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Objective: To analyse the trend in life expectancy (LE), healthy life expectancy (HLE) and socio-economic inequalities by neighbourhood in Barcelona from the pre-pandemic period (2018-2019) to the pandemic period (2020-2021)., Method: LE and HLE at birth were computed using the municipal register of inhabitants and quality of life (EuroQol) from the Barcelona Health Survey of 2016. Inequalities were assessed with the gap between quantiles of neighbourhood income., Results: In 2020, there was a reduction in LE among men (-1.98 years) and women (-2.44) and in HLE among men (-1.44). Socio-economic inequalities in LE and HLE between neighbourhoods widened since 2019 to 2021 (LE: from 3.92 to 4.86 years for men, and from 1.30 to 3.60 for women; HLE: from 6.88 to 7.70 years for men, and from 7.85 to 9.31 for women)., Conclusions: The pandemic has substantially reduced LE and HLE, with larger effects among low-income neighbourhoods, especially among women., (Copyright © 2022 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

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., (Copyright © 2019 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To analyse changes in health professionals' and immigrant users' perceptions of the quality of care provided to the immigrant population during the crisis., Methods: A qualitative descriptive-interpretative and exploratory study was conducted in two areas of Catalonia. Semi-structured individual interviews were used with a theoretical sample of medical (n=24) and administrative (n=10) professionals in primary care (PC) and secondary care (SC), and immigrant users (n=20). Thematic analysis was conducted and the results were triangulated., Results: Problems related to technical and interpersonal quality emerged from the discourse of both professionals and immigrants. These problems were attributed to cutbacks during the economic crisis. Regarding technical quality, respondents reported an increase in erroneous or non-specific diagnoses, inappropriate use of diagnostic tests and non-specific treatments, due to reduction in consultation times as a result of cuts in human resources. With regard to interpersonal quality, professionals reported less empathy, and users also reported worse communication, due to changes in professionals' working conditions and users' attitudes. Finally, a reduction in the resolution capacity of the health services emerged: professionals described unnecessary repeated PC visits and limited responses in SC, while young immigrants reported an insufficient response to their health problems., Conclusion: The results indicate a deterioration in perceived technical and interpersonal quality during the economic crisis, due to cutbacks mainly in human resources. These changes affect the whole population, but especially immigrants., (Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Health services in Spain are currently being improved. Definition of the services portfolio has been one of the elements in this process, from which public health services have been largely left out. In the present article public health services are examined from the perspective of the Public Health Agency of Barcelona. We propose a scheme to classify services into productive public health services, health care services, services that are intermediate products, support services, and liaison or coordinating services. Indicators of productivity, result, impact, and cost are explored, and a catalogue of services for a public health organization with a well defined population and area is proposed.

Objective: The presence of trihalomethanes in the water systems of several Spanish cities has been demonstrated. The aim of this study was to analyze trihalomethane concentrations in the water provided for human consumption in the city of Barcelona., Methods: We analyzed 151 water samples collected in 1998. The analyses were performed in the Public Health Laboratory of Barcelona using the purge-and-trap method and subsequent determination by gas chromatography and mass spectrometry. The results are presented according to the source of the water: the rivers of Llobregat or Ter, or a mixture of these., Results: Trihalomethane concentrations in the water from Ter were relatively low, with a predominance of chloroform and bromodichloromethane, while concentrations in the water from Llobregat were much higher, with a predominance of bromoform and dibromochloromethane. Mixed water showed intermediate concentrations. The total concentrations reached in the water from Llobregat were above 100 microg/l., Conclusions: The results show the need to continue reducing organic pollution and halogenated compounds in the water used for human consumption in Barcelona.

