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Cannabis use is becoming one of the most common risk behaviours in adolescents worldwide. Its initiation and experimentation are mostly given during the adolescence. The consequences of cannabis use can be detrimental, leading to physical and mental disorders, strained relationships, family and school problems, or dependence syndrome. The World Health Organization (WHO) reported that research on risk and protective factors for recreational cannabis use has been limited to a few high-income countries, where Spain is not included. In Spain, and particularly in Andalusia, little is known about the factors influencing cannabis use behaviour in adolescents, necessitating an examination of its prevalence and related factors. This research requires observational longitudinal studies and reliable registry data. Based on these arguments, the overall goal of the thesis was to identify factors associated with cannabis use in Andalusian adolescents to prevent its use. More specifically, the thesis has the following objectives: (1) understanding factors associated with cannabis use among Andalusian adolescents, (2) identifying risk profiles for the onset of cannabis use based on usage trajectories, (3) exploring gender differences in beliefs about cannabis use, and (4) summarizing key findings on the influence of peers on cannabis behavior within adolescent friendships., El consumo de cannabis se está convirtiendo en una de las conductas de riesgo más comunes en los adolescentes de todo el mundo. Su iniciación y experimentación se dan mayoritariamente durante la adolescencia. Las consecuencias del consumo de cannabis pueden ser perjudiciales, dando lugar a trastornos físicos y mentales, relaciones sociales tensas, problemas familiares y escolares o síndrome de dependencia. La Organización Mundial de la Salud (OMS) informó que la investigación sobre los factores de riesgo y de protección para el consumo recreativo de cannabis se ha limitado a ciertos países de ingresos altos, donde España no está incluida. En España, y particularmente en Andalucía, se sabe poco sobre los factores que influyen en el comportamiento de consumo de cannabis en los adolescentes, por lo que es necesario examinar su prevalencia y factores relacionados. Para lograr este propósito, se requieren estudios longitudinales observacionales y datos de registro fiables. En base a estos argumentos, el objetivo general de la tesis fue identificar los factores asociados al consumo de cannabis en adolescentes andaluces, con la finalidad de prevenir su consumo. Más específicamente, la tesis tiene los siguientes objetivos específicos: (1) identificar y comprender los factores asociados con el consumo de cannabis entre los adolescentes andaluces, (2) identificar los perfiles de riesgo para el inicio del consumo de cannabis en función de las trayectorias/transiciones de uso, (3) explorar las diferencias de género en las creencias sobre el consumo de cannabis y (4) resumir los hallazgos clave sobre la influencia de los compañeros en el comportamiento del cannabis dentro de las amistades adolescentes.

Objectives: This study assessed potential differences between girls and boys in the prevalence rates of cannabis use, sociodemographic factors, and beliefs about cannabis use. Methods: 1,896 Andalusian adolescents aged 14–18 participated in an online survey based on the I-Change model. The survey assessed their beliefs about cannabis use, including attitudes, social influences, self-efficacy, action planning, and intention to use. Multivariate analyses of variance were then conducted to examine potential gender differences in these beliefs, while controlling for last month’s cannabis use. Results: Significantly more boys used cannabis in the last month, had boyfriends/girlfriends, and had more pocket money compared to girls. Additionally, girls – in comparison to boys - were more convinced of the disadvantages of cannabis use, but were also more convinced of some of the advantages (such as freedom from boredom, and medicinal use), reported having less favorable social norms for cannabis use, had more female best friends using cannabis, and felt pressure to use cannabis from their female peers. Conclusion: These findings highlight the need for cannabis prevention programs to consider gender differences in beliefs about cannabis use. Programs should not only address general risk factors for cannabis use but also evaluate if their interventions effectively target beliefs that are particularly important for girls and boys.

