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Casal B, Iglesias E, Rivera B, Currais L, Storti CC. Identifying the impact of the business cycle on drug-related harms in European countries. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104240. [PMID: 37890393 DOI: 10.1016/j.drugpo.2023.104240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/24/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND The evidence resulting from the analysis of the association between economic fluctuations and their impact on the substance use is mixed and inconclusive. Effects can be pro-cyclical (drug-related harms are predicted to rise when economic conditions improve), counter-cyclical (drug-related harms are predicted to rise in bad economic times) or unrelated to business cycle conditions as different transmission mechanisms could operate simultaneously. METHODS The main aim of this study is to assess, from a macroeconomic perspective, the impact of economic cycles on illegal drug-related harms in European countries over the 2000-2020 period. To this end, the regime-dependent relationship between drug-related harm, proxied by unemployment, and the business cycle, proxied by overdose deaths will be identified. Applying a time dynamic linear analysis, within the framework of threshold panel data models, structural-breaks will also be tested. RESULTS The relationship between economic cycles (proxied by unemployment) and drug-related harms (proxied by overdose deaths) is negative, and therefore found to be pro-cyclical. One percentage point in the country unemployment rate is predicted to reduce the overdose death rate by a statistically significant percentage of 2.42. A counter-cyclical component was identified during the 2008 economic recession. The threshold model captures two effects: when unemployment rates are lower than the estimated thresholds, ranging from 3.92% to 4.12%, drug-related harms and unemployment have a pro-cyclical relationship. However, when unemployment rates are higher than this threshold, this relationship becomes counter-cyclical. CONCLUSIONS The relationship between economic cycles and drug-related harms is pro-cyclical. However, in situations of economic downturns, a counter-cyclical effect is detected, as identified during the 2008 economic recession.
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Affiliation(s)
- Bruno Casal
- Faculty of Economics and Business, Department of Economy. University of A Coruña, A Coruña, Spain
| | - Emma Iglesias
- Faculty of Economics and Business, Department of Economy. University of A Coruña, A Coruña, Spain
| | - Berta Rivera
- Faculty of Economics and Business, Department of Economy. University of A Coruña, A Coruña, Spain.
| | - Luis Currais
- Faculty of Economics and Business, Department of Economy. University of A Coruña, A Coruña, Spain
| | - Claudia Costa Storti
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
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2
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Piñeiro B, Spijker JJA, Trias-Llimós S, Blanes Llorens A, Permanyer I. Trends in cause-specific mortality: deaths of despair in Spain, 1980-2019. J Public Health (Oxf) 2023; 45:854-862. [PMID: 37491646 PMCID: PMC10687877 DOI: 10.1093/pubmed/fdad133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Research from various countries has shown increases in alcohol- and drug-related deaths and suicide, known as 'deaths of despair' over recent decades, particularly among low-educated middle-aged individuals. However, little is known about trends in death-of-despair causes in Spain. Therefore, we aim to descriptively examine this among 25-64-year-olds from 1980 to 2019 and by educational attainment for the years 2017-19. METHODS We obtained mortality and population data from the National Institute of Statistics to estimate age-standardized mortality rates and assess educational inequalities using the relative index of inequality (RII). RESULTS Deaths of despair as a share of total mortality slightly increased from 2000 onwards, particularly among 25-64-year-old men (from 9 to 10%). Only alcohol-related mortality declined relatively more since 1980 compared with all-cause mortality. Regarding educational differences, low-educated men presented higher mortality rates in all death-of-despair causes (alcohol-related: RII 3.54 (95% CI: 2.21-5.66); drug-related: RII 3.49 (95% CI: 1.80-6.77); suicide: RII 1.97 (95% CI: 1.49-2.61)). Women noteworthy differences were only observed for alcohol-related (RII 3.50 (95% CI: 2.13-5.75)). CONCLUSIONS Findings suggest an increasing proportion of deaths of despair among 25-64-year-olds since 2000, particularly among men. Public health policies are needed to reduce and prevent these premature and preventable causes of mortality.
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Affiliation(s)
- Bárbara Piñeiro
- Centre d’Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, 08193 Bellaterra/Barcelona, Spain
| | - Jeroen J A Spijker
- Centre d’Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, 08193 Bellaterra/Barcelona, Spain
| | - Sergi Trias-Llimós
- Centre d’Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, 08193 Bellaterra/Barcelona, Spain
| | - Amand Blanes Llorens
- Centre d’Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, 08193 Bellaterra/Barcelona, Spain
| | - Iñaki Permanyer
- Centre d’Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, 08193 Bellaterra/Barcelona, Spain
- ICREA, 08010 Barcelona, Spain
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3
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Drydakis N. The perceived social rejection of sexual minorities: Substance use and unprotected sexual intercourse. Drug Alcohol Rev 2022; 41:1341-1354. [PMID: 35737568 DOI: 10.1111/dar.13500] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 04/24/2022] [Accepted: 05/11/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION This study presents associations between the perceived social rejection of sexual minorities and tobacco, alcohol and cannabis consumption and unprotected sexual intercourse in the capital of Greece, Athens. This is the first Greek study to evaluate the concept of the minority stress theory on sexual minorities' substance use and unprotected sexual intercourse. In addition, this is among the first international studies to examine whether periods of adverse economic conditions are associated with sexual minorities' substance use and unprotected sexual intercourse. METHODS Two-panel datasets covering the periods 2013-2014 and 2018-2019 were used to determine the perceived social rejection, that is, whether sexual minorities have been rejected by friends, treated unfairly in educational and/or workplace environments, treated negatively in social situations and received poor health and public services due to their sexuality. RESULTS The estimates indicate that perceived social rejection is associated with the increased consumption of tobacco (by 9.1%, P < 0.01), alcohol (by 7.1%, P < 0.01) and cannabis (by 12.5%, P < 0.01), as well as unprotected sexual intercourse (by 6.5%, P < 0.01). In the first three cases, the magnitude of the associations is stronger for men than women and there is increased cannabis consumption during periods of deteriorated economic conditions (by 5.5%, P < 0.01). DISCUSSION AND CONCLUSIONS In the European Union, reducing stigma, substance use, risky sexual behaviours and health inequalities for sexual minorities is a goal of public health. If minority stress is correlated with substance use and risky sexual behaviours leading to detrimental physical/mental health outcomes then prevention and support interventions should be designed.
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Affiliation(s)
- Nick Drydakis
- School of Economics, Finance and Law, Centre for Pluralist Economics, Faculty of Business and Law, Anglia Ruskin University, Cambridge, UK.,Pembroke College, University of Cambridge, Cambridge, UK.,Centre for Science and Policy, University of Cambridge, Cambridge, UK.,Global Labor Organization, Essen, Germany.,Institute of Labor Economics, Bonn, Germany
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4
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Scoppetta O, Avendaño BL, Cassiani C. Factors Associated with the Consumption of Illicit Drugs: a Review of Reviews. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-020-00464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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5
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Castellari E, Tiboldo G, Moro D, Bimbo F. La Dolce Vita in times of harshness: Prevalence of health-related behaviors during the great recession in Italy. ECONOMICS AND HUMAN BIOLOGY 2021; 43:101062. [PMID: 34536660 DOI: 10.1016/j.ehb.2021.101062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
The current work investigates the heterogeneous effect of the 2008 recession on health outcomes in the Italian population across the main geographic areas. Health outcomes were proxied by individual-level information on healthy/risky behaviors, such as individual fruit and vegetable consumption, frequency of bodyweight monitoring, smoking, and alcohol intake. These health outcomes were employed as dependent variables in the empirical model that included some socioeconomic individual aspects (e.g., age, gender, education, and income source), as well as consumer price index data for tobacco products, alcoholic beverages, and fruit and vegetables. In this work, we used twelve years of data (2005-2016) from the Italian Multipurpose Household Survey (MHS), which collects individual self-reported characteristics, augmented with information on unemployment rates at the regional level, as well as with consumer price indexes for the goods analyzed. The results indicated that the 2008 economic crisis lowered the probability that individuals engage in healthy behaviors, such as self-monitoring their bodyweight, mostly among individuals in northern and central areas. Likewise, the economic downturn increased the probability of smoking regardless of the geographic area, with a larger magnitude in individuals in northern and central areas, whose health outcomes were more impacted by the economic downturn than individuals living in the southern and island areas.
