Introduction:Climate change (CC) is a major global challenge with detrimental environmental, social and health impacts. Adolescents and youth are particularly vulnerable to the adverse emotional and mental health effects of CC. However, concern about CC can prompt them to engage in climate action. This study aimed to assess social inequalities in CC concern and their relationship with the health and wellbeing of adolescents in Barcelona in 2021. Materials and methods:A cross-sectional study was performed using data from the 2021-Secondary Education Risk Factors Survey (FRESC), among students in 8th, 10th, and 12th grades and vocational training. CC concern was measured by agreement with the statement "I'm concerned about climate change" . Health outcomes included: self-perceived health; mental health (via Strengths and Difficulties Questionnaire); depression (via Warwick-Edinburgh Mental Wellbeing Scale); and life satisfaction. Demographic variables included gender, grade, contextual socioeconomic status and school ownership. Poisson regression models with robust variance estimated prevalence ratios (PR) and 95% confidence intervals (CI). Results:Of 3,290 adolescents surveyed, 73.3% reported CC concern revealing gender inequalities (80.4%: girls; 65.8%; boys; 75.8%: non-binary). CC concern was most prevalent among 12th-grade and non-binary vocational training students. In 8th and 10th grades, concerned girls showed better health outcomes (poor health: prevalence ratio (PR) [95%CI]= 0.70[0.57-0.86]; poor mental health: PR [95%CI] = 0.68[0.48-0.97]; probable depression: PR [95%CI] = 0.75[0.58-0.95]), while the opposite trend was found in older students. Conclusion:CC concern was more prevalent among girls and non-binary students. In lower grades, concerned girls showed better health outcomes but this reversed in higher grades. Adolescents must be included in policymaking, with a focus on climate justice to protect their health and wellbeing.

Background: Poor oral health severely affects quality of life, disproportionately impacting individuals with low socioeconomic status due to limited or partial dental coverage. In Barcelona, many people face barriers to dental care. In 2018, the Barcelona City Council launched a free dental service for economically disadvantaged populations to improve access to essential treatments. Objective: This study evaluates Barcelona's Social Dentistry Service regarding its scope, patient profiles, satisfaction, and perceived impact from professional and patient perspectives. Methods: We conducted a non-experimental, mixed-methods evaluation involving patients and dental professionals. Data were obtained through interviews with both groups, an online questionnaire for professionals, and analysis of service records from 2018 to 2022. Results: From November 2018 to December 2022, the service provided 39,557 visits to 4499 individuals (4344 adults; 155 children). Professionals strongly endorsed the service, stressing its necessity and positive impact. Patients reported high satisfaction, citing accessibility, effective treatments, and professional quality as strengths, while also expressing concerns about gaps in coverage and future availability. Both groups reported benefits beyond oral health, including improved physical and mental well-being, social relationships, and self-care. Patients highlighted pain relief, increased self-esteem, quality of life, and motivation for social participation. Conclusion: The Social Dentistry Service markedly improves patients' oral health, psychological well-being, and social integration. Universal dental coverage policies are needed; meanwhile, similar interventions should be sustained and expanded in areas lacking coverage.

Objectives:This scoping review aimed to map and synthesize the available literature on interventions that mitigate the effects of housing insecurity on the health and wellbeing of children and adolescents (0-18 years), describing their characteristics, levels of action (structural, intermediate, or individual/group), and reported outcomes. Methods:In January 2025, we conducted a comprehensive search across four databases (PubMed, Scopus, Web of Science, and CINAHL) and 1 gray literature search engine (Carrot2), without time restrictions. 6,002 articles underwent three sequential screening phases. Results were described through a narrative synthesis of the evidence. Results:Twenty-six studies were included. Public housing, housing vouchers, and subsidies to private housing developers were the most common interventions, targeting structural and intermediate levels. Reported outcomes varied: physical health and healthcare use generally improved, while mental health and educational effects were mixed. Only two studies assessed multi-assistance programs. Conclusion:Affordability-focused interventions can improve health for children and adolescents, while multi-assistance approaches show promise. Broader welfare policies may also benefit this population. Future research should diversify geographically, use mixed methods, address age-specific outcomes, and examine more decommodifying housing strategies.

