[Evolution of Asthma Prevalence and Sociodemographic and Health Factors Associated in Madrid Region (1996-2013)]. / Evolución de la prevalencia de asma y factores sociodemográficos y de salud asociados en población de 18 a 64 años de la Comunidad de Madrid (1996-2013).

OBJECTIVE: Asthma is an important public health issue. The goal of this study is to analyse the trends in self-reported asthma prevalence in the Madrid Region and its association with socio-demographic and health factors. METHODS: Data from the "Non-Communicable Disease Risk Factor Surveillance System" in adult population (SIVFRENT-A) 1996-2013 were used. Prevalences and 95% CI were estimated for: current asthma, cumulative prevalence of asthma and asthma attack in the last 12 months, in five periods. Changes in inter-period prevalence were estimated by calculating prevalence ratios (PR) with 95% CI by Poisson regression. The association between asthma prevalence socio-demographic and health variables was evaluated by multivariate logistic regression. RESULTS: Current prevalence of asthma and cumulative prevalence of asthma increased per study period an average of 14%. Asthma attack prevalence in the last 12 months increased an average of 19%. It was associated (statistically significant) to an increase of current prevalence of asthma, cumulative prevalence of asthma and asthma attack prevalence in the last 12 months: being a woman, ORa: 1.55; ORa: 1.35 and ORa: 1.46 respectively; have poor self-perceived health, ORa: 3.09; ORa: 2.63 and ORa: 2.89; and intense physical activity, ORa: 1.48; ORa: 1.32 and ORa: 1.49. In the case of current prevalence of asthma and cumulative prevalence of asthma also be studying, ORa: 1.34 and ORa: 1.46 respectively. CONCLUSIONS: Self-reported asthma prevalence increased in the last decades. The prevalence was higher in woman, persons with poor self-perceived health and adults with intense physical activity.

OBJETIVO: El asma representa un importante problema de salud pública. El objetivo de este estudio fue analizar la evolución de la prevalencia de asma autopercibido en la Comunidad de Madrid y su asociación con factores sociodemográficos y de salud. METODOS: Se incluyó a la población de 18 a 64 años de la Comunidad de Madrid. La fuente de información fue el Sistema de Vigilancia de Factores de Riesgo de Enfermedades No transmisibles (SIVFRENT-A). El período de estudio fue de 1996 a 2013 dividido en cinco etapas. Se estimaron las prevalencias y sus intervalos de confianza al 95% (IC95%) para prevalencia de asma actual, prevalencia acumulada de asma y crisis asmática en los últimos 12 meses en cinco períodos. Los cambios en la prevalencia interperiodo se estimaron calculando razones de prevalencia (RP) y su IC95% mediante regresión de Poisson. Mediante regresión logística multivariante se evaluó la asociación entre la prevalencia de asma y las variables sociodemográficas y las de salud. RESULTADOS: La prevalencia actual y la acumulada de asma aumentaron de media por periodo de estudio un 14%. La prevalencia de crisis asmática en los últimos 12 meses aumentó un 19%. Se asociaron de forma estadísticamente significativa a mayor prevalencia de asma actual, mayor prevalencia acumulada de asma y mayor prevalencia de crisis asmática en los últimos 12 meses ser mujer (prevalencia actual: ORa: 1,55; ORa: 1,35 y ORa: 1,46 respectivamente), tener mala salud autopercibida (ORa: 3,09; ORa: 2,63 y ORa: 2,89 respectivamente) y realizar actividad física intensa (ORa: 1,48; ORa: 1,32 y ORa: 1,49 respectivamente) y ser estudiante se asoció con mayor prevalencia de asma actual y prevalencia acumulada de asma (ORa: 1,34; ORa: 1,46 respectivamente). CONCLUSIONES: La prevalencia de asma autopercibida es mayor en las últimas décadas. Ser mujer, tener una mala salud autopercibida y realizar actividad física intensa se asocian a una mayor prevalencia.

Evolución de la prevalencia de asma y factores sociodemográficos y de salud asociados en población de 18 a 64 años de la Comunidad de Madrid (1996-2013) / Evolution of asthma prevalence and sociodemographic and heatlh factors associated in Madrid Region (1996-2013)

Fundamentos: El asma representa un importante problema de salud pública. El objetivo de este estudio fue analizar la evolución de la prevalencia de asma autopercibido en la Comunidad de Madrid y su asociación con factores sociodemográficos y de salud. Métodos: Se incluyó a la población de 18 a 64 años de la Comunidad de Madrid. La fuente de información fue el Sistema de Vigilancia de Factores de Riesgo de Enfermedades No transmisibles (SIVFRENT-A). El período de estudio fue de 1996 a 2013 dividido en cinco etapas. Se estimaron las prevalencias y sus intervalos de confianza al 95% (IC95%) para prevalencia de asma actual, prevalencia acumulada de asma y crisis asmática en los últimos 12 meses en cinco períodos. Los cambios en la prevalencia interperiodo se estimaron calculando razones de prevalencia (RP) y su IC95% mediante regresión de Poisson. Mediante regresión logística multivariante se evaluó la asociación entre la prevalencia de asma y las variables sociodemográficas y las de salud. Resultados: La prevalencia actual y la acumulada de asma aumentaron de media por periodo de estudio un 14%. La prevalencia de crisis asmática en los últimos 12 meses aumentó un 19%. Se asociaron de forma estadísticamente significativa a mayor prevalencia de asma actual, mayor prevalencia acumulada de asma y mayor prevalencia de crisis asmática en los últimos 12 meses ser mujer (ORa: 1,55; ORa: 1,35 y ORa: 1,46 respectivamente), tener mala salud autopercibida (ORa: 3,09; ORa: 2,63 y ORa: 2,89 respectivamente) y realizar actividad física intensa (ORa: 1,48; ORa: 1,32 y ORa: 1,49 respectivamente) y ser estudiante se asoció con mayor prevalencia de asma actual y prevalencia acumulada de asma (ORa: 1,34; ORa: 1,46 respectivamente). Conclusión: La prevalencia de asma autopercibida es mayor en las últimas décadas. Ser mujer, tener una mala salud autopercibida y realizar actividad física intensa se asocian a una mayor prevalencia (AU)

