using mass media before its deployment and stressing its objectives, responsible institution and data privacy safeguards. The preferences in the survey administration relate to factors such as skills in the use of mobile phones, age, availability of time and educational level. The participants recommend questionnaires shorter than 10 minutes. Conclusions The possibility of obtaining data through MPS at a population level represents an opportunity to improve the availability of risk-factor data. Steps towards increasing the acceptability and overcoming technological and methodological challenges need to be taken.

Comparability of population surveys across countries is key to appraising trends in population health. Achieving this requires deep understanding of the methods used in these surveys to examine the extent to which the measurements are comparable. In this study, we obtained detailed protocols of 8 nationally representative surveys from 2007–2013 from Brazil, Chile, Colombia, Mexico, the United Kingdom (England and Scotland), and the United States—countries that that differ in economic and inequity indicators. Data were collected on sampling frame, sample selection procedures, recruitment, data collection methods, content of interview and examination modules, and measurement protocols. We also assessed their adherence to the World Health Organization's “STEPwise Approach to Surveillance” framework for population health surveys. The surveys, which included half a million participants, were highly comparable on sampling methodology, survey questions, and anthropometric measurements. Heterogeneity was found for physical activity questionnaires and biological samples collection. The common age range included by the surveys was adults aged 18–64 years. The methods used in these surveys were similar enough to enable comparative analyses of the data across the 7 countries. This comparability is crucial in assessing and comparing national and subgroup population health, and to assisting the transfer of research and policy knowledge across countries.

