Salud y ajuste
A continuación se recogen los artículos de investigación publicados por el equipo HBSC. Para hacer más sencilla la búsqueda, los artículos se dividen por áreas temáticas. Pulse aquella que le interese y será redirigido a las publicaciones científicas publicadas en esta temática.
Salud y ajuste psicológico
A partir de la concepción más actual de salud, fundamentada en el modelo biopsicosocial, la salud no se entiende únicamente como la ausencia de afecciones o enfermedades, sino que se trata de un estado completo de bienestar físico, psicológico y social. Los indicadores que se presentan en este apartado han sido seleccionados de acuerdo con este paradigma, de manera que reflejan una visión global de la salud a través de distintos componentes de reconocida importancia. Así, se incluyen los resultados correspondientes a la percepción de salud o salud percibida, que se define como la valoración subjetiva que hace el individuo de su propia salud; la frecuencia de malestar psicosomático; la satisfacción vital, elemento fundamental en la caracterización actual de bienestar subjetivo; y la calidad de vida relacionada con la salud, un indicador de bienestar emocional.
A continuación se recogen los artículos de investigación publicados por el equipo HBSC en esta temática.

Adopted Adolescents at School: Social Support and Adjustment.

       Paniagua, C., García-Moya, I., Moreno, C. (2020)

Youth & Society.

JCR (2019): SOCIAL ISSUES (18 DE 42). Q2 / SOCIAL SCIENCES, INTERDISCIPLINARYCIAL (35 de 104). Q2 / SOCIOLOGY (54 de 148). Q2
FI: 1.794

Enlace
Abstract: There is a need of additional research into the social aspects of adoptees’ school experiences. For that purpose, the present study used a sample of adopted (n = 541) and non-adopted (n = 582) adolescents from the Health Behavior in School-aged Children (HBSC) study in Spain. Specifically, we analyzed social support at school (from classmates and teachers), explored adjustment differences between domestic adoptees, intercountry adoptees, and non-adopted adolescents, and examined whether adoption status and adjustment problems explain potential differences in support from teachers and from classmates. Results showed more difficulties in domestic adoptees than in the other two groups. Furthermore, differences were found in the role of adoption status and adjustment problems in classmate and teacher support: once conduct problems were taken into account, the association between adoption status and classmate support became non-significant. In contrast, both conduct problems and adoption status were significant factors associated with lower teacher support.
Bullying and its Influence on Well-Being in Adopted Adolescents.
       Paniagua, C., Moreno, C., Sánchez-Queija, I., Rivera, F. (2020)
Journal of Child and Family Studies.
JCR (2019): FAMILY STUDIES (24 Of 47). Q3 / PSYCHOLOGY, DEVELOPMENTAL (59 OF 77): Q4 / PSYCHIATRY (99 OF 141): Q3
FI: 1.310
Enlace
Abstract: Despite the large body of evidence on bullying, little attention has been paid to adoptees, who represent a population more vulnerable to experiencing problems in peer relationships and school adjustment. This study presents the results from the Spanish Health Behaviour in School-aged Children (HBSC) Study. We studied bullying among 251 adopted and 753 non-adopted adolescents aged between 11 and 15 years and its relationship with their well-being. We analyzed different roles (bully, victim, and bully-victim) and types of bullying (physical, verbal, relational, and cyberbullying). In addition, we explored possible differences concerning the type of adoption (domestic or intercountry). The results show that domestic adoptees usually experience more bullying, whereas intercountry adoptees showed no differences compared with non-adoptees. On the other hand, the relationship between bullying and well-being is virtually identical for both types of adoptees and non-adoptees. Thus, adoption alone does not seem to be a risk factor for bullying. It is the particular circumstances surrounding each type of adoption what can put adolescents at a greater risk. Teachers should consider paying special attention to instances of bullying involving domestic adoptees in order to improve their peer relationships.
Cross-National Time Trends in Adolescent Mental Well-Being From 2002 to 2018 and the Explanatory Role of Schoolwork Pressure.
    Cosma, A., Stevens, G., Martin, G., Duinhof, E. L., Walsh, S. D., Garcia-Moya, I., Költő, A. Gobina, I., Canale, N., Catunda, C., Inchley, J., de Looze, M. (2020)
Journal of Adolescent Health.