Background: Asthma is an important public health issue. The goal of this study was to analyse the trends in self-reported asthma prevalence in the Madrid Region and its association with socio-demographic and health factors. Methods: Data from the “Non-Communicable Disease Risk Factor Surveillance System” in adult population [SIVFRENT-A] 1996-2013 were used. Prevalences and 95% CI were estimated for: current asthma, cumulative prevalence of asthma and asthma attack in the last 12 months, in five periods. Changes in inter-period prevalence were estimated by calculating prevalence ratios [PR] with 95% CI by Poisson regression. The association between asthma prevalence socio-demographic and health variables was evaluated by multivariate logistic regression. Results: Current prevalence of asthma and cumulative prevalence of asthma increased per study period an average of 14%. Asthma attack prevalence in the last 12 months increased an average of 19%. It was associated [statistically significant] to an increase of current prevalence of asthma, cumulative prevalence of asthma and asthma attack prevalence in the last 12 months: being a woman [ORa: 1.55; ORa: 1.35 and ORa: 1.46 respectively]; have poor self-perceived health, [ORa: 3.09; ORa: 2.63 and ORa: 2.89]; and intense physical activity [ORa: 1.48; ORa: 1.32 and ORa: 1.49]. In the case of current prevalence of asthma and cumulative prevalence of asthma also be studying [ORa: 1.34 and ORa: 1.46 respectively]. Conclusion: Self-reported asthma prevalence increased in the last decades. The prevalence was higher in woman, persons with poor self-perceived health and adults with intense physical activity (AU)

[Young people dating violence surveillance in Madrid, Spain]. / Violencia de pareja en jóvenes de 15 a 16 años de la Comunidad de Madrid.

BACKGROUND: Dating violence in young adults is an important public health issue because of its magnitude and impact on health. The goal of this study is to determine the prevalence 12 months before the survey by sex and its association with socio-demographic and health risk behavior. METHODS: Data were drawn from the Non-communicable Disease Risk-Factor Surveillance System in young people (Spanish acronym, SIVFRENT-J), on a representative sample of students of the fourth-year of secondary education (15 to 16 years) in Madrid Region. The students were asked whether they had ever suffered any physical violence (PV) and/or sexual violence (SV) dating episodes. Prevalence with 95% confidence intervals (CI95%) of the occurrence of such episodes were estimated; generalized linear models with binomial family and logarithmic link were used to estimate the association between physical and/or sexual violence (PSV) and health risk behavior through prevalence ratios (PR, CI95%). RESULTS: In 1713 dating girls and 1664 dating boys, the prevalence of PV was 2.9% (CI95%:2.0-3.9) and 4.0% (CI95%:2.9-5.0) (p>0.05), SV 5.3% (CI95%:4.1-6.5) and 2.4% (CI95%:1.6-3.2) (p< 0.001) and PSV 7.1% (CI95%:5.6-8.6) and 5.1% (CI95%:4.0-6.3) (p<0.05) in that order. In the girls explanatory model, PSV was associated with eating disorders PR:1.74 (CI95%:1.14-2.66), sexual risk behavior (SRB), PR:1.67 (CI95%:1.11-2.50), excessive alcohol consumption, PR:1.57 (CI95%:1.06-2.34) and worse perceived health, PR:1.67 (CI95%:1.08-2.57). In boys, PSV was associated with having been born in a country other than Spain, PR:2.05 (CI95%:1.32-3.18), eating disorders, PR:2.79 (CI95%:1.58-4.92), SRB, PR:2.22 (CI95%:1.34-3.66) and drug consumption, PR:2.14 (CI95%:1.39-3.28). CONCLUSION: VFS was higher in girls and was associated to others health risk factors with similar characteristics according to sex.

Violencia de pareja en jóvenes de 15 a 16 años de la Comunidad de Madrid / Young people dating violence surveillance in Madrid, Spain

Fundamentos: La violencia de pareja en jóvenes es un importante problema de salud pública por su magnitud y repercusiones. El objetivo fue estimar su prevalencia según sexo y su asociación con factores sociodemográficos y conductas de riesgo para la salud. Métodos: Se utilizó el Sistema de Vigilancia de Factores de Riesgo de Enfermedades No Transmisibles en población juvenil (SIVFRENT-J) 2011-2012 en una muestra representativa de estudiantes de 4º curso de la Enseñanza Secundaria Obligatoria (15 a 16 años) de la Comunidad deMadrid. Se preguntó por violencia física (VF) y violencia sexual (VS). Se calculó la prevalencia con intervalos de confianza al 95%(IC95%). La asociación entre violencia física y/o sexual (VFS) y conductas de riesgo para la salud se analizó con la razón de prevalencia (RP IC95%) mediante modelos lineales generalizados con vínculo logarítmico y familia binomial. Resultados: En 1.713 chicas y 1.664 chicos con pareja la prevalencia de VF fue respectivamente del 2,9% (IC95%:2,0-3,9) y del 4,0% (IC95%:2,9- 5,0) (p>0,05), la de VS fue del 5,3% (IC95%:4,1-6,5) y 2,4% (IC95%:1,6- 3,2) (p<0,001) y la de VFS 7,1% (IC95%:5,6-8,6) y 5,1%(IC95%:4,0-6,3) (p<0,05). En chicas, en los modelos explicativos, la VFS se asoció con desorden alimentario: RP:1,74 (IC95%:1,14-2,66), conducta sexual de riesgo (CSR): RP:1,67 (IC95%:1,11-2,50), consumo excesivo de alcohol, RP:1,57 (IC95%:1,06-2,34) y mala salud percibida, RP:1,67 (IC95%:1,08-2,57). En chicos, la VFS se asoció con ser extranjero: RP:2,05 (IC95%:1,32-3,18), desorden alimentario: RP:2,79 (IC95%:1,58-4,92), CSR: RP:2,22 (IC95%:1,34- 3,66) y consumo de drogas: RP:2,14 (IC95%:1,39-3,28). Conclusiones: La VFS predomina en chicas y se asocia a diferentesconductas de riesgo según el sexo (AU)

