[Housework, gender and health in the working population]. / Trabajo doméstico, género y salud en población ocupada.

OBJECTIVE: To analyse the relation between domestic workload and self-perceived health status among workers and to examine whether there are gender inequalities. METHODS: The selected population were the 215 men and 106 women younger than 65 years interviewed in the Terrassa Health Survey, 1998 who had a paid work and were married or cohabiting. Adjusted odds ratios (aOR) by domestic workload, age and occupational social class with their 95% confidence intervals (CI) were calculated. RESULTS: Whereas among men domestic workload was not associated with health status, among women poor self-perceived health status was positively related to household size (aOR = 3.65; 95% IC = 1.06-12.54) and to lack of a person for doing domestic tasks (aOR = 4.43; 95% CI = 1.05-18.62). CONCLUSION: Both household characteristics and having a support for facing domestic tasks play an important role in gender health inequalities.

Género, desigualdades y salud pública: conocimientos y desconocimientos / Gender inequalities and public health: awarenesses and ignorances

Los objetivos de esta revisión son describir el concepto de género y las teorías que explican las diferencias y desigualdades según el género, poner en evidencia las desigualdades de salud según el género y describir la influencia de los trabajos (productivo y reproductivo) en las desigualdades de salud según el género. Varios autores definen el género como un constructo analítico que se fundamenta en la organización social de los sexos (la construcción social del sexo biológico). Las teorías sociológicas y sociobiológicas de género son las más utilizadas para explicar diferencias y desigualdades en la asignación de los roles desempeñados por mujeres y hombres. La diferencia básica entre la visión sociológica y la visión sociobiológica es que para esta última el principal eje que diferencia mujeres y hombres se fundamenta en las diferencias biológicas y no en las sociales. La salud de mujeres y hombres es diferente y es desigual. Diferente porque hay factores biológicos que se manifiestan de forma diferente en la salud y en los riesgos de enfermedad. Desigual porque hay otros factores, explicados en parte por el género, que afectan de una manera injusta la salud de las personas. Los roles ocupacionales y familiares son primordiales en la vida de la mayoría de los adultos y por lo tanto han sido utilizados con frecuencia como ejes en la investigación de las desigualdades en salud según género. El trabajo, tanto el productivo (remunerado) como el reproductivo (no remunerado), tiene unas complejas relaciones con el género y con la salud, pues traduce las estructuras normativas de socialización y oportunidades. Es importante tener en cuenta la perspectiva de género tanto en la recogida y análisis de datos poblacionales, como en el diseño de estudios específicos. El análisis desde el punto de vista del género ofrece un material fértil para comprender las relaciones entre sociedad y salud porque, por un lado dependen de una base biológica que tiene características diferentes para mujeres y hombres (el sexo) y, por otro, del contexto social en el cual nos desenvolvemos (AU)

The aims of this review are to describe the concept of gender and the theories which explain gender-based differences and inequalities in health, and to describe the influence of workload (productive and reproductive) into gender-based inequalities in health. Several authors have defined gender as an analytical construct based on the social organisation of the sexes (the social projection of biological sex). In order to explain differences and inequalities in the assignment of roles taken by men and women, the sociological theory, and the sociobiological theory are the two most widely used. The basic difference is that for the latter, the main framework that differences men and women derives from their biological differences, rather than from social ones. Men’s health and women’s health are different and unequal. Different because there are biological factors which manifest themselves differently in terms of health and in the risk of illness. Unequal because there are other factors, partly explained by gender, which affect a person’s health in an unfair manner. Occupational and family roles are very important in most adults’ lives and consequently have often been used as a framework in research into gender-based health inequalities. Work, both productive (paid) and reproductive (unpaid) is related in a complex way to gender and to health, since it translates structural norms of socialisation and opportunity. It is important to take the gender perspective into account, not only in the collection and the analysis of populational data, but also in the design of specific studies. The analysis from this point of view offers a fertile substrate for understanding the relationships between society and health since, on one hand, they depend on a biological basis which has different characteristics for men and women (sex), while on the other, they also depend on the social context in which we are immersed (AU)

[The importance of the gender perspective in health interview surveys]. / La importancia de la perspectiva de género en las encuestas de salud.

The identification and measurement of the population health needs should be the first step in health planning. In order to guarantee equity criteria, to know the situation of the whole population, and therefore also that of women, is a key issue. Health interview surveys are a good tool for pinpointing the needs of the population, but mainly they are usually focused on health risk factors that explain men's health status such as health behaviours and paid job. These factors often fail to capture aspects that are relevant for women's health, such as household work. The main objective of this paper is to emphasise the importance of a gender perspective in the design and analysis of health interview surveys, and to propose variables that should be included in health surveys in order to better know gender health inequalities. Likewise, this article deals with the gender concept and its importance as a health inequality factor. Gender is an analytical construct based on the social organisation of the sexes that can be used to better understand the conditions and factors influencing women's and men's health beginning by the social roles that each culture and society assigns to people based on their sex. Health is a complex process determined by a wide range of factors: biological, social, environmental and health services related factors. Gender, because of its close relation to all of them, plays a key role. The gender approach is characterised by the analysis of the social relation between men and women, taking into account that sex is a determinant of social inequalities. This paper presents the variables that health interview surveys should include from a gender approach point of view: reproductive work, productive work, social class, social support, self-perceived health status, quality of life, mental health and chronic conditions. In addition, issues related to the wording of questions, data collection and analysis are discussed.