JCR (2019): PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH (30 OF 193): Q1 / PEDIATRICS (9 OF 128): Q1
FI: 3.900
Enlace
Abstract: Purpose: Previous research has shown inconsistent time trends in adolescent mental well-being, but potential underlying mechanisms for such trends are yet to be examined. This study investigates cross-national time trends in adolescent mental well-being (psychosomatic health complaints and life satisfaction) in mainly European countries and the extent to which time trends in schoolwork pressure explain these trends. Methods: Data from 915,054 adolescents from 36 countries (50.8% girls; meanage = 13.54; standard deviationage = 1.63) across five Health Behaviour in School-aged Children surveys (2002, 2006, 2010, 2014, and 2018) were included in the analyses. Hierarchical multilevel models estimated cross-national trends in adolescent mental well-being and schoolwork pressure. We also tested whether schoolwork pressure could explain these trends in mental well-being. Results: A small linear increase over time in psychosomatic complaints and schoolwork pressure was found. No change in life satisfaction emerged. Furthermore, there was large cross-country variation in the prevalence of, and trends over time in, adolescent mental well-being and schoolwork pressure. Overall, declines in well-being and increases in schoolwork pressure were apparent in the higher income countries. Across countries, the small increase in schoolwork pressure over time partly explained the increase in psychosomatic health complaints. Conclusions: Our findings do not provide evidence for substantial declines in mental well-being among adolescents. Yet, the small increase in mental well-being and increases in schoolwork pressure appear to be quite consistent across high-income countries. This calls for the attention of public health professionals and policy-makers. Country differences in trends in both adolescent mental well-being outcomes and schoolwork pressure were considerable, which requires caution regarding the cross-national generalization of national trends.
Intersectionality and Adolescent Mental Well-being: A Cross-Nationally Comparative Analysis of the Interplay Between Immigration Background, Socioeconomic Status and Gender.
       Kern, M. R., Duinhof, E. L., Walsh, S. D., Cosma, A., Moreno-Maldonado, C., Molcho, M., Currie, C., Stevens, G.W.J.M. (2020)
Journal of Adolescent Health.
JCR (2019): PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH (30 OF 193): Q1 / PEDIATRICS (9 OF 128): Q1
FI: 3.900
Enlace
Abstract: Purpose: Intersectionality theory highlights the importance of the interplay of multiple social group memberships in shaping individual mental well-being. This article investigates elements of adolescent mental well-being (life dissatisfaction and psychosomatic complaints) from an intersectional perspective. It tests mental well-being consequences of membership in combinations of multiple social groups and examines to what extent such intersectional effects depend on the national context (immigration and integration policies, national-level income, and gender equality). Methods: Using Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy, we assessed the role of the national context in shaping the interplay between immigration background, socioeconomic status, and gender, using data from 33 countries from the 2017/2018 Health Behaviour in School-aged Children survey. Results: We found no uniform intersectionality effects across all countries. However, when allowing the interplay to vary by national context, results did point toward some intersectional effects. Some aggravated negative effects were found for members of multiple disadvantaged social groups in countries with low levels of income equality and restrictive migration policies, whereas enhanced positive effects were found for members of multiple advantaged groups in these countries. Similarly, mitigated negative effects of membership in multiple disadvantaged groups were shown in countries with higher levels of income equality and more inclusive migration policies, whereas mitigated positive effects were found for multiply advantaged individuals. Although for national-level gender equality results pointed in a similar direction, girls' scores were counterintuitive. High national-level gender equality disproportionately benefitted groups of disadvantaged boys, whereas advantaged girls were doing worse than expected, and reversed effects were found for countries with low gender equality. Conclusions: To fully understand social inequalities in adolescent mental well-being, the interplay between individual-level and national-level indicators must be explored.
Factors associated with life satisfaction of adolescents living with employed and unemployed parents in Spain and Portugal: A person focused approach.
    Moreno-Maldonado, C., Jiménez-Iglesias, A., Camacho, I., Rivera, F., Moreno, C., & Matos, M. G. (2020).
Children and Youth Services Review.