Background: Dating violence in young adults is an important public health issue because of itsmagnitude and impact on health. The goal of this study is to determine the prevalence 12 months before the survey by sex and its association with socio-demographic and health risk behavior. Methods: Data were drawn from the Non-communicable Disease Risk-Factor Surveillance Systemin young people (Spanish acronym, SIVFRENT- J), on a representative sample of students of the fourth-year of secondary education (15 to 16 years) inMadrid Region. The students were asked whether they had ever suffered any physical violence (PV) and/or sexual violence (SV) dating episodes. Prevalence with 95% confidence intervals (CI95%) of the occurrence of such episodes were estimated; generalized linear models with binomial family and logarithmic link were used to estimate the association between physical and/or sexual violence (PSV) and health risk behavior through prevalence ratios (PR, CI95%). Results: In 1713 dating girls and 1664 dating boys, the prevalence of PV was 2.9% (CI95%:2.0-3.9) and 4.0% (CI95%:2.9-5.0) (p>0.05), SV 5.3% (CI95%:4.1-6.5) and 2.4% (CI95%:1.6-3.2) (p< 0.001) and PSV 7.1% (CI95%:5.6-8.6) and 5.1% (CI95%:4.0-6.3) (p<0.05) in that order. In the girls explanatory model, PSV was associated with eating disorders PR:1.74 (CI95%:1.14-2.66), sexual risk behavior (SRB), PR:1.67 (CI95%:1.11-2.50), excessive alcohol consumption, PR:1.57 (CI95%:1.06-2.34) and worse perceived health, PR:1.67 (CI95%:1.08-2.57). In boys, PSV was associated with having been born in a country other than Spain, PR:2.05 (CI95%:1.32-3.18), eating disorders, PR:2.79 (CI95%:1.58-4.92), SRB, PR:2.22 (CI95%:1.34- 3.66) and drug consumption, PR:2.14 (CI95%:1.39-3.28). Conclusion: VFS was higher in girls and was associated to others health risk factors with similar characteristics according to sex (AU)

Effect of a smoking ban and school-based prevention and control policies on adolescent smoking in Spain: a multilevel analysis.

We evaluated the impact of a smoking ban in schools and of school-based smoking prevention and control policies on adolescent smoking. Annual surveys carried out between 2001 and 2005 that were representative of students in the 4th year of secondary education in the Madrid region, with 203 schools and 9127 students participating. The student questionnaire gathered information about personal and family variables. The contextual factors were: the periods before (years 2001-2002) and after the law; and through a survey of school management boards: compliance with the law, policy reflected in the school regulations, existence of complaints against smoking, and undertaking of educational activities regarding smoking. Multilevel logistic regression models were constructed with two dependent variables: current smoking and the proportion giving up smoking. Smoking declined in 2003, the first year after the law came into force (Odds ratio: 0.80; CI 95%: 0.66-0.96), and this decline was maintained in 2005. By contrast, smoking increased in those schools that did not undertake educational programmes regarding smoking (Odds ratio: 1.34; CI 95%: 1.13-1.59), and in those that received complaints about smoking (Odds ratio: 1.12; CI 95%: 0.96-1.29). This association is partly due to the effect of the increase in giving up smoking. The inclusion of contextual variables into the model with the individual factors reduces the variability of smoking between schools by 32.6%. In summary, the coming into force of a law banning smoking in schools, and the implementing of educational policies for the prevention and control of smoking are related to a lower risk of adolescent smoking.

Individual and contextual factors associated to smoking on school premises.

INTRODUCTION: Despite regulations, tobacco consumption in schools is still very common. The objective was to evaluate the relationship of personal, family, and school-level contextual factors with smoking on school premises. METHODS: A representative survey was undertaken of students in the 4th year of secondary education in the Madrid region (Spain), including 79 schools and 3,622 individuals. The student questionnaire gathered information about personal and family variables. The contextual factors were type of school, perception of compliance with the law, smoking policy, existence of complaints against smoking, and undertaking of educational activities regarding smoking. Analysis was carried out in the smoking population (n = 1,179) using multilevel logistic regression models. RESULTS: During the last 30 days, 50.6% of smokers had smoked on school premises. Having a father with a university education (in comparison with fathers who have not attained any educational level) reduces this probability (odds ratio [OR]: 0.43; 95% CI: 0.19-0.96), whereas smoking a larger number of cigarettes (p < .001), illicit drug consumption (p < .001), and low academic achievement (p = .052) increases it. The probability is reduced when there is no parental permission to smoke (OR: 0.66; 95% CI: 0.43-1.01) and is lower both in nonsubsidized private schools (OR: 0.29; 95% CI: 0.12-0.67) and in state subsidized private schools (OR: 0.17; 95% CI: 0.09-0.34) than in public schools. CONCLUSIONS: A very low level of educational attainment by the father, smoking a higher number of cigarettes, as well as illicit drug consumption, low academic achievement, having parental permission to smoke, and attending public schools are all related to a higher probability of smoking on school premises.

