Search

Obtaining reliable health estimates at the small area level (such as neighbourhoods) using survey data usually poses the problem of small sample sizes. To overcome this limitation, we explored smoothing techniques in order to estimate poor mental health prevalence at the neighbourhood level and analyse its profile by income in Barcelona city (Spain).A Bayesian smoothing model with a logit-normal transformation was applied to four repeated cross-sectional waves of the Barcelona health survey for 2001, 2006, 2011 and 2016. Mental health status was identified from the 12-item General Health Questionnaire. Income inequalities were analysed with neighbourhood income in quantiles for each year and trends in the pooled analysis.The prevalence of poor mental health ranged from 14.6% in 2001 to 18.9% in 2016. The yearly difference between neighbourhoods was 12.4% in 2001, 16.7% in 2006, 14.2% in 2011, and 20.0% in 2016. The odds ratio and 95% credible interval (95%CI) of experiencing poor mental health was 1.40 times higher (95%CI: 1.02-1.91) in less advantaged neighbourhoods than in more advantaged neighbourhoods in 2001, 1.61 times higher (95%CI: 1.01-2.59) in 2006 and 2.31 times higher (95%CI: 1.57-3.40) in 2016.This study shows that the Bayesian smoothed techniques allows detection of inequalities in health in neighbourhoods and monitoring of interventions against them. In Barcelona, mental health problems are more prevalent in low-income neighbourhoods and raised in 2016.

ObjectiveThis study describes the prevalence of vaccine hesitancy associated with the Catalan systematic childhood vaccination calendar and some related psychosocial determinants among paediatric primary care nurses in Barcelona (Spain).MethodsCross-sectional descriptive study. In 2017 we invited the paediatric nurses (N = 165) working in Barcelona public primary health centres with paediatric departments (N = 41) to participate. They answered a questionnaire with sociodemographic and behavioural variables: severity and perceived probability of contracting the diseases of the vaccines in the vaccination schedule; safety and protection offered by each vaccine; and beliefs, social norms, and knowledge about vaccines. Outcome variable was vaccine hesitancy, dichotomized into not hesitant (nurses who would vaccinate their own offspring), and hesitant (including those who would not vaccinate them, those who had doubts and those who would delay the administration of one or more vaccines). We performed bivariate analysis and adjusted logistic regression models.Results83% of paediatric nurses (N = 137) agreed to participate. 67.9% had the intention to vaccinate their children of all the vaccines in the systematic schedule. 32.1% of nurses experienced vaccine hesitancy, especially about the HPV (21.9%) and varicella (17.5%) vaccines. The multivariate analysis suggests associations between hesitancy and low perception of the severity of whooping cough (aOR: 3.88; 95%CI:1.32–11.4), low perception of safety of the HPV vaccine (aOR:8.5;95%CI:1.24–57.8), the belief that vaccines are administered too early (aOR:6.09;95%CI:1.98–18.8), and not having children (aOR:4.05;95%CI:1.22–13.3).ConclusionsAlthough most paediatric nurses had the intention to vaccinate their own children, almost one-third reported some kind of vaccine hesitancy, mainly related to doubts about HPV and varicella vaccines, as well as some misconceptions. These factors should be addressed to enhance nurses’ fundamental role in promoting vaccination to families.

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.

Objectives: To explore the health effects of a community health intervention on older people who are isolated at home due to mobility problems or architectural barriers, to identify associated characteristics and to assess participants’ satisfaction. Design: Quasi-experimental before–after study. Setting: Five low-income neighbourhoods of Barcelona during 2010–15. Participants: 147 participants, aged ≥59, living in isolation due to mobility problems or architectural barriers were interviewed before the intervention and after 6 months. Intervention: Primary Health Care teams, public health and social workers, and other community agents carried out a community health intervention, consisting of weekly outings, facilitated by volunteers. Measurements: We assessed self-rated health, mental health using the General Health Questionnaire (GHQ-12), and quality of life through the EuroQol scale. Satisfaction with the programme was evaluated using a set of questions. We analysed pre and post data with McNemar tests and fitted lineal and Poisson regression models. Results: At 6 months, participants showed improvements in self-rated health and mental health and a reduction of anxiety. Improvements were greater among women, those who had not left home for ≥4 months, those with lower educational level, and those who had made ≥9 outings. Self-rated health [aRR: 1.29(1.04–1.62)] and mental health improvements [β: 2.92(1.64–4.2)] remained significant in the multivariate models. Mean satisfaction was 9.3 out of 10. Conclusion: This community health intervention appears to improve several health outcomes in isolated elderly people, especially among the most vulnerable groups. Replications of this type of intervention could work in similar contexts. Resumen: Objetivos: Explorar los efectos sobre la salud de una intervención de salud comunitaria en personas mayores aisladas en casa debido a problemas de movilidad o a barreras arquitectónicas, identificar las características asociadas y evaluar la satisfacción de las personas participantes. Diseño: Estudio cuasi-experimental antes-después. Emplazamiento: Cinco barrios de baja renta de Barcelona durante 2010-15. Participantes: Se entrevistó a 147 participantes, ≥59 años, antes y 6 meses después de la intervención. Intervención: Equipos de atención primaria, trabajadores sociales, de salud pública y otros agentes comunitarios desarrollaron una intervención que consistía en salidas semanales, facilitadas por voluntarios. Mediciones: Se evalúo la salud autopercibida, la salud mental utilizando la escala GHQ-12 y la calidad de vida mediante la escala EuroQol. La satisfacción se evaluó mediante un conjunto de preguntas. Analizamos los datos previos y posteriores con pruebas de McNemar y modelos de regresión lineal y de Poisson ajustados. Resultados: A los 6 meses, los participantes mostraron mejoras en la salud percibida, en la salud mental y en la reducción de la ansiedad. Las mejoras fueron mayores entre las mujeres, las personas que no habían salido de casa durante ≥4 meses, las de bajo nivel educativo y las que habían realizado ≥9 salidas. La salud percibida (aRR: 1,29 [1,04-1,62]) y las mejoras en salud mental [(β: 2,92 [1,64-4,2]) permanecieron significativas en los modelos multivariados. La satisfacción media fue de 9,3 sobre 10. Conclusión: Esta intervención de salud comunitaria parece mejorar varios resultados de salud en las personas mayores aisladas, especialmente en los grupos más vulnerables. Replicar este tipo de intervención podría funcionar en contextos similares.