Lesbian, gay, and bisexual adolescents have less mental well-being than heterosexual adolescents, which is partly explained by experiencing stigma in the form of school bullying or bad family relationships. However, it is unclear whether this association is different according to specific sexual orientations (lesbian, gay, bisexual), gender (cisgender boys, cisgender girls), and in different types of municipality (small towns, intermediate cities, and a metropolis). The aim of this study was to analyze the association between mental well-being and specific sexual orientations, taking into account the role of school bullying and family relationships, among cisgender adolescents in Catalonia (Spain), from a gender and territorial perspective. Data were collected using two cross-sectional questionnaires in secondary school students aged 15-19 years from Central Catalonia (N = 5,962) and the Catalan metropolis of Barcelona (N = 1,601) during 2021-2022. First, linear regression models showed an inverse association between mental well-being and being gay or bisexual among boys in small towns. In intermediate cities and the metropolis, this inverse association was observed only with being bisexual. In girls, there was a weaker inverse association between mental well-being and being bisexual across all three types of municipality. Second, school bullying and family relationships had an indirect effect on mental well-being. Our results suggest that having a lesbian, gay, and bisexual sexual orientation is more penalized in cisgender boys than in cisgender girls and that despite the progressive acceptation of gay identities in intermediate cities and a metropolis compared to small towns, stigma toward bisexuality persists in all types of municipality.

Despite being generally considered healthy, adolescence is a crucial period where health behaviours are established, which can impact future well-being. Factors such as social determinants, psychosocial variables, and risk behaviours play significant roles in determining general and mental health, with important gender differences. This article aims to study social inequalities in the prevalence of mental distress and poor self-perceived health of 14 to 18-year-old students schooled in Central Catalonia and Barcelona in the 2021–2022 academic year, separately for boys and girls. Cross-sectional study using data from two surveys that monitor health and health behaviours in Central Catalonia (DESKcohort) and in Barcelona (FRESC survey) during the year 2021–2022. The final sample included 7,309 adolescents (51.8

This study analysed gender and socioeconomic (SE) inequalities in adolescent mental well-being in Barcelona, Spain, using data from two cross-sectional waves (2016 and 2021), examining the potential impact of the COVID-19 pandemic and considering pre-existing disparities. The research aimed to understand how these factors influenced mental well-being at two time points, with a particular focus on intersecting vulnerabilities. A repeated cross-sectional analysis was performed using data from the FRESC survey (students aged 13–16 years: 2016, N = 2274; 2021, N = 2179). Mental well-being was measured using the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS). Multivariate linear regressions accounted for individual- and school-level SE characteristics, including clustering at the school level, and effect sizes (Cohen’s d) were used to assess changes over time. Analyses included stratification by sex and exploration of collinearity among SE indicators. Mental well-being scores were significantly lower in 2021 compared to 2016, with sharper reductions observed in girls (effect size = –0.43, 95

BACKGROUND:Research on the health and well-being of non-binary adolescents is limited, with most studies conducted in Anglo-Saxon and Northern European countries, often relying on non-representative samples. This study aimed to: (1) compare the socioeconomic characteristics of cisgender and nonbinary adolescents in secondary education; (2) examine differences in experiences of discrimination and problematic relationships with family and peers; (3) compare substance use between cisgender and nonbinary adolescents; and (4) analyze gender identity differences in health and wellbeing outcomes. METHODS:This cross-sectional study used data from the 2021 FRESC Health Survey on Adolescence in Barcelona. The survey is based on a representative sample of secondary education students aged 13-19. The final sample size consisted of 3,272 individuals (62 identified as nonbinary). Respondents answered questions covering experiences of discrimination, problematic relationships, substance use, and a wide range of health and well-being variables. Logistic regression models, adjusted for socioeconomic variables, were used to test the associations between gender identity and the various health-related variables. RESULTS:In the sample, 1.9% identified as nonbinary (2.6% among those assigned female at birth and 1.2% among those assigned male at birth). Nonbinary individuals were younger, more likely to have a lower socioeconomic status, live in single-mother households, and have a mother born outside Catalonia. Overall, nearly all health-related outcomes, except for substance use, were worse for cisgender girls but, particularly, for nonbinary individuals, compared to cisgender boys. CONCLUSION:Cisgender girls and, especially, nonbinary adolescents report lower well-being compared to cisgender boys across a range of well-being domains. These findings highlight the importance of expanding research on nonbinary adolescents and incorporating questions about gender identity in health surveys, while also distinguishing between cisgender boys and girls. Additionally, targeted interventions are essential to support young people in expressing and living authentically in alignment with their gender identity.

