Effect of physical activity, obesity and sleep on health-related quality of life in individuals with Metabolic Syndrome

218 p.[ES] Introducción La calidad de vida relacionada con la salud (CVRS) se ha convertido en un parámetro indispensable para la salud pública, pudiendo estimar la carga de enfermedad global en las poblaciones, siendo un buen predictor de mortalidad. Debido al aumento en la prevalencia del síndrome metabólico (SMet) en la población resulta imprescindible averiguar cuál es la relación entre el SMet y la CVRS. Por este motivo, el objetivo principal de la presente tesis doctoral es estimar la CVRS en adultos que padecen SMet y los factores relacionados que influyen en la misma. Metodología Se utilizó la información disponible del estudio PREDIMED-Plus, un ensayo clínico aleatorizado multicéntrico, que recoge los datos sobre CVRS mediante el cuestionario SF-36, así como medidas antropométricas, nivel de actividad física y duración de sueño mediante acelerometría. Se realizó un análisis descriptivo transversal de la CVRS. Mediante modelos de regresión lineal ajustados por potenciales factores confusores, se evaluó la asociación entre la CVRS, el nivel de actividad física, el grado de obesidad y la duración del sueño, al comienzo del estudio y al año de seguimiento. Además, se realizaron modelos de regresión logística para averiguar si la actividad física, el índice de masa corporal (IMC) y la duración del sueño predicen cambios clínicamente significativos en la CVRS. Resultados Nuestros resultados reflejan que el aumento en la actividad física conlleva un incremento en las puntuaciones medias de la CVRS. En las mujeres, se encontraron hasta 10 puntos de diferencia entre la actividad física ligera y la moderada-vigorosa en la función física, rol físico, vitalidad, función social y rol emocional. Además, aquellos sujetos que mejoraron sus niveles de actividad física a lo largo del año de seguimiento, tuvieron un 91% de posibilidades de mejora clínicamente significativa de su componente agregado físico (PCS), respecto a aquellos que se mantuvieron inactivos durante un año (OR = 1,91; IC 95%: 1,23-2,96). En cuanto al grado de obesidad, cuanto mayor es el IMC, menores son las puntuaciones medias en las esferas físicas. Sin embargo, un IMC >30kg/m2, predice una mejora de dichas esferas a un año y son aquellos sujetos que pierden peso a lo largo del año los que más probabilidades tienen de mejorar su CVRS, respecto a aquellos que no modificaron su IMC (PCS OR = 1,85; IC 95% = 1,43-2,40). Se observa que los valores extremos en la duración de sueño de noche (9h) afectan negativamente a la PCS. También, se ha encontrado una correlación entre dormir la siesta y la mejora del componente agregado mental (MCS) en aquellos individuos con un sueño nocturno corto (<7h) (Coeficiente β = 6,3 (1,3-11,3) p= 0,01). Conclusiones Nuestros resultados ponen de manifiesto que el SMets afecta negativamente en las esferas físicas de la CVRS. El nivel de actividad física, el IMC y la duración del sueño son factores relacionados que influyen en la misma. Se sugiere que una mejora en estos factores provoca una mejoría de la CVRS en individuos que padecen SMets. No obstante, se precisan más ensayos clínicos para evaluar estas asociaciones.[EN] Introduction Health-related quality of life (HRQoL) has become an essential parameter for public health, given its ability to estimate the global burden of disease in populations makes it a good predictor of mortality. Due to the increased prevalence of metabolic syndrome (MetS) in the population, it is vital to discern the relationship between MetS and HRQoL. As such, the main objective of this doctoral thesis is to estimate HRQoL in adults with MetS and the related factors that influence it. Methods Available information was used from the PREDIMED-Plus study, a multicenter randomized clinical trial that collects data on HRQoL using the SF-36 questionnaire, anthropometric measurements, level of physical activity and sleep duration using accelerometry. A cross-sectional descriptive analysis of HRQoL was performed. Through linear regression models adjusted for potential confounding factors, the association between HRQoL, level of physical activity, degree of obesity, and sleep duration was evaluated at the start of the study and at a one-year follow-up. Additionally, logistic regression models were fit to discern whether physical activity, body mass index (BMI), and sleep duration predict clinically significant changes in HRQoL. Results Our results reflect that increased physical activity leads to an increase in the mean HRQoL scores. In women, up to a 10-point difference was found between light and moderate-to-vigorous physical activity in physical function, physical role, vitality, social function, and emotional role. Furthermore, subjects who improved their physical activity levels throughout the follow-up year had a 91% chance of clinically significant improvement in their physical aggregate component (PCS), compared to those who remained inactive during that year (OR = 1.91; 95% CI: 1.23-2.96). In terms of obesity, the higher the BMI, the lower the average scores in physical areas. However, a BMI >30kg/m2 predicts an improvement in these areas at one year and subjects who lose weight throughout the year are more likely to improve their HRQoL, compared to those whose BMI was unchanged (PCS OR = 1.85, 95% CI = 1.43-2.40). We observed that extreme values in nightly sleep duration (9h) negatively affect the PCS. A correlation was also found between napping and improving the physical aggregate component (MCS) in individuals with a short night's sleep (<7h) (Coefficient β = 6.3 (1.3-11.3) p= 0.01). Conclusions Our results show that MetS negatively affects the physical domains of HRQoL and physical activity level, BMI and sleep duration are related factors that influence it. Results suggest that improving these factors leads to an improved HRQoL in individuals with MetS. However, more clinical trials are needed to evaluate these associations