Superblocks are currently being introduced in Barcelona to respond to the city’s scarcity of green spaces and high levels of air pollution, traffic injuries, and sedentariness. The aim is to calm the streets by reducing the number of square meters dedicated to private vehicles and to reclaim part of this public space for people. Salut als Carrers (Health in the Streets) is a project to evaluate the potential environmental and health effects of the superblock model with an equity perspective in Barcelona. This study aims to explain the various interventions implemented in different neighborhoods in Barcelona and the methods that will be used to evaluate them in a quasi-experimental and health impact assessment (HIA) approaches. Given the complexity of the intervention evaluated, the project employs mixed methodologies. Quantitative methods include: (a) a pre–post health survey of 1200 people randomly selected from the municipal register asked about self-perceived health and quality of life, social support, mental health, mobility, physical activity, neighborhood characteristics, and housing; (b) pre–post environmental measurements, mainly of nitrogen dioxide (NO2), particulate matter of less than 10 µm (PM10), and particulate matter of less than 2.5 µm (PM2.5) and black carbon; (c) pre–post environmental walkability measures using the Microscale Audit of Pedestrian Streetscapes (MAPS) tool; (d) use of public space and physical activity levels using the System for Observing Play and Recreation in Communities (SOPARC), a validated observation tool; (e) pre–post traffic injury measures with a comparison group; and (f) the comparison and integration of pre–post assessment with previous HIAs and the improvement of future HIAs. Qualitative studies will be performed to analyze residents’ perception of these effects by using: (a) various focus groups according to different participant characteristics who are more or less likely to use the superblocks; and (b) a guerrilla ethnography, which is a method that combines ethnographic observation and semi-structured interviews. This study, which evaluates the impact of an ambitious urban-renewal program on health, will help to assess the effectiveness of public policy in terms of health and health inequalities.

ObjectiveTo evaluate the acceptability and effectiveness of a pilot intervention programme using gay geosocial mobile applications (apps) to offer rapid HIV and other STI tests to men who have sex with men (MSM) in Barcelona between December 2015 and March 2016.MethodologyWe offered rapid HIV, syphilis and hepatitis C testing by sending private messages on apps for sexual and social encounters. Acceptance was defined as the proportion of users who favourably responded to the message and effectiveness was defined as the proportion of users who attended our facilities among those who were interested in attending. To identify variables associated with the response to the messages, multivariate logistic regression was used. Adjusted OR (ORa) and 95% CIs were calculated. We collected information on sociodemographics, sexual behaviours and app usage from the contacted user profiles and from users who attended our facilities. A descriptive analysis was carried out.Results2656 individual messages were sent. Overall, a 38.4% response rate was obtained, 83.0% of them found it acceptable to receive the unsolicited message, and 73.2% effectiveness was obtained. Responders had higher odds of being 45 years or older (ORa=1.48; 95% CI 1.06 to 2.08), being connected at the moment the message was sent or during the previous hour (ORa=1.92; 95% CI 1.38 to 2.68), having a profile photo not exposing bare chest or abdomen (ORa=1.44; 95% CI 1.07 to 1.92) and using the Grindr app (ORa=1.39; 95% CI 1.12 to 1.73). Of those who were tested and took the survey (n=77), 45.5% had not taken an HIV test in over a year, 24.7% had had a previous STI diagnosis, 51.4% had reported anal sex without condom and 52% had consumed alcohol or drugs for sex.ConclusionsThe response rate, acceptance and effectiveness observed in this study indicate that this strategy could be a useful tool for promoting STI testing among high-risk MSM population.

Resumen Esta etnografía se realizó en Barcelona, ciudad que ofrece diferentes recursos de ocio homosexual, como las saunas gay. El objetivo fue analizar desde los estudios sobre género y masculinidades, cómo se articula la sexualidad, la percepción sobre la infección por VIH y otras infecciones de transmisión sexual (ITS), y las medidas preventivas en trabajadores sexuales masculinos (TSM) usuarios de saunas gay. Se realizaron 10 entrevistas en profundidad y observación entre 2012 y 2016. Las prácticas de sexo seguro son más frecuentes con clientes, mientras que las de riesgo se realizan más con parejas no comerciales. La orientación sexual juega un rol relevante, los homosexuales asumen más prácticas de riesgo en el trabajo sexual que los heterosexuales. Consumo de drogas o la escasez de redes de apoyo se relacionaron con mayor vulnerabilidad social y conductas de riesgo. Contraer el VIH aún genera miedo, mientras que tener otras ITS se percibe como parte de la vida sexual de un hombre. El TSM afianza una masculinidad con múltiples parejas sexuales, breadwinner y por otra parte, cuestiona un modelo heteronormativo. Las intervenciones para la prevención del VIH e ITS en este colectivo, deberían considerar los determinantes sociales como las precarias alternativas laborales y el ofrecer mayor soporte social. Abstract This ethnography was conducted in Barcelona, a city that provides different gay leisure resources, such as gay saunas. We aimed to analyze from studies on gender and masculinities, how sexuality, perception of HIV infection and other sexually transmitted infections (STIs), and preventive measures are articulated in gay sauna male sex workers (MSW). Ten in-depth interviews and observation were conducted between 2012 and 2016. Safe sex practices are more frequent with clients, while risk practices are carried out more with non-commercial partners. Sexual orientation plays an important role. Homosexuals assume riskier practices in sex work than heterosexuals. Drug use or lack of support networks were associated with higher social vulnerability and risk behaviors. Contracting HIV still creates fear, while having other STIs is perceived as part of a man’s sexual life. The MSW affirms masculinity with concurrent sexual partners, breadwinner, and on the other hand, questions a heteronormative model. Interventions for the prevention of HIV and STIs in this group should consider social determinants such as inferior work alternatives and the provision of more significant social support.

There is a wealth of information and research on health inequalities in Barcelona, but this issue has not been clearly prioritised on the political agenda. The arrival in government of a new left-wing party (Barcelona en Comú) in 2015, gave an important boost to the political agenda to reduce inequalities and health inequalities. The aim of this review is to describe the progress made in relation to health inequalities in these four years and especially in the areas involving public health. With respect to evidence and communication on health inequalities, the progress made is presented in the Barcelona annual health report and the creation of the Observatory on Health, Inequalities and Impacts of Municipal Policies. The policies presented refer to different municipal strategies, the Health Plan, the promotion of the Barcelona Health in the Neighbourhoods programme and the Plan for Tackling Inequalities in the Barcelona Public Health Agency. The combination of political will, technical capacity and the drive of citizens have facilitated progress in the city of Barcelona in policies to reduce social inequalities in health.