JCR (2019): FAMILY STUDIES (18 de 46). Q2 / SOCIAL WORK (7 de 43). Q1
FI: 1.684
Enlace
Abstract: Family and friend relationships may have a protective effect against the negative consequences of parental unemployment. However, whereas some studies have shown positive effects of family and peer relationships for all adolescents, others suggest that vulnerable groups have more difficulty benefiting from the positive effects of these relationships. The aim of this work was: (1) to analyze the association of different factors (satisfaction with family and friends, age, sex, and country) with life satisfaction in four groups of adolescents created according to their parents’ employment status (both parents unemployed, unemployed mothers and employed fathers, unemployed fathers and employed mothers, and both parents unemployed); and (2) to examine differences between countries in the constellations of factors related to adolescents life satisfaction in each group. The sample was composed of 21,081 adolescents from Portugal and Spain (11–16 years old) who participated in the 2014 edition of the HBSC study in both countries. Classification tree Analyses for the first objective, and general linear model and mean comparisons for the second, were performed. Results showed that some factors were associated with high life satisfaction in the majority of the adolescents: high family and friend satisfaction, being male, being younger, and being Spanish. However, for adolescents with both parents unemployed, life satisfaction was associated only with family satisfaction and age. Sex- and country-based differences were significant in all adolescents with at least one employed parent, but were not significant in adolescents with both parents unemployed. Findings highlight that family satisfaction plays a fundamental role in adolescent life satisfaction —especially for those with both parents unemployed— and that cultural and sex differences disappear in vulnerable situations.
The Role of Body Image in Internalizing Mental Health Problems in Spanish Adolescents: An Analysis According to Sex, Age, and Socioeconomic Status.
    Ramos, P., Moreno-Maldonado, C., Moreno, C., & Rivera, F. (2019).
Frontiers in Psychology, 10:1952.
JCR (2018): PSYCHOLOGY, MULTIDISCIPLINARY (40 OF 137): Q2
FI: 2,129
Enlace
Abstract: During adolescence there is a relatively high prevalence of weight problems and eating disorders. Furthermore, body image plays an important role in weight control and eating behaviors as well as in mental health. This study analyses the influence of body mass index, perception of being overweight, and body image satisfaction (BIS) on internalizing symptoms related to mental health in adolescents. In addition, sex, age, socioeconomic status (SES), dieting, and physical activity are taken into consideration. This research is based on the international study Health Behaviour in School-aged Children (HBSC). The sample consists of 4531 Spanish adolescents from 13 to 18 years old. Participants were selected through random multi-stage sampling stratified by conglomerates. Two instruments were employed: the HBSC questionnaire and the Youth Self-Report (Achenbach System of Empirically Based Assessment, ASEBA). Results demonstrated that BIS –the emotional component related to body image– was the main predictor of adolescent internalizing symptoms. In addition, results show double-inequalities according to the interaction effects of sex, age, and SES. Likewise, interesting results are shown regarding how dieting behaviors to lose or gain weight/volume and physical activity relate to body image perception and satisfaction, as well as with internalizing symptoms. This study highlights important body image aspects relevant to intervention and prevention of internalized mental health problems in adolescence.
Direct and Indirect Influences of Objective Socioeconomic Position on Adolescent Health: The Mediating Roles of Subjective Socioeconomic Status and Lifestyles.
    Moreno-Maldonado, C., Ramos, P., Moreno, C., & Rivera, F. (2019).
International Journal of Environmental Research and Public Health, 16(9), 1637.
JCR (2018): ENVIRONMENTAL SCIENCES (112 OF 250): Q2, PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH (67 OF 185): Q2
FI: 2,468
Enlace
Abstract: The use of composite indices and subjective measures to evaluate socioeconomic position, taking into account the effect of inequalities on adolescent health-related behaviors, can contribute to understanding the effect of inequalities on health during adolescence. The aim of this study was to examine the direct and indirect contribution of objective and subjective socioeconomic factors in a broad range of health and lifestyles outcomes. The data come from a representative sample of adolescents (N = 15,340; M age = 13.69) of the Health Behavior in School-aged Children study in Spain. Structural equation modeling was used for data analysis. A global index for evaluating objective socioeconomic position predicted both health and healthy lifestyles. Subjective socioeconomic status mediated the relationship between objective socioeconomic position and health but did not have a significant effect on healthy lifestyles when objective indicators were considered. Lastly, fit indices of the multiple-mediator model—including the direct effect of objective socioeconomic position on health and its indirect effects through the subjective perception of wealth and lifestyles—explained 28.7% of global health variance. Interventions aimed at reducing the impact of health inequalities should address, in addition to material deprivation, the psychological and behavioral consequences of feeling poor.