Background: Tobacco use in Spain is still high, with many smoking related deaths. However, a decrease in smoking prevalence in men has been observed in recent years, with a stabilisation or an increase among women. This paper studies the evolution of cancer mortality in Barcelona city (Catalonia, Spain) according to age and sex over the period 1984-1998., Subjects and Method: The evolution of annual mortality by age and sex was calculated. Specific mortality rates were estimated by age and sex strata; crude and standardized death rates for each year were also determined. Finally, for the 35-64 years population, specific mortality rates were estimated for each 5-year period (1984-1988, 1989-1993, and 1994-1998)., Results: Mortality rates do not change for men aged 35-39, 50-54 and 55-59 years. There was a decrease in lung cancer mortality rates in the 1994-1998 period compared to the first period for those men in the 60-64 years group. In men in the 40-44 and 45-49 years groups, rates increased in the second and stabilize in the last period. Global rates in men in the 35-64 years group, both crude and adjusted, were in the first and last 5-year periods. Among women, rates are much lower, although there was a significant increase in the 35-39 and 45-49 years groups. Crude and adjusted rates in all women aged 35 to 64 years displayed an increase in the last 5-year period., Conclusions: These results show that in Barcelona the decrease in smoking prevalence among males is now leading to an initial decrease in lung cancer mortality. The turning point seems to be in the period 1989-1993. On the contrary, there is a clear increase among young women, although the rates are still much lower.

Objective: The aim of the study is to know the accuracy of the variables birth weight and gestational age in the Barcelona Birth Registry. Hospital medical records are used as gold standard., Methods: A representative sample (n = 1,932) was selected from all the residents born in the city of Barcelona between 1st of May and 31st of December of 1996. The variables birth weight and gestational age were evaluated. Exhaustivity, sensitivity, specificity and predictive value for these variables were calculated., Results: The Registry shows a high exhaustivity for the study variables. The lowest value of sensitivity corresponds to premature births (65.1%) and the lowest value of specificity to term births (63.9%). The predictive value positive was 77.5% for preterm births and 76.7% for term births., Conclusions: In general, exhaustivity and accuracy of the Barcelona Birth Registry are high, but sensitivity for preterm births in the Registry is lower. However, the corresponding maternal and child health indicators do not vary in an important manner.

Objective: Evaluation of the impact of the reform of primary health care services on the population health., Design: Comparative analysis of mortality rates for the 1984-96 period in three zones of homogeneous socioeconomic level, assessing the effect of the differential development of the reform of public primary health care services., Setting: The study is restricted to the 23 health areas with lower socioeconomic status in the city of Barcelona (443092 inhabitants)., Measurements and Main Results: The study areas are categorized in three groups, according to the sequence of the reform: reformed between 1984 and 1989, RAP1 zone, reformed between 1990 and 1991, RAP2 zone, and those still served by the old scheme in 1992, NORAP zone. General mortality rates are analyzed, and also mortality rates by those avoidable conditions. Significant differences among the three zones are initially visible. The mortality decline is 13.6% in the RAP1 zone and 10.3% in the NORAP zone, so that the decline in the RAP1 zone is 32% greater than in the NORAP zone. At the end of the study, mortality due to stroke and hypertension is lower in the RAP zones than in the NORAP zone. Perinatal mortality shows a clear decline in the three zones. No relevant changes are seen for tuberculosis or cervical cancer. Lung cancer mortality increases except in RAP1 zone where it declines, to the point that the excess mortality from that cause estimated by comparison with the NORAP zone in the initial phase of the study vanishes. Death rates from cirrhosis and motor vehicle accident decline in all zones., Conclusions: There is a clear association between the process of reform of primary care and the decrease in general mortality in these zones of low socioeconomic level. These results suggest that the reform of primary health care services in Spain may have a significant impact in the mortality of the population of lower socioeconomic level. The study highlight the cost in health and human lives of maintaining obsolete and overburdened services for some segments of the population, and justify the need and urgency of completing the process of reform initiated in 1984 and still unfinished in 1999.

Background: This paper studies smoking epidemiology in school-age students., Material and Methods: A cross-sectional survey of 8th grade students (13-14 years-old) in the schools of Barcelona (Catalonia, Spain) in 1987, 1992 and 1994., Results: The perception of smoking in the students environment has decreased. The proportion of regular smokers decreases, from 12.6% in 1987 to 9.5% in 1994 (p < 0.05) (an annual decrease of 3.5%) although the proportion who experiment with tobacco remains table., Conclusions: There is a decrease in the prevalence of regular smoking in the school-age population (13-14 years-old) in Barcelona (Spain).