Se presenta el protocolo de los dos subestudios sobre el efecto de la crisis económica en la mortalidad, la salud reproductiva y las desigualdades en salud en Espa˜na. Subestudio 1: describir la evolución de la mortalidad y la salud reproductiva entre 1990 y 2013 mediante un estudio longitudinal ecológico en las comunidades autónomas. Se analizarán los cambios producidos por la crisis económica en la tendencia de los indicadores de mortalidad y salud reproductiva utilizando datos panel (17 comunidades autónomas por a˜nos de estudio) y ajustando modelos de Poisson de efectos aleatorios. Subestudio 2: analizar las desigualdades según la privación socioeconómica en la mortalidad y en la salud reproductiva en varias zonas de Espa˜na. Se realizará un estudio ecológico de tendencias en el cual se analizará la precrisis (1999- 2003 y 2004-2008) y la crisis (2009-2013). Se ajustarán modelos de efectos aleatorios según Besag York y Mollié para estimar los indicadores de mortalidad y de salud reproductiva suavizados en secciones censales. The aim is to present the protocol of the two sub-studies on the effect of the economic crisis on mortality and reproductive health and health inequalities in Spain. Substudy 1: describe the evolution of mortality and reproductive health between 1990 and 2013 through a longitudinal ecological study in the Autonomous Communities. This study will identify changes caused by the economic crisis in trends or reproductive health and mortality indicators using panel data (17 Autonomous Communities per study year) and adjusting Poisson models with random effects variance. Substudy 2: analyse inequalities by socioeconomic deprivation in mortality and reproductive health in several areas of Spain. An ecological study analysing trends in the pre-crisis (1999–2003 and 2004–2008) and crisis (2009–2013) periods will be performed. Random effects models Besag York and Mollié will be adjusted to estimate mortality indicators softened in reproductive health and census tracts. Esta investigación ha sido parcialmente financiada por el proyecto “Efectos de la crisis en la salud de la población y sus determinantes en España” (PI13/00897)y "Efecto de la crisis económica en la salud sexual y reproductiva y en lasdesigualdades sociales y económicas en España y sus Comunidades Autónomas" (PI13/02292) financiados ambos por el Instituto de Salud Carlos III (cofinanciado por la European Regional Development Fund).

ResumenLa administración local es responsable de áreas que determinan la salud. Hay evidencia del impacto en salud de las políticas urbanas. Se describen barreras y recomendaciones para el pleno desarrollo de la promoción de la salud en ciudades y barrios. Las barreras a la promoción de la salud son generalizadas: la falta de liderazgo y voluntad política refleja la atribución de los resultados en salud a los servicios sanitarios y el desconocimiento ciudadano, técnico y político de las causas profundas del bienestar y la salud. Las ideologías y los prejuicios, las políticas que ignoran la evidencia, las culturas sectoriales, los tiempos políticos cortos, la falta de información poblacional de salud y los espacios de participación limitados reducen las oportunidades para la salud urbana. Existen grandes retornos en salud de las políticas locales en la primera infancia, escuelas saludables, empleo, transporte activo, espacios verdes, servicios de ocio y comunitarios, planificación urbana, vivienda y protección de la salud alimentaria y ambiental. Entre las herramientas clave destacan la priorización política de la salud y la equidad, la «salud en todas las políticas» y la participación de comunidades, movimientos sociales y sociedad civil. Lo anterior requiere una planificación y una financiación de estructuras y procesos, información de salud por ejes de equidad y fortalecimiento de las capacidades del sector de salud, del resto de sectores y de la sociedad. Concluimos que las políticas locales tienen un gran potencial para maximizar la salud y la equidad. Las recomendaciones para implementarlas son cada vez más sólidas y viables.AbstractLocal administration is responsible for health-related areas, and evidence of the health impact of urban policies is available. Barriers and recommendations for the full implementation of health promotion in cities and neighbourhoods have been described. The barriers to the promotion of urban health are broad: the lack of leadership and political will, reflectes the allocation of health outcomes to health services, as well as technical, political and public misconceptions about the root causes of health and wellbeing. Ideologies and prejudices, non-evidence-based policies, narrow sectoral cultures, short political periods, lack of population-based health information and few opportunities for participation limit the opportunities for urban health. Local policies on early childhood, healthy schools, employment, active transport, parks, leisure and community services, housing, urban planning, food protection and environmental health have great positive impacts on health. Key tools include the political prioritisation of health and equity, the commitment to «Health in All Policies» and the participation of communities, social movements and civil society. This requires well organised and funded structures and processes, as well as equity-based health information and capacity building in the health sector, other sectors and society. We conclude that local policies have a great potential for maximising health and equity and equity. The recommendations for carrying them out are increasingly solid and feasible.

Tourism gentrification is as process of urban change and neighborhoods transformation, according to the needs of affluent visitors, increasing in some global cities. However, the link between tourism gentrification and resident’s health is still an understudied topic. Using Photovoice, a participatory action research method, the aim of this study was to identify the perceived pathways that underlie the relationship between tourism gentrification and health among residents of Gotic neighborhood, in Barcelona. The study was conducted between January 2018 and January 2019. Thirteen residents, recruited from two neighborhood organizations, took photographs of how tourism gentrification of the neighborhood was affecting their health. Participants analyzed and critically discussed their photographs in small group sessions. Through a consensus-building process, participants categorized 35 photographs and identified 7 emerging categories acknowledged as possible pathways between tourism gentrification and health, in Gotic neighborhood: 1) decline of social networks; 2) loss of identity; 3) environmental changes; 4) pollution; 5) changes in services and stores; 6) property speculation/eviction and; 7) activism by residents. This Photovoice study recognizes important pathways underlying the relationship between tourism gentrification in the Gotic neighborhood and the health of its residents, by altering the built environment, the social environment or psychological factors. Among them, six pathways were related to negative health outcomes, both physical and mental (respiratory diseases; worse nutrition habits; sleep deprivation; stress, anxiety and depression). ‘Activism by residents’ was perceived to buffer the negative health effects of living in a touristic area. The study also provides recommendations to tackle this serious urban health issue.