To assess the effect of a permanent gun-carrying restriction on gun-related mortality in Colombia between 2008 and 2014, and determine differences in the effect of the restriction by place of death and sex.In 2012, Bogotá and Medellín introduced a permanent gun-carrying restriction. We compared gun-related mortality rates in these cities (intervention cities) with the rates in all other Colombian cities with more than 500 000 inhabitants (control cities). We used data from the Colombian National Department of Statistics to calculate monthly gun-related mortality rates between 2008 and 2014 for intervention and control cities. We used a differences-in-differences method with fixed effects to assess differences in gun-related mortality in intervention and control cities before and after the introduction of the gun-carrying restriction. We stratified effects by place of death (public area or residence) and sex. We made robustness checks to test the assumptions of the models.Gun-related deaths in the control and intervention cities decreased between 2008 and 2014; however, the decrease was greater in the intervention cities (from 20.29 to 14.93 per 100 000 population; 26.4%) than in the control cities (from 37.88 to 34.56 per 100 000 population; 8.8%). The restriction led to a 22.3% reduction in the monthly gun-related mortality rate in Bogotá and Medellín. The reduction was greater in public areas and for males. Robustness checks supported the assumptions of the models.The permanent restriction on carrying guns reduced gun-related deaths. This policy could be used to reduce gun-related injuries in urban centres of other countries with large numbers of gun-related deaths.Évaluer l'impact d'une restriction permanente du port d'armes sur le taux de mortalité lié aux armes à feu en Colombie entre 2008 et 2014, et déterminer les différences d'impact de cette restriction en fonction du lieu du décès et du sexe.En 2012, Bogotá et Medellín ont instauré une restriction permanente du port d'armes. Nous avons comparé les taux de mortalité liés aux armes à feu dans ces villes (villes d'intervention) avec les taux observés dans l'ensemble des autres villes colombiennes de plus de 500 000 habitants (villes de contrôle). Les données fournies par le Département administratif national de la statistique en Colombie nous ont permis de calculer les taux de mortalité liés aux armes à feu entre 2008 et 2014 dans les villes d'intervention et de contrôle. Nous avons utilisé la méthode des doubles différences à effets fixes pour mesurer les disparités entre la mortalité liée aux armes à feu dans les villes d'intervention et de contrôle, avant et après l'instauration de la restriction du port d'armes. Nous avons ensuite segmenté les résultats en fonction du lieu du décès (espace public ou domicile) et du sexe. Nous avons également procédé à des tests de robustesse pour évaluer les hypothèses des modèles.Les décès causés par des armes à feu dans les villes de contrôle et d'intervention ont diminué entre 2008 et 2014. Cependant, la diminution était plus importante dans les villes d'intervention (de 20,29 à 14,93 par 100 000 habitants ; 26,4 %) que dans les villes de contrôle (de 37,88 à 34,56 par 100 000 habitants ; 8,8 %). La restriction a entraîné une baisse de 22,3 % de la mortalité mensuelle liée aux armes à feu, tant à Bogotá qu'à Medellín. Cette baisse s'est avérée plus importante dans les espaces publics et pour les individus de sexe masculin. Les tests de robustesse ont confirmé les hypothèses des modèles.La restriction permanente du port d'armes a un impact positif sur la mortalité liée aux armes à feu. Cette politique pourrait être employée par d'autres pays où le nombre de décès attribuables aux armes à feu est élevé, afin de réduire le nombre de blessures par balles dans les centres urbains.Evaluar el efecto de una restricción permanente al porte de armas en la mortalidad relacionada con las armas en Colombia entre 2008 y 2014, y determinar las diferencias en el efecto de la restricción por lugar de muerte y sexo.En 2012, Bogotá y Medellín establecieron una restricción permanente al porte de armas. Se compararon las tasas de mortalidad por arma de fuego en estas ciudades (ciudades de intervención) con las tasas en todas las demás ciudades colombianas con más de 500.000 habitantes (ciudades de control). Se utilizaron los datos del Departamento Nacional de Estadística de Colombia para calcular las tasas mensuales de mortalidad por armas de fuego entre 2008 y 2014 para las ciudades de intervención y control. Se utilizó un método de diferencia en diferencias con efectos fijos para evaluar las diferencias en la mortalidad relacionada con armas de fuego en las ciudades de intervención y control antes y después del establecimiento de la restricción al porte de armas. Se estratificaron los efectos por lugar de muerte (área pública o residencia) y sexo. Se realizaron controles de solidez para probar los supuestos de los modelos.Las muertes relacionadas con armas de fuego en las ciudades de control e intervención disminuyeron entre 2008 y 2014; sin embargo, la disminución fue mayor en las ciudades de intervención (de 20, 29 a 14,93 por cada 100.000 habitantes; 26,4 %) que en las ciudades de control (de 37,88 a 34,56 por cada 100.000 habitantes; 8,8 %). La restricción condujo a una reducción del 22,3 % en la tasa mensual de mortalidad relacionada con armas de fuego en Bogotá y Medellín. La reducción fue mayor en las áreas públicas y en los hombres. Los controles de solidez apoyaron los supuestos de los modelos.La restricción permanente al porte de armas redujo las muertes relacionadas con las armas. Esta política podría ser utilizada para reducir las lesiones relacionadas con armas de fuego en los centros urbanos de otros países con un gran número de muertes relacionadas con este tipo de armas.تقييم تأثير التقييد الدائم لحمل السلاح على الوفيات المرتبطة بالأسلحة في كولومبيا بين عامي 2008 و2014، وتحديد الاختلافات في تأثير التقييد حسب مكان الوفاة والجنس.قامت كل من بوجوتا وميديلين في عام 2012، بفرض تقييد دائم على حمل السلاح. وقمنا بمقارنة معدلات الوفيات المرتبطة بالأسلحة في هاتين المدينتين (مدن التدخل)، بالمعدلات المقابلة لها في جميع المدن الكولومبية الأخرى التي يزيد عدد سكانها عن 500000 نسمة (مدن السيطرة). وقمنا بالاستعانة بالبيانات من إدارة الإحصاءات الوطنية الكولومبية لحساب معدلات الوفيات الشهرية المرتبطة بالسلاح بين عامي 2008 و2014 في مدن التدخل والسيطرة. كما استخدمنا طريقة الاختلافات في الفارق ذات التأثيرات الثابتة، لتقييم الاختلافات في الوفيات المرتبطة بالأسلحة النارية في مدن التدخل والسيطرة قبل وبعد فرض قيود حمل السلاح. وقمنا بتصنيف التأثيرات حسب مكان الوفاة (المنطقة العامة أو مقر الإقامة) والجنس. كما أجرينا فحوصات فعالية لاختبار افتراضات النماذج.انخفض معدل الوفيات المرتبطة بالأسلحة في مدن السيطرة والتدخل بين عامي 2008 و2014؛ إلا أن الانخفاض كان أكبر في مدن التدخل (من 20.29 إلى 14.93 لكل 100000 نسمة؛ 26.4%)، منه في مدن السيطرة (من 37.88 إلى 34.56 لكل 100000 نسمة؛ 8.8%). أدى التقييد إلى انخفاض بنسبة 22.3% في معدل الوفيات الشهرية المرتبطة بالسلاح في بوجوتا وميديلين. كان الانخفاض أكبر في المناطق العامة، وبالنسبة للذكور. كما أيدت فحوصات الفعالية افتراضات النماذج.أدى التقييد الدائم على حمل السلاح إلى خفض الوفيات المرتبطة بالأسلحة. يمكن استخدام هذه السياسة للحد من الإصابات المرتبطة بالأسلحة في المراكز الحضرية في البلدان الأخرى ذات الأعداد الكبيرة من الوفيات المرتبطة بالأسلحة.旨在评估 2008 年至 2014 年哥伦比亚实施的永久性持枪限制对涉枪死亡率的影响，并根据死亡地点和性别确定限制效果的差异。.2012 年，波哥大和梅德林实施了永久性持枪限制。我们比较了这两座城市（干预城市）与居住人口超过 500 000 的所有其他哥伦比亚城市（控制城市）的涉枪死亡率。我们使用哥伦比亚国家统计局的数据，计算 2008 年至 2014 年干预城市和控制城市每月涉枪事件的死亡率。我们采用具有固定效应的倍差法来评估实施持枪限制前后干预城市和控制城市涉枪死亡率的差异。我们根据死亡地点（公共区域或居民区）和性别对影响进行分层。我们开展了稳健性检验来验证模型的假设。.2008 年至 2014 年间，控制城市和干预城市中涉枪事件的死亡人数有所下降；但干预城市的下降幅度（从每 100 000 人口 20.29 下降至 14.93；26.4%）大于控制城市（从每 100 000 人口 37.88 下降至 34.56；8.8%）。这一限制导致波哥大和梅德林每月涉枪死亡率下降 22.3%。这一数字在公共区域和男性中的减少幅度更大。稳健性检验支持模型的假设。.对携带枪支的永久性限制减少了涉枪死亡率。对于涉枪死亡人数较多的其他国家而言，这项政策可以用来减少其城市中心地区涉枪事件带来的损伤。.Оценить влияние постоянного ограничения на ношение оружия на уровень смертности от огнестрельных ранений в Колумбии в период с 2008 по 2014 годы и определить различия в эффективности ограничения в зависимости от места гибели и пола жертвы.В 2012 году в городах Богота и Медельин были введены постоянные ограничения на ношение оружия. Авторы сравнили уровень смертности от огнестрельного оружия в этих городах (города проведения вмешательства) с показателями в других колумбийских городах с населением более 500 000 жителей (контрольные города). Для расчета показателей смертности от огнестрельных ранений в городах проведения вмешательства и контрольных городах использовались данные Национального административного департамента статистики Колумбии за период с 2008 по 2014 годы. Авторы применили метод «разность разностей» с фиксированными эффектами для оценки разницы в показателях смертности от огнестрельных ранений в городах проведения вмешательства и контрольных городах до и после вступления в силу ограничений на ношение оружия. Эффекты были стратифицированы по месту гибели (в общественном месте или дома) и полу жертв. Для проверки модельных предположений авторы провели проверку надежности результатов.Уровень смертности от огнестрельных ранений в период с 2008 по 2014 годы снизилась как в городах проведения вмешательства, так и в контрольных городах; однако в городах проведения вмешательства снижение было значительнее (с 20,29 до 14,93 человека на 100 000 населения; 26,4%), чем в контрольных городах (с 37,88 до 34,56 человека на 100 000 населения; 8,8%). Ежемесячный показатель смертности от огнестрельных ранений в городах Богота и Медельин вследствие введенного ограничения снизился на 22,3%. Снижение было значительнее выражено для общественных мест и для мужчин. Проверка надежности результатов подтвердила основные предположения модели.Постоянное ограничение на ношение оружия уменьшило количество погибших от огнестрельных ранений. Этот подход может использоваться для уменьшения травматизма от огнестрельных ранений в городских центрах других стран с высокими показателями смертности от огнестрельных ранений.