Background: This study examines the evolution of tobacco use among schoolchildren in sixth and seventh grades in Barcelona (11-13 years) and identifies smoking risk factors through cross-sectional and follow-up analysis. POBLATION AND METHODS: The cohort consists of 1,003 students attending 13 schools who served as control units for a study assessing the effects of a school-based addictive substances prevention program. Participants answered the same questionnaire in 1990 and 1991. Risk factors for the experimentation and for regular smoking are studied through cross-sectional and prospective studies., Result: In a year, smokers increase from 9.7% to 18.9% and regular smokers rise from 1.1% to 5.5%. The initial cross-sectional analysis finds stronger associations than the follow-up one. Some variables loose their significance in the longitudinal analysis. Among non-smokers, the strongest predictors to emerge are intention to smoke, the belief that smoking is fun, peers, siblings and mother consumption, and being male; however girls appear to consolidate the consumption more than boys among the cohort of triers., Conclusions: Tobacco use prevalences are consistent with other studies developed in our city. Social environment emerges as an important predictor; friends, siblings and mothers tobacco use and gender are the main risk factors.

Objective: Determine the prevalence and characteristics of tobaccoism, as well as some attitudes and their knowledge about tobaccoism in nursing university students in Catalonia., Methods: A descriptive study with transversal section has been done. A self-filling anonymous questionnaire was designed following the guidelines of the European Regional Office of the W.H.O. We selected a sample of conglomerates of classrooms at random which was stratified according to levels in all the university schools in Catalonia. The field work was performed during the first term of the academic year 1994-1995 handing the questionnaires individually to the students and collecting them once filled. In the data analysis we used the ji squared test to Pearson with the Yates' correction and the lineal tendency test of Mantel-Haenszel., Results: 904 students answered the questionnaire. The global prevalence of smokers is 38.7% (IC 95%: 35.8-41.6). There were no significant differences when considering levels or sex. The prevalence of tobaccoism in students over 24 years of age is 13% higher (p < 0.01) than in the group between 18 and 24 years of age. The group of daily smokers consumes an average of 12 cigarettes per day (DE: 5.9 cig/day). Significant differences were observed between smokers and nonsmokers in all the attitude variables analysed towards tobaccoism. 32% of third year students consider their knowledge is not enough in order to give advice against tobacco., Conclusions: A prevalence higher than 30% of the established objective in the Health Plan in Catalonia has been observed for the nursing professionals in the year 2000.

Background: Perinatal mortality is considered a good effectiveness health care indicator during pregnancy, deliver and early perinatal period. The aims of this investigation were to describe the magnitude and tendency of underreporting perinatal mortality in Barcelona, Spain from 1985 to 1994 and to determine underreporting predictive variables., Subjects and Methods: Perinatal deaths between 1985 and 1994 were studied according to WHO international statistics criteria and deaths from 1988 to 1994 were also studied according to the WHO national statistics criteria. Sources of information were: Statistical Deaths Certificates and the Active Surveillance Registry that collect information about perinatal deaths directly from hospitals. A perinatal death was considered underreported if it was registered in the Active Surveillance Register but not in the Statistical Death Certificate., Results: 24.5% perinatal deaths were underreported from 1985 to 1995 (according to international statistics criteria) and 24.9% from 1988 to 1994 (according national statistics criteria). In both periods underreporting decreased. Deaths in the first 24 hours of live (OR = 1.8; CI 95% = 1-3), newborns weight between 1,000 and 1,499 g (OR = 1.5; CI 95% = 0.6-3.8), hospitals with mortality registry (OR = 4; CI 95% = 2.2-7.1) and the first years of the study (OR = 0.7; CI 95% = 0.7-0.8) were predictive of underreporting., Conclusions: Underreporting perinatal deaths decreased during the study period. Deaths of newborns with low birth weight and who lived less than 24 hours were more underreported. The work developed by Active Surveillance Registry contributed to the decense of underreporting perinatal deaths.