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Affiliation(s)
- Elena Castellari
- Università Cattolica del Sacro Cuore, Via Emilia Parmense, 84, 29122 Piacenza, PC, Italy
| | - Giulia Tiboldo
- Università Cattolica del Sacro Cuore, Via Emilia Parmense, 84, 29122 Piacenza, PC, Italy.
| | - Daniele Moro
- Università Cattolica del Sacro Cuore, Via Emilia Parmense, 84, 29122 Piacenza, PC, Italy
| | - Francesco Bimbo
- Università degli Studi di Foggia, Via Napoli 25, 71121 Foggia, FG, Italy
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6
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Sane Schepisi M, Di Napoli A, Asciutto R, Vecchi S, Mirisola C, Petrelli A. The 2008 Financial Crisis and Changes in Lifestyle-Related Behaviors in Italy, Greece, Spain, and Portugal: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8734. [PMID: 34444482 PMCID: PMC8392284 DOI: 10.3390/ijerph18168734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 12/17/2022]
Abstract
Italy, Greece, Spain, and Portugal have all been strongly affected by the 2008 financial crisis, which has had a negative impact on health. We systematically evaluated the effects of the crisis on lifestyle and socioeconomic inequalities. We conducted a literature search using MEDLINE, Embase, the Cochrane Library, and health economics databases for studies reporting quantitative comparisons before and after (or during) the crisis on the following risk behaviors: alcohol consumption, smoking habit, healthy diet, physical activity, and psychotropic drugs and substance abuse, without setting any age restrictions. We selected 34 original articles published between 2011 and 2020. During/after the crisis, alcohol consumption and substance abuse decreased, while psychotropic drug use increased. We also observed a deterioration in healthy eating behavior, with a reduction in fruit and vegetable consumption. Smoking habit and physical activity showed a more complex, controversial trend. Socioeconomic inequalities were affected by the recession, and the negative effects on unhealthy lifestyle tended to be more pronounced among the disadvantaged. These results suggest the need to implement health policies and interventions aimed at monitoring risk behaviors, with special regard to disadvantaged people, and considering the potential additional impact of the COVID-19 pandemic.
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Affiliation(s)
- Monica Sane Schepisi
- National Institute for Health, Migration and Poverty (INMP), 00153 Rome, Italy; (M.S.S.); (A.D.N.); (R.A.); (C.M.)
- Ministry of Health—General Directorate for Health Prevention, 00144 Rome, Italy
| | - Anteo Di Napoli
- National Institute for Health, Migration and Poverty (INMP), 00153 Rome, Italy; (M.S.S.); (A.D.N.); (R.A.); (C.M.)
| | - Rosario Asciutto
- National Institute for Health, Migration and Poverty (INMP), 00153 Rome, Italy; (M.S.S.); (A.D.N.); (R.A.); (C.M.)
| | - Simona Vecchi
- Department of Epidemiology—Lazio Region, ASL Rome 1, 00147 Rome, Italy;
| | - Concetta Mirisola
- National Institute for Health, Migration and Poverty (INMP), 00153 Rome, Italy; (M.S.S.); (A.D.N.); (R.A.); (C.M.)
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), 00153 Rome, Italy; (M.S.S.); (A.D.N.); (R.A.); (C.M.)
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Hall J, Goranitis I, Kigozi J, Guariglia A. New evidence on the impact of the Great Recession on health-compromising behaviours. ECONOMICS AND HUMAN BIOLOGY 2021; 41:100980. [PMID: 33571870 DOI: 10.1016/j.ehb.2021.100980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 01/06/2021] [Accepted: 01/10/2021] [Indexed: 06/12/2023]
Abstract
Using data from the English Longitudinal Study of Ageing over the period 2004-2017, this paper explores the effects of the Great Recession and its aftermath upon health-compromising behaviours in adults aged 50 and over. We introduce new techniques into this area of research, namely dynamic random-effects logit estimators which control for initial conditions and correlated individual effects. We observe a lack of crisis effect upon the probabilities of smoking and being physically inactive, as well as of transitioning in and out of these behaviours. In line with other recent literature, this suggests that the relationship between economic recessions and smoking and physical inactivity may have broken down. Alternatively, the over 50s may have been protected from the crisis and subsequent austerity measures. Nonetheless, both the crisis and post-crisis period were associated with a lower probability of drinking frequently.
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Affiliation(s)
- James Hall
- Institute for Primary Care & Health Sciences, David Weatherall Building, Keele University, Newcastle-under-Lyme, ST5 5BG, United Kingdom.
| | - Ilias Goranitis
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, B15 2TT, United Kingdom.
| | - Jesse Kigozi
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, B15 2TT, United Kingdom.
| | - Alessandra Guariglia
- Department of Economics, University of Birmingham, University House, Edgbaston, Birmingham, B15 2TY, United Kingdom.
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8
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Herin F, Othenin J, Jouanjus E, Rousseau V, Niezborala M, Lapeyre-Mestre M. Evolution of medication consumption in a working environment in France: Results of the four waves of the "Drugs and Work" study (1986-2016). Pharmacoepidemiol Drug Saf 2021; 30:661-668. [PMID: 33625778 DOI: 10.1002/pds.5211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 02/18/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Previous studies in the working environment have underlined the high prevalence of drug consumption. The aim of this study was to present the main characteristics of this consumption in French workers and to identify changes from the 1986, 1996, 2006 and 2016 surveys. METHODS The design was a repeated cross-sectional study in 1986, 1996, 2006 and 2016. At each wave, demographic and socio-professional characteristics, self-reported consumption of medications during the week before the occupational medical visit, and perceived difficult working conditions and extraprofessional problems were collected among a sample of workers. Factors associated with consumption of any drug and of main therapeutic classes were investigated through multivariate logistic regression models, using 2016 as the reference for investigating temporal trends. RESULTS Prevalence of use of any drug was significantly higher in 2016, with marked changes observed in comparison with 1986: absolute decrease of psychotropic (-5.1%, p < 0.0001), antibiotics (-2.7%, p < 0.0001) and cardiovascular drug use (-3.8%, p < 0.0001), increase of analgesic use (+8.3%, p < 0.0001). Difficult working conditions, age and female gender were independently associated with analgesic drug use, and extraprofessional problems and female gender associated with psychotropic drug use. CONCLUSIONS This analysis of self-reported drug use in the working environment illustrates the global patterns of medication use in a French active population over 3 decades. The favorable development in the level of consumption of psychotropic drugs should not underestimate the attention to be paid to the determinants of chronic consumption, or possible transfers to less stigmatized medications.