Background Contact tracing is a crucial part of the public health surveillance toolkit. However, it is labor-intensive and costly to carry it out. Some countries have faced challenges implementing contact tracing, and no impact evaluations using empirical data have assessed its impact on COVID-19 mortality. This study assesses the impact of contact tracing in a middle-income country, providing data to support the expansion and optimization of contact tracing strategies to improve infection control. Methods We obtained publicly available data on all confirmed COVID-19 cases in Colombia between March 2 and June 16, 2020. (N = 54,931 cases over 135 days of observation). As suggested by WHO guidelines, we proxied contact tracing performance as the proportion of cases identified through contact tracing out of all cases identified. We calculated the daily proportion of cases identified through contact tracing across 37 geographical units (32 departments and five districts). Further, we used a sequential log-log fixed-effects model to estimate the 21-days, 28-days, 42-days, and 56-days lagged impact of the proportion of cases identified through contact tracing on daily COVID-19 mortality. Both the proportion of cases identified through contact tracing and the daily number of COVID-19 deaths are smoothed using 7-day moving averages. Models control for the prevalence of active cases, second-degree polynomials, and mobility indices. Robustness checks to include supply-side variables were performed. Results We found that a 10 percent increase in the proportion of cases identified through contact tracing is related to COVID-19 mortality reductions between 0.8% and 3.4%. Our models explain between 47%-70% of the variance in mortality. Results are robust to changes of specification and inclusion of supply-side variables. Conclusion Contact tracing is instrumental in containing infectious diseases. Its prioritization as a surveillance strategy will substantially impact reducing deaths while minimizing the impact on the fragile economic systems of lower and middle-income countries. This study provides lessons for other LMIC.