This article profiles the city of Barcelona, focusing on public health and its 40-year history of Health Reporting, and how these reports help to implement evidence-based policies. The first section outlines the city's main characteristics, including its challenges and the description of public health in the city. Then we follow with an overview of the 40 years of health reports in the city, explaining the evolution through the years. Finally, we present five examples of how evidence on health and health impact of policies has been used to inform and drive public policies of housing, climate change, transport and road safety, socioeconomic inequalities, and COVID-19 inequalities. Forty years after its inception, the Barcelona Health Report stands as a milestone in a long tradition of accountability to society regarding the health situation and its determinants in the city. This long-standing initiative reflects a continued political commitment to creating spaces for debate, transparency, and evidencebased policy-making. Also, it shows Barcelona's political commitment to promoting health equity. The lessons learned from this experience can provide valuable insights for other cities, particularly in Southern Europe, looking to enhance their health governance and policy frameworks through evidence-based approaches.

There is a growing body of evidence on health inequalities according to gender identity, in which sex assigned at birth is often overlooked. The aim of our study was to assess the relevance of examining both gender identity and sex assigned at birth in health population surveys, by comparing the health outcomes, behaviours, and interpersonal relationships in cisgender boys, cisgender girls, transgender and gender expansive (TGE) youth assigned male at birth (AMAB) and TGE youth assigned female at birth (AFAB), in a general population sample of adolescents schooled in Catalonia, Spain. Cross-sectional study using a questionnaire in students aged 12–19 years from Catalonia (N = 9177) in 2021–2022. We assessed the differences in health outcomes (self-perceived overall health and mental wellbeing), health-related behaviours (quality of diet, physical activity, consumption of tobacco, alcohol and cannabis, and compulsive screen and digital entertainment use), and interpersonal relationships (family relationships, bullying victimization, and sexual violence) in cisgender boys, cisgender girls, TGE AMAB and TGE AFAB, using descriptive statistics and Pearson chi-square tests. We used Poisson regression models with robust variance to examine the associations between the health outcomes and gender identity and sex assigned at birth. TGE AMAB adolescents had a greater prevalence of worse overall health (PRadj=2.01, 95

OBJECTIVE:Physical activity (PA) may be key to reducing problematic Internet use (PIU) among adolescents. Given that Internet usage patterns and PA participation can vary significantly across genders and different age groups, this study aims to analyze the association between PIU and PA, mental health and other contextual factors, in students aged thirteen to nineteen in Barcelona, by sex and age. METHODS:A cross-sectional study using data from the 2021 FRESC Survey was carried out, which included 3,256 students in the city of Barcelona. The dependent variable was PIU, measured with the validated CIUS scale. Poisson regression was used to estimate crude and adjusted prevalence ratios (PRa) with 95% confidence intervals (IC95%). RESULTS:In the group over sixteen years old, lower PIU was associated with regular PA in girls (PRa=0.62, IC95%=0.39-0.97) and in boys (PRa=0.51, IC95%=0.35-0.74). Lower PIU in girls under sixteen was associated with higher frequency of sports activities (PRa=0.53, IC95%=0.31-0.88). Poor mental health was associated with higher PIU across all groups (boys under sixteen, PRa=3.31, IC95%=2.42-4.51). CONCLUSIONS:PA is associated with lower PIU in all groups except boys under sixteen years old. Other factors associated with higher PIU includes poor mental health and poor family relationships. PA promotion programs with a gender perspective could be key to addressing PIU in adolescents.

In this cross-sectional study, we analyzed data from the Survey of Risk Factors in a Secondary School Students (FRESC) representative survey among secondary school students aged 13 to 19 in the city of Barcelona. At all school grades, sexual harassment was more commonly reported by girls than by boys (17% of girls vs 4.2% of boys). The factors associated with sexual harassment were higher school grade, having a mental health disorder, cannabis abuse, and discrimination because of sexual orientation in girls and discrimination because of sexual orientation in boys. These findings highlight the potentially strong impact of sexual harassment on adolescents’ lives and underscore the importance of preventing this form of violence.