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Affiliation(s)
- Fabrice Herin
- Service Des Maladies Professionnelles Et Environnementales, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,UMR-Inserm 1295, Université De Toulouse, Toulouse, France
| | - Jerome Othenin
- Service Des Maladies Professionnelles Et Environnementales, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Emilie Jouanjus
- UMR-Inserm 1295, Université De Toulouse, Toulouse, France.,Service De Pharmacologie Médicale Et Clinique, CIC 1436, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Vanessa Rousseau
- Service De Pharmacologie Médicale Et Clinique, CIC 1436, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | - Maryse Lapeyre-Mestre
- UMR-Inserm 1295, Université De Toulouse, Toulouse, France.,Service De Pharmacologie Médicale Et Clinique, CIC 1436, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,PharmacoEPi cohortS and biobankS (PEPSS), CIC de Toulouse, Université Paul Sabatier-Toulouse 3, Toulouse, France
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9
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Azagba S, Shan L, Qeadan F, Wolfson M. Unemployment rate, opioids misuse and other substance abuse: quasi-experimental evidence from treatment admissions data. BMC Psychiatry 2021; 21:22. [PMID: 33423671 PMCID: PMC7798212 DOI: 10.1186/s12888-020-02981-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 11/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relationship between economic conditions and substance abuse is unclear, with few studies reporting drug-specific substance abuse. The present study examined the association between economic conditions and drug-specific substance abuse admissions. METHODS State annual administrative data were drawn from the 1993-2016 Treatment Episode Data Set. The outcome variable was state-level aggregate number of treatment admissions for six categories of primary substance abuse (alcohol, marijuana/hashish, opiates, cocaine, stimulants, and other drugs). Additionally, we used a broader outcome for the number of treatment admissions, including primary, secondary, and tertiary diagnoses. We used a quasi-experimental approach -difference-in-difference model- to estimate the association between changes in economic conditions and substance abuse treatment admissions, adjusting for state characteristics. In addition, we performed two additional analyses to investigate (1) whether economic conditions have an asymmetric effect on the number of substance use admissions during economic downturns and upturns, and (2) the moderation effects of economic recessions (2001, 2008-09) on the relationship between economic conditions and substance use treatment. RESULTS The baseline model showed that unemployment rate was significantly associated with substance abuse treatment admissions. A unit increase in state unemployment rate was associated with a 9% increase in treatment admissions for opiates (β = 0.087, p < .001). Similar results were found for other substance abuse treatment admissions (cocaine (β = 0.081, p < .001), alcohol (β = 0.050, p < .001), marijuana (β = 0.036, p < .01), and other drugs (β = 0.095, p < .001). Unemployment rate was negatively associated with treatment admissions for stimulants (β = - 0.081, p < .001). The relationship between unemployment rate and opioids treatment admissions was not statistically significant in models that adjusted for state fixed effects and allowed for a state- unique time trend. We found that the association between state unemployment rates and annual substance abuse admissions has the same direction during economic downturns and upturns. During the economic recession, the negative association between unemployment rate and treatment admissions for stimulants was weakened. CONCLUSION These findings suggest that economic hardship may have increased substance abuse. Treatment for substance use of certain drugs and alcohol should remain a priority even during economic downturns.
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Affiliation(s)
- Sunday Azagba
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, 84108, USA.
| | - Lingpeng Shan
- grid.223827.e0000 0001 2193 0096Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT 84108 USA
| | - Fares Qeadan
- grid.223827.e0000 0001 2193 0096Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT 84108 USA
| | - Mark Wolfson
- grid.266097.c0000 0001 2222 1582Department of Social Medicine, Population and Public Health, University of California Riverside School of Medicine, Riverside, CA 92501 USA
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10
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Martínez-Jiménez M, Vall Castelló J. Effects of macroeconomic fluctuations on mental health and psychotropic medicine consumption. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2020; 20:277-297. [PMID: 32307621 DOI: 10.1007/s10754-020-09281-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/09/2020] [Indexed: 06/11/2023]
Abstract
Our aim in this paper is to understand the impact of macroeconomic fluctuations on mental health and psychotropic medicine consumption. In order to do that we exploit differences in the fluctuations of business cycle conditions across regional units in Catalonia. Our findings suggest that, in general, economic fluctuations at the local level had no significant effect on the consumption of psychotropic medicines. However, we show that a deterioration in local labour market conditions is associated with a reduction in the consumption of anxiolytics medicines. We also report an increase in the consumption of anxiolytics in regions with a softer deterioration in the economic situation. Although we report mild improvements in both mental and physical health for some sub-groups of the population, we also find significant reductions on the probability of sleeping 6 h or more. Thus, these elements point towards potential negative effects of local labour market conditions on health in the medium/long term.
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Affiliation(s)
- Mario Martínez-Jiménez
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, Lancaster LA1 4YG, United Kingdom
| | - Judit Vall Castelló
- Department of Economics, University of Barcelona & IEB, John M.Keynes, 1-11, 08034, Barcelona, Spain.
- CRES-UPF, Ramon Trias Fargas, 25-27, 08005, Barcelona, Spain.
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11
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Price A. Online Gambling in the Midst of COVID-19: A Nexus of Mental Health Concerns, Substance Use and Financial Stress. Int J Ment Health Addict 2020; 20:362-379. [PMID: 32837444 PMCID: PMC7357671 DOI: 10.1007/s11469-020-00366-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This study examined the emerging impact of COVID-19 on gambling during the first 6 weeks of emergency measures in Ontario, Canada. A cross-sectional online survey of 2005 gamblers, including a sub-sample of 1081 online gamblers (age 18 years and older), was administered to assess risky gambling behaviours and motivations, financial impacts from COVID-19, the influence of COVID-19 on online gambling, mental health concerns and substance use. A series of odds ratio comparisons and measures of association were carried out. Results show significant likelihood of online gambling among those classified as high-risk gamblers (according to the Problem Gambling Severity Index) and those with past experience of online gambling, though migration from land-based gambling was apparent. Among high-risk online gamblers, the most predictive risk factors included moderate and severe anxiety and depression, reduced work hours, being influenced to gamble due to COVID-19, gambling under the influence of cannabis or alcohol and risky gambling motives tied to mental health concerns, including gambling because it helps with nervousness and depression, chasing gambling losses and seeking to earn income. This study has confirmed many of the risk associations presented in emerging COVID-19-related studies and past research on global economic crisis relating to gambling risk, mental health concerns and substance use. However, unlike many past studies, the present paper takes note of all of these elements holistically and provides incremental clarity on online gambling risk factors during the pandemic, specifically.
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Affiliation(s)
- Alex Price
- Centre for the Advancement of Best Practices, The Responsible Gambling Council, 205-411 Richmond Street East, Toronto, Ontario M5A 3S5 Canada
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12
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Mateo-Urdiales A, Barrio Anta G, José Belza M, Guerras JM, Regidor E. Changes in drug and alcohol-related mortality by educational status during the 2008-2011 economic crisis: Results from a Spanish longitudinal study. Addict Behav 2020; 104:106255. [PMID: 31968299 DOI: 10.1016/j.addbeh.2019.106255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/12/2019] [Accepted: 12/08/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The objective was to assess changes in drug- and alcohol-related mortality by educational attainment during the last financial crisis in Spain. METHODS Data came from the 2001 Census Longitudinal Study. We included 22.2 million residents in Spain aged ≥35 at census date followed-up until December 2011. Outcomes were drug-related mortality (DRM) and deaths directly attributable to alcohol (DDA). Mortality risks before and during the crisis were assessed using age-standardized rates and educational inequalities by estimating age-adjusted Rate Ratios (RR) and Relative Indexes of inequality (RII) between educational groups. RESULTS During the first four year of the crisis, DRM and DDA in men and women increased in all educational subgroups except for DRM in men with tertiary studies (-15%). The increase in mortality was larger in those with higher educational status, with women with tertiary studies experiencing the largest increases in DRM (+100%) and DDA (+114%). Mortality risks for both outcomes followed an educational gradient before and during the crisis in men and women, with those with primary studies being at higher risk. Absolute and relative measures of inequality decreased during the crisis, except for DRM in men. CONCLUSIONS DRM and DDA follow an inverse educational gradient, with those with primary studies being at higher risk. During the last financial crisis, DRM decreased only in men with tertiary studies, with DRM and DDA increasing in all other groups. The increase was larger in those with higher educational status, reducing inequalities in all groups except of DRM in men.
