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Libuy N, Church D, Ploubidis G, Fitzsimons E. Fast food proximity and weight gain in childhood and adolescence: Evidence from Great Britain. Health Econ 2024; 33:449-465. [PMID: 37971895 PMCID: PMC10952272 DOI: 10.1002/hec.4770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 11/19/2023]
Abstract
We study the relationship between proximity to fast food restaurants and weight gain from late childhood to early adolescence. We use the Millennium Cohort Study, a UK-wide nationally representative longitudinal study, linked with granular geocoded food outlet data to measure the presence of fast food outlets around children's homes and schools from ages 7 to 14. We find that proximity to fast food outlets is associated with increased weight (body mass index, overweight, obese, body fat, weight), but only among those with maternal education below degree level. Within this sample, those with lower levels of emotional regulation are at heightened risk of weight gain.
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Affiliation(s)
- Nicolás Libuy
- Centre for Longitudinal Studies, Social Research Institute, UCLLondonUK
| | - David Church
- Centre for Longitudinal Studies, Social Research Institute, UCLLondonUK
| | - George Ploubidis
- Centre for Longitudinal Studies, Social Research Institute, UCLLondonUK
| | - Emla Fitzsimons
- Centre for Longitudinal Studies, Social Research Institute, UCLLondonUK
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Libuy N, Ibáñez C, Araneda AM, Donoso P, Contreras L, Guajardo V, Mundt AP. Community-Based Prevention of Substance Use in Adolescents: Outcomes Before and During the COVID-19 Pandemic in Santiago, Chile. Prev Sci 2024; 25:245-255. [PMID: 37099212 PMCID: PMC10130801 DOI: 10.1007/s11121-023-01539-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 04/27/2023]
Abstract
A primary community prevention approach in Iceland was associated with strong reductions of substance use in adolescents. Two years into the implementation of this prevention model in Chile, the aim of this study was to assess changes in the prevalence of adolescent alcohol and cannabis use and to discuss the impact of the COVID-19 pandemic on the substance use outcomes. In 2018, six municipalities in Greater Santiago, Chile, implemented the Icelandic prevention model, including structured assessments of prevalence and risk factors of substance use in tenth grade high school students every 2 years. The survey allows municipalities and schools to work on prevention with prevalence data from their own community. The survey was modified from an on-site paper format in 2018 to an on-line digital format in a shortened version in 2020. Comparisons between the cross-sectional surveys in the years 2018 and 2020 were performed with multilevel logistic regressions. Totally, 7538 participants were surveyed in 2018 and 5528 in 2020, nested in 125 schools from the six municipalities. Lifetime alcohol use decreased from 79.8% in 2018 to 70.0% in 2020 (X2 = 139.3, p < 0.01), past-month alcohol use decreased from 45.5 to 33.4% (X2 = 171.2, p < 0.01), and lifetime cannabis use decrease from 27.9 to 18.8% (X2 = 127.4, p < 0.01). Several risk factors improved between 2018 and 2020: staying out of home after 10 p.m. (X2 = 105.6, p < 0.01), alcohol use in friends (X2 = 31.8, p < 0.01), drunkenness in friends (X2 = 251.4, p < 0.01), and cannabis use in friends (X2 = 217.7, p < 0.01). However, other factors deteriorated in 2020: perceived parenting (X2 = 63.8, p < 0.01), depression and anxiety symptoms (X2 = 23.5, p < 0.01), and low parental rejection of alcohol use (X2 = 24.9, p < 0.01). The interaction between alcohol use in friends and year was significant for lifetime alcohol use (β = 0.29, p < 0.01) and past-month alcohol use (β = 0.24, p < 0.01), and the interaction between depression and anxiety symptoms and year was significant for lifetime alcohol use (β = 0.34, p < 0.01), past-month alcohol use (β = 0.33, p < 0.01), and lifetime cannabis use (β = 0.26, p = 0.016). The decrease of substance use prevalence in adolescents was attributable at least in part to a reduction of alcohol use in friends. This could be related to social distancing policies, curfews, and homeschooling during the pandemic in Chile that implied less physical interactions between adolescents. The increase of depression and anxiety symptoms may also be related to the COVID-19 pandemic. The factors rather attributable to the prevention intervention did not show substantial changes (i.e., sports activities, parenting, and extracurricular activities).
