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The aim of the study was to identify the environmental factors that influence alcohol consumption, according to university students, and assess the relative importance and the frequency attributed to each factor. A study using Concept Mapping methodology was performed with a sample of nursing students, who participated in two face-to-face data collection sessions. In session 1, a consensus about the environmental aspects that influence their alcohol consumption was obtained. In session 2, the statements obtained were rated according to their relative importance and frequency in alcohol use (1 = minimum; 5 = maximum). Subsequently, all data were analyzed with the RCMAP of the statistical package R 3.6.1.Approximately 60 students participated in each session. Most were women aged 20 to 24. In session 1, a total of 55 statements were obtained and classified into 7 different clusters: Advertising (9 statements); Family environment (4 statements); Social pressure (12 statements); Responsibilities/norms (4 statements); Holidays and leisure time (7 statements); Emotional situations (8 statements); Accessibility (11 statements). Factors related to social pressure, holidays and leisure time, and alcohol accessibility were considered the most important and frequent in alcohol consumption. In contrast, alcohol advertising was considered the least important (mean 2.6 out of 5) and frequent (mean 2.1 out 5) factor. In conclusion, the factors considered most relevant among nursing students match those having more resources allocated for prevention and health promotion, except for alcohol advertising, which was perceived as less important and frequent compared with the other factors.

The consequences of climate change are becoming increasingly evident and highlight the important interdependence between the well-being of people and ecosystems. Although climate change is a global phenomenon, its causes and consequences vary dramatically across territories and population groups. Among settings particularly susceptible to health impacts from climate change are cities with a Mediterranean climate. Here, impacts will put additional pressure on already-stressed ecosystems and vulnerable economies and societies, increasing health inequalities. Therefore, this article presents and discusses a conceptual framework for understanding the complex relationship between climate change and health in the context of cities with Mediterranean climate from a social and climate justice approach. The different elements that integrate the conceptual framework are: (1) the determinants of climate change; (2) its environmental and social consequences; (3) its direct and indirect impacts on health; and (4) the role of mitigation and adaptation policies. The model places special emphasis on the associated social and health inequalities through (1) the recognition of the role of systems of privilege and oppression; (2) the distinction between structural and intermediate determinants of climate change at the root of health inequalities; (3) the role of individual and collective vulnerability in mediating the effects of climate change on health; and (4) the need to act from a climate justice perspective to reverse health inequities.

This paper documents the management of two programs for the universal prevention of substance use offered in secondary schools by the public health services of the city of Barcelona, reviewing the period from 1989-1990 to 2016-2017. Both programs had proven effectiveness in evaluations with a comparison group, they are promoted by the public health agency free of cost, and are taught by teachers, using standardized manuals with support materials and training. The coverage achieved over recent years declined from 40% to 25%. Changes observed in the acceptance and implementation of these programs could be related with logistics and follow-up by the public health services, changes in substance availability, and with budget cuts in education. The monitoring of effective programs by public health services is essential to preserve their actual implementation., (Copyright © 2021 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

This paper makes a first proposal for a public health surveillance system for climate change in cities, and describes the process that led to its definition. After several years of monitoring different aspects related to climate change and its impact, the public health services of Barcelona made a preliminary proposal and gathered a working group of experts to discuss and review it. Four categories of components were defined: climate data, health impacts of climate change and its determinants, contributions of the city to mitigation (especially those with health co-benefits), and actions to reduce vulnerability to extreme events. They were broken in twelve components, with indicators for each. The proposal was further refined with subsequent reviews, and is being used by the city public health services involved in this field., (Copyright © 2021 SESPAS. All rights reserved.)