Background Unemployment affects the physical and mental health of affected individuals, which can be explained by its direct effect on worsening finances due to the lack of income as well as by its negative psychosocial effects. “Employment in the Neighborhoods” return to work program was implemented in Barcelona specifically in the neighborhoods characterized with a greater economic deprivation and by high unemployment to improve personal and occupational abilities and skills of the participants to reintegrate them into the workforce. The aim of this study is to determine the association between the lack of economic resources and psychosocial factors with respect to mental health and self-rated health in unemployed persons participating in the program “Employment in the Neighborhoods”. Methods Cross-sectional study. Data collected from a self-administered questionnaire. Generalized linear models were constructed, adjusted by age and social class, to estimate prevalence ratios and analyze any possible association between economic resources, psychosocial factors and poor self-rated health and mental health. Results Nine hundred forty-eight persons of 2763 participants in the “Employment in the Neighborhoods” program completed the questionnaire. 46.9% were women. 72.5% of women and 61.9% of men were at risk of poor mental health and 25.5% of women and 21.1% of men reported poor self-rated health. Low self-esteem [women: PR 1.88 95%CI (1.24–2.84); men: PR 2.51 95%CI (1.57–4.02)] and medium social support [2.01 (1.30–3.09)], in men, and low social support [1.74 (1.13–2.68)] in women are associated with worsening of self-rated health. In men, low self-esteem [1.40 (1.19–1.64)] and delay in paying bills [1.38 (1.17–1.64)] were associated with the risk of poor mental health; in women were associated low self-esteem [1.27 (1.11–1.44)] and received a non-contributory allowance [1.37 (1.09–1.74)]. Conclusions Economic resources, self-esteem and social support are necessary for good general and mental health among unemployed persons. The high prevalence of poor mental health among persons participating in the active labor market program “Employment in the Neighborhoods” could be due to a substantial deficit in these factors.

The following essay outlines the intervention and presents a framework that will serve as a guide in the evaluation of the different effects of the Superblocks. Superblocks consist of amalgamations of blocks throughout the city, with the goal of improving the habitability of public spaces, advancing sustainable mobility, increasing urban green, and promoting residents’ participation and coresponsibility, while ultimately influencing residents’ health and health inequities. The evaluation framework considers the following aspects: the interventions implemented in the Superblock strategy, the changes that occur at neighbourhood and individual level and the population turnover as intermediate factors and finally the health outcomes. Inequity dimensions are also considered.

ResumenObjetivoConocer las explicaciones sobre prácticas sexuales de riesgo, la percepción del virus de la inmunodeficiencia humana (VIH) y propuestas de intervención para prevenir infecciones por VIH en un grupo de hombres que tienen sexo con hombres.MétodosEstudio cualitativo con una muestra de 13 hombres que tenían sexo con hombres, participantes de una cohorte de VIH seronegativos contactados en saunas gay de Barcelona. Se realizaron entrevistas en profundidad semiestructuradas y un posterior análisis de contenido temático.ResultadosLas prácticas sexuales de riesgo se atribuyeron a una masculinidad asociada a una alta necesidad sexual, a determinados lugares de intercambio sexual (como saunas, fiestas privadas y clubs), al consumo de drogas y al deseo de experimentar con el riesgo y la propia sexualidad. La infección por VIH se percibía como una enfermedad normalizada, aunque contraerla se asociaba a vergüenza y culpa. Entre las propuestas de intervención se encontraban: concienciar sobre lo que significa vivir con el VIH, generar más alarma social, incorporar las nuevas tecnologías en la prevención y aumentar las acciones en lugares de encuentro gay.ConclusionesEl concepto de la masculinidad desempeña un papel fundamental en las prácticas sexuales entre los hombres que tienen sexo con hombres. Se sugiere innovar en los programas preventivos e incorporar la percepción de riesgo y la infección por el VIH desde una perspectiva de género.AbstractObjectiveTo explore views about risky sexual behaviors and perceptions of HIV, and to propose interventions for preventing HIV infections in a group of men who have sex with men.MethodsWe performed a qualitative study in a sample of 13 men who have sex with men, who were participating in an HIV-seronegative cohort, and who we contacted via saunas for the gay community in Barcelona (Spain). We performed in-depth semi-structured interviews, followed by content analysis.ResultsRisky sexual behaviors were associated with masculinity related to strong sexual needs, certain sexual exchange venues (such as saunas, private parties and clubs), drug use, and a desire to experiment with risk and one's own sexuality. HIV infection was perceived as a normalized disease, although becoming infected was still associated with shame and guilt. Proposed interventions included raising awareness of what it is like to live with HIV, generating greater social alarm, incorporating new technologies in prevention, and intensifying activity at gay venues.ConclusionsThe concept of masculinity plays a fundamental role in sexual practices among men who have sex with men. We suggest renewed innovation in preventive programs and incorporating the perception of risk and HIV infection from a gender perspective.

This ethnography was conducted in Barcelona, a city that provides different gay leisure resources, such as gay saunas. We aimed to analyze from studies on gender and masculinities, how sexuality, perception of HIV infection and other sexually transmitted infections (STIs), and preventive measures are articulated in gay sauna male sex workers (MSW). Ten in-depth interviews and observation were conducted between 2012 and 2016. Safe sex practices are more frequent with clients, while risk practices are carried out more with non-commercial partners. Sexual orientation plays an important role. Homosexuals assume riskier practices in sex work than heterosexuals. Drug use or lack of support networks were associated with higher social vulnerability and risk behaviors. Contracting HIV still creates fear, while having other STIs is perceived as part of a man's sexual life. The MSW affirms masculinity with concurrent sexual partners, breadwinner, and on the other hand, questions a heteronormative model. Interventions for the prevention of HIV and STIs in this group should consider social determinants such as inferior work alternatives and the provision of more significant social support.Esta etnografía se realizó en Barcelona, ciudad que ofrece diferentes recursos de ocio homosexual, como las saunas gay. El objetivo fue analizar desde los estudios sobre género y masculinidades, cómo se articula la sexualidad, la percepción sobre la infección por VIH y otras infecciones de transmisión sexual (ITS), y las medidas preventivas en trabajadores sexuales masculinos (TSM) usuarios de saunas gay. Se realizaron 10 entrevistas en profundidad y observación entre 2012 y 2016. Las prácticas de sexo seguro son más frecuentes con clientes, mientras que las de riesgo se realizan más con parejas no comerciales. La orientación sexual juega un rol relevante, los homosexuales asumen más prácticas de riesgo en el trabajo sexual que los heterosexuales. Consumo de drogas o la escasez de redes de apoyo se relacionaron con mayor vulnerabilidad social y conductas de riesgo. Contraer el VIH aún genera miedo, mientras que tener otras ITS se percibe como parte de la vida sexual de un hombre. El TSM afianza una masculinidad con múltiples parejas sexuales, breadwinner y por otra parte, cuestiona un modelo heteronormativo. Las intervenciones para la prevención del VIH e ITS en este colectivo, deberían considerar los determinantes sociales como las precarias alternativas laborales y el ofrecer mayor soporte social.