Prevalence and correlates of skin cancer risk behaviors in Madrid (Spain).

OBJECTIVE: To estimate the prevalence and correlates of skin cancer-related behaviors in a representative sample of the population of the region of Madrid (Spain). METHODS: We performed a cross-sectional study based on a telephone survey. A total of 2,007 participants aged 18-64 years completed a questionnaire that included items on knowledge about the risk of skin cancer, sun exposure, the use of ultraviolet (UV) lamps and sunburn during the previous year. Logistic regression models were constructed, adjusted for gender, age, educational level and employment status. RESULTS: Sun exposure as a risk factor for skin cancer was identified by 92.3% of participants and artificial tanning by 73.6%. Knowledge of risk factors was greater among university graduates and women (P<.001). A total of 14.6% were usually exposed to the sun in the summer during the hours of maximum UV radiation, while 4.3% had used UV lamps during the previous year; the use of these lamps was more frequent among women (P<.001) and young people (P<.05). The prevalence of sunburn was 13.2% and was lower among women: odds ratio (OR) 0.68 (95% CI: 0.51-0.90); this prevalence declined with greater age (p linear trend <0.001) and was higher among students: OR 1.60 (95% CI: 1.07-2.40). CONCLUSIONS: Numerous sociodemographic factors are related to UV radiation exposure and sunburn, with young people at highest risk. UV exposure is more frequent among women, whereas sunburn is more common among men.

Mortalidad atribuible al consumo de tabaco en España en 2006 / Smoking-attributable deaths in Spain, 2006

Fundamento y objetivo: Estimar la mortalidad atribuible al consumo de tabaco en España en 2006, y compararla con las estimaciones de años anteriores. Población y método:A partir de la prevalencia de tabaquismo y la mortalidad correspondientes a España, y los riesgos relativos de muerte por enfermedades causadas por el tabaquismo, procedentes del Cancer Prevention Study II, se ha calculado la mortalidad atribuible al tabaquismo en los individuos de edad ≥ 35 años. Resultados: En el año 2006 se produjeron 53.155 muertes atribuibles al tabaquismo en individuos ≥ 35 años, lo que supone el 14,7% (25,1% en varones y 3,4% en mujeres) de todas las muertes ocurridas en los mismos. El 88,7% (47.174) de estas muertes atribuibles corresponde a varones y el 11,3% (5.981) a mujeres. Por causas, destacan las muertes atribuibles por: tumores malignos (24.058), especialmente cáncer de pulmón (16.482), enfermedades cardiovasculares (17.560), especialmente cardiopatía isquémica (6.263) e ictus (4.283), y enfermedades respiratorias (11.537), especialmente enfermedad pulmonar obstructiva crónica (9.886). Desde el año 2001 prosigue el descenso en la mortalidad atribuible en los varones y el ascenso en las mujeres.Conclusiones: Una de cada 7 muertes ocurridas cada año en individuos mayores de 35 años en España es atribuible al consumo de tabaco (una de cada 4 en varones y una de cada 29 en mujeres). A pesar del descenso de las muertes atribuibles al tabaquismo respecto a años anteriores (excepto en las mujeres, en quienes aumenta), este número de muertes y el porcentaje de la mortalidad total que representa sigue siendo muy elevado (AU)

Background and objective: This study estimates smoking-attributable mortality in Spain in 2006. Population and method: Source data included 1) smoking prevalence in Spain; 2) deaths occurred in Spain; and 3) relative risks of mortality by tobacco-caused diseases drawn from the Cancer Prevention Study II. All data corresponded to individuals aged 35 years and older. Results: In 2006, 53,155 smoking-attributable deaths were estimated (14.7% of all deaths occurred in individuals ≥ 35 years; 25.1% in men and 3.4% in women). Almost 90% (47,174) of these attributable deaths corresponded to men, and 11.3% (5,981) to women. The most frequent attributable deaths were: cancer (24,058), specially lung cancer (16,482), cardiovascular disease (17,560), specially ischemic heart disease (6,263) and stroke (4,283), and respiratory disease (11,537), specially chronic obstructive lung disease (9,886). Since 2001, a decrease in smoking-attributable mortality was observed in men and an increase in women. Conclusions:About one out of 7 deaths occurring annually in individuals ≥ 35 years in Spain is attributable to smoking (one in 4 in men and one in 29 in women). Despite a decreasing trend in the number of smoking-attributable deaths over time (except in women, where they increase), the toll of estimated attributable deaths is still very high (AU)

Prevalence and correlates of skin cancer risk behaviors in Madrid (Spain)

Objetivo: Estimar la prevalencia y los factores asociados a las conductas relacionadas con el cáncer depiel en una muestra representativa de la Comunidad de Madrid (Espa˜ na).Métodos: Estudio transversal basado en encuesta telefónica. Un total de 2.007 personas de 18-64 a˜noscompletaron un cuestionario sobre conocimiento de riesgos del cáncer de piel, la exposición al sol, el usode aparatos de bronceado artificial y quemaduras solares durante el último a˜no. Se elaboraron modelosde regresión logística, ajustando por sexo, edad, nivel educativo y situación laboral.Resultados: Un 92,3% identificaron la exposición al sol como un factor de riesgo para el cáncer de piel,disminuyendo al 73,6% para el bronceado artificial. Este conocimiento es mayor entre las personas coneducación superior y en las mujeres (p<0,001). El 14,6% estuvieron expuestos al sol en verano durante lashoras de máxima radiación ultravioleta (UV), y el 4,3% utilizaron lámparas UV en el último a˜no, siendomás frecuente en las mujeres (p <0,001) y jóvenes (p <0,05). La prevalencia de quemaduras solares fue del13,2%, siendo menor en las mujeres (odds ratio [OR] de 0,68; IC95%: 0,51-0,90), disminuyendo a medidaque aumenta la edad (p de tendencia lineal <0,001) y más alta entre los estudiantes (OR de 1,60; IC95%:1,07-2,40).Conclusiones: Se detectan numerosos factores sociodemográficos asociados a la exposición a la radiaciónUV y las quemaduras solares, siendo la población más joven la de mayor riesgo. La exposición aradiación UV es más frecuente entre las mujeres, mientras que las quemaduras solares son más comunesen los hombres (AU)