Continuous management improvement should be an aspiration for all public sector organizations. External comparison or benchmarking identifies good practices in similar organizations. For public health services, it is not easy to obtain such indicators. The objectives of this paper are to describe the process of conducting a benchmarking exercise for a public health agency, and to share its results. For this purpose, agencies that may be compared were identified, and their websites were searched for annual reports or other documents with indicators of the activities or results of public health services. Limitations and contextual aspects of the indicators of the different organizations were identified, as well as ways to improve their comparability. Finally, a set of 19 indicators is proposed, as an initial core for quality management comparisons., (Copyright © 2021 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

We aimed to characterize the availability and promotion of alcohol at alcohol outlets in Madrid and to compare them according to type of outlet and area-level socioeconomic status. We used the OHCITIES instrument to characterise the alcohol outlets in 42 census tracts of Madrid in 2016. We specified alcohol availability as the density of alcohol outlets and the number of alcohol outlets with extended opening hours (12 or more). We registered any type of promotion associated to alcohol outlets that could be perceived from outside the outlet. We calculated and compared proportions of availability and promotion by alcohol outlet (on- and off-premise) using chi-squared and Fisher Exact tests. We estimated the availability and promotion of alcohol densities per census tract according to area-level socioeconomic status. To assess statistical significance, we used Kruskal-Wallis tests. We recorded 324 alcohol outlets, 241 on-premise and 83 off-premise. Most of the outlets had extended opening hours (73.77%) and at least one sign promoting alcohol (89.51%). More on-premise outlets had extended opening hours and higher presence of alcohol promotion than off-premise (p < 0.001). Higher density of alcohol outlets, extended opening hours and presence of alcohol promotion were found in higher socioeconomic areas (all p < 0.001). These results were also observed for on-premise alcohol outlets. Alcohol availability and promotion were associated with alcohol outlets in Madrid. Future alcohol policies regulating the availability and promotion of alcohol should consider outlet types and area-level socioeconomic status.

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.

Objective: To determine the predisposition to use roll-your-own (RYO) cigarettes and the beliefs about RYO cigarettes of all the students of 3°-4° of ESO during the years 2016-17 and 2018-19. A cross-sectional study., Setting: Bisaura High School from Sant Quirze de Besora. Primary Health Care in the Catalan Health Institute, Catalunya, Spain., Participants: 111 3rd and 4th of ESO (14-16 years)., Main Measurements: Dependent variables used were future intentions of smoking and beliefs regarding RYO cigarettes. Independent variables were sex, course and ever smoked. The prevalence of the different dependent variables was described and compared according to the different independent variables with Pearson's Khi-square test., Results: 26.6% of the adolescents intended to smoke in the future of which 17.4% intended to smoke RYO cigarettes and 13.8% manufactured cigarettes (MC). Around 30% of adolescents express at least one wrong belief regarding RYO cigarettes. For example, the 26.7% believed that smoking RYO cigarettes generated less addiction than MC and the 32.1% that was less harmful. Those who had smoked at some time in their life had a greater intention to smoke in the future (54.5%), to smoke MC (27.3%) and RYO cigarettes (40.9%) than those who had never smoked (7.7%, 4.6% and 1.5% respectively) (p<0.005). Some misconceptions differed depending on whether adolescents had ever smoked in life, sex and course. The boys believed that smoking RYO cigarettes was more natural than smoking MC (p<0.005)., Conclusions: Educational activities to improve the information that young people have regarding RYO cigarettes are needed., (Copyright © 2021 The Author(s). Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: The objective of this study was to describe the temporal relationship between an illicit drug market abrupt disruption and the number of discarded syringes collected from public space in Barcelona., Methods: The monthly number of discarded syringes collected and interrupted time-series analyses were used to analyze changes and trends from January 2014 to December 2017, before and after an illicit drug market disruption comparing three different areas of the city: intervened (A) and not intervened (B) high trafficking areas and, as a reference, a low trafficking area (C)., Results: After the disruption, a decrease in the average number of syringes collected in area A was observed, although the trend was not significant (p value 0.09). In area B, there was a significant increase with an upward trend in the average number of collected syringes (p value <0.001). A flat trend was observed throughout the period in area C (p value 0.62) The systematic counting of discarded syringes collected from public places is confirmed as a useful indicator to monitor drug dealing and use in urban areas. It may help public health services strengthen safe needle disposal practices and harm reduction interventions in these areas., (Copyright © 2020 Elsevier B.V. All rights reserved.)