The Effect of Lifestyle Intervention on Health-Related Quality of Life in Adults with Metabolic Syndrome: A Meta-Analysis

[EN] The aim of this meta-analysis was to assess the effects of a lifestyle intervention through health education on nutrition, physical activity, and healthy habits on physical and mental health-related quality of life (HRQoL), in adults with metabolic syndrome (MetS). The databases used were PubMed, WOS, and Scopus. The inclusion criteria were: observational, longitudinal and randomized clinical trial (RCT) study designs, adults (both sexes), with at least two criteria of MetS, lifestyle intervention and comparison with a control group, and a measurement of HRQoL with a validated questionnaire. We analyzed the Hedges’ g and SF-36 score. I2 statistics were calculated and possible publication and small study biases were assessed using Egger’s test and funnel plots. Seven RCTs were selected for meta-analysis, based on 637 study participants. Significant improvements were found in the physical dimensions of the HRQoL scores for subjects in the active intervention compared to the group that received general lifestyle information (Hedges’ g 0.61, 95% confidence interval (CI) = 0.31–0.91). Mental health-related quality of life was also significantly improved in the intervention group compared with the control group (Hedges’ g 0.84, 95% CI = 0.64–1.03). In conclusion, our results suggest that, according to the RCTs selected for this meta-analysis, a lifestyle intervention significantly improves HRQoL in all its domains.SIThis research was funded by Fondo de Investigación para la Salud (FIS), which is co-funded by the European Regional Development Fund grant PI17/00532

Health-Related Quality of Life (HRQOL) Instruments and Mobility: A Systematic Review

[EN] Physical function is one of the most important constructs assessed in health-related quality of life (HRQOL), and it could be very useful to assess movement ability from the perspective of the patient. The objective of this study was to compare the content of the domains related to mobility covered by the HRQOL questionnaires based on the International Classification of Functioning, Disability and Health (ICF) and to evaluate their quality according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance. For this, a systematic review was carried out in the databases Scopus, Web of Science and Science Direct. The inclusion criteria were development and/or validation studies about generic HRQOL measures, and the instruments had to include items related to mobility and studies written in English or Spanish. The comparison of content was performed using the ICF coding system. A total of 3614 articles were found, 20 generic HRQOL instruments were identified and 120 (22.4%) mobility-related items were found. Walking was the most represented category. Low-quality evidence on some measurement properties of the generic HRQOL instruments was revealed. The CAT-Health is a useful questionnaire to be used in rehabilitation due to its psychometric properties and its content.S