Objective: To estimate the prevalence and correlates of skin cancer-related behaviors in a representativesample of the population of the region of Madrid (Spain).Methods: Weperformed a cross-sectional study based on a telephone survey.Atotal of 2,007 participantsaged 18-64 years completed a questionnaire that included items on knowledge about the risk of skincancer, sun exposure, the use of ultraviolet (UV) lamps and sunburn during the previous year. Logisticregression models were constructed, adjusted for gender, age, educational level and employment status.Results: Sun exposure as a risk factor for skin cancer was identified by 92.3% of participants and artificialtanning by 73.6%. Knowledge of risk factors was greater among university graduates andwomen(P<.001).Atotal of 14.6% were usually exposed to the sun in thesummerduring the hours ofmaximumUVradiation,while 4.3% had used UV lamps during the previous year; the use of these lamps was more frequent amongwomen (P<.001) and young people (P<.05). The prevalence of sunburn was 13.2% and was lower amongwomen: odds ratio (OR) 0.68 (95% CI: 0.51-0.90); this prevalence declined with greater age (p linear trend<0.001) and was higher among students: OR 1.60 (95% CI: 1.07-2.40).Conclusions: Numerous sociodemographic factors are related to UV radiation exposure and sunburn,with young people at highest risk. UV exposure is more frequent among women, whereas sunburn ismore common among men (AU)

[Smoking-attributable deaths in Spain, 2006]. / Mortalidad atribuible al consumo de tabaco en España en 2006.

BACKGROUND AND OBJECTIVE: This study estimates smoking-attributable mortality in Spain in 2006. POPULATION AND METHOD: Source data included 1) smoking prevalence in Spain; 2) deaths occurred in Spain; and 3) relative risks of mortality by tobacco-caused diseases drawn from the Cancer Prevention Study II. All data corresponded to individuals aged 35 years and older. RESULTS: In 2006, 53,155 smoking-attributable deaths were estimated (14.7% of all deaths occurred in individuals≥35 years; 25.1% in men and 3.4% in women). Almost 90% (47,174) of these attributable deaths corresponded to men, and 11.3% (5,981) to women. The most frequent attributable deaths were: cancer (24,058), specially lung cancer (16,482), cardiovascular disease (17,560), specially ischemic heart disease (6,263) and stroke (4,283), and respiratory disease (11,537), specially chronic obstructive lung disease (9,886). Since 2001, a decrease in smoking-attributable mortality was observed in men and an increase in women. CONCLUSIONS: About one out of 7 deaths occurring annually in individuals≥35 years in Spain is attributable to smoking (one in 4 in men and one in 29 in women). Despite a decreasing trend in the number of smoking-attributable deaths over time (except in women, where they increase), the toll of estimated attributable deaths is still very high.

Ingesta de alimentos, energía y nutrientes en la población de 5 a 12 años de la Comunidad de Madrid: resultados de la encuesta de nutrición infantil 2001-2002 / Food, energy and nutrient intake in children aged 5-12 in the autonomous community of Madrid, Spain: results of the 2001/2002 children’s nutrition survey

Fundamento: Para conocer la situación alimentaria y nutricionalen la población infantil, sobre la que no existía información actualizada,el Instituto de Salud Pública desarrolló la Encuesta de NutriciónInfantil de la Comunidad de Madrid 2001/2002 (ENICM). En estetrabajo se analiza la ENICM para describir y evaluar la ingesta de alimentos,energía y nutrientes en esta población.Métodos: Estudio transversal sobre una muestra representativa dela población de 5-12 años de la Comunidad de Madrid. La informaciónalimentaria se recogió en 2001 y 2002 mediante dos recuerdos de24 horas. Se ha estudiado la ingesta total diaria de alimentos, energíay nutrientes. Los análisis incluyen los 1.852 niños con informacióncompleta en los dos recuerdos (90,8% de las entrevistas realizadas).Resultados: La ingesta media total diaria de alimentos es1.460,7 gramos/persona/día. Salvo para los lácteos, huevos y aceites,la ingesta en los grupos alimentarios básicos es inadecuada, particularmentebaja en las frutas frescas, verduras y hortalizas. La ingestamedia energética y nutricional resultante es 1.905,9 kcal/persona/día;43,6% hidratos de carbono; 17,4% proteínas, 39,0% lípidos (13,3%grasas saturadas, 16,8% monoinsaturadas, 5,0% poliinsaturadas);363,8 mg de colesterol; 13,6 g de fibra e ingestas por debajo de lasrecomendadas de zinc, ácido fólico, vitaminas D y E (ambos sexos) yhierro y vitamina B6 (niñas).Conclusiones: La dieta de la población infantil de la Comunidadde Madrid presenta desequilibrios que es necesario mejorar: ingestainadecuada de alimentos básicos, exceso de proteínas, grasas saturadasy colesterol y déficit de hidratos de carbono, fibra y algunosmicronutrientes(AU)