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

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

Objectives: Alcohol availability and promotion are not distributed equally in the urban context. Evidence shows that the socioeconomic level seems to influence the amount of alcohol-related elements in an area. Some studies suggest that tourism could also affect the distribution of these elements. We explore with a valid instrument in a large city whether there is an association between high tourism pressure and a greater presence of alcohol-related elements in the urban environment., Design: Observational ecological study., Setting: The study was conducted in Barcelona during 2017-2018., Participants: We assessed urban exposure to alcohol by performing social systematic observation using the OHCITIES Instrument in a stratified random sample of 170 census tracts within the city's 73 neighbourhoods., Primary and Secondary Outcome Measures: For each census tract we calculated the density of alcohol premises, and of promotion in public places per 1000 residents. We estimated tourism pressure using the number of tourist beds per 1000 residents in each neighbourhood and calculated quartiles. To assess the relationship between rate ratios of elements of alcohol urban environment and tourism pressure, we calculated Spearman correlations and fitted Poisson regression models with robust error variance., Results: The median densities obtained were of 8.18 alcohol premises and of 7.59 alcohol advertising and promotion elements visible from the public space per 1000 population. Census tracts with the highest tourism pressure had 2.5 (95% CI: 1.85-3.38) times more outlets and 2.3 (95% CI: 1.64-3.23) times more promotion elements per 1000 residents than those in the lowest tourism pressure quartile., Conclusions: We observed a strong association between tourism pressure and alcohol exposure in the city of Barcelona., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

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

Cannabis is the third most used psychoactive substance worldwide. The legal status of cannabis is changing in many Western countries, while we have very limited knowledge of the public health impact of cannabis-related harms. There is a need for a summary of the evidence of harms and risks attributed to cannabis use, in order to inform the definition of cannabis risky use. We have conducted a systematic review of systematic reviews, aiming to define cannabis-related harms. We included systematic reviews published until July 2018 from six different databases and following the PRISMA guidelines. To assess study quality we applied the AMSTAR 2 tool. A total of 44 systematic reviews, including 1,053 different studies, were eligible for inclusion. Harm was categorized in three dimensions: mental health, somatic harm and physical injury (including mortality). Evidence shows a clear association between cannabis use and psychosis, affective disorders, anxiety, sleep disorders, cognitive failures, respiratory adverse events, cancer, cardiovascular outcomes, and gastrointestinal disorders. Moreover, cannabis use is a risk factor for motor vehicle collision, suicidal behavior and partner and child violence. Cannabis use is a risk factor for several medical conditions and negative social consequences. There is still little data on the dose-dependency of these effects; evidence that is essential in order to define, from a public health perspective, what can be considered risky use of cannabis. This definition should be based on quantitative and qualitative criteria that informs and permits the evaluation of current approaches to a regulated cannabis market., Competing Interests: Conflict of interest H.L.-P.: has received travel grants from the laboratories honoraria and travel grants from Janssen and Lundbeck, none of these COI are related to the current research. The other authors declare that they have no known conflicts of interest., (Copyright © 2020 Elsevier B.V. and ECNP. All rights reserved.)

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

The objective of this study is to analyze the performance of regional public health services in Spain using the information accessible in their annual reports. A search of these was conducted, and 9 were obtained from the 17 Autonomous Communities. Their analysis shows some variation in the structure of the organizations providing public health services, as well as in the published contents and in the indicators used for management. The service portfolio, annual objectives and resources allocated are not always detailed. If the evaluation of public services and its dissemination are basic for transparency and quality management, there is much room for improvement. The compilation of annual reports by public health services is not systematic, and those that exist provide insufficient information for a comparative analysis of their activity, effectiveness and efficiency., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