Objectives: Loneliness is a public health issue among older adults. We designed an intervention offering 10 sessions with diverse artistic methods (ArtGran). This study assessed the effectiveness of ArtGran in reducing loneliness and its negative effects on health in community-dwelling older adults in 2022 in Barcelona. Study design: Quasi-experimental study, with an intervention group (IG) and a comparison group (CG). Methods: The sample included residents aged >= 70 years from 6 selected neighbourhoods of Barcelona. In each neighbourhood, an IG and a CG was formed with participants who reported loneliness and without special mobility needs. The participants were referred from primary care centres, social services, and community health centres. We included 138 participants (IG = 63, CG = 75). We collected data on loneliness, quality of life (QoL-5D), mood, and self-perceived health before and after the intervention through validated questionnaires. To assess the effect of the intervention, we built Poisson models with robust variance and linear regression models. Results: At the end of the intervention, participants in the IG were more likely than those in the CG to be able to perform their usual activities without problems (adjusted prevalence ratio [aPR] = 1.22; 95% confidence interval [CI]: 1.02-1.45). Compared with the CG, participants in the IG attending more than half of the sessions had lower levels of loneliness (aPR = 1.36; 95%CI: 1.07-1.73), a better ability to perform their usual activities (aPR [95%CI] = 1.24 [1.05-1.48]), and higher happiness scores (b = 0.73; P = 0.01). Conclusions: The effectiveness of the intervention was more pronounced when participants had high attendance. Our results suggest that high attendance of the ArtGran program was helpful in shielding older individuals from loneliness, fostering positive moods, and preserving their functional status. (c) 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Objective: To describe the prevalence of obesity and analyse possible differences in it according to sociodemographic characteristics, diet, physical activity, screen use and family perception of the weight and dietary habits of schoolchildren aged 3 to 4 years in Barcelona. Methods: We conducted a cross-sectional study in a representative sample of schools selected based on the socioeconomic status (SES) of the corresponding neighbourhood and school ownership. We selected 101 schools in Barcelona and recruited pupils aged 3 to 4 years during the 2016-2017 academic year (n = 2936 children). Anthropometric measurements were taken in each participant. Family members completed a questionnaire on eating habits, physical activity, sleeping hours, screen use and the family's perception of the child's weight and diet. The primary variable was the body mass index (BMI) for age and sex, subsequently categorised as normal weight, overweight or obese. Results: Approximately 7.0% of girls and 7.1% of boys aged 3 to 4 years presented obesity. The prevalence of obesity (8.3%) was higher in neighbourhoods of lower SES compared to those of higher SES (5.2%; P = .004). Parents of children with obesity reported that the child had some excess weight or excess weight in 46.9% of cases, 3.9% indicated the child's weight was appropriate and 0.9% that the child was a little underweight or underweight ( P < .001). Discussion: The prevalence of obesity in children aged 3 to 4 years is high. There are social and geographical inequalities, and obesity was more prevalent in areas of lower SES. A large percentage of the families of children with obesity do not consider that the child's weight is excessive. (c) 2024 Asociaci & oacute;n Espa & ntilde;ola de Pediatr & iacute;a. Published by Elsevier Espa & ntilde;a, S.L.U. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Abstract Crises have the potential to affect mental well-being (MWB), especially at vital stages of personal development such as adolescence. The objective of this study was to investigate the 2016-21 trends of social inequalities in the MWB of adolescents in Barcelona, stratifying by sex. Sequential, cross-sectional study based on the FRESC survey, held by the ASPB, representative of 8th and 10th grade adolescents (13-16 years old) schooled in Barcelona, in 2016 (N = 2,154) and 2021 (N = 2,299). MWB was examined using the validated WEMWBS, scoring from 14 (lowest) to 70 (highest) MWB. A temporal trend analysis of inequalities in MWB was carried out using the student socioeconomic status (SES) (low/average/high), measured with the validated FAS. For each group, the effect size of the WEMWBS means was measured with Cohen’s D. Linear regressions were performed, adjusting for academic grade, student country of origin, type of school and school index of vulnerable students. Adjusted β coefficients (aβ) and their statistical significance (p<.05) were estimated. In 2016, boys had higher MWB mean scores than girls (54.0 vs 50.8) (p<.01). In 2021, sex differences persisted, but with lower scores (51.7 vs 47.0) (p<.01) and still with a moderate effect size (0.52 in 2021 vs 0.40 in 2016). In multivariate regression models, boys in low SES showed the greatest MWB decrease in 2016 (low vs high SES: aβ= -3.44; p<.01). A significant temporal trend 2016-2021 of MWB worsening was observed in all groups, except for boys in low SES. The greatest deterioration in MWB was observed in girls, similarly in different SES (low SES: aβ= -3.52; p<.01). Boys in low SES showed the worst MWB in 2016 whereas all SES categories of girls had a significant trend of deterioration in MWB (2016-21). The latter could be attributed, among other factors, to a differential effect of the COVID-19 pandemic. These results underline the importance of addressing inequalities in the MWB, particularly among adolescent girls. Key messages • This study reveals a deterioration in mental well-being temporal trends (2016-2021) among adolescents in Barcelona, especially in girls. • Findings emphasize the need to address social inequalities for improving mental well-being outcomes in adolescent populations.