Characterization of Resilient Adolescents in the Context of Parental Unemployment.
    Moreno-Maldonado, C., Jiménez-Iglesias, A., Rivera, F., & Moreno, C. (2019).
Child Indicators Research.
JCR (2018): SOCIAL SCIENCE, INTERDISCIPLINARY (39 OF 104): Q2
FI: 1,656
Enlace
Abstract: This research analyzes a group of Spanish adolescents at high risk of adversity –conceptualized as living in households with no employed parent– in one of the countries where unemployment rates have risen significantly due to the recent economic recession. The objective was to identify sociodemographic and contextual factors that promote resilience in this context. Using the Extreme Group Approach and the theoretical framework of resilience, two groups of adolescents living in households with no employed parent were selected from the HBSC-2014 edition in Spain depending on their adaptive response to the risk, measured by a global health score. Therefore, from a total sample of 1336 adolescents at high risk (living in households with no employed parent), 290 resilient adolescents (those who presented the highest scores in their global health score) and 618 maladaptive adolescents (those presenting lower scores in their global health score) were selected, resulting in a final sample composed of 908 adolescents aged 11–18 years old (M = 15.2; DT = 2.18), with a balanced representation of boys and girls. Results showed that support from, and satisfaction with, family and friend relationships, as well as support from classmates and teachers, and satisfaction with the school environment, are protective factors that can foster resilience when facing adversity provoked by parental unemployment and its negative consequences for adolescent health. Intervention programs aimed at reducing the negative impact of parental unemployment on adolescent health should consider these contextual factors, as well as individual factors such as age or sex.
The sources of support and their relation on the global health of adopted and non-adopted adolescents. 
Paniagua, C., Moreno, C., Rivera, F., & Ramos, P. (2019).
Children and Youth Services Review, bcy028
JCR (2018): FAMILY STUDIES (18 de 46). Q2 / SOCIAL WORK (7 de 43). Q1
FI: 1.684
Enlace
Abstract: Despite its importance, few studies have analysed the influence of social support on the global health of adoptees, especially during adolescence. Considering research claiming that the emotional and social development is one of the last areas to recover from an initial adversity in life, it would be expected that the influence of the social support received by adoptees would follow a different logic to that which characterises the normative population. The present study aims to analyse the roles of the family, friends, classmates and teachers and their relationship with global health, by exploring whether there are any differences between adoptees and non-adoptees. The sample consists of 28,768 adolescents aged between 11 and 18, who participated in the Spanish cross-sectional study Health Behaviour in School-Aged Children (HBSC) 2014. In this sample, 394 were adopted. The results show that family support is more relevant for adoptees than non-adoptees, and classmate and teacher support is more relevant for non-adoptees than adoptees. In addition, in the case of adopted adolescents, there is no direct relationship between the school context and their global health; instead, the relationship is mediated by family and friends support. 
Under the Same Label: Adopted Adolescents’ Heterogeneity in Well-Being and Perception of Social Contexts. 
Paniagua, C., Moreno, C., Román, M., Palacios, J., Grotevant, H. D., & Rivera, F. (2019).
Youth & Society, 1-25
JCR (2018): SOCIAL ISSUES (5 DE 42). Q1 / SOCIAL SCIENCES, INTERDISCIPLINARYCIAL (13 de 104). Q1 / SOCIOLOGY (22 de 148). Q1
FI: 2.523
Enlace
Abstract: This study compares a sample of 223 adopted adolescents with a nonadopted reference group representative of the Spanish adolescent population from the “Spanish Health Behaviour in School-Aged Children (HBSC) study.” Variables related to the family context, peers, school context, and emotional well-being are compared. Adoptees are not only analyzed as a group, but also according to the type of adoption (domestic or intercountry) and the birth area of origin (Asia, Latin America, and Eastern Europe). The results showed more similarities than differences between the whole group of adoptees and the reference group, as well as heterogeneity within the adoptees depending on their origin. 
Social inequality in adolescent life satisfaction: Comparison of measure approaches and correlation with macro-level indices in 41 countries.
Zaborskis, A. Grincaite, M., Lenzi, M., Tesler, R., Moreno-Maldonado, C., & Mazur, J. (2019).
Social Indicators Research, 141 (3), 1055–1079.