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Affiliation(s)
- Nicolás Libuy
- Department of Psychiatry and Mental Health, Facultad de Medicina, Hospital Clínico Universidad de Chile, Universidad de Chile, Avenida La Paz 1003, Recoleta, Santiago, Chile
- Doctorado en Psicoterapia, Facultad de Medicina y Facultad de Ciencias Sociales, Universidad de Chile y Universidad Católica de Chile, Santiago, Chile
- Millennium Nucleus to Improve, the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile
| | - Carlos Ibáñez
- Department of Psychiatry and Mental Health, Facultad de Medicina, Hospital Clínico Universidad de Chile, Universidad de Chile, Avenida La Paz 1003, Recoleta, Santiago, Chile
- Department of Neuroscience, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Ana María Araneda
- Department of Psychiatry and Mental Health, Facultad de Medicina, Hospital Clínico Universidad de Chile, Universidad de Chile, Avenida La Paz 1003, Recoleta, Santiago, Chile
| | - Paula Donoso
- Department of Psychiatry and Mental Health, Facultad de Medicina, Hospital Clínico Universidad de Chile, Universidad de Chile, Avenida La Paz 1003, Recoleta, Santiago, Chile
| | - Lorena Contreras
- Department of Psychiatry and Mental Health, Facultad de Medicina, Hospital Clínico Universidad de Chile, Universidad de Chile, Avenida La Paz 1003, Recoleta, Santiago, Chile
| | - Viviana Guajardo
- Department of Psychiatry and Mental Health, Facultad de Medicina, Hospital Clínico Universidad de Chile, Universidad de Chile, Avenida La Paz 1003, Recoleta, Santiago, Chile
| | - Adrian P Mundt
- Department of Psychiatry and Mental Health, Facultad de Medicina, Hospital Clínico Universidad de Chile, Universidad de Chile, Avenida La Paz 1003, Recoleta, Santiago, Chile.
- Facultad de Medicina, Universidad Diego Portales, Santiago, Chile.
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Núñez D, Gaete J, Guajardo V, Libuy N, Araneda AM, Contreras L, Donoso P, Ibañez C, Mundt AP. Brief Report: The Association of Adverse Childhood Experiences and Suicide-Related Behaviors Among 10th-Grade Secondary School Students. Arch Suicide Res 2024; 28:399-410. [PMID: 36330838 DOI: 10.1080/13811118.2022.2134067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The association between adverse childhood experiences and suicide-related behaviors (SRB) of adolescents has been widely studied in Western high-income countries, but not yet in Latin America. The aim of this study was to determine this association and to explore a dose-response relationship between adverse childhood experiences and SRB in Chile. We conducted a cross-sectional survey to assess adverse childhood experiences up to 1 year prior to the survey and SRB (suicide ideation and attempts) in a sample of secondary school students. Multilevel and multivariable logistic regressions were run with SRB as dependent and adverse childhood experiences as independent variables, adjusted by self-esteem, general mental health, friend and parental support, and the age at onset of cannabis and alcohol use. We included 7,458 adolescents (48.7% girls), mean age = 16.0 (SD = 0.7), and found a prevalence of 78.1% for at least one adverse childhood experience. The 6-month prevalence of suicidal ideation was 18.1% (95% confidence interval [CI]: 17.2%-19.0%), and the prevalence of suicide attempts was 5.0% (95% CI: 4.6-5.6). Among all adverse childhood experiences, only sexual abuse was a risk factor for both SRB. We also found an independent effect of the total number of adverse childhood experiences on suicidal ideation (p < .001) and on suicide attempts (p < .001). Additionally, ages at onset of alcohol and cannabis use were associated with suicidal ideation and suicidal attempts, respectively. This is the first study exploring the influence of adverse childhood experiences on suicide-related behaviors in adolescents from Latin America.HIGHLIGHTSSexual abuse is associated with suicidal ideation and suicide attempts in 10th-grade secondary school studentsThere is a dose-response effect between adverse childhood experiences and suicide-related behaviorAges at onset of alcohol and cannabis use were associated with suicidal ideation and suicidal attempts, respectively.
