A multi-state model to estimate incidence of heroin use

Background: Existing incidence estimates of heroin use are usually based on one information source. This study aims to incorporate more sources to estimate heroin use incidence trends in Spain between 1971 and 2005. Methods: A multi-state model was constructed, whereby the initial state "heroin consumer" is followed by transition to either "admitted to first treatment" or to "left heroin use" (i.e. permanent cessation or death). Heroin use incidence and probabilities of entering first treatment ever were estimated following a back-calculation approach. Results: The highest heroin use incidence rates in Spain, around 1.5 per 1,000 inhabitants aged 10-44, occurred between 1985 and 1990; subdividing by route of administration reveals higher incidences of injection between 1980 and 1985 (a mean of 0.62 per 1.000) and a peak for non-injectors in 1990 (0.867 per 1,000). Conclusions: A simple conceptual model for heroin users' trajectories related to treatment admission, provided a broader view of the historical trend of heroin use incidence in Spain

Sex differences in the cumulative incidence of substance use by birth cohort

BACKGROUND: Men present higher overall rates of substance use and abuse than women; yet, evidence suggests that an increase of substance use by the younger cohorts of women in recent decades is narrowing this gap in western societies. Moreover, younger cohorts may also be reporting earlier initiation of substance use, representing an increased risk for developing substance-related problems. With this study we intend to identify changes in the patterns of substance use of men and women in Spain for public health policy, planning and intervention. METHODS: Sex differences in the cumulative incidence of alcohol, tobacco, cannabis and cocaine were examined by birth cohort using a combined sample of individuals aged 15-64 years from eight editions of the Spanish National Survey on Drugs (1995-2009). RESULTS: Initiation of substance use in Spain is progressively taking place at younger ages, particularly among women. The gender-gap of life-time occurrence of substance use is narrowing (cannabis and cocaine) almost closing (alcohol) and even reversing (tobacco) in the youngest cohort. CONCLUSION: These results reflect the particular evolution and trends of Spanish society regarding substance use. Women's increased use of substances and the earlier age of initiation of substance use by both sexes present particular challenges for prevention and treatment of future substance-related problems. The trends registered for legal and illegal substances would require re-evaluation of existing prevention policies.This work was supported by the Delegación del Gobierno para el Plan Nacional sobre Drogas of the Ministerio de Salud y Política Social, grant numbers: PNSD 2007/I044 and 2011/I073; FIS-Redes/nde investigación cooperativa, grant number: RD06/0001/1018; and AGAUR, grant number: 2009 SGR 00718. Albert Sánchez-Niubò was supported by Instituto de Salud Carlos III, grant number: CA08/00214. The work was partially developed within the framework of the EU project JUST/2010/DPIP/AG/1410: New methodological tools for/npolicy and programme evaluatio

Sex differences in the cumulative incidence of substance use by birth cohort

BACKGROUND: Men present higher overall rates of substance use and abuse than women; yet, evidence suggests that an increase of substance use by the younger cohorts of women in recent decades is narrowing this gap in western societies. Moreover, younger cohorts may also be reporting earlier initiation of substance use, representing an increased risk for developing substance-related problems. With this study we intend to identify changes in the patterns of substance use of men and women in Spain for public health policy, planning and intervention. METHODS: Sex differences in the cumulative incidence of alcohol, tobacco, cannabis and cocaine were examined by birth cohort using a combined sample of individuals aged 15-64 years from eight editions of the Spanish National Survey on Drugs (1995-2009). RESULTS: Initiation of substance use in Spain is progressively taking place at younger ages, particularly among women. The gender-gap of life-time occurrence of substance use is narrowing (cannabis and cocaine) almost closing (alcohol) and even reversing (tobacco) in the youngest cohort. CONCLUSION: These results reflect the particular evolution and trends of Spanish society regarding substance use. Women's increased use of substances and the earlier age of initiation of substance use by both sexes present particular challenges for prevention and treatment of future substance-related problems. The trends registered for legal and illegal substances would require re-evaluation of existing prevention policies.This work was supported by the Delegación del Gobierno para el Plan Nacional sobre Drogas of the Ministerio de Salud y Política Social, grant numbers: PNSD 2007/I044 and 2011/I073; FIS-Redes/nde investigación cooperativa, grant number: RD06/0001/1018; and AGAUR, grant number: 2009 SGR 00718. Albert Sánchez-Niubò was supported by Instituto de Salud Carlos III, grant number: CA08/00214. The work was partially developed within the framework of the EU project JUST/2010/DPIP/AG/1410: New methodological tools for/npolicy and programme evaluatio