Objective: The objective of this study is to assess the contribution of job strain, according to the Karasek's demand-control model, on the job satisfaction and stress-related psychological symptoms in nurses and nurse aids of caring units of a public hospital of Barcelona, independently of other aspects of both the work and the outside of work environment., Methods: A cross-sectional study was designed and data were collected through a self-administered questionnaire that was answered by 273 people of caring units of a public hospital of Barcelona (response rate 81%). Job strain that classifies workers into four groups, low strain, high strain, active jobs, and passive jobs, was measured through the items of the "Job Content" questionnaire about demands and control adapted for this study. Job satisfaction and two types of psychological symptoms, anxious and somatic symptoms were analyzed first at the bivariate level and then by adjusting logistic regression models that included both work and nonwork variables., Results: The three outcomes were significantly associated with job strain, being the low strain situation the most positive one and the high strain the most negative one. Adjusted odds ratios (OR) of the high strain jobs versus the low strain jobs were 0.20 (CI 95% = 0.05-0.45) for job satisfaction, 3.45 (CI 95% = 1.63-7.33) for anxious symptoms and 3.72 (CI 95% = 1.65-8.38) for the psychosomatic symptoms. Passive and active jobs fell in between these extremes. Other variables both from the work environment and from the outside of work environment were associated with these outcomes., Conclusion: This study shows the importance of job strain on the job satisfaction and stress-related psychological symptoms of this group of workers, even after adjusting by other variables of the work and of the outside of work environment. This finding underscores the importance of considering, jointly with the classical work hazards, those related with the psychosocial work environment in implementing strategies for improving health and welfare among nurses.

Objective: To study demographic and health related variables included in the municipal birth registry. Differences among municipal districts are assessed, as an approach to the study of inequalities in pregnancy, in birth and in its care., Design: Observational study, based on secondary utilization of vital statistics data. SITE: The city of Barcelona (Catalonia, Spain), for the 1990-1991 years., Participants: Births from women who are city residents., Main Results: Births concentrate around maternal ages of 25-29 years and 30-34. Adolescent mothers (less than 20 years) represent only a proportion of 1.9% of all births, and births from women above 34 years 13.7%, although only 2.1% of all births are from mothers above 40 years of age. Low birth weight (less than 2,500 g) occurs in 5.6% of all births. Preterm births (less than 37 weeks) occur in 4.7% of all deliveries. Teen age fertility, births to women above 34 years, low birth weight and preterm deliveries are compared across districts. Overall, four out of ten women use a public hospital for delivery, but this varies greatly among districts. There is no information on the father for 1.6% of all births., Conclusions: The completeness of this information source is high and the municipal registry is a useful database for the analysis of inequalities in small areas, using health related indicators which have higher frequency than more traditional indicators based on rare events (such as infant mortality). Differences among areas are found, related to life conditions and to prenatal and birth care.

Background: Mortality caused by acute adverse drug reactions (AADR) increased in Spain over the eighties and has become one of the major causes of death for youth. This paper presents the results of a study in the city of Barcelona during the 1983-92 decade; based in the city drug information system., Methods: The study includes all deaths caused by AADR autopsied in the Forensic Institute between 1983 and 1992. Mortality of city residents is analyzed by cohort, grouping data in two-years and adjusting Poisson regression to mortality rates by age group, birth cohort and period of study., Results: During this period a sharp increase in AADR mortality is seen, as there were 19 deaths in the city in 1983 and 160 in 1992. The increase concentrates in the years 1987-89. Although previously the increasing mortality of drug users was related by some observers with the progressive deterioration of their health status, linked to their increasing age and to the cumulative effects of years of substance dependence, the mortality analysis points to a clear period effect, resulting in an increased mortality across all age groups, for cohorts born after 1960., Conclusions: These results point to changes in the illegal drug market in the city or in the patterns of abuse as most likely causes for the increase. The results also suggest that since 1989 there is a stabilization in mortality due to AADR, which deserves further study.

We present the evaluation of the population impact of a social and health maternal and child intervention, implemented in a low income urban area (Ciutat Vella) in Barcelona, Spain. Intervention was based on increasing access to health and social services for pregnant women and for the children. A quasiexperimental design with a nonequivalent control group and multiple measurements was used. We compared infant and perinatal cumulative mortality rates between Ciutat Vella District and the rest of the city, before (1983-86) and after the intervention (1987-89, 1990-92). Results showed that the significant differences found previously to the program between the mortality rates disappeared with the development of the program. Infant mortality in Ciutat Vella was 17.7/.000 births in 1983-86, and became 13.1/1.000 births in 1987-89, and 13.4 in 1990-92; in the rest of the city, infant mortality was 9.5/1.000 births in 1983-86, and became 8.8/ and 7.7/1000 births respectively. A comprehensive social and health care program implemented in small low income areas may contribute to reduce inequalities in maternal and child health.