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Sepúlveda C, Ibáñez C, Libuy N, Guajardo V, Araneda AM, Contreras L, Donoso P, Mundt AP. Facilitating Factors and Barriers to the Implementation of the Icelandic Prevention Model of Adolescent Substance Use in Chile: A Focus Group Study. Health Promot Pract 2023:15248399231201551. [PMID: 37846059 DOI: 10.1177/15248399231201551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
The use of alcohol and other drugs is a major public health problem in adolescence. The implementation of evidence-based prevention strategies is still scarce in the global south. This study aimed to evaluate facilitators and barriers to the implementation of the Icelandic prevention model of adolescent substance use (IPM) in Chile. We conducted a qualitative study of stakeholders during the implementation process of the IPM in six municipalities of the Metropolitan Region of Santiago, Chile. We convened six focus groups with parents and professionals from schools and municipal prevention teams (38 participants). Recordings were transcribed and submitted to a six-step thematic analysis. The following facilitators emerged: Participants valued the contribution of the IPM to articulate existing programs and teams, its community focus, and the local data obtained through the survey. There were also several barriers: Those included resistance to adopting a foreign model, the tension between generating local strategies and looking for measures to ensure the fidelity of the implementation, socioeconomic differences between and within municipalities, low-risk perception and supervision of parents in Chile, and a culture that generally does not discourage adolescent substance use. Implementation of the IPM was largely accepted by the stakeholders who agreed with the community approach of the model. The main barriers to consider were related to cultural and socioeconomic factors that need to be addressed in further research and may limit the effects of the model in Chile.
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Affiliation(s)
| | - Carlos Ibáñez
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago, Chile
- Departamento de Neurociencias, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Nicolás Libuy
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago, Chile
- Doctorado en Psicoterapia, Facultad de Medicina y Facultad de Ciencias Sociales, Universidad de Chile y Universidad Católica de Chile, Santiago, Chile
- Millennium Nucleus to Improve, the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile
| | - Viviana Guajardo
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Ana María Araneda
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Lorena Contreras
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Paula Donoso
- Departamento de Pediatría, Hospital Clínico Universidad de Chile, Santiago, Chile
- Departamento de Pediatría y Cirugía Infantil, Facultad de Medicina Oriente, Universidad de Chile, Santiago, Chile
| | - Adrian P Mundt
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina Norte, Universidad de Chile, Santiago, Chile
- Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
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Libuy N, Guajardo V, Ibáñez C, Araneda AM, Contreras L, Donoso P, Gaete J, Mundt AP. Parental practices and their association with alcohol and cannabis use among adolescents in Chile. Front Psychol 2023; 14:1209584. [PMID: 37767214 PMCID: PMC10520567 DOI: 10.3389/fpsyg.2023.1209584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/15/2023] [Indexed: 09/29/2023] Open
Abstract
Background Adolescent alcohol and cannabis use are common in Chile. The present study aimed to assess the relationship between perceived parenting practices and alcohol and cannabis use among adolescents in a Latin American context. Methods We adapted and implemented a substance use prevention strategy in Chile, which included surveys of tenth-grade students from six municipalities in the Metropolitan Region of Greater Santiago. We assessed the reliability and factorial structure of the parenting scale with 16 items, which formed part of the survey. We dichotomized parenting scores into high (above the median) and low. The association of parenting practices with alcohol and cannabis use in adolescents was assessed using multivariate multilevel regression models. Results A total of 7,538 tenth-grade students from 118 schools were included in the study. The 16-item scale of parenting practices showed good internal consistency (Omega total = 0.84), and three factors representing Relationship between parents and adolescents, Norms and monitoring, and Parents knowing their children's friends and the parents of their children's friends. High total scores of parenting were associated with lower odds of lifetime alcohol use (OR 0.57; 95% CI: 0.49-0.65), past-month alcohol use (OR 0.63; 95% CI: 0.57-0.70), lifetime drunkenness (OR 0.64; 95% CI: 0.58-0.72), and lifetime cannabis use (OR 0.54; 95% CI: 0.47-0.61). Above median scores on each parenting subscale were associated with significantly lower odds of substance use. The strongest associations were observed for the subscale Norms and monitoring. Interactions between parenting and gender showed a significantly stronger effect of parenting practices on alcohol and cannabis use among girls. Conclusion Different types of parenting practices were associated with a lower prevalence of adolescent alcohol and cannabis use. Improving parenting practices has the potential to prevent adolescent substance use in Chile, especially among girls.