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Affiliation(s)
- Alberto Mateo-Urdiales
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom.
| | | | - María José Belza
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Juan-Miguel Guerras
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Enrique Regidor
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Departmento de Salud Pública y Materno infantile, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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13
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Balbo N, Carapella P, Toffolutti V. Trends in the use of mind-altering drugs among European adolescents during the Great Recession. Health Policy 2020; 124:568-574. [PMID: 32223916 DOI: 10.1016/j.healthpol.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/06/2020] [Accepted: 03/10/2020] [Indexed: 11/16/2022]
Abstract
Despite the growing evidence of health-responses to macroeconomic fluctuations, little research has been carried out on the economic reflexes of licit and illicit drug-consumption, especially among teenagers. This paper uses data on adolescents between 15 and 17 years old from 25 European countries to test, if and how, the substance-use pattern has changed during the Great Recession. The data come from two cross-sectional waves (2007 and 2011) of the European School Survey Project on Alcohol and Other Drugs (ESPAD) (n = 137,989 individuals). One percentage point increase in the unemployment rate is associated with an increase [decrease] in the probability of having tried inhalants and cocaine [ecstasy] at least once, by about 0.005 (95 % CI: 0.004, 0.006) and 0.001 (95 % CI: 0.0001, 0.001) [-0.001 (95 % CI: -0.001, -0.001)] respectively. Social protection expenditure reduces the use of inhalants, whereas ecstasy consumption rises. The pattern for cocaine is unclear.
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Affiliation(s)
- Nicoletta Balbo
- "Carlo F. Dondena" Centre for Research on Social Dynamics and Public Policies, Bocconi University, Via Roentgen, 1, 20136, Milan, Italy; Department of Social and Political Sciences, Bocconi University, Via Roentgen, 1, 20136, Milan, Italy
| | - Piergiorgio Carapella
- "Carlo F. Dondena" Centre for Research on Social Dynamics and Public Policies, Bocconi University, Via Roentgen, 1, 20136, Milan, Italy; Confindustria Economic Research Department, Viale dell'Astronomia, 30, 00144, Rome, Italy
| | - Veronica Toffolutti
- "Carlo F. Dondena" Centre for Research on Social Dynamics and Public Policies, Bocconi University, Via Roentgen, 1, 20136, Milan, Italy; Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom.
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Regidor E, Ronda E, Tapia Granados JA, Pulido J, de la Fuente L, Barrio G. Reversal of Upward Trends in Mortality During the Great Recession by Employment Status at Baseline in a National Longitudinal Study. Am J Epidemiol 2019; 188:2004-2012. [PMID: 31241161 DOI: 10.1093/aje/kwz150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 12/17/2022] Open
Abstract
Because of the healthy worker effect, mortality rates increased in individuals who were employed and those who were unemployed, and decreased in those economically inactive at baseline in reported studies. To determine if such trends continue during economic recessions, we analyzed mortality rates in Spain before and during the Great Recession in these subgroups. We included 21,933,351 individuals who were employed, unemployed, or inactive in November 2001 and aged 30-64 years in each calendar-year of follow-up (2002-2011). Annual age-adjusted mortality rates were calculated in each group. The annual percentage change in mortality rates adjusted for age and educational level in employed and unemployed persons were also calculated for 2002-2007 and 2008-2011. In employed and unemployed men, mortality rates increased until 2007 and then declined, whereas in employed and unemployed women, mortality rates increased and then stabilized during 2008-2011. The mortality rate among inactive men and women decreased throughout the follow-up. In the employed and the unemployed, the annual percentage change was reversed during 2008-2011 compared with 2002-2007 (-1.2 vs. 3.2 in employed men; -0.3 vs. 4.1 in employed women; -0.8 vs. 2.9 in unemployed men; and -0.6 vs. 1.3 in unemployed women). The upward trends in mortality rates among individuals who were employed or unemployed in 2001 were reversed during the Great Recession (2008-2011).
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Saez M, Barceló MA, Saurina C, Cabrera A, Daponte A. Evaluation of the Biases in the Studies that Assess the Effects of the Great Recession on Health. A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2479. [PMID: 31336776 PMCID: PMC6678595 DOI: 10.3390/ijerph16142479] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Our main objective was to evaluate the fundamental biases detected in studies assessing the effects the Great Recession had on health for the case of Spain. As secondary objectives we presented methods to control these biases and to discuss the results of the studies in question if they had controlled for them. METHODS We carried out a systematic review of the literature published up to June 2018. We evaluated the biases that could have happened in all the eligible studies. RESULTS From the review, we finally selected 53 studies. Of the studies we reviewed, 60.38% or 32 out of 53, were evaluated as having a high risk of bias. The main biases our review revealed were problems with evaluation, time bias, lack of control of unobserved confounding, and non-exogeneity when defining the onset of the Great Recession. CONCLUSIONS The results from the studies that controlled the biases were quite consistent. Summing up, the studies reviewed found that the Great Recession increased the risk of declaring poor self-rated health and the deterioration of mental health. Both the mortality rate and the suicide rate may well have increased after the Great Recession, probably after a three- to four-year delay.
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Affiliation(s)
- Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, 17003 Girona, Spain.
- Network Biomedical Research Center of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain.
| | - Maria Antònia Barceló
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, 17003 Girona, Spain
- Network Biomedical Research Center of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Carme Saurina
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, 17003 Girona, Spain
- Network Biomedical Research Center of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Andrés Cabrera
- Network Biomedical Research Center of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Andalusian School of Public Health, 18080 Granada, Spain
- Instituto de Investigación Biosanitaria (IBS), Hospital Universitario de Granada, Universidad de Granada, 18014 Granada, Spain
| | - Antonio Daponte
- Network Biomedical Research Center of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Andalusian School of Public Health, 18080 Granada, Spain
- Instituto de Investigación Biosanitaria (IBS), Hospital Universitario de Granada, Universidad de Granada, 18014 Granada, Spain
- Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), 18080 Granada, Spain
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Moreno-Lostao A, Barrio G, Sordo L, Cea-Soriano L, Martínez D, Regidor E. Mortality in working-age population during the Great Recession and austerity in Spain. PLoS One 2019; 14:e0218410. [PMID: 31247019 PMCID: PMC6597056 DOI: 10.1371/journal.pone.0218410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/31/2019] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To analyze the mortality trend in Spain before, during and after the economic crisis and austerity policies in the working-age population. METHODS From 2005 to 2016 we calculated the annual all-cause mortality rate and the annual mortality rate from the main causes of death in the population aged 15 to 64. We also estimated the linear trends in mortality rates during four time intervals-2005-2007 (before crisis), 2008-2010 (first part of the crisis), 2011-2013 (second part of the crisis and implementation of austerity policies) and 2014-2016 (after the crisis)- by the annual percentage change (APC). RESULTS The all-cause mortality rate in men and women showed the greatest decline in 2008-2010 and the smallest decline in 2014-2016. The decline in 2011-2013 was higher than in 2014-2016. The APCs in 2005-2007, 2008-2010, 2011-2013 and 2014-2016 were -2.8, -4.1, -3.0 and -1.5 in men and -1.0. -2.1, -1.1 and -0.6 in women, respectively, although the APC in 2014-2016 in women was not significant. In 2014-2016, cancer mortality showed the largest decrease, mortality from cardiovascular diseases (men), respiratory diseases and traffic accidents reversed and showed an upward trend, and the downward trend in mortality from infectious diseases and digestive diseases was equal to or greater than that observed before the crisis. CONCLUSION The decline in all-cause mortality in the working-age population during the economic crisis and the introduction of austerity measures was greater than that observed before and after the economic crisis. The slowing of the decline after the crisis was due to the reversal of the trend in mortality from cardiovascular and respiratory diseases.