The well-being and satisfaction of individuals with serious mental illnesses (SMI) and their family caregivers are less than desirable. Research on the quality of life (QoL) of individuals with SMI and their caregivers, including disorders other than schizophrenia, is limited. Thus, this study aimed to investigate the self-perception of QoL in patients with SMI and their family caregivers and the associated factors. This cross-sectional study was conducted in patients with SMI and their caregivers who completed self-assessment instruments to determine their QoL. Social support and burden in caregivers and symptomatology levels in individuals with SMI were assessed. The physical aspect of QoL in individuals with SMI was associated with employment status and symptom severity. The physical component of caregivers’ QoL was associated with kinship relationship, the presence of other family members with disabilities, social support, and age. The mental component was associated with global symptomatology and the diagnosis of major depression in individuals with SMI and caregiver burden in family members. In conclusion, these findings on correlated factors of QoL in individuals with SMI and their caregivers could be used in developing therapeutic interventions for mental health. Plain summary: A significant number of people with serious mental health problems and their families often endure poor quality of life. However, research on how these individuals truly feel about their lives is limited. This study aimed to explore the perceptions of quality of life among individuals with serious mental health issues and their family caregivers in Spain. We sought to understand the personal sentiments of these individuals and their caregivers regarding their quality of life and the factors that influence it. Our findings indicate that job status, symptoms of the illness, and family relationships play crucial roles in how these individuals view their quality of life. Additionally, car

INTRODUCCIÓN. Las agresiones laborales de tipo 2 (realizadas por pacientes y allegados y relacionadas con la práctica asistencial) son una preocupación prioritaria para los profesionales que se encargan de la salud laboral del personal del sector sanitario. Sin embargo, la declaración de dichas agresiones no es muy frecuente, por lo que no se consigue contar con una estadística real y ajustada de los casos que ocurren. OBJETIVOS. El propósito de esta tesis es diseñar y validar un cuestionario para estudiar la declaración de las agresiones laborales tipo 2 en sanitarios e identificar los factores que influyen en que esta no se produzca adecuadamente. MATERIALES Y MÉTODOS. Se planteó un estudio mixto combinando metodología cuantitativa y cualitativa que se desarrolló en diferentes etapas. La primera se focalizó en el diseño del cuestionario, mediante la operacionalización del constructo y generación de ítems, elaborándose un conjunto de tópicos y una batería de preguntas resultantes de una búsqueda bibliográfica y un análisis cualitativo de la información obtenida mediante grupos focales con personal afectado (profesionales de ámbito sanitario) (n=40). En una segunda etapa, se realizó una validación del contenido mediante un panel Delphi online (n=19), con dos tipos de expertos (especialistas y afectados) y dos rondas de respuestas. Se evaluó la pertinencia y claridad de los ítems, apoyándonos en medidas de concentración y dispersión de las respuestas (media, mediana, porcentaje de respuestas altas (4-5) y V de Aiken). Posteriormente, para evaluar la reproductibilidad del cuestionario, se obtuvo el coeficiente de correlación intraclase mediante la administración del cuestionario en dos ocasiones a un grupo de profesionales de ámbito sanitario (n=31), con un intervalo de dos semanas entre cada administración (Test-retest). Finalmente, se pilotó el cuestionario en el personal del Hospital San Juan de Dios del Aljarafe y se analizaron los datos obtenidos para evaluar sus

Aim: A systematic review was performed to summarize the key findings of the peer influence on cannabis use through Social Network Analysis (SNA) studies and identify limitations and gaps with the purpose of informing future research and practice. Longitudinal studies were included since they provide robust information about social relationships change over time. Background: Adolescents’ cannabis use is a global problem, which has awakened an interest in its determinants such as social influences. Research has shown the importance of these influences on cannabis uptake and use. SNA is an useful relational approach to examine socialization mechanisms related to the onset of cannabis use in adolescents. Method: A search was conducted in PyscINFO, PubMed, Scopus and Web of Science for longitudinal articles published until February 2023, to examine cannabis use and peer’s social networks. We focus on peers’ influence of peers on cannabis use. Additionally, information about effect of cannabis use for peer selection was collected. Results: The results of the included studies (n = 8) showed that friends’ cannabis use was most often/strongly associated with cannabis use. There was also an increase of cannabis use when the adolescent did not feel close to the school’s peers, had a higher proportion of friendships relative to the total number of ties in the neighborhood, had a central position, did not belong to any group but had ties to members of two or more groups, had cannabis user friends (especially in early ages), and lived in a neighborhood where cannabis was used. Conclusion: Cannabis use is mainly related to friends’ use. Yet, future studies are warranted to control for relevant selection effects to further knowledge on network effects on cannabis use, improving the design, and improving the modeling of the network. This systematic review may inform about the critical aspects of preventing cannabis use among adolescents, taking into consideration their complex soc