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Affiliation(s)
- Nicolás Libuy
- Department of Psychiatry and Mental Health, Medical Faculty, Universidad de Chile, Santiago, Chile
- Doctorado en Psicoterapia, Facultad de Medicina y Facultad de Ciencias Sociales, Universidad de Chile y Universidad Católica de Chile, Santiago, Chile
- ANID, Millennium Science Initiative Program, Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile
| | - Viviana Guajardo
- Department of Psychiatry and Mental Health, Medical Faculty, Universidad de Chile, Santiago, Chile
| | - Carlos Ibáñez
- Department of Psychiatry and Mental Health, Medical Faculty, Universidad de Chile, Santiago, Chile
| | - Ana María Araneda
- Department of Psychiatry and Mental Health, Medical Faculty, Universidad de Chile, Santiago, Chile
| | - Lorena Contreras
- Department of Psychiatry and Mental Health, Medical Faculty, Universidad de Chile, Santiago, Chile
| | - Paula Donoso
- Department of Psychiatry and Mental Health, Medical Faculty, Universidad de Chile, Santiago, Chile
| | - Jorge Gaete
- ANID, Millennium Science Initiative Program, Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile
- Research Center for School Mental Health, Faculty of Education (ISME), Universidad de Los Andes, Santiago, Chile
| | - Adrian P. Mundt
- Department of Psychiatry and Mental Health, Medical Faculty, Universidad de Chile, Santiago, Chile
- Medical Faculty, Universidad Diego Portales, Santiago, Chile
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Contreras L, Libuy N, Guajardo V, Ibáñez C, Donoso P, Mundt AP. The alcohol prevention magnitude measure: Application of a Spanish-language version in Santiago, Chile. Int J Drug Policy 2022; 107:103793. [PMID: 35820325 DOI: 10.1016/j.drugpo.2022.103793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/02/2022] [Accepted: 07/02/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND The Alcohol Prevention Magnitude Measure (APMM) is an instrument to monitor and improve substance use prevention at the community level developed in Sweden. The aim of this study was to produce and apply a Spanish-language version of the APMM. METHOD We translated and adapted the APMM using an expert panel. We retained 37 indicators in five dimensions, with total scores ranging from 0 to 100 points and 0 to 20 in each dimension. The instrument was administered to the prevention coordinators in six socioeconomically heterogeneous municipalities of Santiago de Chile, during the pilot implementation of a community-based prevention model in 2019 and 2020. We calculated median scores for the instrument and each dimension. We tested for differences between 2019 and 2020 using the Wilcoxon Test and between municipalities with the Friedman Test. RESULTS The Spanish version of the APMM was acceptable to stakeholders. The median scores were 49.3 (range: 34.0 to 64.0) in 2019 and 67.3 (range 55.5 to 80.5) in 2020. The median scores for Staff and budget were 14.0 in 2019 and 2020, for Prevention policy 5.0 in 2019 and 16.0 in 2020, for Cooperation with key agents 12.0 in both years, for Supervision and alcohol licenses 4.3 in 2019 and 9.0 in 2020, and for Prevention activities 11.0 in 2019 and 15.0 in 2020. The scores in the dimensions Prevention policy and Supervision and alcohol licenses significantly increased in 2020. The differences between the municipalities were not significant. CONCLUSIONS Improvements of the prevention index between 2019 and 2020 in the dimension Prevention policies may be related to the intervention. Improvements in Supervision and alcohol licenses could be related to curfew policies in the context of the COVID-19 pandemic. The Spanish version of the APMM deserves larger scale testing in Latin America.
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Affiliation(s)
- Lorena Contreras
- Department of Psychiatry and Mental Health, Medical Faculty, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Nicolás Libuy
- Department of Psychiatry and Mental Health, Medical Faculty, Hospital Clínico Universidad de Chile, Santiago, Chile; Doctorado en Psicoterapia, Facultad de Medicina y Facultad de Ciencias Sociales, Universidad de Chile y Universidad Católica de Chile, Santiago, Chile
| | - Viviana Guajardo
- Department of Psychiatry and Mental Health, Medical Faculty, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Carlos Ibáñez
- Department of Psychiatry and Mental Health, Medical Faculty, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Paula Donoso
- Department of Psychiatry and Mental Health, Medical Faculty, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Adrian P Mundt
- Department of Psychiatry and Mental Health, Medical Faculty, Hospital Clínico Universidad de Chile, Santiago, Chile; Medical Faculty, Universidad Diego Portales, Santiago, Chile.
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Libuy N, Gilbert R, Mc Grath-Lone L, Blackburn R, Etoori D, Harron K. Gestational age at birth, chronic conditions and school outcomes: a population-based data linkage study of children born in England. Int J Epidemiol 2022; 52:132-143. [PMID: 35587337 PMCID: PMC9908051 DOI: 10.1093/ije/dyac105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/28/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION We aimed to generate evidence about child development measured through school attainment and provision of special educational needs (SEN) across the spectrum of gestational age, including for children born early term and >41 weeks of gestation, with and without chronic health conditions. METHODS We used a national linked dataset of hospital and education records of children born in England between 1 September 2004 and 31 August 2005. We evaluated school attainment at Key Stage 1 (KS1; age 7) and Key Stage 2 (KS2; age 11) and any SEN by age 11. We stratified analyses by chronic health conditions up to age 2, and size-for-gestation, and calculated population attributable fractions (PAF). RESULTS Of 306 717 children, 5.8% were born <37 weeks gestation and 7.0% had a chronic condition. The percentage of children not achieving the expected level at KS1 increased from 7.6% at 41 weeks, to 50.0% at 24 weeks of gestation. A similar pattern was seen at KS2. SEN ranged from 29.0% at 41 weeks to 82.6% at 24 weeks. Children born early term (37-38 weeks of gestation) had poorer outcomes than those born at 40 weeks; 3.2% of children with SEN were attributable to having a chronic condition compared with 2.0% attributable to preterm birth. CONCLUSIONS Children born with early identified chronic conditions contribute more to the burden of poor school outcomes than preterm birth. Evaluation is needed of how early health characteristics can be used to improve preparation for education, before and at entry to school.