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

This paper describes the use of focus groups as part of the evaluation of programmes to control food allergy and intolerance (FAI) in school settings in the city of Barcelona (Spain). After fostering their adoption and as a qualitative component of their evaluation, the public health services ran two focus groups, one with people from schools that manage their own kitchen, and another from companies that outsource this service. There were 28 participants from 46% of the centres invited. All the schools seem to have implemented a self-control programme on FAI. Although outsourcing companies already had a programme, the schools that managed their own service mostly adopted the programme promoted by the public health services. The number of schoolchildren with reported FAI reduced after the programme, as it required more rigorous documentation from families., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: This paper describes the presence of alcohol in the public space, assessing establishments that offer it, its advertising, and signs of consumption, as factors that may influence its consumption., Method: Descriptive observational study based on cluster sampling with two-step selection. Results are described, and the spatial association between variables is assessed., Results: In the 20 census tracts studied, 306 premises were identified that offered alcoholic beverages: 204 were on-premises and 102 were off-premises, mainly supermarkets and food retail stores. Their spatial distribution was uneven, concentrated in two central districts. We identified 72 publicity items, mostly sponsorship of musical events. There were many promotional items linked to on- premises, especially in their terraces. Five people were detected promoting consumption or selling alcohol in the Old Town. In each time slot, between 39 and 51 signs of consumption on the public space were observed (mostly abandoned beer cans), more frequent at night and in the Old Town. There is an association between the presence of establishments that offer alcohol and advertising. There is no relationship between these variables and signs of consumption in the public space; these are concentrated in the Old Town, which has greater presence of tourism., Conclusions: The urban environment is characterized by elements that stimulate alcohol use and its distribution is uneven, with a strong influence of tourism-related activities. Further regulation of alcohol promotion, availability and consumption in the public space may change its social image and decrease its use.