BackgroundIn Colombia, smoking is the second leading modifiable risk factor for premature mortality. In December 2016, Colombia passed a major tax increase on tobacco products in an effort to decrease smoking and improve population health. While tobacco taxes are known to be highly effective in reducing the prevalence of smoking, they are often criticised as being regressive in consumption. This analysis attempts to assess the distributional impact (across socioeconomic groups) of the new tax on selected health and financial outcomes.MethodsThis study builds on extended cost-effectiveness analysis methods to study the new tobacco tax in Colombia, and estimates, over a time period of 20 years and across income quintiles of the current urban population (80% of the country population), the years of life gained with smoking cessation and the increased tax revenues, all associated with a 70% relative price increase of the pack of cigarettes. Where possible, we use parameters that vary by income quintile, including price elasticity of demand for cigarettes (average of −0.44 estimated from household survey data).FindingsOver 20 years, the tax increase would lead to an estimated 191 000 years of life gained among Colombia’s current urban population, with the largest gains among the bottom two income quintiles. The additional annual tax revenues raised would amount to about 2%–4% of Colombia’s annual government health expenditure, with the poorest quintiles bearing the smallest tax burden increase.ConclusionsThe tobacco tax increase passed by Colombia has substantial implications for the country’s population health and financial well-being, with large benefits likely to accrue to the two poorest quintiles of the population.

Colombia has a high prevalence of overweight (56%) and obesity (19%) among adults and is experiencing a growing trend in the prevalence of associated chronic conditions. Evidence suggests that sugar sweetened beverages (SSB) are associated to overweight/obesity, and that taxes on these beverages could reduce their associated health consequences. This paper assesses the potential effect of different levels of a SSB tax in Colombia on overweight and obesity prevalence. Using peer-reviewed local data on own-price elasticity of SSB, we applied a comparative risk assessment strategy to simulate the effect of the SSB tax on a nationally representative nutritional survey with 7140 adults in 2010 (ENSIN, 2010). Our results varied depending on the tax scenario, pass-through assumption and household socio economic strata (SES). We found that among individuals belonging to lower SES households, the SSB tax would reduce overweight and obesity between 1.5-4.9 and 1.1-2.4 percentage points (p 0.05), respectively. Among individuals belonging to higher SES households, we found no statistically significant effects on obesity, and a reduction on overweight prevalence between 2.9 and 3.9 percentage points (p 0.05). In the most conservative scenario (40% pass-through), a tax rate of at least 75 cents of Colombian peso (0.75 COP) per milliliter (24% of the average price) is needed to have statistically significant effects on both overweight and obesity prevalence among lower SES households. The results of this study suggest that a SSB tax could reduce the overweight and obesity prevalence in Colombia, especially among lower SES households. This study shows that SSB taxes have a particularly beneficial effect in the most vulnerable population. Additional social and individual benefits, or individual costs arising from the tax are not assessed in this research, implying that even larger health gains could be observed.

Objectives To estimate productivity losses due to absenteeism and presenteeism and their determinants in patients with depression from five Colombian cities. Methods We used data from a multicenter, mixed-methods study of adult patients diagnosed with major depressive disorder or double depression (major depressive disorder plus dysthymia) during 2010. The World Health Organization’s Health and Work Performance Questionnaire was used to assess absenteeism and presenteeism. We explored the determinants of productivity losses using a two-part model. We also used a costing model to calculate the corresponding monetary losses. Results We analyzed data from 107 patients employed in the last 4 weeks. Absenteeism was reported by 70% of patients; presenteeism was reported by all but one. Half of the patients reported a level of performance at work at least 50% below usual. Average number of hours per month lost to absenteeism and presenteeism was 43 and 51, respectively. The probability of any absenteeism was 17 percentage points lower in patients rating their mental health favorably compared with those rating it poorly (standard error [SE] 0.09; P < 0.10) and 19 percentage points higher in patients with at least one comorbidity compared with patients with none (SE 0.10; P < 0.10). All other covariates showed no significant associations on hours lost to absenteeism. Patients with favorable mental health self-ratings had 16.4 fewer hours per month of presenteeism compared with those with poor self-ratings (SE 4.52; P < 0.01). The 2015 monetary value of productivity losses amounted to US $840 million. Conclusions This study in a middle-income country confirms the high economic burden of depression. Health policies and workplace interventions ensuring adequate diagnosis and treatment of depression are recommended.