Backgound: In order to ascertain the food intake and nutritionalsituation of the children of the Community of Madrid, on which noupdated information was available, the Institute of Public Healthconducted the 2001/2001 Children’s Nutrition Survey of theCommunity of Madrid (CNSCM). This study offers an analysis of theCNSCM that describes and evaluates the food, energy and nutrientintake of this segment of the population.Methods: Cross-sectional survey on a representative sample ofchildren aged 5-12 years from the Community of Madrid. Dietrelatedinformation was collected in 2001 and 2002 by means of two24-hour recalls. Total daily food, energy and nutrient intake werestudied. The analysis included only the 1852 children who hadcompleted both 24-h recalls (90.8% of all interviews).Results: The average daily food intake is 1460.7grams/person/day. Except for dairy products, eggs and oils, intakefrom the basic food groups is inadequate, and is particularly low forfresh fruits, green leafy vegetables and garden vegetables in general.The resulting average energy and nutrition intake is 1905.9kcal/person/day; 43.6% carbohydrates, 17.4% proteins, 39.0% fats(13.3% saturated fats, 16.8% monosaturated fats, 5.0%polyunsaturated fats); 363.8 mg cholesterol, 13.6 g of fiber and lowerthan recommended intakes of zinc, folic acid, vitamins D and E (bothsexes) and iron and vitamin B6 (girls).Conclusions: The diet of the children of the Community ofMadrid shows a number of imbalances that should be improved:inadequate intake from basic food groups; excess of proteins,saturated fats and cholesterol; and a deficit of carbohydrates, fiberand certain micronutrients(AU)

Impact of the "Tobacco control law" on exposure to environmental tobacco smoke in Spain.

BACKGROUND: The initial evaluations of the introduction of legislation that regulates smoking in enclosed public places in European countries, describe an important effect in the control of exposure to environmental tobacco smoke. However, the evidence is still limited. The objective of this study is to estimate the short-term effects of the comprehensive "Tobacco control law" introduced in Spain on January 2006, which includes a total ban of smoking in workplaces and a partial limitation of smoking in bars and restaurants. METHODS: Cross-sectional, population-based study. The self-reported exposure to environmental tobacco smoke at home, at work, in bars and restaurants of the population aged 18 to 64 years in the Madrid Region during a period prior to the law (October and November 2005; n = 1750) was compared to that of the period immediately after the law came into force (January-July 2006; n = 1252). Adjusted odds ratios (OR) were calculated using logistic regression models. RESULTS: Passive exposure to tobacco smoke at home has hardly changed. However, at indoor workplaces there has been a considerable reduction: after the law came into force the OR for daily exposure > 0-3 hours versus non-exposure was 0.11 (95% CI: 0.07 to 0.17) and for more than 3 hours, 0.12 (95% CI: 0.09 to 0.18). For fairly high exposure in bars and restaurants versus non-exposure, the OR in the former was 0.30 (95% CI: 0.20 to 0.44) and in the latter was 0.24 (95% CI: 0.18 to 0.32); for very high exposure versus non-exposure they were 0.16 (95% CI: 0.10 to 0.24) and 0.11 (95% CI: 0.07 to 0.19), respectively. These results were similar for the smoking and non-smoking populations. CONCLUSION: A considerable reduction in exposure to environmental tobacco smoke in the workplace and, to a lesser extent, in bars and restaurants, is related to the implementation of the "Tobacco control law". Although only initial figures, these results already demonstrate the effectiveness of strategies that establish control measures to guarantee smoke-free places.

[Food, energy and nutrient intake in children aged 5-12 in the autonomous community of Madrid, Spain: results of the 2001/2002 Children's Nutrition Survey]. / Ingesta de alimentos, energía y nutrientes en la poblacion de 5 a 12 años de la comunidad de Madrid: resultados de la encuesta de nutricion infantil 2001-2002.

BACKGROUND: [corrected] In order to ascertain the food intake and nutritional situation of the children of the Community of Madrid, on which no updated information was available, the Institute of Public Health conducted the 2001/2001 Children's Nutrition Survey of the Community of Madrid (CNSCM). This study offers an analysis of the CNSCM that describes and evaluates the food, energy and nutrient intake of this segment of the population. METHODS: Cross-sectional survey on a representative sample of children aged 5-12 years from the Community of Madrid. Diet-related information was collected in 2001 and 2002 by means of two 24-hour recalls. Total daily food, energy and nutrient intake were studied. The analysis included only the 1852 children who had completed both 24-h recalls (90.8% of all interviews). RESULTS: The average daily food intake is 1460.7 grams/person/day. Except for dairy products, eggs and oils, intake from the basic food groups is inadequate, and is particularly low for fresh fruits, green leafy vegetables and garden vegetables in general. The resulting average energy and nutrition intake is 1905.9 kcal/person/day; 43.6% carbohydrates, 17.4% proteins, 39.0% fats (13.3% saturated fats, 16.8% monosaturated fats, 5.0% polyunsaturated fats); 363.8 mg cholegterol, 13.6 g of fiber and lower than recommended intakes of zinc, folic acid, vitamins D and E (both sexes) and iron and vitamin B6 (girls). CONCLUSIONS: The diet of the children of the Community of Madrid shows a number of imbalances that should be improved: inadequate intake from basic food groups; excess of proteins, saturated fats and cholesterol; and a deficit of carbohydrates, fiber and certain micronutrients.

Clustering of behavioural risk factors and compliance with clinical preventive recommendations in Spain.