Objective: To provide information on persons treated for alcohol use disorders (AUD) over 20 years in a large city in a Southern European country and its trends, adding knowledge on the frequency of treatment from a population perspective., Methods: This is a study of the number of annual admissions to ambulatory addiction treatment centers funded by the public sector in Barcelona (Catalonia, Spain) for the years 1996-2015. Descriptive analyses of AUD admissions were conducted, comparing changes in the number of patients entering treatment by different independent variables across periods. For city residents, sex and age-specific population annual treatment initiation rates were estimated., Results: The number of ambulatory admissions to AUD treatment increased over the study period. There were about 2100 treatment admissions per year in 2011-2015, of which one fourth were women. About half of these patients had never been treated before for any substance use disorder. Annual rates of treatment initiation among city residents were 208 and 68 per 100,000 people aged 15 and older for men and women respectively, almost the double among 45-54 years old citizens. Rates of total AUD treatment admission increased moderately, but declined among younger adult men., Conclusions: These figures provide a basic population-based estimation for formal AUD treatment use in a Southern European urban setting with services available free of charge. The development of ambulatory publicly funded addiction centers may have improved access to treatment for people with AUD. age-related changes in treatment admissions may either be related to trends in the population pattern of drinking or to changes in the city demographics., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Alcohol urban environment has been associated with individual alcohol behaviors. We are constantly exposed to a wide variety of alcohol products, its marketing and promotion and signs of alcohol consumption that may influence alcohol-drinking behaviors. In this photo-essay, we include photographs that visually explain the exposure to alcohol in the urban streetscape of Madrid. These photographs show the pervasiveness of alcohol products in this city, which can be found everywhere at any time., (Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: To estimate the effect of opening two services for people who use drugs and three police interventions on the number of discarded syringes collected from public spaces in Barcelona between 2004 and 2014., Methods: We conducted an interrupted time-series analysis of the monthly number of syringes collected from public spaces during this period. The dependent variable was the number of syringes collected per month. The main independent variables were month and five dummy variables (the opening of two facilities with safe consumption rooms, and three police interventions). To examine which interventions affected the number of syringes collected, we performed an interrupted time-series analysis using a quasi-Poisson regression model, obtaining relative risks (RR) and 95% confidence intervals (CIs)., Results: The number of syringes collected per month in Barcelona decreased from 13,800 in 2004 to 1655 in 2014 after several interventions. For example, following the closure of an open drug scene in District A of the city, we observed a decreasing trend in the number of syringes collected [RR=0.88 (95% CI: 0.82-0.95)], but an increasing trend in the remaining districts [RR=1.11 (95% CI: 1.05-1.17) and 1.08 (95% CI: 0.99-1.18) for districts B and C, respectively]. Following the opening of a harm reduction facility in District C, we observed an initial increase in the number collected in this district [RR=2.72 (95% CI: 1.57-4.71)] and stabilization of the trend thereafter [RR=0.97 (95% CI: 0.91-1.03)]., Conclusion: The overall number of discarded syringes collected from public spaces has decreased consistently in parallel with a combination of police interventions and the opening of harm reduction facilities., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objectives: To describe the development and test-retest reliability of OHCITIES, an instrument characterising alcohol urban environment in terms of availability, promotion and signs of consumption., Design: This study involved: (1) developing the conceptual framework for alcohol urban environment by means of literature reviewing and previous alcohol environment research experience; (2) pilot testing and redesigning the instrument; (3) instrument digitalisation; (4) instrument evaluation using test-retest reliability., Setting: Data for testing the reliability of the instrument were collected in seven census sections in Madrid in 2016 by two observers., Primary and Secondary Outcome Measures: We computed per cent agreement and Cohen's kappa coefficients to estimate inter-rater and test-retest reliability for alcohol outlet environment measures. We calculated interclass coefficients and their 95% CIs to provide a measure of inter-rater reliability for signs of alcohol consumption measures., Results: We collected information on 92 on-premise and 24 off-premise alcohol outlets identified in the studied areas about availability, accessibility and promotion of alcohol. Most per cent-agreement values for alcohol measures in on-premise and off-premise alcohol outlets were greater than 80%, and inter-rater and test-retest reliability values were generally above 0.80. Observers identified 26 streets and 3 public squares with signs of alcohol consumption. Intraclass correlation coefficient between observers for any type of signs of alcohol consumption was 0.50 (95% CI -0.09 to 0.77). Few items promoting alcohol unrelated to alcohol outlets were found on public spaces., Conclusions: The OHCITIES instrument is a reliable instrument to characterise alcohol urban environment. This instrument might be used to understand how alcohol environment associates with alcohol behaviours and its related health outcomes, and can help in the design and evaluation of policies to reduce the harm caused by alcohol., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objective: To assess gender and age differences in hazardous drinking and to analyse and compare the factors associated with it in men versus women, and in 50 to 64-year-old versus ≥65-year-old people in Europe., Methods: Cross-sectional study with data from 65,955 people aged ≥50 years from 18 countries (SHARE project, 2011-2013). The outcome variable, hazardous drinking, was calculated using an adaptation of the AUDIT-C test. Several individual (sociodemographic, life-style and health factors) and contextual variables (country socioeconomic indicators and alcohol policies) were analysed. The prevalence of hazardous drinking was estimated by each exposure variable. To estimate associations, multilevel Poisson regression models with robust variance were fit, yielding prevalence ratios and their 95% confidence intervals (95%CI)., Results: Overall, the prevalence of hazardous drinking was 21.5% (95%CI = 21.1-22.0), with substantial differences between countries. The proportion of hazardous drinking was higher in men than in women [26.3%(95%CI = 25.6-27.1); 17.5%(95%CI = 17.0-18.0), respectively], as well as in middle-aged people than in older people [23.6%(95%CI = 23.0-24.3); 19.2%(95%CI = 18.6-19.8), respectively]. At the individual level, associations were found for migrant background, marital status, educational level, tobacco smoking, depression and self-perceived health. At the contextual level, hazardous drinking was associated with gender inequalities in society (only in women) and alcohol advertising regulations (both genders)., Conclusions: One in five people aged ≥50 years in the countries studied is a hazardous drinker, with large differences by countries, gender and age group. Interventions and policies aimed at preventing or reducing alcohol use in this population should account for country, gender and age differences, as well as individual characteristics. Copyright © 2016 John Wiley & Sons, Ltd., (Copyright © 2016 John Wiley & Sons, Ltd.)

Background: We aimed to describe gender and region differences in the prevalence of binge drinking and in the association between binge drinking and well-being, among older adult Europeans., Methods: This is a cross-sectional study using the Survey of Health, Ageing and Retirement in Europe (SHARE) wave 4, conducted between 2011 and 2012, including 58 489 individuals aged 50 years or older. Sixteen European countries were grouped in four drinking culture regions: South, Central, North and East. We categorized drinking patterns as: never, former, no-binge and binge drinkers. We used the CASP-12 questionnaire to measure well-being. To assess the association between binge drinking and well-being, we fitted two-level mixed effects linear models., Results: The highest percentage of binge drinkers was found in Central Europe (17.25% in men and 5.05% in women) and the lowest in Southern Europe (9.74% in men and 2.34% in women). Former, never and binge drinkers had a significant negative association with well-being as compared with no-binge drinkers. There was a significant interaction in this association by gender and region. Overall, associations were generally stronger in women and in Southern and Eastern Europe. The negative association of binge drinking with well-being was especially strong in Southern European women (β = -3.80, 95% CI: -5.16 to - 2.44, P value <0.001)., Conclusion: In Southern and Eastern European countries the association between binge drinking and well-being is stronger, especially in women, compared with Northern and Central Europe. Cultural factors (such as tolerance to drunkenness) should be further explored., (© The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