Social inequalities in health related behaviours in Barcelona.

OBJECTIVE: This study describes social class inequalities in health related behaviours (tobacco and alcohol consumption, physical activity) among a sample of general population over 14 years old in Barcelona. DESIGN: Cross sectional study (Barcelona Health Interview Survey). SETTING: Barcelona city (Spain). PARTICIPANTS: A representative stratified sample of the non-institutionalised population resident in Barcelona was obtained. This study refers to the 4171 respondents aged over 14. DATA: Social class was obtained from a Spanish adaptation of the British Registrar General classification. In addition, sociodemographic variables such as family structure and employment status were used. As health related behaviours tobacco consumption, alcohol consumption, usual physical activity and leisure time physical activity were analysed. Age adjusted percentages were compared by social class. Multivariate analysis was performed using logistic regression models. MAIN RESULTS: Women in the upper social classes were more likely to smoke, the adjusted odds ratio (OR) for social class V in reference to social class I was 0.36 (95% confidence intervals (95%CI): 0.19, 0.67), while the opposite occurred among men although it was not statistically significant in multivariate analysis. Smoking cessation was more likely among men in the higher classes (OR for class V 0.41, 95%CI: 0.18, 0.90). Excessive alcohol consumption among men showed no differences between classes, while among women it was greater in the upper classes. Engaging in usual physical activity classified as "light or none" in men decreased with lowering social class (OR class IVa: 0.55 and OR class IVb: 0.47). Women of social classes IV and V were less likely to have two or more health risk behaviours (OR for class V 0.33, 95% CI: 0.18, 0.62). CONCLUSION: Health damaging behaviours are differentially distributed among social classes in Barcelona. Health policies should take into account these inequalities.

Trends in social class inequalities in health status, health-related behaviors, and health services utilization in a Southern European urban area (1983-1994).

BACKGROUND: The objective of this study was to describe the evolution of social class inequalities in Barcelona (Spain) residents in perceived health status, health-related behaviors, and utilization of health services between 1983 and 1994. METHODS: The information was obtained from the Health Interview Surveys conducted in 1983, 1986, 1992, and 1994 in Barcelona. In this study we included noninstitutionalized people ages >14 years. Social class was obtained from the Spanish adaptation of the British Registrar General classification. We studied health status, health-related behaviors, and health services utilization variables. Age-adjusted percentages and the relative index of inequality were obtained. RESULTS: Of the health status variables, having been confined to bed and acute restriction of activity in the 2 weeks prior to the interview showed an increase in inequalities by social class in 1994. The pattern of chronic conditions by social class in men did not change between 1983 and 1994. Women had a higher prevalence of chronic conditions and the inequalities among social classes had increased. In men there were no social class inequalities in smoking in 1983. In 1992 and 1994 smoking was more prevalent in men of social classes IV and V. In women, smoking was more prevalent in social classes I and II in 1983 than in social classes IV and V, something that had changed by 1994. Lack of usual physical activity in men was always more prevalent in social classes I and II, and this difference increased since more people of advantaged classes moved into inactivity. Health services utilization showed no inequalities in the years studied. CONCLUSION: The changing pattern according to social class of smoking and physical activity practice needs to be taken into account by policy-makers and public health workers.

Social inequalities in perceived health and the use of health services in a southern European urban area.

People of lower social class have worse health and less access to health services and preventive care. This article describes social class inequalities in health status and use of services, both curative and preventive, in Barcelona, in a country with a national health service. The cross-sectional study uses information from the 1992 Barcelona Health Interview Survey. Social class was designated using an adaptation of the British Registrar General classification. The study variables measured health status, health services utilization, and preventive practices. Bivariate and multivariate analyses were used. Some 88 percent of men in social class I and 81 percent in class V had very good or good perceived health status. For women these figures were 85.2 and 57.6 percent, respectively. Chronic illness increased with lower social class. There were no social class differences in the frequency of physician visits during the two weeks prior to the interview among people with poor perceived health. Some 60.7 percent of women aged over 29 in social class I had periodic cervical smears, but only 32 percent of those in class V; the corresponding figures for mammography were 37.8 and 11.3 percent. The national health service has advantages in terms of access to health services, but more knowledge about the quality of these services is required. The study findings are sufficient to defend the undertaking of equitable health policies, especially in providing access to preventive care for the entire population.

[Influence of paid work on the perceived health state in women]. / Influencia del trabajo remunerado en el estado de salud percibido de las mujeres.