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Affiliation(s)
| | - Gregorio Barrio
- Health National School, Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Sordo
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Lucía Cea-Soriano
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - David Martínez
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Enrique Regidor
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Regidor E, Albaladejo R, Mateo A, de la Fuente L, Barrio G, Ortega P. Macroeconomic fluctuations, changes in lifestyles and mortality from diabetes: a quasiexperimental study. J Epidemiol Community Health 2019; 73:317-323. [PMID: 30700493 DOI: 10.1136/jech-2018-211464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 12/07/2018] [Accepted: 01/10/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND To evaluate trends in diabetes-related health behaviours and mortality from diabetes and other chronic diseases in the Spanish population before, during and after the 2008 economic crisis. METHODS Annual population measurements were obtained from national surveys and administrative registries for 2004-2016. Using segmented regression analysis, we calculated the annual percentage change (APC) in 2004-2007, 2008-2010, 2011-2013 and 2014-2016 in risk behaviours (smoking, alcohol consumption, obesity and meals away from home), in healthy behaviours (fruit and vegetable intake and physical activity) and in mortality rates from diabetes, cardiovascular disease and cancer. RESULTS In general, during the economic crisis (2008-2013), the Spanish population reduced risk behaviours and improved healthy behaviours as compared with the trend observed before and afterwards. Diabetes mortality decreased more during the crisis than before or afterwards. The APC in each time interval was -3.3, -3.7, -4.4 and -2.6 in all-age mortality and -2.9, -5.2, -6.7 and -1.3 in premature mortality (less than 75 years). Only in older people (≥75 years) diabetes mortality showed similar decline before and during the crisis. Mortality from cardiovascular disease also declined more during the crisis, except for all-age mortality and older people in the second part of the crisis, whereas the downward trend in cancer mortality was smaller during the crisis years. CONCLUSIONS During the 6 years of the economic crisis in Spain, the favourable changes in health behaviours were accompanied by an important reduction in diabetes mortality in the population.
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Affiliation(s)
- Enrique Regidor
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Romana Albaladejo
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Alberto Mateo
- School of Public Health, Health Education North West, Manchester, UK.,National Epidemiology Center, Instituto de Salud Carlos III, Madrid, Spain
| | - Luis de la Fuente
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,National Epidemiology Center, Instituto de Salud Carlos III, Madrid, Spain
| | - Gregorio Barrio
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Paloma Ortega
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Arroyo E, Cabrera-León A, Renart G, Saurina C, Serra Saurina L, Daponte A, Saez M. Did psychotropic drug consumption increase during the 2008 financial crisis? A cross-sectional population-based study in Spain. BMJ Open 2019; 9:e021440. [PMID: 30674485 PMCID: PMC6347932 DOI: 10.1136/bmjopen-2017-021440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES AND SETTING Although psychotropic drugs are used to treat mental health disorders, little evidence analyses the effects the 2008 economic downturn had on psychotropic drug consumption in the case of Spain. We analyse these effects, considering both gender and employment situation. PARTICIPANTS We used the microdata from the face-to-face cross-sectional population-based Spanish National Health Survey for two periods: 2006-2007 (n=28 954) and 2011-2012 (n=20 509). Our samples included adults (>15 years old). METHODS The response variables are consumption (or not) of antidepressants or sedatives and the explanatory variables are the year of the survey, gender and employment status. Covariates are mental health problems, mental health index General Health Questionnaire (GHQ-12) and self-reported health outcome variables such as self-rated health, chronic diseases, smoking behaviour, sleeping hours, body mass index, physical activity in the workplace, medical visits during the past year, age, region of residence (autonomous communities), educational level, marital status and social class of the reference person. Finally, we include interactions between time period, gender and employment status. We specify random effects logistic regressions and use Bayesian methods for the inference. RESULTS The economic crisis did not significantly change the probability of taking antidepressant drugs (OR=0.56, 95% CI 0.18 to 2.56) nor sedatives (OR=1.21, 95% CI 0.26 to 5.49). In general, the probability of consuming antidepressants among men and women decreases, but there are differences depending on employment status. The probability of consuming sedatives also depends on the employment status. CONCLUSIONS While the year of the financial crisis is not associated with the consumption of antidepressants nor sedatives, it has widened the gap in consumption differences between men and women. Although antidepressant use dropped, the difference in consumption levels between men and women grew significantly among the retired, and in the case of sedatives, risk of women taking sedatives increased in all groups except students.
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Affiliation(s)
- Elena Arroyo
- Research Group on Statistics, Econometrics and Health (GRECS), Universitat de Girona, Girona, Spain
- CIBER of Epidemiology and Public Health, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Andrés Cabrera-León
- CIBER of Epidemiology and Public Health, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Escuela Andaluza de Salud Publica, EASP, Granada, Spain
| | - Gemma Renart
- Research Group on Statistics, Econometrics and Health (GRECS), Universitat de Girona, Girona, Spain
- CIBER of Epidemiology and Public Health, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Carme Saurina
- CIBER of Epidemiology and Public Health, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Laura Serra Saurina
- Research Group on Statistics, Econometrics and Health (GRECS), Universitat de Girona, Girona, Spain
- CIBER of Epidemiology and Public Health, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Center for Research in Occupational Health (CiSAL), Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain
- Center for Research in Occupational Health (CiSAL), Experimental and Health Sciences, IMIM (Hospital del Mar Medical Research Institute) Parc de Salut Mar, Barcelona, Spain
| | - Antonio Daponte
- CIBER of Epidemiology and Public Health, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Escuela Andaluza de Salud Publica, EASP, Granada, Spain
- Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), Escuela Andaluza de Salud Pública (EASP), Granada, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), Universitat de Girona, Girona, Spain
- CIBER of Epidemiology and Public Health, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Bilal U, Cooper R, Abreu F, Nau C, Franco M, Glass TA. Economic growth and mortality: do social protection policies matter? Int J Epidemiol 2018; 46:1147-1156. [PMID: 28338775 DOI: 10.1093/ije/dyx016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2017] [Indexed: 12/31/2022] Open
Abstract
Background In the 20th century, periods of macroeconomic growth have been associated with increases in population mortality. Factors that cause or mitigate this association are not well understood. Evidence suggests that social policy may buffer the deleterious impact of economic growth. We sought to explore associations between changing unemployment (as a proxy for economic change) and trends in mortality over 30 years in the context of varying social protection expenditures. Methods We model change in all-cause mortality in 21 OECD (Organization for Economic Cooperation and Development) countries from 1980 to 2010. Data from the Comparative Welfare States Data Set and the WHO Mortality Database were used. A decrease in the unemployment rate was used as a proxy for economic growth and age-adjusted mortality rates as the outcome. Social protection expenditure was measured as percentage of gross domestic product expended. Results A 1% decrease in unemployment (i.e. the proxy for economic growth) was associated with a 0.24% increase in the overall mortality rate (95% confidence interval: 0.07;0.42) in countries with no changes in social protection. Reductions in social protection expenditure strengthened this association between unemployment and mortality. The magnitude of the association was diminished over time. Conclusions Our results are consistent with the hypothesis that social protection policies that accompany economic growth can mitigate its potential deleterious effects on health. Further research should identify specific policies that are most effective.
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Affiliation(s)
- Usama Bilal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Social and Cardiovascular Epidemiology Research Group, Universidad de Alcala, Madrid, Spain
| | - Richard Cooper
- Department of Public Health Sciences, Loyola University Stritch School of Medicine, Chicago, IL, USA
| | | | - Claudia Nau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Manuel Franco
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Social and Cardiovascular Epidemiology Research Group, Universidad de Alcala, Madrid, Spain
| | - Thomas A Glass
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Berg N, Kiviruusu O, Huurre T, Lintonen T, Virtanen P, Hammarström A. Associations between unemployment and heavy episodic drinking from adolescence to midlife in Sweden and Finland. Eur J Public Health 2018; 28:258-263. [PMID: 29240887 DOI: 10.1093/eurpub/ckx207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Unemployment and alcohol use have often been found to correlate and to act as risk factors for each other. However, only few studies have examined these associations at longitudinal settings extending over several life phases. Moreover, previous studies have mostly used total consumption or medical diagnoses as the indicator, whereas subclinical measures of harmful alcohol use, such as heavy episodic drinking (HED), have been used rarely. The aim of this study was to examine the associations between HED and unemployment from adolescence to midlife in two Nordic countries. Methods Participants of separate cohort studies from Sweden and Finland were recruited at age 16 in 1981/1983 and followed up at ages 21/22, 30/32 and 43/42, (n = 1080/2194), respectively. Cross-lagged autoregressive models were used to determine associations between HED and unemployment. Results In the Swedish cohort, HED at ages 16 and 30 in men and HED at age 21 in women were associated with subsequent unemployment. In the Finnish cohort, we found corresponding associations at age 16 in women and at age 22 in men. However, the gender differences were not statistically significant. The associations from unemployment to HED were non-significant in both genders, in both cohorts and at all ages. Conclusions Our results suggest that heavy drinkers are more likely to experience unemployment in subsequent years. The associations from HED to unemployment seem to exist through the life course from adolescence to midlife. More emphasis should be put on reducing alcohol related harms in order to improve labour-market outcomes.