This paper describes the review process of the Agency of Public Health of Barcelona's service portfolio in response to the budget cuts introduced since 2010 in the public administrations in Spain. A working group reviewed the different business activities, taking into account their costs and generated revenue and their justification, assessing factors such as the existence of legal constraints, tied funding, explicit demands from the founding administrations and other actors that may be capable of undertaking particular activities. The changes and their consequences are described. The new service portfolio has been consolidated and is considered ratified by the Agency board, which was renewed after political changes. We conclude that this is because it was based on professional consensus and management criteria, which are key for the smooth operation of a public autonomous executive organisation., (Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Harmful use of alcohol is one of the world's leading health risks. A positive association between certain characteristics of the urban environment and individual alcohol consumption has been documented in previous research. When developing a tool characterising the urban environment of alcohol in the cities of Barcelona and Madrid we observed that alcohol is ever present in our cities. Urban residents are constantly exposed to a wide variety of alcohol products, marketing and promotion and signs of alcohol consumption. In this field note, we reflect the normalisation of alcohol in urban environments. We highlight the need for further research to better understand attitudes and practices in relation to alcohol consumption. This type of urban studies is necessary to support policy interventions to prevent and control harmful alcohol use., (Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Climate change poses huge challenges for public health, and cities are at the forefront of this process. The purpose of this paper is to present the issues climate change poses for public health in the city of Barcelona, how they are being addressed, and what are the current major challenges, trying to contribute to the development of a baseline understanding of the status of adaptation in cities from a public health perspective. The major issues related to climate change faced by the city are common to other urban centers in a Mediterranean climate: heat waves, water availability and quality, air quality, and diseases transmitted by vectors, and all are reviewed in detail with empirical data. They are not a potential threat for the future, but have actually challenged the city services and infrastructure over the last years, requiring sustainable responses and rigorous planning., (© The Author(s) 2016.)

Background: National estimates on per capita alcohol consumption are provided regularly by various sources and may have validity problems, so corrections are needed for monitoring and assessment purposes. Our objectives were to compare different alcohol availability estimates for Spain, to build the best estimate (actual consumption), characterize its time trend during 2001-2011, and quantify the extent to which other estimates (coverage) approximated actual consumption., Methods: Estimates were: alcohol availability from the Spanish Tax Agency (Tax Agency availability), World Health Organization (WHO availability) and other international agencies, self-reported purchases from the Spanish Food Consumption Panel, and self-reported consumption from population surveys. Analyses included calculating: between-agency discrepancy in availability, multisource availability (correcting Tax Agency availability by underestimation of wine and cider), actual consumption (adjusting multisource availability by unrecorded alcohol consumption/purchases and alcohol losses), and coverage of selected estimates. Sensitivity analyses were undertaken. Time trends were characterized by joinpoint regression., Results: Between-agency discrepancy in alcohol availability remained high in 2011, mainly because of wine and spirits, although some decrease was observed during the study period. The actual consumption was 9.5 l of pure alcohol/person-year in 2011, decreasing 2.3 % annually, mainly due to wine and spirits. 2011 coverage of WHO availability, Tax Agency availability, self-reported purchases, and self-reported consumption was 99.5, 99.5, 66.3, and 28.0 %, respectively, generally with downward trends (last three estimates, especially self-reported consumption). The multisource availability overestimated actual consumption by 12.3 %, mainly due to tourism imbalance., Conclusions: Spanish estimates of per capita alcohol consumption show considerable weaknesses. Using uncorrected estimates, especially self-reported consumption, for monitoring or other purposes is misleading. To obtain conservative estimates of alcohol-attributable disease burden or heavy drinking prevalence, self-reported consumption should be shifted upwards by more than 85 % (91 % in 2011) of Tax Agency or WHO availability figures. The weaknesses identified can probably also be found worldwide, thus much empirical work remains to be done to improve estimates of per capita alcohol consumption.