BACKGROUND: Several studies show that paid work has a positive effect on women's health, although few studies have shown this relationship in Southern-European countries. The aim of this paper was to analyze the self-perceived health status of women of Barcelona, Spain according to their type of work (homemaker or worker). PATIENTS AND METHODS: Cross sectional study using the 1992 Barcelona Health Interview Survey data. SUBJECTS: 1194 women aged 25 to 64 years old. Bivariate analysis of women's perceived health status by all other variables. A logistic regression model was performed with the dependent variable being women's self-perceived health status and the independent variables: type of work (homemaker or worker), age, number of chronic diseases, medical care visits, children under 12 years and elderly over 65 years living at home and social class based on occupation. RESULTS: 15.8% of workers and 31.4% of homemakers reported poor self-perceived health status (p < 0.05). This same distribution was maintained when adjusting for all independent variables. Social class had an important relationship with health, with women from lower social classes reporting poorer self-perceived health status than homemakers from upper social classes. CONCLUSIONS: The 1992 Barcelona Health Interview Survey analysis confirms that in Barcelona as well, paid work has a positive relationship on women's self-perceived health status.

Migration within Spain, level of education, and cervical cancer screening.

Migration has been related to the utilization of preventive care services. We analysed the relation between cervical cancer screening and migration within the same country and socioeconomic status in a context in which there is no organized screening. The health survey of Barcelona (Spain) was the data source. Barcelona, a city in north eastern Spain, has experienced important migration from the south and other regions of Spain. Variables studied were the migrant women's year of arrival, age at arrival, educational attainment and Pap smear test uptake. Multivariate logistic regression analysis was performed to examine the correlations among the variables of interest. Just over 30% of the women had never had a Pap smear test. Uptake was higher among younger, educated women born either in Barcelona or abroad. After adjusting for age, migrant women were at higher risk for not participating in screening tests (odds ratio: 1.23; 1.09-1.39); but after adjusting for educational attainment and age, the odds ratio was no longer significant. This study shows that migrants within Spain have less access to preventive services, such as cervical cancer screening in an opportunistic setting. However, this association is almost completely explained by socioeconomic status. Migration could be seen as a social factor that puts people at risk of falling into lower socioeconomic status associated with poor access to screening.

[Risk factors of pregnancy in teenagers using family planning. Work Group on Sexuality and Adolescence]. / Factores de riesgo de embarazo en adolescentes usuarias de planificación familiar. Grupo de Trabajo sobre Sexualidad y Adolescencia.

BACKGROUND: Pregnancy and maternity during adolescence constitutes an obstetric and perinatal risk factor and reason for increased social alarm. Nonetheless, the predisposing factors have been little studied in Spain. METHODS: The demographic data and information on the age of onset of sexual relations, contraceptive methods used, in addition to the reason for the first visit, corresponding to the users of six municipal family planning centers in Barcelona who were under the age of 20 years at the time of the first visit were analyzed. Likewise, the principal incidences in the follow up, including pregnancies, abortions and changes in contraceptive methods were collected. RESULTS: From October 1989 to September 1990 823 first visits corresponding to adolescents were registered. Forty-five percent (380) were under the age of 18 years with 716 (87%) having initiated full sexual relations with more than two years having passed prior to the first visit to the center in 183 cases (26%). The most frequent reason for the visit to the center was to request contraception (48%). The lack of labor and academic activity, in addition to the infrequent use of condoms were associated to pregnancy as the reason for the consultation in 42 cases. Twenty-four adolescents became pregnant during follow up being associated to the early initiation of sexual relations, with an interval of two or more years prior to attending the center and a change in contraceptive method. CONCLUSIONS: The delay in attending family planning centers and the use of little effective contraceptive methods are risk factors for undesired pregnancy in adolescence.

[Maternity in adolescents at high social risk]. / Maternidad en adolescentes de alto riesgo social.

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.

PIP: Trends are analyzed for 1987-90 in indicators of prenatal care and follow-up of adolescents in the maternal-child health program of Ciutat Vella, a low-income district of Barcelona. The maternal-child health program was established in 1986 to prevent unwanted pregnancies and make prenatal and postnatal care more accessible for residents of the district who were deemed to be at high social risk. Records for 175 adolescents served by the program during the 4 study years were examined. 56.6% stated that the pregnancy was unplanned and only 28% that it was planned. The duration of pregnancy was under 37 weeks in 8.6% and over 42 weeks in 1.7%. The first prenatal consultation took place in the first trimester for 56.6%, in the second trimester for 22.9%, and in the third trimester for 9.1%. 88% of deliveries took place in 2 public facilities. A significant proportion of the adolescent mothers presented social risk factors. Of the 175 adolescents, 4 were prostitutes, 9 had histories of treatment for alcohol or heroin use, 19 had no partner, 6 lived alone, and 18 had older children. Prostitution, history of treatment for addiction, and lack of a partner were associated with increased risk for low birth weight, although statistical significance was marginal. Over the course of the 4 study years, the proportion of low birth weight infants declined from 19.3% to 6.3% and the proportion of mothers seeking care in the first trimester increased from 45.6% to 62.5%. The proportion of adolescents with social risk factors remained stable at around 25%. The fact that the study was descriptive and lacked a control group and the method of data collection through semistructured questionnaires constitute limitations on the generalizability of the findings.