Juegos de Salud Pública: la gamificación como método de aprendizaje

[ES] La innovación en el proceso de enseñanza-aprendizaje se ha convertido en un aspecto fundamental que posibilita un cambio en el paradigma educativo y permite alcanzar el “aprendizaje significativo”. En los últimos años, con motivo de la pandemia se ha puesto aún más si cabe la necesidad de prevención de enfermedades infecciosas, mediante el lavado de manos. En las asignaturas de Salud Pública del Grado de Enfermería y Podología impartidas por el Área de Medicina Preventiva y Salud Pública de la Universidad de León, se imparten dichos contenidos de una forma teórico/práctica tradicional, reportando opiniones de los alumnos relacionadas con baja motivación, interés y/o comprensión de estos contenidos. Ante estos problemas, el objetivo de la presente innovación docente fue mejorar las competencias, la motivación y la autorregulación del aprendizaje de los estudiantes, en la importancia de la higiene de manos en la prevención de enfermedades infecciosas, mediante la gamificación de una práctica. Se llevó a cabo una actividad de gamificación a través de un breakout con una narrativa relacionada con la historia biográfica de Ignaz Semmelweis. Se evaluaron los resultados mediante dos encuestas de satisfacción, y se realizó una comparación entre las opiniones de los estudiantes que habían participado en la práctica gamificada y aquellos asignados a la metodología tradicional. El grado de satisfacción con la práctica gamificada ha sido mayor respecto a los alumnos que recibieron la práctica de forma tradicional, obteniendo valores estadísticamente significativos en todos los ítems (p<0,05). Además, cabe destacar el interés de los estudiantes con “la aplicación de la gamificación a otras prácticas” que fue la pregunta que obtuvo una mayor valoración. Por otra parte, los resultados sobre los conocimientos adquiridos durante la misma fueron satisfactorios, por lo que en el futuro sería interesante plantear esta metodología para la adquisición de otros conocimientos de la asignatura

Sociodemographic profile and description of the presenting symptom in women with breast cancer in a population-based study: Implications and role for nurses

Describir la frecuencia y tipología del síntoma de presentación de las mujeres diagnosticadas de cáncer de mama en España así como su perfil sociodemográfico. Estudio descriptivo anidado en un estudio epidemiológico poblacional (MCC-SPAIN) en 10 provincias españolas. Entre 2008 y 2012 se reclutaron 836 casos histológicamente confirmados de cáncer de mama que refirieron algún síntoma previo al diagnóstico en entrevista directa informatizada. Para la comparación de 2 variables discretas se empleó el test de la Chi cuadrado de Pearson. El síntoma de presentación más frecuente entre las mujeres que refirieron como mínimo un síntoma fue notarse un bulto en la mama (73%), seguido de lejos por notar cambios en la mama (11%). Se observó heterogeneidad en la frecuencia del síntoma de presentación a nivel geográfico, y con estado menopáusico. No se observó asociación entre tipo de síntoma de presentación y el resto de variables sociodemográficas exploradas, salvo para nivel de estudios donde las mujeres con un nivel de estudios mayor tendieron a reportar proporcionalmente otros síntomas diferentes al nódulo en la mama con mayor frecuencia que las mujeres con menos estudios. Las mujeres posmenopáusicas refirieron notar cambios en la mama (13%) con mayor frecuencia que las mujeres premenopáusicas (8%), aunque sin llegar a la significación estadística (p = 0,056). El síntoma de presentación más frecuente es la aparición de un «bulto en la mama», seguido por «cambios en la mama». Podría existir heterogeneidad sociodemográfica del tipo de síntoma de presentación a tener en cuenta por las enfermeras en sus intervenciones socio-sanitariasTo describe the frequency and typology of the presenting symptom of women diagnosed of breast cancer in Spain and their socio-demographic profile. Descriptive study nested in a population epidemiological study (MCC-SPAIN) in 10 Spanish provinces. Between 2008 and 2012, 836 histologically confirmed incident cases of breast cancer were recruited who reported some symptom prior to diagnosis in a direct computerized interview. For the comparison of 2 discrete variables, the Pearson Chi square test was used. The most frequent presenting symptom among women who reported at least one symptom was noticing a «lump in the breast» (73%), followed far behind by noticing «changes in the breast» (11%). The frequency of the presenting symptom showed some geographic heterogeneity as well as with menopausal status. No association was observed between the type of presenting symptom and the rest of the sociodemographic variables explored, except for the educational level in which women with a higher educational level tended to proportionally report other symptoms different from the «lump in the breast» more frequently than less educated. Postmenopausal women reported noticing changes in the breast (13%) more frequently than premenopausal women (8%), although without reaching statistical significance (P = .056). The most frequent presenting symptom is «breast lump», followed by «breast changes». There could be sociodemographic heterogeneity in the type of presenting symptom to be taken into account by nurses in their socio-sanitary interventionsEl estudio fue financiado por las subvenciones PI12/00150 y PI17CIII/00034 del Instituto de Salud Carlos III-FEDER-Una manera de construir Europa, así como por la «Acción transversal del cáncer», aprobada por el Ministerio de Ciencia el 11 de octubre de 2007, y por otras ayudas competitivas del Instituto de Salud Carlos III-FEDER (PI08/1770, PI08/0533, PI08/1359, PI09/00773, PI09/01286, PI09/01903, PI09/02078, PI09/01662, PI11/01403, PI11/01889-FEDER, PI11/00226, PI11/01810, PI11/02213, PI12/00488, PI12/00265, PI12/01270, PI12/00715, PI14/01219, PI14/0613, PI15/00069, PI17/02286), de la Fundación Marqués de Valdecilla (API10/09), de la Consejería de Salud de la Junta de Andalucía (2009-S0143), de la Fundación Caja de Ahorros de Asturias y por la Universidad de Oviedo, por la Agencia de Gestión de Ayudas Universitarias y de Investigación (AGAUR) de Beca de la Generalitat de Catalunya 2017SGR723, de la Asociación Española Contra el Cáncer (AECC) Fundación Científica beca GCTRA18022MORE. Universidad de Huelva. Junta de Andalucía (Fondos FEDER) UHU-20207