ObjetivoDescribir la prevalencia de obesidad y analizar posibles diferencias según características sociodemográficas, alimentación, actividad física, visionado de pantallas y percepción familiar sobre el peso y la alimentación de sus hijos/as en escolares de 3 a 4años de Barcelona.MétodoEstudio transversal a una muestra representativa de escuelas según nivel socioeconómico (NSE) del barrio y titularidad. Se seleccionaron 101 escuelas de Barcelona y se reclutó al alumnado de 3 a 4años en el curso 2016-2017 (n=2.936 niños/as). Se tomaron medidas antropométricas. Los familiares respondieron a un cuestionario de hábitos sobre alimentación, actividad física, horas de sueño, visionado de pantallas y percepción familiar sobre el peso y la alimentación de su hijo/a. La variable principal fue el índice de masa corporal (IMC), calculado por edad y sexo, y categorizado en normopeso, sobrepeso u obesidad.ResultadosEl 7,0% de las niñas y el 7,1% de los niños de 3-4años presentaron obesidad. En los distritos de NSE desfavorecido hubo mayor obesidad (8,3%) que en los más favorecidos (5,2%; p=0,004). Los padres/madres de niños/as cuyo peso fue de obesidad declararon que el peso de su hijo/a era un poco excesivo o excesivo en un 46,9%, en un 3,9% indicaron que era adecuado, y el 0,9% que era un poco bajo o bajo (p<0,001).DiscusiónLa prevalencia de obesidad en niños y niñas de 3 a 4años es elevada. Existen desigualdades sociales, siendo superior en áreas de NSE más desfavorecidas. Un elevado porcentaje de familias de niños/as con obesidad no consideran que el peso de sus hijos/as sea excesivo.

Objectives: Adolescence is a crucial life stage that can lead to excess weight and body dissatisfaction. Social inequalities in these issues may have been exacerbated by the COVID-19 pandemic. We aimed to analyze the presence of socioeconomic inequalities and their changes in these inequalities stratified by sex in 13- to 19-year-olds in a large Mediterranean city (Barcelona, Spain). Study design: Cross-sectional population-based study. Methods: We used data from the 2016 and 2021 editions of the FRESC survey, which is a representative citywide survey that captures various aspects of adolescent health. Excess weight was determined by objective body mass index measurements. Body dissatisfaction was defined as the discrepancy between perceived and desired body shape. Socioeconomic status was divided into five pseudo-quintiles by using the Family Affluence Scale. We calculated the corresponding prevalence estimates and fitted robust Poisson regression models to estimate both simple and complex measures of inequality, including relative and absolute differences between the two survey years. Results: The overall prevalence of excess weight increased from 25.3% [23.9-26.6] to 29.8% [28.2-31.4] between 2016 and 2021. Similarly, body dissatisfaction increased from 44.2% [42.6-45.8] to 60.4% [58.7 -62]. Socioeconomic inequalities in excess weight significantly increased in girls (adjusted ratio of the relative index of inequalities 1/4 1.72 [1.08; 2.74] but not in boys. No significant changes were detected in body dissatisfaction in either girls or boys. Conclusions: Our findings highlight the presence of a sex-specific change in socioeconomic inequalities in adolescent well-being regarding excess weight and body dissatisfaction. These results underscore the need for local public policies to improve social equity in adolescent health. (c) 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights are reserved, including