This study aims to evaluate the effects of a community-based counselling intervention to improve contraception use among immigrant and native residents in deprived neighbourhoods. Randomized controlled trial. Women aged 14-49 years and men aged 14-39 years from two low-income neighbourhoods with high proportion of immigration in Barcelona (Catalonia, Spain) who had not undergone irreversible contraception and were not planning a pregnancy were recruited (2011-13). A culturally developed and theoretically based brief counselling intervention was delivered in community settings. The primary outcome was the consistent use of effective contraceptive methods (optimal use). Secondary outcomes were the incorrect use of effective methods and the use of less effective methods stratified by sex and migrant status. Differences within subgroups from baseline to the 3-month follow-up were analysed by intention to treat and per protocol. The effects were assessed with adjusted robust Poisson regressions. The study enrolled and randomized 746 eligible participants. There were no differences between the intervention and control groups in demographic characteristics. Optimal use significantly increased in men, women, immigrants and natives in the intervention group, with no changes in the control group. In the intervention group, inconsistent use of effective methods decreased by 54.9% and that of less effective methods by 47.2%. The overall adjusted prevalence ratio of optimal use in the intervention group versus the control group was 1.138 (95% CI: 1.010-1.284). This brief counselling intervention increased the consistent use of effective contraception in low-income neighbourhoods with a high proportion of immigration.

ResumenEl proyecto Ineq-Cities analizó en 16 ciudades europeas las desigualdades en mortalidad en áreas pequeñas y describió intervenciones para reducir las desigualdades en salud. Esta nota de campo describe la diseminación del proyecto en España. De acuerdo con las recomendaciones del proyecto, se pretendió trasladar a actores clave, principalmente personas técnicas y responsables municipales y agentes sociales locales, algunos de los resultados, junto a una introducción a las desigualdades urbanas en salud y las estrategias para abordarlas. Se realizaron 24 talleres a los que asistieron más de 350 profesionales de 92 municipios, un libro-resumen, tres artículos en medios no especializados, una propuesta de moción municipal y actividades de difusión en redes sociales. Los receptores lo valoraron positivamente y destacaron la necesidad de sistematizar estos productos. Este proceso puede haber contribuido a la inclusión de las desigualdades en salud en la agenda política y a la capacitación del personal técnico para afrontarlas.AbstractThe Ineq-Cities project analyzed inequalities in mortality in small areas and described interventions to reduce inequalities in health in 16 European cities. This field note describes the dissemination of the project in Spain. In accordance with the recommendations of the project, the objective was to translate relevant results to key stakeholders – mainly technical staff, municipal officers and local social agents – and to provide an introduction to urban inequalities in health and strategies to address them. Twenty-four workshops were given, attended by more than 350 professionals from 92 municipalities. Knowledge dissemination consisted of the publication of a short book on inequalities in health and the approach to this problem in cities and three articles in nonspecialized media, a proposal for a municipal motion, and knowledge dissemination activities in social networks. Users rated these activities highly and stressed the need to systematize these products. This process may have contributed to the inclusion of health inequalities in the political agenda and to the training of officers to correct them.

The aim is to present the protocol of the two sub-studies on the effect of the economic crisis on mortality and reproductive health and health inequalities in Spain. Substudy 1: describe the evolution of mortality and reproductive health between 1990 and 2013 through a longitudinal ecological study in the Autonomous Communities. This study will identify changes caused by the economic crisis in trends or reproductive health and mortality indicators using panel data (17 Autonomous Communities per study year) and adjusting Poisson models with random effects variance. Substudy 2: analyse inequalities by socioeconomic deprivation in mortality and reproductive health in several areas of Spain. An ecological study analysing trends in the pre-crisis (1999-2003 and 2004-2008) and crisis (2009-2013) periods will be performed. Random effects models Besag York and Mollié will be adjusted to estimate mortality indicators softened in reproductive health and census tracts.

Health policies are specified in documents that contain values, objectives, strategies, and interventions to be implemented. The objective of our study was to analyse health policy documents of six European cities and one county council published around 2010 to determine (i) how cities conceptualize health inequalities, and (ii) what strategies are proposed to reduce them. We performed a qualitative document analysis. We selected Health or Health Inequalities policy documents and analysed the following aspects: general characteristics of the document, inclusion and definition of health inequalities, promotion of good governance and participation, number of objectives, and evaluation. We also described specific objectives. Rotterdam, London, and Stockholm use a conceptual framework. Two of them define health inequalities as a social gradient. Intersectoral action, participation, and evaluation are included in most documents. Interventions focus mainly on the socioeconomic context. Journal of Public Health Policy (2013) 34, 100-120. doi:10.1057/jphp.2012.57; published online 22 November 2012; corrected online 6 December 2012

Local administration is responsible for health-related areas, and evidence of the health impact of urban policies is available. Barriers and recommendations for the full implementation of health promotion in cities and neighbourhoods have been described. The barriers to the promotion of urban health are broad: the lack of leadership and political will, reflectes the allocation of health outcomes to health services, as well as technical, political and public misconceptions about the root causes of health and wellbeing. Ideologies and prejudices, non-evidence-based policies, narrow sectoral cultures, short political periods, lack of population-based health information and few opportunities for participation limit the opportunities for urban health. Local policies on early childhood, healthy schools, employment, active transport, parks, leisure and community services, housing, urban planning, food protection and environmental health have great positive impacts on health. Key tools include the political prioritisation of health and equity, the commitment to «Health in All Policies» and the participation of communities, social movements and civil society. This requires well organised and funded structures and processes, as well as equity-based health information and capacity building in the health sector, other sectors and society. We conclude that local policies have a great potential for maximising health and equity and equity. The recommendations for carrying them out are increasingly solid and feasible.