Background: A large share of premature mortality is Spain in related with the abuse of addictive substances: tobacco, alcohol and non-institutionalized drugs. Adolescence is a key period for the adoption of their use. An accurate knowledge of the attitudes, beliefs, environmental perceptions and behaviours of teen-agers is necessary for the design and evaluation of preventive interventions., Methods: Data were obtained from a survey conducted in 1992 on smoking, alcohol and non-institutionalized drugs in 8th grade students (13-14 years old) of a representative sample of the schools of the city of Barcelona (Catalonia, Spain)., Results: Up to 44.1% have ever smoked, 10.9% are regular smokers and 15.5% have bought tobacco at some point. There are no differences in smoking patterns by sex at this age. Even if 35.5% never drink alcohol, 1.7% drink it daily, 15.5% drink on week-ends and 62.9% at family celebrations, while 13.5% have bought alcohol at some point and 22.4% report having got drunk at least once. There are no differences by sex in alcohol use at this age. Concerning non-institutionalized drugs, 35.4% of the students think that many adults use them, and 22.4% say that some friends have tried them., Conclusions: The results show the increasing penetration of tobacco and alcohol in the personal environment of the students, and the process of initiation. Compared with previous studies in this population, we can estimate a modest and non-significant reduction of regular smoking, and a reduction in daily and regular alcohol use.

Due to the 1992 Barcelona Olympic Games some modifications were introduced in the epidemiologic surveillance system for infectious diseases in place in the city, in order to expand its coverage and shorten its timeliness in detecting outbreaks and investigating cases. These modifications were introduced for a group conditions (hepatitis, meningococcal disease, legionnaire's disease and food outbreaks), selected on the basis of incidence, time of the year, previous experience in other settings, and likelihood of outbreak occurrence. In the June-August 1992 period (Olympic period), no increases in the incidence of selected conditions were observed when compared to the same period in 1986 to 1991. Major changes were observed in the source of food outbreak reporting, with a large increase in outbreaks reported by emergency room departments. There was an increase in the number of domestic foodborne outbreaks and a reduction in those related with restaurants. Timeliness in the detection of cases was shortened. The use of similar modifications can be useful for epidemiologic surveillance systems in other comparable settings or occasions.

The target of this study is to describe the prevalence and the associated factors to the smoking consumption in a sample of schoolchildren. During the academic year 1991-92 were administered 1,816 surveys among students of 13 and 18 years-old, whom corresponded to 7th and 8th EGB courses and all courses of BUP, COU and FP grades. The survey, include five Barcelona schools and one of Raimat (Lleida). The total rate of regular smokers was 28.6%, without differences between sex. The associated variables to smoking daily consumption in the bivariate analysis were to be more than 15 years old (OR = 3.5), to be student of FP grades (OR = 2.5), the low socioeconomic level (OR = 1.4), the influence of other smokers in the environment of the student (OR = 1.6), the advantageous attitudes the smoking consumption (OR = 37.0), a little level of physical activity (OR = 2.1), the alcohol associated consumption (OR = 15.1), and the greater responsibility of weekly own money (OR = 2.4). In the multivariate analysis stays the effect of all these variables, less for the socioeconomic level. In conclusion our results are consistent with previous studies and reinforce the necessity of approaching these factors in the preventive smoking programs in schoolchildren.

This paper describes the distribution of fertility and abortion rates in the city of Barcelona (Spain) in adolescent in 1990. The adolescents' socio-demographic background and characteristics of their family unit obtained from the statistically bulletin of birth are analyzed. In this year, there were 248 births and 195 abortions to women between 15 and 19 years-old, yielding a rate of 3.9 and 3.1 per thousand, respectively, so that at least 7 per 1000 were pregnant. Fertility rates varied by district between 0.8 in Sarrià-Sant Gervasi and 14.6 in the inner city district of Ciutat Vella, with a high positive correlation of these rates and a district social problem index (r = 0.96) and a high negative correlation with an index of family economic wealth (r = 0.93). Around two thirds (63%) of the adolescent mothers reported to be living with their parents after childbirth, and their companion joins this unit in four out of ten cases. In 14.5% of births, the father's age under 20, although the most of them (39.1%) were between 20 and 24 years-old. Although teenage fertility rates have been declining during the last years in Barcelona, the strong correlation with socio-economic indicators encourages the design of specific programs addressing socially disadvantaged groups. In addition, several risk factors can be used to identify adolescent mothers at risk when designing specific interventions such as the lack of recognized paternity by the father, dropping out of school, or lacking family's support.