Abstract Purpose: We aimed to analyse the presence and changes of socioeconomic inequalities in excess weight and body dissatisfaction, stratified by sex, in 13- to 19-year-olds in a large Mediterranean city (Barcelona, Spain). Methods: We used data from the 2016 and 2021 editions of the FRESC survey, which is a representative citywide survey that captures various aspects of adolescent health. Excess weight was determined by objective body mass index measurements. Body dissatisfaction was defined as the discrepancy between perceived and desired body shape. Socioeconomic status was divided into five pseudo-quintiles by using the Family Affluence Scale. We calculated the corresponding prevalence estimates and fitted robust Poisson regression models to estimate both simple and complex measures of inequality, including relative and absolute differences between the two survey years. Results: During the study period, the overall prevalence of excess weight (25.3[23.9-26.6] vs. 29.8[28.2- 31.4]) and body dissatisfaction (44.2[42.6-45.8] vs. 60.4[58.7-62]) increased. Socioeconomic inequalities in excess weight significantly increased in girls (adjusted ratio of the relative index of inequalities = 1.72[1.08;2.74] but not in boys. Presence and persistence of socioeconomic inequalities were detected in body dissatisfaction in both girls and boys. Conclusions: Our findings highlight the presence of a sex-specific change in socioeconomic inequalities in adolescent well-being regarding excess weight and body dissatisfaction. These results underscore the need for local public policies to improve social equity in adolescent health.

OBJECTIVE:The problematic use of mobile phones is a phenomenon that can be associated with a specific individual profile and it has been seen that there are associated factors, although most of them have been studied in a limited way and in small samples. The aim of this study was to describe the association between the problematic use of the mobile phone and social traits, health, and health-related behaviors among high school students. METHODS:This is a cross-sectional study performed in a representative sample of students aged 13-18 years in the Lifestyle Risk Factors in Secondary School Students (FRESC) survey conducted in 2016 in Barcelona (n=3,778). Problematic mobile phone use was obtained from the Mobile Related Experiences Questionnaire (CERM). Multivariate logistic regression models were built to assess the relationship between this variable and social, health and behavioural variables. RESULTS:A total of 52% of girls and 44% of boys reported frequent or occasional problems with their mobile phone usage. The factors associated with the dependent variable were poor relationships with the family, mobile phone usage before sleeping or during dinner, inadequate hours of sleep, sedentariness, substance consumption and poor mental health. CONCLUSIONS:The problematic use of the mobile is frequent among students and there are several associated social, health and behavioral factors. There are substantial differences by sex and age, with the strongest associations in younger girls.

Half of all mental health disorders appear during adolescence, although it is still far from clear how they relate to gender (not sex) criteria. This study aims both to analyse the relationship between gender and adolescent mental health and to propose an index: the Gender Adherence Index (GAI). We used cross-sectional, secondary data from 3888 adolescents (aged 13-19) from the FRESC Health Survey on Adolescence in Barcelona. We analysed the interaction among sex, age and socio-economic status with several mental health indices. Additionally, we computed a Gender Adherence Index (GAI) to transcend the information-poor binary sex label, and thus assess to what extent mental health can be predicted by the gender expression of adolescents irrespective of their biological sex. We found that older age and lower economic status have a greater impact on the emotional distress of girls, who reported lower self-perceived mental health than boys. Nevertheless, girls obtained higher scores regarding their prosocial behaviour, which is protective against mental health problems. The GAI was retained in all statistical models stressing it as a relevant metric to explain the variability of adolescent emotional distress. Young people who showed adherence to normative femininity in their lifestyles showed higher prosocial behaviour but did not tend to present more emotional distress. Despite its limitations, this is a novel attempt to explore the relationship between gender expression and mental health. Better defined indices of gender adherence could help us to improve our predictive capacity of mental health disorders during adolescence.