Socioeconomic inequalities affect different areas of health, including sexual and reproductive health. The aim of the present study was to analyze inequalities in the use of contraception among women resident in Spain in 2006.This is a cross-sectional study of women aged 15-49 years and resident in Spain in 2006 that analyzes the use of contraception during their first experience of sexual intercourse and during the 4 weeks before the interview (n = 5,141). Socioeconomic inequalities are measured with indicators of socioeconomic position, such as level of education, social class, and country of origin, and such characteristics as age, religion, age at first intercourse, living with partner, and number of children.Contraception was used by 70.4% of the women during their first experience of sexual intercourse and by 78.1% during the previous 4 weeks. The women who used contraception most during their first experience of sexual intercourse were nonreligious younger women from developed countries who had a higher level of education and who had their first experience after the age of 18. The women who used contraception most often during sex in the previous 4 weeks were younger women with a higher level of education who did not live with a partner, who had children, and who had used contraception during their first experience.There are socioeconomic inequalities in the use of contraception among women in Spain. The use of contraception during the first experience of sexual intercourse was associated with more frequent use of contraception during sex in the 4 weeks before the interview.

ResumenObjetivoSe llevó a cabo una intervención comunitaria para reducir el aislamiento de las personas mayores debido a barreras arquitectónicas. Este estudio evalúa sus efectos.MétodosEstudio cuasiexperimental antes-después. Se localizaron en la comunidad personas mayores aisladas en tres zonas desfavorecidas en 2009-11. Salieron quincenalmente con voluntariado y una silla-oruga motorizada. Se estudió la satisfacción y se comparó, con pruebas de McNemar, su estado de salud percibido, su calidad de vida y su salud mental antes y después de cuatro salidas.ResultadosParticiparon 74 personas (edad mediana: 83 años; rango intercuartílico: 78-89). La salud percibida mejoró un 21%, la mental un 24% y el malestar psicológico se redujo un 16%. El 98% estaban satisfechas.ConclusionesLa intervención mejoró la salud percibida y la salud mental de las personas participantes. Debería evitarse que estas personas residan en edificios con barreras arquitectónicas, y si no es posible, implementar programas similares a éste.AbstractObjectiveSocial isolation impairs health. An intervention to reduce isolation due to architectural barriers in elderly persons was carried out in Barcelona (Spain). This study aimed to evaluate its effects on health.MethodsWe conducted a quasi-experimental before-after study. Isolated older people were identified in three deprived urban areas from 2009 to 2011. Participants had twice-weekly outings with volunteers in a stair-climbing power wheelchair. User satisfaction was evaluated and perceived health status, quality of life, and mental health before and after four outings were compared with McNemar tests.ResultsThere were 74 participants (median age: 83 years; IQR: 78-89). Perceived health improved by 21%, mental health by 24%, and psychological distress was reduced by 16%. Most participants (98%) were satisfied.ConclusionThe intervention improved perceived health and mental health. Elderly people with impaired mobility should not live in buildings with architectural barriers and, if this cannot be avoided, similar programs should be implemented.

ResumenHay gran evidencia sobre los efectos de la pobreza y la exclusión social en la salud infantil. En los últimos años se ha apreciado un interés creciente por el impacto del gradiente social en la salud infantil según la posición social, la educación familiar, el sexo o la etnia. Diversos estudios de cohortes han demostrado la relación entre la posición socioeconómica materna en el período perinatal y la salud en la edad adulta. La comisión de determinantes sociales en salud (CSDH, Commission on Social Determinants of Health) de la Organización Mundial de la Salud propuso eliminar las brechas en la salud en una generación, otorgando un papel destacado al desarrollo temprano (ECD, early child development). El nivel de educación familiar y el rendimiento académico son determinantes fundamentales de las desigualdades. Se dispone de muy poca evidencia empírica sobre la efectividad de las intervenciones dirigidas a disminuir las desigualdades. La mayoría de las intervenciones en la infancia y la adolescencia se encaminan al cambio de conductas individuales, y muy pocas se han evaluado de forma crítica. Se revisan algunas iniciativas e intervenciones recientes dirigidas a reducir las desigualdades sociales en salud infantil, y se presenta un listado a tener en cuenta al evaluar las intervenciones dirigidas a la promoción de la salud y la prevención en las escuelas desde la perspectiva de las desigualdades sociales y de género. Se proponen algunas estrategias para la recogida de información, la investigación y las políticas sanitarias y educativas.AbstractThere is considerable evidence of the impact of poverty and social exclusion on child health. In the last few years, interest has grown in the concept of social gradients in health, according to social position, family educational level, gender, and ethnic background. Several cohort studies have demonstrated an association between maternal socioeconomic position during the prenatal period and adult health. The Commission on Social Determinants of Health of the World Health Organization proposed closing the health gap in a generation by giving a major role to early child development.Family educational level and academic achievement are fundamental determinants of health inequalities. There is scarce empirical evidence on the effectiveness of interventions to reduce child health inequalities. Most of the interventions in children and adolescents aim to change individual behavior, and very few have been critically evaluated. The present manuscript provides a review of initiatives and recent interventions aimed at reducing social inequalities, as well as a checklist to be taken into account in interventions on health promotion and disease prevention in schools from the perspective of social and gender inequalities. Strategies for data collection, research and health and educational policies are proposed.

Aims: To describe the prevalence of recent use of alcohol, medication, and illegal drugs among patients who attended emergency departments (EDs) as a result of suffering an injury due to any external mechanism and to identify factors associated with alcohol and drug use. Methods: A cross-sectional study was conducted in eight university hospitals in Spain. Participants were adult patients admitted to a trauma ED. Oral fluid was used to test for psychoactive substances analyzed by gas chromatography-mass spectrometry. Socio-demographic data and information on circumstances of the injury were collected through interviews. Results: The analysis included 1579 patients admitted to the EDs (56.4% men). Among Young people (= 40 years, 7.4% of men and 1.6% of women were positive for any illegal substance, and 16.3% and 11.0% respectively for alcohol. Prevalence of substance detected varied across mechanism of injury, gender and age group. Night-time injury was associated with substance use. Conclusions: A high proportion of injured patients who were treated in an EDs tested positive for psychoactive drugs. Routine testing at trauma departments would maximize the identification of patients who may benefit from referral to specialized addiction treatment centers, or brief interventions. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

The purpose of this qualitative study is to investigate young people's perceptions, in Barcelona, Spain, about the evolution, magnitude, causes and determinants of traffic crashes, to describe their opinions on road safety regulations, and to explore their suggestions and proposals. Interviews were conducted with 43 key informants and 12 focus groups involving 98 participants. Discussion guides were designed to get insight on perceptions of relevance and trends in road traffic injuries, determinants of these, regulations and enforcement, as well as to gather their own ideas for reducing traffic injuries. Young people are aware that traffic injuries are a relevant and increasingly serious problem. The main determinants identified are: driving under the influence of drugs and alcohol, fatigue, night driving, unsafe infrastructures, age of drivers and lack of public transport alternatives. Young people admit that fines, speed cameras and alcohol breath testing reduce risky driving. They prefer community work to fines. They have a poor image of public administrations in charge of prevention of traffic injuries. They demand information on traffic regulations and politicians' decisions, and a considerable increase in weekend and night time public transport. Effectiveness of interventions to reduce traffic injuries can be improved by taking the recipients' perceptions into account.