OBJECTIVE: To examine the relationship between the clustering of behavioural risk factors and compliance with clinical preventive practices. METHOD: Cross-sectional study using a telephone interview of a sample of 16043 persons, representative of the population aged 18-64 years in the Madrid Region (Spain). The criteria for providing clinical preventive services were based on recommendations issued by the Spanish Society for Family and Community Medicine. Analyses were performed using logistic regression with adjustment for age, education, social class and year of interview. RESULTS: A positive dose-response association was observed between the number of behavioural risk factors (tobacco smoking, hazardous alcohol drinking, leisure-time sedentariness and unbalanced diet) and non-compliance of recommendations for blood-pressure and cholesterol testing, and for cytology and mammography screening (P < 0.001). Compared to subjects with no behavioural risk factors, those with all four risk factors showed a higher frequency of non-compliance of blood pressure assessment: OR = 2.5 (95% CI: 1.6, 3.8) in men and 2.7 (1.5, 4.8) in women, and cholesterolaemia testing: OR = 2.6 (1.8, 3.9) in men and 2.7 (1.5, 5.1) in women. Furthermore, among women, the presence of these four risk factors was also associated with a higher frequency of non-performance of cytology: OR = 6.4 (2.8, 14.8) and mammography screening: OR = 10.2 (2.1, 49.8). However, as it is a cross-sectional study, we do not know the direction of this relationship, therefore, any causal inference should be made with caution. CONCLUSIONS: Clustering of behavioural risk factors is associated with greater non-compliance with recommendations for both blood pressure and cholesterolaemia testing, and for cytology and mammography screening.

Clustering of behavior-related risk factors and its association with subjective health.

OBJECTIVES: To describe the clustering of behavior-related risk factors in the adult population of the Autonomous Community of Madrid (Spain) and evaluate the association between the level of aggregation of these factors and suboptimal subjective health. METHODS: Data were drawn from the Non-communicable Disease Risk-Factor Surveillance System (Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles [SIVFRENT]). We studied the associations between smoking, high-risk alcohol consumption, leisure-time sedentariness and unbalanced diet in 16,043 persons aged 18-64 years and compared the observed against the expected proportions. Logistic regression was used to estimate the association between clustering of risk factors and suboptimal health (fair, poor and very poor). RESULTS: Almost 20% of subjects had 3 or 4 risk factors simultaneously. Most combinations of 3 risk factors exceeded expectations and, in particular, 4 factor clustering yielded observed/expected quotients of 2.15 (95% confidence interval [CI]: 1.93-2.38) in men and 2.96 (95% CI, 2.46-3.46) in women. In both sexes, the individual factor most closely associated with the remaining risk factors was smoking. Aggregation of risk factors was more frequent among men, younger age groups and subjects with low educational level. Compared with persons with none of the 4 risk factors, those that simultaneously had 3 or 4 more frequently reported suboptimal subjective health (OR = 2.49; 95% CI, 1.59-3.90 in men and OR = 1.96; 95% CI, 1.29-2.97 in women). CONCLUSIONS: Behavior-related risk factors tend to aggregate, and this accumulation is higher among men, younger age groups, and subjects with a low educational level. A greater level of clustering is associated with a higher frequency of suboptimal perceived health.

Agregación de factores de riesgo ligados al comportamiento y su relación con la salud subjetivaAgregación de factores de riesgo ligados al comportamiento y su relación con la salud subjetiva / Clustering of behavioural risk factors and their association with subjective health

Objetivos: Describir la agregación de factores de riesgo relacionados con el comportamiento en la población adulta de la Comunidad de Madrid y evaluar la asociación del grado de agregación de dichos factores con la salud subjetiva sub-óptima. Métodos: Los datos proceden del Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles (SIVFRENT). Las relaciones entre el consumo de tabaco, el consumo de alcohol de riesgo, el sedentarismo en tiempo libre y la dieta desequilibrada fueron estudiadas en 16.043 personas de 18 a 64 años, y se compararon las proporciones observadas respecto a las esperadas. Mediante un análisis de regresión logística se estimó la asociación entre la agregación de factores de riesgo y la salud percibida subóptima (regular, mala y muy mala). Resultados: Cerca del 20% de los sujetos presentan 3 o 4 factores de riesgo simultáneamente. La mayoría de combinaciones de 3 factores de riesgo son superiores a las esperadas, destacando la agregación de los 4 factores con un cociente observado/esperado de 2,15 (IC del 95%, 1,93-2,38) en varones y de 2,96 (IC del 95%, 2,46-3,46) en mujeres. En ambos sexos, el factor individual que más se asocia al resto de factores de riesgo es el tabaco. La agregación de factores de riesgo es más frecuente en varones, en edades jóvenes y en el nivel educativo bajo. En comparación con los que carecen de los 4 factores de riesgo, los que presentan simultáneamente 3 o 4 de ellos tienen con mayor frecuencia una salud percibida subóptima (OR = 2,49; IC del 95%, 1,59-3,90 en varones y OR = 1,96; IC del 95%, 1,29-2,97 en mujeres). Conclusiones: Los factores de riesgo ligados al comportamiento se agregan, y esta acumulación es superior en varones, en personas jóvenes y con bajo nivel de estudios. Un mayor grado de agregación se asocia a mayor frecuencia de salud percibida subóptima

Objectives: To describe the clustering of behavioural risk factors in the adult population of the Autonomous Community of Madrid (Spain), and to evaluate the association between the level of aggregation of such factors and suboptimal subjective health. Methods: Data were drawn from the Non-communicable Disease Risk-Factor Surveillance System (Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles - SIVFRENT). We studied the relationships between tobacco use, high-risk alcohol consumption, leisure-time inactivity and unbalanced diet in 16,043 people aged 18-64, comparing observed against expected proportions. Logistic regression was used to estimate the association between aggregation of risk factors and suboptimal health (fair, poor and very poor health). Results: Almost 20% of subjects had 3 or 4 risk factors. Most combinations of three risk factors exceeded expectations and, in particular, 4-factor clustering yielded observed/expected quotients of 2.15 (95% confidence interval [CI], 1.93-2.38) in men and 2.96 (95% CI, 2.46-3.46) in women. In both sexes, smoking was the individual factor most frequently associated with the remaining risk factors. Aggregation of risk factors was more frequent among men, in younger age groups and among subjects with low educational level. Compared to people with none of the 4 risk factors, those with 3 or four reported suboptimal subjective health more frequently (OR = 2.49; 95% CI, 1.59-3.90 for men and OR = 1.96; 95% CI, 1.29-2.97 for women). Conclusions: Behavioural risk factors tend to aggregate, and this clustering is higher among men, in younger age groups and among subjects with a low educational level. A greater level of clustering is associated with a higher frequency of suboptimal self-rated health

[Recent decrease in smoking-attributable mortality in Spain]. / La mortalidad atribuible al tabaquismo comienza a descender en España.