Coverage of overdose prevention programs for opiate users and injectors: a cross-sectional study

Background. The use of opiates, particularly heroin, remains an important cause of morbidity and mortality. Half of the deaths among heroin consumers are attributed to overdose. In response to this problem, overdose prevention programs (OPPs) were designed. The objective of our study was to assess coverage of OPPs among the target population in a specific Spanish region (Catalonia) and to identify characteristics related to attendance./nMethods. A cross-sectional survey recruited individuals from outpatient treatment centers (OTCs), therapeutic communities (ThCs), and harm reduction facilities (HRFs) in Catalonia. From 513 participants, 306 opiate users and/or injectors were selected for this study. Coverage was calculated as the proportion of subjects who declared having participated in an OPP. A Poisson regression with robust variance was used to assess factors (socio-demographic aspects and psychoactive substance use patterns) associated to OPP participation, taking into account recruitment strategy./nResults. Average age of the 306 subjects was 39.7 years (s.d.: 7.7); 79% were male; 79.2% lived in urban areas and 56.3% were unemployed or had never worked. Overall OPP coverage was 43.5% (95% CI: 37%–49%). Training was received mostly in HRF (60%), followed by OTC (24.4%), prison (19%), and ThC (16%). OPP sessions were attended by 41% of Spanish-born study participants and by 63.3% of foreigners; 92.2% of the participants lived in urban areas. The Poisson regression analysis adjusted by age, sex, and type of recruitment center showed that OPP participation rates were higher for individuals with foreign nationality (PR = 1.3; 95% CI: 1.04–1.72), for those living in municipalities with more than 100,000 inhabitants (PR = 2.0; 95% CI: 1.37–2.81) or the Barcelona conurbation (PR = 2.5; 95% CI: 1.68–3.77), and for those having ever been in prison (PR = 1.6; 95% CI: 1.41–1.81) and had first consumption when they were less than 12 years old (PR = 1.2; 95% CI: 1.06–1.45)./nConclusion. Coverage as a whole can be considered high. However, in Catalonia, new strategies ought to be developed in order to attract opiate users and injectors not currently participating, by expanding OPP offer to services and regions where coverage is poor.Funding for this study was provided by the Spanish Government Grant: Instituto de Salud Carlos III-FIS PI11/01358. Further financial support was provided by the Agència de Gestió d’Ajuts Universitaris i de Recerca (AGAUR 2009 SGR 718) and FIS-Redes de investigación cooperativa RD12/0028/0018

Propuestas de clase social neoweberiana y neomarxista a partir de la Clasificación Nacional de Ocupaciones 2011

En España, la nueva Clasificación Nacional de Ocupaciones (CNO-2011), que ha variado sustancialmente respecto a la del año 1994, requiere la adaptación de la clase social ocupacional para ser utilizada en estudios de desigualdades en salud. En este artículo se presentan dos propuestas para medir la clase social: la nueva clasificación de clase social ocupacional (CSO-SEE12), basada en la CNO-2011, desde un enfoque neoweberiano, y una propuesta de clase social desde un enfoque neomarxista. La CSO-SEE12 se construye a partir de una revisión detallada de los códigos de la CNO-2011. Por su parte, la clase social neomarxista se establece a partir de variables sobre los bienes de capital, de organización y de cualificación. La CSO-SEE12 que se propone consta de siete clases sociales que pueden ser agrupadas en un número menor de categorías, según las necesidades del estudio. La clasificación neomarxista consta de 12 categorías, en las cuales las y los propietarios se dividen en tres categorías en función de los bienes de capital y las personas asalariadas en nueve categorías formadas a partir de los bienes de organización y cualificación. Estas propuestas se complementan con la proposición de una clasificación del nivel educativo que integra los diferentes planes de estudio en España, y ofrece las correspondencias con la Clasificación Internacional Normalizada de la Educación