To evaluate the effectiveness of a contraceptive counselling intervention among adolescents by sex and origin.A pre-post study with a 3-month follow-up was conducted in adolescents from three disadvantaged neighbourhoods. Participants received a counselling session at a community centre. Contraception use at last intercourse and knowledge, beliefs and self-efficacy before and after the intervention were compared with χ(2) and McNemar tests, stratified by sex and origin (autochthonous or immigrant).A total of 138 (76%) participants completed the follow-up. Fifty-five percent of the participants were girls, 85% were aged 16-19 years and 71% were immigrants. Knowledge and several self-efficacies increased after the intervention. Condom use increased by 5.4% and the proportion not using any method declined by 7.7%.Contraceptive counselling in the community setting increased the use of contraception and improved psychosocial determinants, especially in immigrant adolescents.

Background An estimated 30% of HIV cases in the European Union are not aware of their serological status. This study aimed to assess the effectiveness of a pilot HIV partner notification program. Methods HIV cases diagnosed between January 2012 and June 2013 at two healthcare settings in Barcelona were invited to participate in a prospective survey. We identified process and outcome measures to evaluate this partner notification program, including the number of partners identified per interviewed index case, the proportion of partners tested for HIV as a result of the partner notification, and the proportion of new HIV diagnoses among their sex or needle-sharing partners. Results Of the 125 index cases contacted, 108 (86.4%) agreed to provide information about partners. A total of 199 sexual partners were identified (1.8 partners per interviewed index case). HIV outcome was already known for 58 partners (70.7% were known to be HIV-positive), 141 partners were tested as result of partner notification, and 26 were newly diagnosed with HIV. The case-finding effectiveness of the program was 18.4%. Conclusion This pilot program provides evidence of the effectiveness of a partner notification program implemented in healthcare settings. This active partner notification program was feasible, acceptable to the user, and identified a high proportion of HIV-infected patients previously unaware of their status.

Background Socioeconomic inequalities are increasingly recognised as an important public health issue, although their role in the leading causes of mortality in urban areas in Europe has not been fully evaluated. In this study, we used data from the INEQCITIES study to analyse inequalities in cause-specific mortality in 15 European cities at the beginning of the 21st century. Methods A cross-sectional ecological study was carried out to analyse 9 of the leading specific causes of death in small areas from 15 European cities. Using a hierarchical Bayesian spatial model, we estimated smoothed Standardized Mortality Ratios, relative risks and 95% credible intervals for cause-specific mortality in relation to a socioeconomic deprivation index, separately for men and women. Results We detected spatial socioeconomic inequalities for most causes of mortality studied, although these inequalities differed markedly between cities, being more pronounced in Northern and Central-Eastern Europe. In the majority of cities, most of these causes of death were positively associated with deprivation among men, with the exception of prostatic cancer. Among women, diabetes, ischaemic heart disease, chronic liver diseases and respiratory diseases were also positively associated with deprivation in most cities. Lung cancer mortality was positively associated with deprivation in Northern European cities and in Kosice, but this association was non-existent or even negative in Southern European cities. Finally, breast cancer risk was inversely associated with deprivation in three Southern European cities. Conclusions The results confirm the existence of socioeconomic inequalities in many of the main causes of mortality, and reveal variations in their magnitude between different European cities, Background Socioeconomic inequalities are increasingly recognised as an important public health issue, although their role in the leading causes of mortality in urban areas in Europe has not been fully evaluated. In this study, we used data from the INEQ-CITIES study to analyse inequalities in cause-specific mortality in 15 European cities at the beginning of the 21st century. Methods A cross-sectional ecological study was carried out to analyse 9 of the leading specific causes of death in small areas from 15 European cities. Using a hierarchical Bayesian spatial model, we estimated smoothed Standardized Mortality Ratios, relative risks and 95% credible intervals for cause-specific mortality in relation to a socioeconomic deprivation index, separately for men and women. Results We detected spatial socioeconomic inequalities for most causes of mortality studied, although these inequalities differed markedly between cities, being more pronounced in Northern and Central-Eastern Europe. In the majority of cities, most of these causes of death were positively associated with deprivation among men, with the exception of prostatic cancer. Among women, diabetes, ischaemic heart disease, chronic liver diseases and respiratory diseases were also positively associated with deprivation in most cities. Lung cancer mortality was positively associated with deprivation in Northern European cities and in Kosice, but this association was non-existent or even negative in Southern European cities. Finally, breast cancer risk was inversely associated with deprivation in three Southern European cities. Conclusions The results confirm the existence of socioeconomic inequalities in many of the main causes of mortality, and reveal variations in their magnitude between different European cities.

To explore views about risky sexual behaviors and perceptions of HIV, and to propose interventions for preventing HIV infections in a group of men who have sex with men.We performed a qualitative study in a sample of 13 men who have sex with men, who were participating in an HIV-seronegative cohort, and who we contacted via saunas for the gay community in Barcelona (Spain). We performed in-depth semi-structured interviews, followed by content analysis.Risky sexual behaviors were associated with masculinity related to strong sexual needs, certain sexual exchange venues (such as saunas, private parties and clubs), drug use, and a desire to experiment with risk and one's own sexuality. HIV infection was perceived as a normalized disease, although becoming infected was still associated with shame and guilt. Proposed interventions included raising awareness of what it is like to live with HIV, generating greater social alarm, incorporating new technologies in prevention, and intensifying activity at gay venues.The concept of masculinity plays a fundamental role in sexual practices among men who have sex with men. We suggest renewed innovation in preventive programs and incorporating the perception of risk and HIV infection from a gender perspective.