Introduction: The objective of this study is to describe the distribution of smoking in the population and to assess changes and trends over recent decades., Material and Method: Cross sectional study in a sample of the non-institutionalized resident population (n=3,509) in Barcelona (Catalonia, Spain) using data from persons over 14 years of age from the health survey of 2011, and assessing trends for 1983-2011 using previous surveys. Dependent variables are having ever been a smoker, having quit, being a current smoker, and smoking daily. Independent variables include sex, age, and time. Prevalence and proportions are estimated, stratifying or adjusting for age., Results: The prevalence of daily smokers is 18.8% in 2011: 22.2% for men and 15.9% for women. The age groups with higher smoking prevalence are 25-34 years for men and 15-24 for women. From 1983 to 2011 the reduction among men has been intense, and for women the prevalence has been decreasing since the survey of 2000. Among smokers, the proportion of both genders who do not smoke daily has increased., Conclusions: The smoking epidemic over the last years shows promising trends. The data do not lend support to the hardening hypothesis for current smokers. Smokers are a shrinking minority, although to improve public health it would be desirable to speed the process of change., (Copyright © 2015 Elsevier España, S.L.U. All rights reserved.)

This article describes the actions of public health services of the city of Barcelona to prevent tuberculosis transmission by noncompliant smear-positive patients by using the possibilities of Spanish Law 3/1986. The actions were based on a resolution of the health authorities on the need to locate such patients and to detain them in hospitals to provide treatment. This involved police cooperation, informing noncompliant patients, and requesting ratification from the Administrative Court. The article describes the process and the characteristics of the cases involved. Over nine years, from July 2006 to June 2015, the law was used in only twelve cases. The authors conclude that the criteria of prudence and proportionality were used in the application of the law, which resulted in the treatment of patients who posed a risk to their environment, reducing the transmission of infection., (Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.)

Objective: To evaluate the effectiveness of a contraceptive counselling intervention among adolescents by sex and origin., Methods: 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)., Results: 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%., Conclusions: Contraceptive counselling in the community setting increased the use of contraception and improved psychosocial determinants, especially in immigrant adolescents., (Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.)

The informal social control over alcohol consumption that was traditional in Southern European countries has weakened. At the same time there is an increase in binge drinking and drunkenness among young people in Spain. To mitigate this problem, regulations on alcohol and driving and restrictions on the sale and consumption of alcohol have been adopted. This paper documents the current regulations in the city of Barcelona and describes efforts to enforce them and their outcomes. Data from the municipal information systems on infringements reported for the period 2008-13 are provided. There is an increasing pressure of municipal services to enforce the rules in two areas: a) alcohol sales at night (retailers); and b) consumption in the public space (citizens). An increase in the controls of drink-driving has also taken place, and the proportion above legal limits has decreased. The largest relative increase occurred in the control of retailers. In Barcelona interventions are made to limit the supply and consumption of alcohol at low cost and during the night, and of driving under the influence of alcohol. There have been no documented episodes of massive drinking in public spaces (known as 'botellón') in the city. These actions, which complement other preventive efforts based on health education, can change the social perceptions of alcohol by minors in a direction less favorable to consumption, promoting environmental prevention.