In the South American nation of Colombia, as elsewhere, patients with type 2 diabetes often avoid care that could prevent their condition from worsening. Availability of health insurance may play a role in explaining this behavior. Some patients with diabetes skip preventive measures because they have insurance and calculate that they can access curative services later in life. Insurers may limit preventive services coverage because they can't be assured of sharing in the eventual savings that emerge when a chronic condition such as diabetes is managed properly. Our analysis of a nationally representative sample of Colombians who have type 2 diabetes and who pay premiums into the country's "contributory" insurance program, found no evidence that insurance influences those individuals to avoid preventive services. The evidence is less clear for those participating in a different, fully subsidized insurance program, who-despite the availability of preventive care-are no more likely to seek preventive visits than are uninsured patients. We propose controlled experiments to identify and measure the true causal effects of insurance on prevention and, more broadly, steps to increase patients' understanding of the benefits of prevention.

In recent years, interest on researching on antenatal care issues and other health promotion and prevention interventions has increased. However, even though there is a growing interest in publishing about antenatal care use, evidence concerning which, and how socioeconomic conditions influence whether a pregnant woman demands or not antenatal consultations on the assumption that the theoretical access to this service has not entry barriers, is still limited. In order to generate this evidence, a two-stage analysis was performed with data gathered on the Demographic and Health Survey (DHS) carried out by Profamilia in Colombia during 2005. The first stage was run as a logistic regression model showing the marginal effects on the probability of attending the first visit and an ordinary least squares model was performed for the second stage accounting for the absences to antenatal consultations once at least one visit was carried out. It was found that mothers living in the Pacific Ocean region as well as young mothers seem to have a lower probability of attending the first visit but these factors are not related to the number of absences to antenatal consultation once the first visit has been achieved. The effect of health insurance was surprising because of the differing effects that the health insurers showed. Some familiar and personal conditions such as willingness to have the last children and number of previous children, demonstrated to be important in the determination of demand. The effect of mother's educational attainment was proved as important whereas the father's educational achievement was not. This paper provides some elements for policy making in order to increase the demand inducement of antenatal care, as well as stimulating research on demand for specific issues on health.

La evidencia sobre la toxicidad del glifosato en el largo plazo es escasa, especialmente cuando se realiza a través de aspersión aérea, donde la distribución no es controlada. Este estudio procura evaluar el potencial efecto que la aspersión por glifosato puede tener en la mortalidad específica por cáncer y algunos subtipos de cáncer en Colombia utilizando los datos disponibles. Este trabajo incluyó datos del Departamento Administrativo Nacional de Estadística (DANE) sobre mortalidad específica por cáncer en individuos residentes de áreas rurales y variables de cultivos y erradicación por medio de aspersión aérea proveniente del monitoreo de la Oficina de las Naciones Unidas contra la droga y el delito. Se construyó un pseudopanel cuya unidad de análisis fue la población a nivel departamental por año con variables de mortalidad por cáncer y cultivos de coca. Este estudio tiene un diseño ecológico y evalúa los efectos de la aspersión en la mortalidad específica por cáncer en la población rural colombiana utilizando diferentes métodos: un modelo de estimadores generalizados de ecuaciones y un modelo de variables instrumentales para conteos y tasas cuya unidad de análisis son los departamentos, dada la imposibilidad de observar la exposición individual; una regresión de panel de efectos fijos y aleatorios de forma comparativa y el método Wild Cluster. En el modelo con estimadores generalizados de ecuaciones para conteos, se encuentra en general un efecto positivo en la mortalidad por cáncer estadísticamente significativo, pero con coeficientes muy pequeños entre fumigación en el departamento y desarrollo de todos los tipos de cáncer y de cáncer hematopoyético. Esta relación se mantiene débilmente en los rezagos, aunque también hay efectos negativos. En promedio, una hectárea adicional asperjada con glifosato incrementa el número de muertes por cualquier tipo de cáncer en los años posteriores a la exposición al herbicida entre 0,0000004 y 0,000010, (p