ObjetivosAnalizar las tendencias de la prevalencia del hábito tabáquico y sus determinantes en la población general de Barcelona entre 1983 y 2000DiseñoEstudio de series temporalesEmplazamientoEncuesta de salud mediante entrevista realizada en el domicilio a muestras representativas de la población general de BarcelonaParticipantesEn los años 1983, 1992 y 2000 se entrevistó a 3.134, 5.004 y 10.000 personas, respectivamenteMediciones y resultados principalesEntre 1983 y 2000 se mantiene la tendencia decreciente del consumo diario de tabaco entre los varones, que pasa del 54,6 al 38,3%, mientras que el consumo en las mujeres aumenta del 20,9% en 1983 al 24,5% en 1992, pero se mantiene estable en 2000 (24,5%). La proporción de fumadores que manifiesta su deseo de dejar de fumar aumenta en ambos sexos entre 1992 y 2000 y pasa del 54,2 al 65,7% del total de los fumadores. También se produce en este período un aumento de la proporción de fumadores que declara haber sido aconsejado para dejar de fumar por su médico (del 36,1 al 48,1%). Las tendencias en ambos sexos muestran un mayor consumo en los grupos socioeconómicos más desfavorecidosConclusionesLos resultados del studio confirman la disminución de la prevalencia del consumo diario de tabaco y el incremento de fumadores que se plantean dejar de fumar, paralelo al aumento del consejo médico. Sin embargo, las tendencias entre los grupos más jóvenes permanecen estables, lo que obliga a intensificar los esfuerzos en este grupo de poblaciónObjectivesTo analyze the prevalence trends for smoking and its determinants in the general population of Barcelona from 1983 to 2000DesignTime series studySettingHealth survey based on home interviews of a representative sample of the general population of BarcelonaParticipantsIn the years 1983, 1992, and 2000 we interviewed 3134, 5004, and 10 000 persons, respectivelyMain outcome measures and resultsBetween 1983 and 2000 daily tobacco use showed a steady tendency to decrease among men, with a prevalence that decreased from 54.6% to 38.3%, while in women, smoking increased between 1983 and 1992 (from 20.9% to 25.4%) but remained stable in 2000 (24.5%). The proportion of smokers who said they wanted to quit increased in both sexes from 1992 (54.2%) to 2000 (65.7%). During this period the proportion of smokers who said their doctor had advised them to quit increased from 36.1% to 48.1%. The trends for both sexes showed that consumption of tobacco products was greater among less privileged socioeconomic groupsConclusionsThe results of this study confirm the decrease in the prevalence of daily consumption of tobacco products and the increase in smokers who would like to quit, in parallel with the increase in advice from physicians to quit. However, the trends among younger groups remained stable, a finding that makes it necessary to intensify efforts aimed at this population group

ResumenObjetivoDescribir las tendencias en el consumo de tabaco, alcohol y cannabis entre los adolescentes escolarizados entre 1987 y 1999 de la ciudad de Barcelona.MétodosEncuestas transversales realizadas a muestras representativas de escolares de segundo curso de Educación Secundaria Obligatoria (ESO) entre 1987 y 1999. Los cuestionarios eran anónimos y autocontestados. Se dispone de datos de 5.013 escolares de la ciudad de Barcelona que participan en alguna de las 5 encuestas.ResultadosTras disminuir de forma uniforme entre 1987 y 1996, en 1999 se observa un aumento del 13,4% en el consumo regular (diario o semanal) de tabaco y del 38,7% en el consumo experimental de tabaco, respecto a las prevalencias observadas en 1996. Con respecto al consumo de alcohol, se observa una disminución global del 14% de los escolares que ha bebido al menos medio vaso de alcohol entre 1987 y 1999. El consumo problemático de alcohol se iguala en ambos sexos, y la proporción que declara haberse emborrachado alguna vez es en 1999 superior en las chicas (14,0%) que en los chicos (10,5%). Mientras en 1996 un 6,9% declaraba haber probado cannabis, la proporción en 1999, sin diferencias entre sexos, era del 7,3% de la población estudiada.ConclusionesEn el período estudiado se observa un aumento del consumo regular de tabaco, una disminución del consumo de alcohol y una estabilización del consumo de cannabis. Las diferencias entre ambos sexos tienden a desaparecer.AbstractObjectiveTo describe trends in tobacco, alcohol, and cannabis consumption among secondary school pupils in Barcelona between 1987 and 1999.MethodsCross-sectional surveys administered to representative samples of pupils in the second year of secondary school between 1987 and 1999. The questionnaires were anonymous and self-completed. We present data from 5013 secondary school pupils from Barcelona who participated in one of the five surveys.ResultsRegular smoking (daily and weekly) showed a uniform decrease between 1987 and 1996. The results of the last survey (1999) showed an increase over those the 1996 survey, ranging from 13.4% for regular smoking to 38.7% for experimental smoking. Between 1987 and 1999, the percentage of schoolchildren who reported drinking at least half a glass of alcohol at some time showed an overall decrease of 14.0%. No differences in sex were found in problematic alcohol consumption, while a higher proportion of girls (14.0%) than boys (10.5%) reported getting drunk at some time. Whereas in 1996, 6.9% of the population studied had smoked cannabis at some time, in 1999 this proportion was 7.3%, with no differences between sexes.ConclusionsDuring the study period regular smoking increased, alcohol consumption decreased and cannabis consumption tended to level-off. Differences between boys and girls tended to disappear.

Background: Health inequalities can be tackled with appropriate health and social policies, involving all community groups and governments, from local to global. The objective of this study was to carry out a scoping review on social and health policies or interventions to tackle health inequalities in European cities published in scientific journals. Methods: Scoping review. The search was done in “PubMed” and the “Sociological Abstracts” database and was limited to articles published between 1995 and 2011. The inclusion criteria were: interventions had to take place in European cities and they had to state the reduction of health inequalities among their objectives. Results: A total of 54 papers were included, of which 35.2% used an experimental design, and 74.1% were carried out in the United Kingdom. The whole city was the setting in 27.8% of them and 44.4% were based on promoting healthy behaviours. Adults and children were the most frequent target population and half of the interventions had a universal approach and the other half a selective one. Half of the interventions were evaluated and showed positive results. Conclusions: Although health behaviours are not the main determinants of health inequalities, the majority of the selected documents were based on evaluations of interventions focusing on them. This article has been partially funded by the project INEQ-CITIES, “Socioeconomic inequalities in mortality: evidence and policies of cities of Europe”; project funded by the Executive Agency for Health and Consumers (Commission of the European Union), project n°2008 12 13