Occupational Heat Exposure and Breast Cancer Risk in the MCC-Spain Study

[EN] Background: Mechanisms linking occupational heat exposure with chronic diseases have been proposed. However, evidence on occupational heat exposure and cancer risk is limited. Methods: We evaluated occupational heat exposure and female breast cancer risk in a large Spanish case-control study. We enrolled 1,738 breast cancer cases and 1,910 frequency-matched population controls. A Spanish job-exposure matrix, MatEmEsp, was used to assign estimates of the proportion of workers exposed (P >= 25% for at least 1 year) and work time with heat stress (wet bulb globe temperature ISO 7243) for each occupation. We used three exposure indices: ever versus never exposed, lifetime cumulative exposure, and duration of exposure (years). We estimated ORs and 95% confidence intervals (CI), applying a lag period of 5 years and adjusting for potential confounders. Results: Ever occupational heat exposure was associated with a moderate but statistically significant higher risk of breast cancer (OR 1.22; 95% CI, 1.01-1.46), with significant trends across categories of lifetime cumulative exposure and duration (P-trend = 0.01 and 0.03, respectively). Stronger associations were found for hormone receptor-positive disease (OR ever exposure = 1.38; 95% Cl, 1.12-1.67). We found no confounding effects from multiple other common occupational exposures; however, results attenuated with adjustment for occupational detergent exposure. Conclusions: This study provides some evidence of an association between occupational heat exposure and female breast cancer risk.SIThis study was partially funded by the “Accion Transversal del Cancer,” approved by the Spanish Ministry Council on October 11, 2007; the Instituto de Salud Carlos III-FEDER (PI08/1770, PI08/1359, PI09/00773, PI09/01286, PI09/01903, PI09/02078, PI09/01662, PI11/01403, PI11/01889, and PI12/00265); the Fundación Marqués de Valdecilla (API 10/09); the Junta de Castilla y León (LE22A10-2); the Consejería de Salud of the Junta de Andalucía (2009-S0143); the Conselleria de Sanitat of the Generalitat Valenciana (AP_061/10); the Recercaixa (2010ACUP 00310); the Regional Government of the Basque Country; the Consejería de Sanidad de la Región de Murcia; the European Commission grants FOOD-CT-2006–036224-HIWATE; the Spanish Association Against Cancer (AECC) Scientific Foundation; the Catalan Government DURSI grant 2014SGR647; the Secretariat for Universities and Research of the Ministry of Business and Knowledge of the Government of Catalonia (2017SGR1085); the Fundación Caja de Ahorros de Asturias; and the University of Oviedo. M.C. Turner is funded by a Ramón y Cajal fellowship (RYC-2017-01892) from the Spanish Ministry of Science, Innovation and Universities and co-funded by the European Social Fund. The authors acknowledge support from the Spanish Ministry of Science and Innovation through the “Centro de Excelencia Severo Ochoa 2019–2023” Program (CEX2018-000806-S) and support from the Generalitat de Catalunya through the CERCA Program. Statistical assistance provided by Ana Espinosa Morano was greatly appreciated