Background: Cannabis use is increasing among Andalusian adolescents, causing health, social and financial problems. School nurses visit schools and provide health promotion to adolescents in Andalusia. In order to better tailor health promotion programs, it is important to understand the sociodemographic and motivational factors related to cannabis use in Andalusian adolescents. Design/Methods: In this cross-sectional study, 369 students (aged 15–18 years) from secondary schools in Andalusia were involved. An anonymous questionnaire based on the I-Change Model was self-administered during school hours. Cannabis users were compared with non-cannabis users regarding sociodemographic and motivational factors. Contingency tables, mean comparison tests, and logistic regression analyses were conducted. Results: The prevalence of cannabis use in the last year was 21.6%. Non-cannabis users had a few positive beliefs toward cannabis use (e.g. the ability to relax or medical benefits), as well as users. Users recognized some disadvantages of cannabis use but played down their importance and mentioned more advantages. Moreover, social influence, especially from peers, plays a critical role in cannabis use. Specific social situations and moods seemed to be special risk factors for cannabis use, such as being at a celebration or feeling good. Results of regression analysis showed that cannabis use is mainly associated with age, low family function, low family affluence, high pocket money, perceiving few disadvantages of cannabis use, much social modeling of cannabis use, social norm and pressure favoring cannabis, low self-efficacy to resist using cannabis and positive intentions to use cannabis. Conclusions: Based on our results, prevention programmes lead by nurses can be tailored to the factors important to prevent cannabis use, focusing on outlining the disadvantages of cannabis use, alternatives for using cannabis when feeling good, increasing salience of healthy social inf

Background: Binge drinking (BD) among adolescents is a public health concern worldwide. This study assessed the cost-effectiveness and cost-utility of a web-based computer-tailored intervention to prevent BD in adolescence. Methods: The sample was drawn from a study evaluating the Alerta Alcohol program. The population consisted of adolescents 15 to 19 years of age. Data were recorded at baseline (January to February 2016) and after 4 months (May to June 2017) and were used to estimate costs and health outcomes, as measured by the number of BD occasions and quality-adjusted life years (QALYs). Incremental cost-effectiveness and cost-utility ratios were calculated from National Health Service (NHS) and societal perspectives and for a time horizon of 4 months. A multivariate deterministic sensitivity analysis of best/worst scenarios by subgroups was used to account for uncertainty. Results: The cost of reducing BD occasions by one per month was €16.63 from the NHS perspective, which from the societal perspective resulted in savings of €7986.37. From the societal perspective, the intervention resulted in an incremental cost of €71.05 per QALY gained from the NHS perspective and this was dominant, resulting in savings of €34,126.64 per QALY gained in comparison with the control group. Subgroup analyses showed that the intervention was dominant for girls from both the perspectives and for individuals 17 years or older from the NHS perspective. Conclusions: Computer-tailored feedback is a cost-effective way to reduce BD and increase QALYs among adolescents. However, long-term follow-up is needed to evaluate more fully changes in both BD and health-related quality of life.

Background To learn about the experiences and opinions of adolescent non-consumers and regular cannabis users about cannabis use and the factors that determine its use, using the I-Change explanatory model as a basis. Methods Qualitative methodology with a content analysis was used. Focus groups were conducted with adolescents who were non-regular cannabis users (those who had not tried cannabis or had only experimented with it before) and semi-structured interviews were conducted with adolescent and young adult in recovery who were in a detoxification program. A deductive analysis of the audio-recorded and transcribed interviews was performed, using the domains of the I-Change Model as a reference. Results Personal problems, social problems or family problems can lead to cannabis use. There was a lack of knowledge and low risk perception about consumption of this drug. There are other factors that influence consumption, the perception of advantages, such as the feeling of freedom and the influence of the peer group. The consumption of this substance in girls is changing, becoming more and more equal to that of boys. The family has an important role to play in preventing drug use. Conclusion Knowledge of these factors is of vital importance as a prior step to the development of efficient intervention measures adjusted to the needs identified and the characteristics of the population.