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Affiliation(s)
- Nicolás Libuy
- Corresponding author. Centre for Longitudinal Studies, UCL Social Research Intitute, 55-59 Gordon Square, WCH1 0NU, London, UK. E-mail:
| | - Ruth Gilbert
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Ruth Blackburn
- Institute of Health Informatics, University College London, London, UK
| | - David Etoori
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Katie Harron
- Great Ormond Street Institute of Child Health, University College London, London, UK
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Libuy N, Bann D, Fitzsimons E. Inequalities in body mass index, diet and physical activity in the UK: Longitudinal evidence across childhood and adolescence. SSM Popul Health 2021; 16:100978. [PMID: 34950761 PMCID: PMC8671115 DOI: 10.1016/j.ssmph.2021.100978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/05/2021] [Accepted: 11/20/2021] [Indexed: 11/20/2022] Open
Abstract
We use longitudinal data across a key developmental period, spanning much of childhood and adolescence (age 5 to 17, years 2006-2018) from the UK Millennium Cohort Study, a nationally representative study with an initial sample of just over 19,000. We first examine the extent to which inequalities in overweight, obesity, BMI and body fat over this period are consistent with the evolution of inequalities in health behaviours, including exercise and healthy diet markers (i.e., skipping breakfast) (n = 7,220). We next study the links between SES, health behaviours and adiposity (BMI, body fat), using rich models that account for the influence of a range of unobserved factors that are fixed over time. In this way, we improve on existing estimates measuring the relationship between SES and health behaviours on the one hand and adiposity on the other. The advantage of the individual fixed effects models is that they exploit within-individual changes over time to help mitigate biases due to unobserved fixed characteristics (n = 6,883). We observe stark income inequalities in BMI and body fat in childhood (age 5), which have further widened by age 17. Inequalities in obesity, physical activity, and skipping breakfast are observed to widen from age 7 onwards. Ordinary Least Square estimates reveal the previously documented SES gradient in adiposity, which is reduced slightly once health behaviours including breakfast consumption and physical activity are accounted for. The main substantive change in estimates comes from the fixed effects specification. Here we observe mixed findings on the SES associations, with a positive association between income and adiposity and a negative association with wealth. The role of health behaviours is attenuated but they remain important, particularly for body fat.
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Affiliation(s)
- Nicolás Libuy
- Centre for Longitudinal Studies, University College London Institute of Education, London, UK
- Corresponding author.
| | - David Bann
- Centre for Longitudinal Studies, University College London Institute of Education, London, UK
| | - Emla Fitzsimons
- Centre for Longitudinal Studies, University College London Institute of Education, London, UK
- Institute for Fiscal Studies, London, UK
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Mc Grath-Lone L, Libuy N, Harron K, Jay MA, Wijlaars L, Etoori D, Lilliman M, Gilbert R, Blackburn R. Data Resource Profile: The Education and Child Health Insights from Linked Data (ECHILD) Database. Int J Epidemiol 2021; 51:17-17f. [PMID: 34788413 PMCID: PMC8856003 DOI: 10.1093/ije/dyab149] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Nicolás Libuy
- University College London, Institute of Health Informatics, London, UK.,Centre for Longitudinal Studies, University College London, Institute of Education, London, UK
| | - Katie Harron
- University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Matthew A Jay
- University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Linda Wijlaars
- University College London, Great Ormond Street Institute of Child Health, London, UK
| | - David Etoori
- University College London, Institute of Health Informatics, London, UK
| | - Matthew Lilliman
- University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Ruth Gilbert
- University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Ruth Blackburn
- University College London, Institute of Health Informatics, London, UK