A multi-state model to estimate incidence of heroin use

Background: Existing incidence estimates of heroin use are usually based on one information source. This study aims to incorporate more sources to estimate heroin use incidence trends in Spain between 1971 and 2005. Methods: A multi-state model was constructed, whereby the initial state "heroin consumer" is followed by transition to either "admitted to first treatment" or to "left heroin use" (i.e. permanent cessation or death). Heroin use incidence and probabilities of entering first treatment ever were estimated following a back-calculation approach. Results: The highest heroin use incidence rates in Spain, around 1.5 per 1,000 inhabitants aged 10-44, occurred between 1985 and 1990; subdividing by route of administration reveals higher incidences of injection between 1980 and 1985 (a mean of 0.62 per 1.000) and a peak for non-injectors in 1990 (0.867 per 1,000). Conclusions: A simple conceptual model for heroin users' trajectories related to treatment admission, provided a broader view of the historical trend of heroin use incidence in Spain

Violence among illicit drug users recruited in drug treatment facilities

Illicit drug use is known to be associated with injuries resulting from violence. This study aims to estimate the prevalence of violence, for the last 12 months, in illicit drug users and study the victim-offender overlap, separately by sex. Persons using illicit drugs (502) were recruited in drug treatment facilities. Violence was assessed using four questions for victim and one for perpetrator in the last 12 months. Associations between violence and socio-demographic, substance use, crime and illegal drug market aspects were examined with Poisson regression models. Victimization was reported by 49.6% men and 54.7% women; offending by 36.5% and 27.6%, respectively. Higher prevalence ratios of both victim and offender were observed among participants with marginal income generation activities and alcohol risk use. Victimization was more likely in women using parenteral route and among men with early illegal drug use, illegal polydrug use or history of imprisonment. Offending was more likely among men reporting psychological treatment, early illegal drug use, illegal polydrug use or past imprisonment, and women reporting early illegal drug use or trafficking. Thus, a high prevalence of violence (both victimization and perpetration) was found in illicit drug users, especially among those involved in market activities and crime. Drug treatment facilities should consider assessing for history and signs of violence and promote community health strategies

Work-related stress factors associated with problem drinking: A study of the Spanish working population

BACKGROUND: Workers may drink to cope with stress or to overcome negative emotions arising from an aversive working context, but results of previous studies are inconclusive on the specific work features affecting alcohol use. METHODS: A cross-sectional study was designed with data on 13,005 working individuals from the Household Survey on Alcohol and Drugs in Spain (EDADES)-2007. We examined the associations between two drinking patterns and four measures of work-related stress factors. RESULTS: Moderate and high levels of exposure to a noxious working environment (OR = 2.15 [95% CI = 1.51-3.06] and OR = 2.23 [95% CI = 1.49-3.36]) and a high level of lack of social support (OR = 1.62 [95% CI = 1.16-2.28]) were associated with heavy drinking, and precariousness with binge drinking for both moderate (OR = 1.22 [95% CI = 1.01-1.46]) and high (OR = 1.33 [95% CI = 1.04-1.70]) levels (OR = 1.21; 95% CI = 1.04-1.40) in men. Significant associations among women were only found when stress factors were analyzed separately. CONCLUSIONS: /nPreventive practices in the workplace targeting alcohol abuse should consider specific production processes and organizational features

Economic crisis and changes in drug use in the Spanish economically active population.