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Affiliation(s)
- Noora Berg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Olli Kiviruusu
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Taina Huurre
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.,Department of Health and Social Welfare, City of Vantaa, Vantaa, Finland
| | - Tomi Lintonen
- Finnish Foundation for Alcohol Studies, Helsinki, Finland.,Faculty of Social Sciences, Health Sciences, University of Tampere, Tampere, Finland
| | - Pekka Virtanen
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Faculty of Social Sciences, Health Sciences, University of Tampere, Tampere, Finland
| | - Anne Hammarström
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Paling T, Vall Castello J. Business cycle impacts on substance use of adolescents: A multi-country analysis. ECONOMICS AND HUMAN BIOLOGY 2017; 27:1-11. [PMID: 28472713 DOI: 10.1016/j.ehb.2017.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 04/05/2017] [Accepted: 04/18/2017] [Indexed: 06/07/2023]
Abstract
Populations respond to changes in the economic climate in a variety of ways. The recent 'Great Recession' has brought attention to the vulnerability of many economies around the world to changes in non-domestic macroeconomic fluctuations. However, empirical evidence on the responses of adolescents' substance consumption behaviour when the economy deteriorates is very scarce. Thus, the focus of this paper is to analyse the substance consumption patterns displayed by adolescents in response to changes in macroeconomic conditions in a large number of countries. Our results show that beer and wine consumption vary counter-cyclically (a 1pp increase in the unemployment rate increases the probability of drinking beer (wine) by 3% (5.5%)) while adolescent smoking prevalence varies pro-cyclically (a 1pp increase in the unemployment rate decreases the probability of being a current smoker by 3.8%). More importantly, we find that the probability of ever being drunk increases by 1.3% for a 1pp increase in the unemployment rate. Further to this, substantial heterogeneous effects from the aggregate-level results were found when analysing a variety of demographic and geographic dimensions. In light of the existing empirical evidence which outlines that early substance initiators demonstrate worse neurological deficits and suffer stronger labour market penalties (compared to later initiators or abstainers) these findings can aid policy makers in reducing these lasting adverse outcomes.
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Affiliation(s)
| | - Judit Vall Castello
- Centre for Research in Health and Economics, Universitat Pompeu Fabra, Ramon Trias Fargas 25-27, Barcelona, Spain.
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22
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Pulido J, Vallejo F, Alonso-López I, Regidor E, Villar F, de la Fuente L, Domingo-Salvany A, Barrio G. Directly alcohol-attributable mortality by industry and occupation in a Spanish Census cohort of economically active population. Drug Alcohol Depend 2017; 180:93-102. [PMID: 28886397 DOI: 10.1016/j.drugalcdep.2017.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/20/2017] [Accepted: 07/25/2017] [Indexed: 11/25/2022]
Abstract
AIMS To assess disparities in directly alcohol-attributable (DAA) mortality by industry/occupation in Spain during 2002-2011 and the contribution of different socio-demographic factors, including socioeconomic position, to explain such disparity. METHODS Nationwide cohort study covering 16 million economically active people living in Spain in 2001. Deaths at age 25-64 were analyzed. Subjects were classified by employment status, industry and occupation at baseline. Poisson regression models were built, calculating rate ratios (RRs) compared to all employees or those in the education sector. RESULTS DAA mortality was much higher in the unemployed than in employees (Crude RR: 2.4; 95% CI: 2.3-2.6) and varied widely across industries/occupations. Crude RRs>3.0 (p<0.05) compared to teachers were found in employees in extractive industries/fishing, agriculture/livestock, construction, catering/accommodation and protective services. Socio-demographic factors, especially age, gender and educational attainment contributed more to explain risk disparities than other factors or potential selection bias. However, after exhaustive sociodemographic adjustment, including education attainment and material wealth, a RR>1.33 (p<0.05) remained in unemployed, catering/accommodation employees and unskilled construction workers. RRs were significantly larger in women than men (p<0.05) among mineworkers/fishworkers/sailors (RR=8.6 vs. 1.2) and drivers (RR=3.7 vs. 1.0). CONCLUSIONS The results could be extrapolated to all alcohol-attributable mortality since disparities for other strongly alcohol-related deaths, although smaller, were in the same direction. Given the wide occupational disparities in alcohol-attributable mortality, implementation of special measures to reduce this mortality in the highest risk groups is fully justified. Future research should better characterize the explanatory factors of disparities and their role in the causal chain.
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Affiliation(s)
- José Pulido
- National School of Public Health, Carlos III Health Institute, Avenida Monforte de Lemos 5, E-28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Avenida Monforte de Lemos 5, E-28029 Madrid, Spain; Department of Preventive Medicine and Public Health, Madrid Complutense University, Ciudad Universitaria s/n, E-28040 Madrid, Spain.
| | - Fernando Vallejo
- National School of Public Health, Carlos III Health Institute, Avenida Monforte de Lemos 5, E-28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Avenida Monforte de Lemos 5, E-28029 Madrid, Spain.
| | - Ignacio Alonso-López
- National School of Public Health, Carlos III Health Institute, Avenida Monforte de Lemos 5, E-28029 Madrid, Spain.
| | - Enrique Regidor
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Avenida Monforte de Lemos 5, E-28029 Madrid, Spain; Department of Preventive Medicine and Public Health, Madrid Complutense University, Ciudad Universitaria s/n, E-28040 Madrid, Spain.
| | - Fernando Villar
- National School of Public Health, Carlos III Health Institute, Avenida Monforte de Lemos 5, E-28029 Madrid, Spain.
| | - Luis de la Fuente
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Avenida Monforte de Lemos 5, E-28029 Madrid, Spain; National Epidemiology Center, Carlos III Health Institute, Avenida Monforte de Lemos 5, E-28029 Madrid, Spain.
| | - Antonia Domingo-Salvany
- IMIM, Institut Hospital del Mar d'Investigacions Mèdiques, Carrer del Dr. Aiguader, 88, E-08003 Barcelona, Spain.
| | - Gregorio Barrio
- National School of Public Health, Carlos III Health Institute, Avenida Monforte de Lemos 5, E-28029 Madrid, Spain.