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Libuy N, Harron K, Gilbert R, Caulton R, Cameron E, Blackburn R. Linking education and hospital data in England: linkage process and quality. Int J Popul Data Sci 2021; 6:1671. [PMID: 34568585 PMCID: PMC8445153 DOI: 10.23889/ijpds.v6i1.1671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Linkage of administrative data for universal state education and National Health Service (NHS) hospital care would enable research into the inter-relationships between education and health for all children in England. OBJECTIVES We aim to describe the linkage process and evaluate the quality of linkage of four one-year birth cohorts within the National Pupil Database (NPD) and Hospital Episode Statistics (HES). METHODS We used multi-step deterministic linkage algorithms to link longitudinal records from state schools to the chronology of records in the NHS Personal Demographics Service (PDS; linkage stage 1), and HES (linkage stage 2). We calculated linkage rates and compared pupil characteristics in linked and unlinked samples for each stage of linkage and each cohort (1990/91, 1996/97, 1999/00, and 2004/05). RESULTS Of the 2,287,671 pupil records, 2,174,601 (95%) linked to HES. Linkage rates improved over time (92% in 1990/91 to 99% in 2004/05). Ethnic minority pupils and those living in more deprived areas were less likely to be matched to hospital records, but differences in pupil characteristics between linked and unlinked samples were moderate to small. CONCLUSION We linked nearly all pupils to at least one hospital record. The high coverage of the linkage represents a unique opportunity for wide-scale analyses across the domains of health and education. However, missed links disproportionately affected ethnic minorities or those living in the poorest neighbourhoods: selection bias could be mitigated by increasing the quality and completeness of identifiers recorded in administrative data or the application of statistical methods that account for missed links. HIGHLIGHTS Longitudinal administrative records for all children attending state school and acute hospital services in England have been used for research for more than two decades, but lack of a shared unique identifier has limited scope for linkage between these databases.We applied multi-step deterministic linkage algorithms to 4 one-year cohorts of children born 1 September-31 August in 1990/91, 1996/97, 1999/00 and 2004/05. In stage 1, full names, date of birth, and postcode histories from education data in the National Pupil Database were linked to the NHS Personal Demographic Service. In stage 2, NHS number, postcode, date of birth and sex were linked to hospital records in Hospital Episode Statistics.Between 92% and 99% of school pupils linked to at least one hospital record. Ethnic minority pupils and pupils who were living in the most deprived areas were least likely to link. Ethnic minority pupils were less likely than white children to link at the first step in both algorithms.Bias due to linkage errors could lead to an underestimate of the health needs in disadvantaged groups. Improved data quality, more sensitive linkage algorithms, and/or statistical methods that account for missed links in analyses, should be considered to reduce linkage bias.
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Affiliation(s)
- Nicolás Libuy
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Katie Harron
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
- UCL Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - Ruth Gilbert
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
- UCL Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK
| | | | | | - Ruth Blackburn
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
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Grath-Lone LM, Libuy N, Etoori D, Blackburn R, Gilbert R, Harron K. Ethnic bias in data linkage. Lancet Digit Health 2021; 3:e339. [PMID: 34045000 DOI: 10.1016/s2589-7500(21)00081-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/01/2021] [Accepted: 04/22/2021] [Indexed: 11/25/2022]
Affiliation(s)
| | - Nicolás Libuy
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - David Etoori
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Ruth Blackburn
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Ruth Gilbert
- Centre for Longitudinal Studies, Institute of Education, University College London, London NW1 2DA, UK; Great Ormond Street Institute of Child Health, University College London, London NW1 2DA, UK
| | - Katie Harron
- Great Ormond Street Institute of Child Health, University College London, London NW1 2DA, UK
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Libuy N, Ibáñez C, Mundt AP. Factors related to an increase of cannabis use among adolescents in Chile: National school based surveys between 2003 and 2017. Addict Behav Rep 2020; 11:100260. [PMID: 32467849 PMCID: PMC7244907 DOI: 10.1016/j.abrep.2020.100260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/29/2020] [Indexed: 12/17/2022] Open
Abstract
Cannabis use in adolescents has more than doubled between 2003 and 2017 in Chile. Exact prevalence of substance use and effect size of associated factors are given. Strongest prevalence factors were friends who use cannabis and low perceived risk. Association of low parental rejection with cannabis use has increased. Tobacco and alcohol use remained strongly associated with cannabis use in adolescents.