Sleep and breast and prostate cancer risk in the MCC-Spain study

Breast and prostate cancers have been associated with circadian disruption. Some previous studies examined associations of sleep duration and breast or prostate cancer risk though findings remain inconsistent. This study examines associations of a range of detailed sleep characteristics and breast and prostate cancer risk in a large-scale population-based case-control study, MCC-Spain. A total of 1738 incident breast cancer cases, 1112 prostate cancer cases and frequency matched controls (n = 1910, and 1493 respectively) were recruited. Detailed data on habitual sleep duration, quality, timing, and daytime napping ("siesta") were collected at recruitment. Additional data on sleep habits during both the previous year and at age 40 years were also subsequently captured. Adjusted odds ratios (ORs) and 95% confidence intervals (CI) were estimated. There were no associations of habitual sleep duration (h), timing of sleep, or any or specific sleep problems, and either breast and prostate cancer risk. There was a significant positive association of ever taking habitual siestas at recruitment and breast cancer risk (OR = 1.22, 95% CI 1.06-1.42), which strengthened with increased frequency or duration. There were also significant positive associations observed for both breast and prostate cancer, among those reporting recent sleep problems, but not sleep problems at age 40 years, in a subsequent circadian questionnaire. Adverse associations with siesta and disturbed sleep during the previous year likely reflect symptoms of developing/diagnosed cancer and comorbidities. Overall, there was no clear association between various sleep characteristics and breast or prostate cancer risk observed.Funding: The study was partially funded by the ‘Accion Transversal del Cancer’, approved by the Spanish Ministry Council on 11 October 2007, by the Instituto de Salud Carlos III-FEDER (PI08/1770, PI08/1359, PI09/00773, PI09/01286, PI09/01903, PI09/02078, PI09/01662, PI11/01403, PI11/01889, PI11/02213; PI12/00265, PI12/01270, PI12/00715, PI12/00150, PI14/01219, PI14/0613, PI15/00069, PI15/00914, PI15/01032, PI17CIII/00034, CIBERESP CB06/02/0073), the Fundación Marqués de Valdecilla (API 10/09), the Junta de Castilla y León (LE22A10- 2), the Consejería de Salud of the Junta de Andalucía (PI-0571-2009, PI-0306-2011, salud201200057018tra), the Conselleria de Sanitat of the Generalitat Valenciana (AP_061/10), the Recercaixa (2010ACUP 00310), the Regional Government of the Basque Country, the European Commission grants FOOD-CT-2006-036224-HIWATE, the Spanish Association Against Cancer (AECC) Scientifc Foundation, the Catalan Government DURSI grant 2014SGR647, 2017SGR723, 2017SGR1085 and 2014SGR850, the Fundación Caja de Ahorros de Asturias and by the University of Oviedo. MCT is funded by a Ramón y Cajal fellowship (RYC-2017-01892) from the Spanish Ministry of Science, Innovation and Universities and co-funded by the European Social Fund. ISGlobal acknowledges support from the Spanish Ministry of Science and Innovation through the “Centro de Excelencia Severo Ochoa 2019–2023” Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program

Alcohol use and family-related factors among Spanish university students: the unHicos project

Background: During adolescence and youth there are relevant changes in the consolidation, gain or loss of consumption habits and lifestyles and the family factors has a fundamental role to development these habits. The study of the consumption of toxins, such as alcohol intake, is crucial at this stage due to the repercussions that said consumption presents in adulthood. Therefore, the objective of our study was to evaluate the associations between alcohol consumption patterns and related family factors (family functioning, family history of alcohol consumption) in Spanish university students. Methods: Observational, descriptive, cross-sectional, multicenter study, carried out in first-year university students from 11 Spanish universities. Through an online questionnaire, alcohol consumption (risky consumption and intensive consumption or binge drinking), family functioning and history of alcohol in the family were evaluated. Risky alcohol consumption and binge drinking were assessed using the AUDIT test, and family functioning was assessed using the family APGAR questionnaire. A descriptive analysis of the data was performed, as well as the Chi-Square test and Student's T-Test, and non-conditional logistic regression models were carried out to examine this association. Results: The prevalence of risky alcohol consumption identified in the 10,167 respondents was 16.9% (95% CI = 16.2–17.6), and that of BD was 48.8% (95% CI = 47.9–48.8). There is a significant association between risky alcohol consumption and family functioning in students of both sexes, with greater consumption in the face of severe dysfunctional support (men OR = 1.72; p < 0.001 and women OR = 1.74; p < 0.001) and family history of consumption (p = 0.005). Regarding the binge drinking pattern, no statistically significant differences were observed. Conclusions: Risky alcohol consumption in university students is associated with dysfunctional family support, unlike the binge drinking pattern, where there is no such association. The findings of this study show the importance of creating prevention programs focused on the family approach in university students, which include alcohol screening in the population with a family history of this substance, and greater social support from health services.This work was supported by the National Drug Plan, Ministry of Health, Social Services and Equality of Spain (Codes: 2010|145, 2013|034 and 2020|030) and project PI16/01947