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Bosque-Prous M, Kunst AE, Brugal MT, Espelt A. Changes in alcohol consumption in the 50- to 64-year-old European economically active population during an economic crisis. Eur J Public Health 2017; 27:711-716. [PMID: 28472296 PMCID: PMC5881701 DOI: 10.1093/eurpub/ckx044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The aim was to compare alcohol drinking patterns in economically active people aged 50-64 years before the last economic crisis (2006) and during the crisis (2013). Methods Cross-sectional study with data from 25 479 economically active people aged 50-64 years resident in 11 European countries who participated in wave 2 or wave 5 of the SHARE project (2006 and 2013). The outcome variables were hazardous drinking, abstention in previous 3 months and the weekly average number of drinks per drinker. The prevalence ratios of hazardous drinking and abstention, comparing the prevalence in 2013 vs. 2006, were estimated with Poisson regression models with robust variance, and the changes in the number of drinks per week with Poisson regression models. Results The prevalence of hazardous drinking decreased among both men (PR = 0.75; 95%CI = 0.63-0.92) and women (PR = 0.91; 95%CI = 0.72-1.15), although the latter decrease was smaller and not statistically significant. The proportion of abstainers increased among both men (PR = 1.11; 95%CI = 0.99-1.29) and women (PR = 1.18; 95%CI = 1.07-1.30), although the former increase was smaller and not statistically significant. The weekly average number of drinks per drinker decreased in men and women. The decreases in consumption were larger in Italy and Spain. Conclusion From 2006 to 2013, the amount of alcohol consumed by late working age drinkers decreased in Europe, with more pronounced declines in the countries hardest hit by the economic crisis.
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Affiliation(s)
- Marina Bosque-Prous
- Agencia de Salut Pública de Barcelona, Barcelona, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton E. Kunst
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M. Teresa Brugal
- Agencia de Salut Pública de Barcelona, Barcelona, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Albert Espelt
- Agencia de Salut Pública de Barcelona, Barcelona, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
- Centros de Investigación Biomédica en Red. Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Departament de Psicobiologia i Metodologia en Ciències de la Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
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Castillo-Carniglia A, Kaufman JS, Pizarro E, Marín JD, Wintemute G, Cerdá M. School collective occupation movements and substance use among adolescents: A school-level panel design. Drug Alcohol Depend 2017; 176:21-27. [PMID: 28511034 DOI: 10.1016/j.drugalcdep.2017.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/09/2017] [Accepted: 02/25/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recently, social movements across the world have demanded reforms to education systems and other institutions. Although such movements have affected large numbers of people across multiple countries, we know little about the impacts they have had on population health. We focus on one example: the massive strikes and collective occupation of secondary schools across Chile, which occurred contemporaneously with a large increase in marijuana use among students in this age group. We aimed to evaluate the causal effects that the 2011 Chilean school strikes had on adolescent substance use, including the initiation of marijuana use and the use of alcohol and marijuana. METHODS School-level, aggregated panel design using data from the National Drug Surveys among Secondary Students from 2005 to 2015 for students in grades 9-12. We used a fixed-effects difference-in-difference model to estimate the effect of school occupations on prevalence of self-reported indicators of drug use. RESULTS Reported marijuana use doubled between 2009 and 2013 among Chilean adolescents. After controlling for secular trends in outcomes and for school characteristics, there was no evidence of increased marijuana initiation, alcohol and marijuana use, or of an increase in heavy use among adolescents being directly attributable to school strikes and occupations in 2011. CONCLUSIONS The 2011 Occupy school movement in Chile had no detectable causal effect on substance use among Chilean adolescents. The increase in marijuana use from 2009 to 2013 seems to be part of broader social changes occurring among the school-age population.
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Affiliation(s)
- Alvaro Castillo-Carniglia
- Violence Prevention Research Program, Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA 95817, United States.
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Esteban Pizarro
- Research Department, National Service for the Prevention and Rehabilitation of Drug and Alcohol Consumption (SENDA), Santiago, Chile
| | - José D Marín
- Research Department, National Service for the Prevention and Rehabilitation of Drug and Alcohol Consumption (SENDA), Santiago, Chile
| | - Garen Wintemute
- Violence Prevention Research Program, Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA 95817, United States
| | - Magdalena Cerdá
- Violence Prevention Research Program, Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA 95817, United States
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How economic recessions and unemployment affect illegal drug use: A systematic realist literature review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 44:69-83. [DOI: 10.1016/j.drugpo.2017.03.013] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 03/15/2017] [Accepted: 03/22/2017] [Indexed: 01/06/2023]
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Alonso I, Vallejo F, Regidor E, Belza MJ, Sordo L, Otero-García L, Barrio G. Changes in directly alcohol-attributable mortality during the great recession by employment status in Spain: a population cohort of 22 million people. J Epidemiol Community Health 2017; 71:736-744. [DOI: 10.1136/jech-2016-208759] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/27/2017] [Accepted: 03/18/2017] [Indexed: 01/16/2023]
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Teixidó-Compañó E, Espelt A, Sordo L, Bravo MJ, Sarasa-Renedo A, Indave BI, Bosque-Prous M, Brugal MT. Differences between men and women in substance use: the role of educational level and employment status. GACETA SANITARIA 2017; 32:41-47. [PMID: 28318754 DOI: 10.1016/j.gaceta.2016.12.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/30/2016] [Accepted: 12/16/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine differences between men and women in hazardous drinking, heavy cannabis use and hypnosedative use according to educational level and employment status in the economically active population in Spain. METHOD Cross-sectional study with data from 2013 Spanish Household Survey on Alcohol and Drugs on individuals aged 25-64 [n=14,113 (women=6,171; men=7,942)]. Dependent variables were hazardous drinking, heavy cannabis use and hypnosedative consumption; the main independent variables were educational level and employment situation. Associations between dependent and independent variables were calculated with Poisson regression models with robust variance. All analyses were stratified by sex. RESULTS Hazardous drinking and heavy cannabis use were higher in men, while women consumed more hypnosedatives. The lower the educational level, the greater the gender differences in the prevalence of this substances owing to different consumption patterns in men and women. While men with a lower educational level were higher hazardous drinkers [RII=2.57 (95%CI: 1.75-3.78)] and heavy cannabis users [RII=3.03 (95%CI: 1.88-4.89)] compared to higher educational level, in women the prevalence was the same. Women with a lower education level and men with a higher education level had higher hypnosedative consumption. Unemployment was associated with increased heavy cannabis use and hypnosedative use in both women and men and with lower hazardous drinking only in women. CONCLUSIONS There are differences between men and women in the use of psychoactive substances that can be explained by the unequal distribution of substance use in them according to educational level. Unemployment was associated with substance use in both men and women.
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Affiliation(s)
- Ester Teixidó-Compañó
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain; Departament de Ciències Experimentals i de la salut, Facultat de Ciències de la Salut i de la Vida, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Albert Espelt
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Departament de Psicobiologia i Metodologia en Ciències de la Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), Spain.
| | - Luis Sordo
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - María J Bravo
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Sarasa-Renedo
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - B Iciar Indave
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Marina Bosque-Prous
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain; Departament de Ciències Experimentals i de la salut, Facultat de Ciències de la Salut i de la Vida, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - M Teresa Brugal
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain; Departament de Ciències Experimentals i de la salut, Facultat de Ciències de la Salut i de la Vida, Universitat Pompeu Fabra (UPF), Barcelona, Spain
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Martin Bassols N, Vall Castelló J. Effects of the great recession on drugs consumption in Spain. ECONOMICS AND HUMAN BIOLOGY 2016; 22:103-116. [PMID: 27039369 DOI: 10.1016/j.ehb.2016.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 03/02/2016] [Accepted: 03/05/2016] [Indexed: 06/05/2023]
Abstract
This paper presents evidence on how the consumption of legal and illegal drugs has changed in response to the Great Recession in Spain. We use a large scale survey from 2005 to 2011 to analyze the association between changes in local economic conditions and drug consumption among individuals aged 15-64. Although Spain was one of the countries hardest hit by the economic downturn, the crisis was unevenly felt across the country. Therefore, we exploit this difference in unemployment rates across provinces to identify the effects of business cycle variations on the consumption of legal and illegal drugs. To the best of our knowledge, this is the first study to find a relation between the deterioration of local economic conditions and a strong increase in the consumption of marihuana and cocaine. We also report a decrease in alcohol consumption but a significant escalation in abusive smoking behavior (smoking every day). We believe that these findings are important not only for the potential negative implications at the individual level but also for the costs to society as a whole.