Background Cannabis is the most commonly used illicit substance worldwide. In Chile, the prevalence of cannabis use among adolescents is the highest in the Americas. Our aim was to identify prevalence trends of cannabis use and associated factors in adolescents. Methods We performed multivariate logistic regression analyses of 416,417 cross-sectional school-based surveys of adolescents from 8th to 12th grade conducted between 2003 and 2017 in Chile. Cannabis use was the dependent variable. Age, gender, socio-economic variables, and factors on the individual, school and family level were assessed as independent variables. Results The prevalence of cannabis use in the past year increased from 13.6% in 2003 to 31.3% in 2017 in a linear trend (F(df:1,6) = 27.6; R2 = 0.79; p < 0.01). The strongest association with cannabis use was seen for having friends who regularly use cannabis, and low perceived risk of cannabis use. Between 2003 and 2017, the strength of association between the variable having friends who regularly use cannabis and cannabis use decreased from OR = 6.2 to OR = 2.9, in a significant linear trend (F(df:1,6) = 60.5; R2 = 0.89; p < 0.01); whereas the OR for low parental rejection of cannabis use with cannabis use increased in a linear trend (F(df:1,6) = 22.8; R2 = 0.75, p < 0.01) from OR = 1.2 to OR = 2.1. Conclusions Increasing cannabis use of adolescents in Chile requires adjustments of prevention strategies. Prevalence factors identified here constitute potential targets for interventions.
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Affiliation(s)
- Nicolás Libuy
- Department of Psychiatry and Mental Health, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Carlos Ibáñez
- Department of Psychiatry and Mental Health, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Adrian P. Mundt
- Department of Psychiatry and Mental Health, Hospital Clínico Universidad de Chile, Santiago, Chile
- Medical Faculty, Universidad Diego Portales, Santiago, Chile
- Corresponding author at: Department of Psychiatry and Mental Health, Hospital Clínico Universidad de Chile, Av. La Paz 1003, Recoleta, Santiago, Chile.
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Libuy N, de Angel V, Ibáñez C, Murray RM, Mundt AP. The relative prevalence of schizophrenia among cannabis and cocaine users attending addiction services. Schizophr Res 2018; 194:13-17. [PMID: 28427930 DOI: 10.1016/j.schres.2017.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/31/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cannabis and cocaine are the most common illicit drugs for which people are treated in addiction services in Latin America. Much research has suggested that the use of cannabis increases the risk of schizophrenia; there is less evidence concerning cocaine. The aim of the present study was to establish the relative prevalence of schizophrenia in people treated for cannabis use and cocaine use disorders in Chile. METHODS A sample of 22,615 people treated for illicit drug use disorders was obtained from a national registry of addiction service users in Chile. Clinical diagnoses were established at admission to substance use treatment programs or at any point during the period of treatment. Prevalence rates of schizophrenia and related disorders, and affective disorders were calculated for the groups of people with cocaine use disorders, and cannabis use disorders. Odds ratios (OR) for schizophrenia and for affective disorders were calculated for cannabis users using the group of people treated for cocaine use disorders as reference category. RESULTS The prevalence of schizophrenia and related disorders was 1.1% in those with cocaine use disorders, but 5.2% in those with cannabis use disorders (OR 4.9; p<0.01). The prevalence of affective disorders was 9.3% in cocaine use disorders, and 13.2% in cannabis use disorders (OR 1.5; p<0.01). CONCLUSIONS The prevalence of schizophrenia and to a lesser extent affective disorders is higher among people with cannabis use disorder than cocaine use disorder among those attending addiction services.
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Affiliation(s)
- Nicolás Libuy
- Mental Health and Psychiatry Department North, Clinical Hospital of University of Chile, Santos Dumont 999, Independencia, Santiago 8380456, Chile.