BACKGROUND AND OBJECTIVE: Certain diseases related to smoking have recently decreased in Spanish adults. This study estimated the burden of smoking-attributable mortality in Spain currently and in previous years. POPULATION AND METHOD: Smoking prevalence and mortality in Spain, and relative risks for death from the Cancer Prevention Study II were used to estimate tobacco-attributable mortality in the Spanish population aged 35 years and over. RESULTS: In 2001, 54,233 deaths were attributable to tobacco use (49,366 in men and 4,867 in women). This represents a global reduction in comparison with the 55,613 deaths attributed to tobacco in 1998 (51,431 in men and 4,182 in women). One out of four current attributable deaths were untimely deaths occurred before age 65 years. CONCLUSIONS: A reduction in the number of smoking-attributable deaths is observed for the first time in Spain, as a result of a clear reduction among men. However, the overall decrease of smoking-related deaths is too small, and the burden of smoking-attributable mortality in Spain remains too high.

La mortalidad atribuible al tabaquismo comienza a descender en España / Recent decrease in smokingattributable mortality in Spain

FUNDAMENTO Y OBJETIVO: Las muertes por algunas de las principales enfermedades relacionadas con el tabaquismo han comenzado a descender en la población adulta española. Este trabajo estima la mortalidad atribuible al tabaquismo en España actualmente y la compara con años anteriores. POBLACIÓN Y MÉTODO: A partir de la prevalencia de tabaquismo y la mortalidad en España, y los riesgos relativos de muerte del Cancer Prevention Study II, se calcula la mortalidad atribuible al tabaquismo en la población española de 35 y más años. RESULTADOS: En 2001 el tabaquismo ocasionó54.233 muertes (49.366 en varones y4.867 en mujeres). Esta cifra supone un descenso global respecto a las 55.613 atribuidas al tabaco en 1998 (51.431 en varones y 4.182 en mujeres). Una cuarta parte de las muertes atribuibles son muertes prematuras ocurridas antes de los 65 años. CONCLUSIONES: Por primera vez se aprecia en España una disminución del número de muertes atribuibles al consumo de tabaco, causada por la clara reducción de éste en los varones. Sin embargo, el descenso globales muy moderado y la carga de mortalidad atribuible al tabaquismo en España sigue siendo muy alta

BACKGROUND AND OBJECTIVE: Certain diseases related to smoking have recently decreased in Spanish adults. This study estimated the burden of smoking-attributable mortality inSpain currently and in previous years. POPULATION AND METHOD: Smoking prevalence and mortality in Spain, and relative risks for death from the Cancer Prevention StudyII were used to estimate tobacco-attributable mortality in the Spanish population aged 35 years and over. RESULTS: In 2001, 54,233 deaths were attributable to tobacco use (49,366 in men and 4,867 in women). This represents a global reduction in comparison with the55,613 deaths attributed to tobacco in1998 (51,431 in men and 4,182 in women).One out of four current attributable deaths were untimely deaths occurred before age 65 years. CONCLUSIONS: A reduction in the number of smoking-attributable deaths is observed for the first time in Spain, as a result of a clear reduction among men. However, the overall decrease of smoking-related deaths is too small, and the burden of smoking-attributable mortality in Spain remains too high

Effectiveness and equity of serum cholesterol and blood pressure testing: a population-based study in Spain.

BACKGROUND: This study examined the effectiveness and equity of serum cholesterol and blood pressure testing in Spain. METHODS: Data were taken from a household survey of 3680 persons of the Basque Country, a region in northern Spain. Analyses were performed using logistic regression, controlling for need, equity, and predisposing factors for serum cholesterol and blood pressure testing. Proxies for need were age, subjective health and cardiovascular risk factors, such as tobacco and alcohol consumption, physical activity at work and at leisure time, and body mass index. Proxies for equity were sex, educational level, and province of residence, and predisposing factors for testing were the marital status and the number of medical visits in the preceding year. RESULTS: The percentage of subjects that had their cholesterol measured rose with age and worse subjective health, but showed no association with any cardiovascular risk factor except body mass index, for which a positive association was observed (P for linear trend, 0.0351). The percentage of subjects with serum cholesterol checked also rose with educational level (P for linear trend, 0.0024). Moreover, women were less likely to have their cholesterolemia tested than men (OR, 0.79; 95% CI, 0.67-0.94). Educational and sex differences in cholesterol testing increased after adjustment for the number of medical visits. Similar results were obtained for blood pressure testing. CONCLUSIONS: Serum cholesterol and blood pressure testing are not performed according to cardiovascular risk, which compromise its effectiveness. Moreover, there are social inequalities in testing, to which healthcare professionals could be contributing.

Assessment of a blood pressure measurement training programme for lay observers.

This study assessed a training programme attended by 25 observers, intentionally chosen for their lay status, who were invited to participate in a prevalence of hypertension study. The results highlight the fact that the 14 trainee observers finally selected were comparable to professionals in terms of both the estimated validity of the blood pressure measurement [the mean difference (standard deviation) compared with the expert being -0.4 (1.8) mmHg for systolic blood pressure and 0.0 (1.8) mmHg for diastolic blood pressure] and estimated inter-observer variability (100% of the observers complying with the criteria recommended for professional health-care workers), even though the training given to the former was in no way more comprehensive than or distinct from that recommended for professional health-care workers in community studies.