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Affiliation(s)
| | - Judit Vall Castelló
- Centre for Research in Health and Economics, Universitat Pompeu Fabra, Ramon Trias Fargas 25-27, Barcelona, Spain.
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Sordo L, Barrio G, Bravo MJ, Villalbí JR, Espelt A, Neira M, Regidor E. Estimating average alcohol consumption in the population using multiple sources: the case of Spain. Popul Health Metr 2016; 14:21. [PMID: 27257407 PMCID: PMC4890273 DOI: 10.1186/s12963-016-0090-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/27/2016] [Indexed: 12/17/2022] Open
Abstract
Background National estimates on per capita alcohol consumption are provided regularly by various sources and may have validity problems, so corrections are needed for monitoring and assessment purposes. Our objectives were to compare different alcohol availability estimates for Spain, to build the best estimate (actual consumption), characterize its time trend during 2001–2011, and quantify the extent to which other estimates (coverage) approximated actual consumption. Methods Estimates were: alcohol availability from the Spanish Tax Agency (Tax Agency availability), World Health Organization (WHO availability) and other international agencies, self-reported purchases from the Spanish Food Consumption Panel, and self-reported consumption from population surveys. Analyses included calculating: between-agency discrepancy in availability, multisource availability (correcting Tax Agency availability by underestimation of wine and cider), actual consumption (adjusting multisource availability by unrecorded alcohol consumption/purchases and alcohol losses), and coverage of selected estimates. Sensitivity analyses were undertaken. Time trends were characterized by joinpoint regression. Results Between-agency discrepancy in alcohol availability remained high in 2011, mainly because of wine and spirits, although some decrease was observed during the study period. The actual consumption was 9.5 l of pure alcohol/person-year in 2011, decreasing 2.3 % annually, mainly due to wine and spirits. 2011 coverage of WHO availability, Tax Agency availability, self-reported purchases, and self-reported consumption was 99.5, 99.5, 66.3, and 28.0 %, respectively, generally with downward trends (last three estimates, especially self-reported consumption). The multisource availability overestimated actual consumption by 12.3 %, mainly due to tourism imbalance. Conclusions Spanish estimates of per capita alcohol consumption show considerable weaknesses. Using uncorrected estimates, especially self-reported consumption, for monitoring or other purposes is misleading. To obtain conservative estimates of alcohol-attributable disease burden or heavy drinking prevalence, self-reported consumption should be shifted upwards by more than 85 % (91 % in 2011) of Tax Agency or WHO availability figures. The weaknesses identified can probably also be found worldwide, thus much empirical work remains to be done to improve estimates of per capita alcohol consumption. Electronic supplementary material The online version of this article (doi:10.1186/s12963-016-0090-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Luis Sordo
- National Epidemiology Center, Carlos III Health Institute, Avenida Monforte de Lemos 5, E-28029 Madrid, Spain ; Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Avenida Monforte de Lemos 5, E-28029 Madrid, Spain ; Department of Preventive Medicine and Public Health, Madrid Complutense University, Ciudad Universitaria s/n, E-28040 Madrid, Spain
| | - Gregorio Barrio
- National School of Public Health, Carlos III Health Institute, Avenida Monforte de Lemos 5, E-28029 Madrid, Spain
| | - María J Bravo
- National Epidemiology Center, Carlos III Health Institute, Avenida Monforte de Lemos 5, E-28029 Madrid, Spain ; Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Avenida Monforte de Lemos 5, E-28029 Madrid, Spain
| | - Joan R Villalbí
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1. E-08023 Barcelona, Spain
| | - Albert Espelt
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Avenida Monforte de Lemos 5, E-28029 Madrid, Spain ; Agència de Salut Pública de Barcelona, Pl. Lesseps, 1. E-08023 Barcelona, Spain
| | - Montserrat Neira
- Ministry of Health, Social Services and Equality, Paseo del Prado 18-20, E-28071 Madrid, Spain
| | - Enrique Regidor
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Avenida Monforte de Lemos 5, E-28029 Madrid, Spain ; Department of Preventive Medicine and Public Health, Madrid Complutense University, Ciudad Universitaria s/n, E-28040 Madrid, Spain
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Dom G, Samochowiec J, Evans-Lacko S, Wahlbeck K, Van Hal G, McDaid D. The Impact of the 2008 Economic Crisis on Substance Use Patterns in the Countries of the European Union. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13010122. [PMID: 26771628 PMCID: PMC4730513 DOI: 10.3390/ijerph13010122] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/29/2015] [Accepted: 01/04/2016] [Indexed: 11/16/2022]
Abstract
Background: From 2008 on, a severe economic crisis (EC) has characterized the European Union (E.U.). However, changes in substance use behavioral patterns as a result of the economic crisis in Europe, have been poorly reflected upon, and underlying mechanisms remain to be identified; Methods: In this review we explore and systematize the available data on the effect of the 2008 economic crisis on patterns of substance use and related disorders, within the E.U. countries; Results: The results show that effects of the recession need to be differentiated. A number of studies point to reductions in population’s overall substance use. In contrast, an increase in harmful use and negative effects is found within specific subgroups within the society. Risk factors include job-loss and long-term unemployment, and pre-existing vulnerabilities. Finally, our findings point to differences between types of substances in their response on economic crisis periods; Conclusions: the effects of the 2008 economic crisis on substance use patterns within countries of the European Union are two-sided. Next to a reduction in a population’s overall substance use, a number of vulnerable subgroups experience serious negative effects. These groups are in need of specific attention and support, given that there is a real risk that they will continue to suffer negative health effects long after the economic downfall has formally been ended.
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Affiliation(s)
- Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, Antwerp 2640, Belgium.
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Szczecin 71-460, Poland.
| | - Sara Evans-Lacko
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, SE5 8AF, UK.
| | | | - Guido Van Hal
- Medical Sociology and Health Policy, Antwerp University, Antwerp 2640, Belgium.
| | - David McDaid
- Personal Social Services Research Unit, London School of Economics and Political Science, London WC2A 2AE, UK.
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Job Loss, Unemployment and the Incidence of Hazardous Drinking during the Late 2000s Recession in Europe among Adults Aged 50-64 Years. PLoS One 2015; 10:e0140017. [PMID: 26445239 PMCID: PMC4596847 DOI: 10.1371/journal.pone.0140017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 09/19/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND To estimate the incidence of hazardous drinking in middle-aged people during an economic recession and ascertain whether individual job loss and contextual changes in unemployment influence the incidence rate in that period. METHODS Longitudinal study based on two waves of the SHARE project (Survey of Health, Ageing and Retirement in Europe). Individuals aged 50-64 years from 11 European countries, who were not hazardous drinkers at baseline (n = 7,615), were selected for this study. We estimated the cumulative incidence of hazardous drinking (≥40g and ≥20g of pure alcohol on average in men and women, respectively) between 2006 and 2012. Furthermore, in the statistical analysis, multilevel Poisson regression models with robust variance were fitted and obtained Risk Ratios (RR) and their 95% Confidence Intervals (95%CI). RESULTS Over a 6-year period, 505 subjects became hazardous drinkers, with cumulative incidence of 6.6 per 100 persons between 2006 and 2012 (95%CI:6.1-7.2). Age [RR = 1.02 (95%CI:1.00-1.04)] and becoming unemployed [RR = 1.55 (95%CI:1.08-2.23)] were independently associated with higher risk of becoming a hazardous drinker. Conversely, having poorer self-perceived health was associated with lower risk of becoming a hazardous drinker [RR = 0.75 (95%CI:0.60-0.95)]. At country-level, an increase in the unemployment rate during the study period [RR = 1.32 (95%CI:1.17-1.50)] and greater increases in the household disposable income [RR = 0.97 (95%CI:0.95-0.99)] were associated with risk of becoming a hazardous drinker. CONCLUSIONS Job loss among middle-aged individuals during the economic recession was positively associated with becoming a hazardous drinker. Changes in country-level variables were also related to this drinking pattern.
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