| | - Valeria de Angel
- Mental Health and Psychiatry Department North, Clinical Hospital of University of Chile, Santos Dumont 999, Independencia, Santiago 8380456, Chile
| | - Carlos Ibáñez
- Mental Health and Psychiatry Department North, Clinical Hospital of University of Chile, Santos Dumont 999, Independencia, Santiago 8380456, Chile
| | - Robin M Murray
- Institute of Psychiatry, King's College, London, United Kingdom
| | - Adrian P Mundt
- Medical Faculty, Universidad Diego Portales, Chile; Medical Faculty, Universidad San Sebastián, Chile
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Zitko P, Borghero F, Zavala C, Markkula N, Santelices E, Libuy N, Pemjean A. Priority setting for mental health research in Chile. Int J Ment Health Syst 2017; 11:61. [PMID: 29026439 PMCID: PMC5625763 DOI: 10.1186/s13033-017-0168-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 09/22/2017] [Indexed: 11/17/2022] Open
Abstract
Background Scientific knowledge is a fundamental tool for making informed health policy decisions, but the link between health research and public policy decision-making is often missing. This study aims to identify and prioritize a national set of research gaps in mental health. Methods A multi-approach method to identify gaps in knowledge was developed, including (1) document analysis and identification of possible research questions, (2) interviews to Ministry of Health key informants, (3) focus groups with different stakeholders, and (4) a web consultation addressed to academics. The identified gaps were translated to a standardized format of research questions. Criteria for prioritization were extracted from interviews and focus groups. Then, a team of various professionals applied them for scoring each question research. Findings Fifty-four people participated in the knowledge gaps identification process through an online consultation (n = 23) and focus groups (n = 18). Prioritization criteria identified were: extent of the knowledge gap, size of the objective population, potential benefit, vulnerability, urgency and applicability. 155 research questions were prioritized, of which 44% were related to evaluation of systems and/or health programs, and 26% to evaluation of interventions, including questions related to cost-effectiveness. 30% of the research questions came from the online consultation, and 36% from key informants. Users groups contributed with 10% of total research questions. Conclusion A final priority setting for mental health research was reached, making available for authorities and research agencies a list of 155 research questions ordered by relevance. The experience documented here could serve to other countries interested in developing a similar process. Electronic supplementary material The online version of this article (doi:10.1186/s13033-017-0168-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pedro Zitko
- Mental Health Department, Ministry of Health of Chile, Santiago, Chile.,Unidad de Estudios Asistenciales, Complejo Asistencial Barros Luco, Gran Avenida José Miguel Carrera 3204, San Miguel, 8900085 Santiago, Chile.,Faculty of Medicine, Universidad Diego Portales, Santiago, Chile
| | | | - Cynthia Zavala
- Mental Health Department, Ministry of Health of Chile, Santiago, Chile.,Department of Public Health, Pontificia Catholic University of Chile, Santiago, Chile
| | - Niina Markkula
- Mental Health Department, Ministry of Health of Chile, Santiago, Chile.,Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Emilio Santelices
- National Health Research Council, Ministry of Health of Chile', Santiago, Chile
| | - Nicolás Libuy
- Department of Psychiatry, Clinical Hospital of University of Chile, Santiago, Chile
| | - Alfredo Pemjean
- Mental Health Department, Ministry of Health of Chile, Santiago, Chile.,Faculty of Medicine, Universidad Diego Portales, Santiago, Chile
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Jorquera N, Alvarado R, Libuy N, de Angel V. Association between Unmet Needs and Clinical Status in Patients with First Episode of Schizophrenia in Chile. Front Psychiatry 2015; 6:57. [PMID: 25954209 PMCID: PMC4404742 DOI: 10.3389/fpsyt.2015.00057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/02/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Schizophrenia is a severe mental disorder involving needs in several matters that are often not covered. A need is defined as a gap between the ideal state and the current state of a patient about a specific topic. AIM To describe needs in patients with first episode of schizophrenia at the start of treatment and to describe associated clinical factors. METHODS Observational descriptive cross-sectional design. Patients were over 15 years old, with first episode schizophrenia, and admitted to treatment in the public health system from six districts in two cities of Chile, between 2005 and 2006. Sociodemographic data, clinical evaluations of current psychosis based on the Positive and Negative Syndrome Scale (PANSS), and the time of untreated psychosis were obtained. A clinical interview was carried out followed by the Camberwell Assessment of Need. RESULTS Twenty-nine patients were evaluated, 79.3% male, mean age 21.9 years old. The areas with more needs reported were; psychotic symptoms with 65.5% of sample, 21.1% of which reported it unmet; and daytime activities, where 44.8% of patients reported a need, 61.54% of them as unmet. The percentage of unmet needs correlated with PANSS score (r = 0.55; p = 0.003), and with time of positive symptoms prior to diagnosis (r = 0.416; p = 0.03). DISCUSSION Needs assessment in schizophrenia is necessary. It may affect its clinical course, be relevant in its management, and help monitor recovery. Defining the main needs in people with first episode schizophrenia and associated factors allows for a better design of treatment strategies in order to obtain better therapeutic results and recovery.
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Affiliation(s)
- Natalia Jorquera
- Mental Health and Psychiatry Department North, Clinical Hospital of University of Chile, University of Chile , Santiago , Chile ; Medicine Faculty, Public Health School, University of Chile , Santiago , Chile
| | - Rubén Alvarado
- Medicine Faculty, Public Health School, University of Chile , Santiago , Chile
| | - Nicolás Libuy
- Mental Health and Psychiatry Department North, Clinical Hospital of University of Chile, University of Chile , Santiago , Chile
| | - Valeria de Angel
- Mental Health and Psychiatry Department North, Clinical Hospital of University of Chile, University of Chile , Santiago , Chile
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