Background: The aim of this study was to estimate the magnitude of gender differences in hazardous drinking among middle-aged people and to analyse whether these differences are associated with contextual factors, such as public policies or socioeconomic factors., Methods: Cross-sectional design. The study population included 50- to 64-year-old residents of 16 European countries who participated in the Survey of Health, Ageing and Retirement in Europe project conducted in 2010-12 (n = 26 017). We estimated gender differences in hazardous drinking in each country. To determine whether different social context or women's empowerment variables were associated with gender differences in hazardous drinking, we fitted multilevel Poisson regression models adjusted for various individual and country-level variables, which yielded prevalence ratios and their 95% confidence intervals (95% CI)., Results: Prevalence of hazardous drinking was significantly higher in men than women [30.2% (95% CI: 29.1-31.4%) and 18.6% (95% CI: 17.7-19.4%), respectively] in most countries, although the extent of these differences varied between countries. Among individuals aged 50-64 years in Europe, risk of becoming a hazardous drinker was 1.69 times higher (95% CI: 1.45-1.97) in men, after controlling for individual and country-level variables. We also found that lower values of the gender empowerment measure and higher unemployment rates were associated with higher gender differences in hazardous drinking., Conclusion: Countries with the greatest gender differences in hazardous drinking were those with the most restrictions on women's behaviour, and the greatest gender inequalities in daily life. Lower gender differences in hazardous drinking seem to be related to higher consumption among women., (© The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: The goal of this study was to estimate excess death due to external causes among 18- to 64-year-olds with alcohol use disorder (AUD) who were treated at public outpatient treatment centers, and the time elapsed from treatment initiation to death., Methods: We conducted a retrospective longitudinal study among 7,012 outpatients aged 18 to 64 years who began treatment for AUD between 1997 and 2007. Deaths due to external causes (intentional and unintentional injuries) were monitored until the end of 2008. Person-years (PY) of follow-up and crude mortality rates (CMRs) were calculated for all study variables, for each sex, and for 2 age groups (18 to 34 and 35 to 64 years). Standardized mortality ratios (SMRs) were estimated by age group and sex. Survival was analyzed using the Kaplan-Meier method and Cox regression., Results: We recorded 114 deaths due to external causes. The CMR was 2.7 per 1,000 PY (95% confidence interval [CI]: 2.2 to 3.2), with significant gender differences only among younger individuals (CMR for males = 3.9 per 1,000 PY [95% CI: 2.2 to 5.5] and CMR for females = 2.8 per 1,000 PY [95% CI: 0.1 to 5.6]). Unintentional injury was the most common cause of death (n = 65), of which acute poisoning (n = 25; 38.5%) and traffic accidents (n = 15; 23.1%) were the most prevalent. Suicide accounted for 91.8% (n = 49) of deaths from intentional injuries. The excess of mortality between the AUD group and the general population (SMR) was 9.5 higher than in the general population (95% CI: 7.9 to 11.4), with significant differences between genders (SMR = 6.1 [95% CI: 4.9 to 7.5] in males and SMR = 20.4 [95% CI: 13.9 to 29.9] in females). Approximately 35% of deaths among individuals aged <35 years and 60% among women occurred within a year of initiating treatment., Conclusions: This study highlights the importance of excess of mortality among people with AUD and patients' vulnerability during the initial years of treatment. Preventing premature deaths due to external causes among women and younger patients with AUD is a priority., (Copyright © 2015 by the Research Society on Alcoholism.)

Objective: The aim of this study is to describe trends in the consumption of manufactured and roll-your-own cigarettes between 1991 and 2012 in Spain, and to project these trends up to 2020., Methods: We estimated daily consumption per capita during 1991-2012 using data on sales of manufactured cigarettes (20-packs) and rolling tobacco (kg) from the Tobacco Market Commission, and using data of the Spanish adult population from the National Statistics Institute. We considered different weights (0.5, 0.8 and 1 g) to compute the number of rolled cigarettes per capita. We computed the annual per cent of change and assessed possible changes in trends using joinpoint regression, and projected the consumption up to 2020 using Bayesian methods., Results: Daily consumption per capita of manufactured cigarettes decreased on average by 3.0% per year in 1991-2012, from 7.6 to 3.8 units, with three trend changes. However, daily consumption per capita of roll-your-own cigarettes increased on average by 14.1% per year, from 0.07 to 0.92 units of 0.5 g, with unchanged trends. Together, daily consumption per capita decreased between 2.9% and 2.5%, depending on the weight of the roll-your-own cigarettes. Projections up to 2020 indicate a decrease of manufactured cigarettes (1.75 units per capita) but an increase of roll-your-own cigarettes (1.25 units per capita)., Conclusions: While the consumption per capita of manufactured cigarettes has decreased in the past years in Spain, the consumption of roll-your-own cigarettes has increased at an annual rate around 14% over the past years. Whereas a net decrease in cigarette consumption is expected in the future, use of roll-your-own cigarettes will continue to increase., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)