Objective: To evaluate the utility of school health examinations performed at four years of age., Design: Evaluation of the results of school health examinations performed on 5,709 children are presented, with the follow up of selected problems found (overweight, growth failure, strabismus, reduced uncorrected visual acuity, hearing loss, psychomotor development and speech development impairment, hydrocele, cryptorchism, haematuria, dental caries and heart murmur)., Setting: 4-year old kindergarten children assessed in the school health program in the city of Barcelona (Catalonia, Spain)., Main Results: The examination identified 1,177 suspected defects in 960 children. Through a telephone interview with the families of 745 of these children, it was found that only 34.1% were previously unknown to families. The most frequently unknown problem was dental caries. Professional help was sought for 54.3% of the suspected defects. Only 10.5% of the suspected problems began any sort of treatment. The most frequently treated problems wer previously uncorrected refractive defects of the vision. Families report that 8.2% of the suspected problems improve., Conclusions: These results suggest that the current health output of school health examinations in our city is modest, and that their cost-opportunity should be reviewed.

The aim of the present study is to identify and prioritize the most important five occupational risk factors perceived by representatives of workers in each one of the economical activity branches (EAB) in Barcelona, by the Delphi Method. A Delphi survey was carried out for each EAB of Barcelona. 273 trade union delegates (from 21 to 28 by EAB) were consulted the three successive postal interviews. The typical risk factors (noise, toxics, and infections agents) appeared in the first and second place in the printing, food, textile, chemical and health branches of activity. However, risk factors related to work organization were pointed out in the first place in the rest of branches. The use of the Delphi method by the occupational health managers of a geographical area could let, in an easy and fast way, identify and prioritize the risk factors of this area in order to introduce effectiveness prevention measures.

Background: The initiation of the smoking habit is related both with personal and environmental characteristics. Several authors have described the association of the smoking habit of parents, older siblings, and friends with the use of tobacco by teens., Methods: This study is based on a cross-sectional survey to 6th and 7th grade students in Barcelona (Spain)., Results: This study confirms there is a growing proportion of smokers among teens when their parents, siblings and friend smoke. Children whose parents have quit smoking behave as the sons of parents who have never smoked, and smoke much less than the children of current smokers. When parents do not smoke, having siblings and friends who smoke increases the frequency of smoking from 0.2 to 3.4%, a 17-fold increase., Conclusions: Current smoking and future smoking intention are related with the number of smokers in the teen environment. These results support preventive programs in schools that include activities to resist external pressures to smoke. It also suggests that helping young adult smokers quit contributes not only to their own health, but also prevents the initiation of smoking among teens in their environment.

Objective: To analyse for the 1987-1990 period the indicators of prenatal care and the social-health follow-up of adolescent girls included in the mother-child programme of Ciutat Vella (Barcelona). This programme was aimed at pregnant women resident in the district and with high social risk profiles., Design: Descriptive and retrospective study., Measurements and Main Results: 175 adolescent mothers were included in the programme during the period under study. This represented 82.9% coverage of all births in the district to this age group. In 10.9% of cases the mother stated she lived alone. 10.2% had had a previous child. There were drug addiction antecedents in 5% of the mothers. The first prenatal check took place during the first three months only in 56% of the pregnancies, with the proportion of low weight births (LWB: weight at birth below 2,500 grams) at 13.1%. During the period under study the proportion of pregnant women checked in the first three months went up from 45.6% to 62.5%, while the proportion of LWB's went down from 19.3% to 6.3%., Conclusions: There has been both a striking improvement in the indicators of prenatal care and less low weight births during the first four years of this programme. It is worth noting the worrying fact that one third of pregnant adolescents do not attend for a prenatal check-up before three months of their pregnancy have elapsed.

We review the literature on school programs of prevention of consumption of tobacco and other addictive substances among adolescents. We describe the keys of these programs. The programs enforcing the abilities to resist the social pressure to the consumption of addictive substances report better results and they achieve significant reduction in the initiation of tobacco consumption. They also report promising results for alcohol and other addictive substances, but they are not so clearly supported. Average duration of the programs is between 8 and 12 ours a year, generally in 6th and 8th course. Other purposes of similar duration based on: self-esteem, the development of activities other than drug consumption, or the simple information on drugs, have not shown significant positive results for these ages.