Association of time of breakfast and nighttime fasting duration with breast cancer risk in the multicase-control study in Spain

Circadian nutritional behaviors, defined by the daily eating/fasting cycle, have been linked with breast cancer. This study aimed to further disentangle the association of nighttime fasting duration and time of breakfast with breast cancer risk. We analyzed data from 1,181 breast cancer cases and 1,326 population controls from the Spanish multicase-control study (MCC-Spain), 2008-2013. We collected circadian nutritional behaviors at mid-age via a telephonic interview. We applied logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CIs) for the association of nighttime fasting duration and time of breakfast with breast cancer risk in all women and stratified by menopausal status. Models were adjusted for age, center, education, family history of breast cancer, age at menarche, number of children, breastfeeding, age at first child, body mass index (BMI), contraceptive use, and hormonal replacement therapy (HRT). A later time of breakfast was associated with a non-significant increased risk of breast cancer (OR = 1.05, 95% CI: 0.95-1.16, per hour increase). This association was stronger among premenopausal women, among whom each hour later, the time of breakfast was associated with an 18% increase in breast cancer risk (OR = 1.18, 95% CI: 1.01-1.40). The association was not observed in postmenopausal women. We did not observe an association between nighttime fasting duration and breast cancer risk after adjusting for the time of breakfast. In this study, late breakfast was associated with increased breast cancer risk, especially among premenopausal women, compared with early breakfast. Aside from nutritional quality, circadian nutritional behaviors should be further studied in relation to cancer

Alcohol use and family-related factors among Spanish university students: the unHicos project

[EN] Background During adolescence and youth there are relevant changes in the consolidation, gain or loss of consumption habits and lifestyles and the family factors has a fundamental role to development these habits. The study of the consumption of toxins, such as alcohol intake, is crucial at this stage due to the repercussions that said consumption presents in adulthood. Therefore, the objective of our study was to evaluate the associations between alcohol consumption patterns and related family factors (family functioning, family history of alcohol consumption) in Spanish university students. Methods Observational, descriptive, cross-sectional, multicenter study, carried out in first-year university students from 11 Spanish universities. Through an online questionnaire, alcohol consumption (risky consumption and intensive consumption or binge drinking), family functioning and history of alcohol in the family were evaluated. Risky alcohol consumption and binge drinking were assessed using the AUDIT test, and family functioning was assessed using the family APGAR questionnaire. A descriptive analysis of the data was performed, as well as the Chi-Square test and Student's T-Test, and non-conditional logistic regression models were carried out to examine this association. Results The prevalence of risky alcohol consumption identified in the 10,167 respondents was 16.9% (95% CI = 16.2–17.6), and that of BD was 48.8% (95% CI = 47.9–48.8). There is a significant association between risky alcohol consumption and family functioning in students of both sexes, with greater consumption in the face of severe dysfunctional support (men OR = 1.72; p < 0.001 and women OR = 1.74; p < 0.001) and family history of consumption (p = 0.005). Regarding the binge drinking pattern, no statistically significant differences were observed. Conclusions Risky alcohol consumption in university students is associated with dysfunctional family support, unlike the binge drinking pattern, where there is no such association. The findings of this study show the importance of creating prevention programs focused on the family approach in university students, which include alcohol screening in the population with a family history of this substance, and greater social support from health servicesSIThis work was supported by the National Drug Plan, Ministry of Health, Social Services and Equality of Spain (Codes: 2010|145, 2013|034 and 2020|030) and project PI16/01947