AIMS: To examine changes in the use of alcohol, cannabis and hypnotics/sedatives between two periods (before and during Spain's economic crisis), and to identify differences in the change between employed and unemployed individuals. DESIGN: Using cross-sectional data from four editions of the Spanish Household Survey on Alcohol and Drugs, we selected economically active individuals aged 16-64 years (total sample = 62 440) and defined two periods, pre-crisis [period 1 (P1) = 2005-07] and crisis (P2 = 2009-11). Poisson regression models with robust variance were fitted to obtain prevalence ratios (PR) of heavy and binge drinking and multinomial regression models to obtain relative risk ratios (RRR) of cannabis and hypnotic/sedative use between the two periods, also considering the interaction between period and employment status. FINDINGS: While the prevalence of alcohol use remained stable, heavy drinking declined in P2 in men both overall [PR = 0.73; 95% confidence interval (CI) = 0.67-0.79] and in the two age groups (16-34 and 35-64 years), and also in women overall (PR = 0.86; 95% CI = 0.75-0.99) and in the older age group. In contrast, binge drinking increased overall in P2 in men (PR = 1.17; 95% CI = 1.12-1.22) and in women (PR = 1.62; 95% CI = 1.49-1.76), and in both age groups. No differences in the change were observed between employed and unemployed individuals. Overall cannabis use remained stable in P2, but unemployed men and women of the older age group were more likely to have increased sporadic use compared to their employed counterparts (RRR = 2.24; 95% CI = 1.36-3.68 and RRR = 3.21; 95% CI = 1.30-7.93, respectively). Hypnotic/sedative use remained stable in P2 in men, but unemployed men were less likely to have increased heavy use in P2 compared with employed men (RRR = 0.69; 95% CI = 0.49-0.97). In women, heavy use increased in P2 overall and in the older age group, irrespective of employment status. CONCLUSION: During a period of economic recession in Spain, heavy drinking decreased and binge drinking increased. Sporadic cannabis use increased among older unemployed men and women. Heavy use of hypnotics/sedatives increased among employed men while older women increased use irrespective of employment status./n© 2015 Society for the Study of Addiction.This work was supported by Delegación del Gobierno para el Plan Nacional sobre Drogas, Ministerio de Salud y Política Social (Grant number: PNSD 2011/I073); FIS-Redes de investigación cooperativa (Grant number RD12/0028/0018); AGAUR (Grant number: 2009 SGR 00718. Albert Sánchez-Niubò was supported by the Instituto de Salud Carlos III (Grant number CA08/00214)

Prevalencia del consumo de hipnosedantes en población ocupada y factores de estrés laboral asociados

OBJECTIVE: To explore the prevalence of the use of hypnotics and sedatives in a sample of the Spanish working population and to examine its association with certain work-related stress factors./nMETHODS: Using data from the 2007 Spanish Household Survey on Alcohol and Drugs (Encuesta Domiciliaria sobre Alcohol y Drogas en España [EDADES]), we analyzed the distribution of the use of hypnotics and sedatives in the previous month in the working population aged 16 to 64 years old (n=13,005). Associations with exposure to certain work-related stress factors (noxious working environment, precariousness, workload, and social support) were examined using logistic regression modelling. RESULTS: The prevalence of the use of hypnotics and sedatives among women in the previous month doubled that of men (6.5% and 3.3%, respectively), while use among the oldest age group was twice that of the youngest group in both sexes (10.2% in women and 5.5% in men older than 45 years), and was four times higher among those reporting poor health (18.9% in women and 11% in men). Concerning work-related stress, exposure to moderate (OR: 1.96; 95%CI: 1.31-2.92) and high (OR: 1.95; 95%CI: 1.14-3.34) levels of precariousness in men and moderate levels in women (OR: 1.43; 95%CI: 1.03-1.99) was associated with the use of hypnotics and sedatives. CONCLUSIONS: The prevalence of the use of hypnotics and sedatives was high in women and in workers older than 45 years. Further research is needed on the relationship between the use of hypnotics and sedatives and workers' health, and on the role that work-related stress factors play in this associationTrabajo financiado parcialmente por la Delegación del Gobierno para el Plan Nacional sobre Drogas, Ministerio de Salud y Política Social: PNSD 2011/I073. FIS-Redes de investigación cooperativa: RD06/0001/1018 y RD12/0028/0018. AGAUR: 2009 SGR 00718. A. Sánchez-Niubò ha estado parcialmente financiado por el Instituto de Salud Carlos III: CA08/0021