JCR (2018) SOCIAL SCIENCE, INTERDISCIPLINARY (35 OF 104): Q2, SOCIOLOGY (50 OF 148): Q2.
FI: 1,703
Enlace
Abstract: Family affluence plays a crucial role in adolescent well-being and is potential
source of health inequalities. There are scarce research findings in this area from a cross-
national perspective. This study introduces several methods for measuring family affluence
inequality in adolescent life satisfaction (LS) and assesses its relationship with macro-level
indices. The data  (N =192,718)  were collected in 2013/2014 in 39 European countries,
Canada,  and  Israel,  according  to the  methodology  of  the  cross-national Health  Behavior in
School-aged Children study. The 11-, 13- and 15-year olds were surveyed by means of
self-report  anonymous  questionnaires.  Fifteen  methods  controlling  for  confounders  were
tested to measure social  inequality in adolescent  LS. In each country,  all measures indi-
cated that adolescent from more affluent families showed higher satisfaction with their life
than did those from less affluent families. According to the Poisson regression estimations,
for instance, the lowest inequality in LS was found among adolescents in Malta, while the
highest inequality in LS was found among adolescents in Hungary. The ratio between the
mean values of LS score at the extreme highest and lowest family affluence levels (Relative
Index of Inequality) derived from the regression-based models distinguished for its posi-
tive correlation with the Gini index, and negative correlation with Gross National Income,
Human  Development  Index  and  the  mean  Overall  Life  Satisfaction  score.  The  measure
allows in-depth exploration of the interplay between individual and macro-socioeconomic
factors affecting adolescent well-being from a cross-national perspective.
Multidimensional poverty among adolescents in 38 countries: Evidence from the Health Behaviour in School-aged Children (HBSC) 2013/14 Study. 
Chzhen, Y., Bruckauf, Z., Toczydlowska, E., Elgar, F. J., Moreno-Maldonado, C., Stevens, G. W., ... & Gariépy, G. (2018).
Child Indicators Research, 11(3), 729–753.
JCR (2017) SOCIAL SCIENCES, INTERDISCIPLINARY (21 OF 98). Q1
FI: 1,858
Enlace
Abstract: This study applied UNICEF’s Multiple Overlapping Deprivation Analysis (MODA) framework to adolescents (aged 11, 13 and 15) in 37 European countries and Canada using data from the 2013/14 Health Behaviour in School-aged Children survey. It is one of the first applications of MODA based entirely on data collected from adolescents themselves rather than from household reference persons on their behalf. Unlike most other multidimensional child poverty studies, the present analysis focuses on non-material, relational aspects of child poverty. Substantial cross-country variation was found in the prevalence of adolescent deprivations in nutrition, perceived health, school environment, protection from peer violence, family environment and information access. These single dimensions of poverty did not closely relate to national wealth and income inequality. However, when we looked at deprivation in three or more dimensions (i.e., multidimensional poverty), we found association with income inequality. In most countries, girls were at a higher risk of multidimensional poverty than boys. In addition, adolescents who lived with both parents in the household or reported higher family wealth were consistently less poor than other adolescents, in both single and multiple dimensions. The results of this study show the interconnectedness of social (family, school support) and psychological (health and violence) dimensions of poverty for adolescents in higher income countries. Children poor in the domains of family and school environment are also likely to be poor in terms of perceived health and protection from peer violence. 
Prevalence of emergency contraceptive pill use among Spanish adolescent girls and their family and psychological profiles.
Jiménez-Iglesias, A., Moreno, C., García-Moya, I., & Rivera, F. (2018)
BMC women's health, 18(1), 67
JCR (2017): OBSTETRICS & GYNECOLOGY (51 OF 82), Q3
FI: 1.806
Enlace
Abstract: Background: Adolescent girls’ family context and psychological characteristics play important roles in their sexual behavior, including the use of the emergency contraceptive pill (ECP). This study aims to (1) determine the prevalence of ECP use among girls who have had sexual intercourse and (2) comparatively analyze their family and psychological profiles according to whether they have used ECPs. Methods: The sample of 1735 Spanish girls aged 15 to 18 came from a representative sample of the 2014 edition of the Health Behaviour in School-aged Children (HBSC) study. Of this sample, 398 girls had sexual intercourse and reported their ECP use. Data collection for the HBSC study was performed through an online questionnaire to which adolescents responded anonymously in school. Data analyses were descriptive and bivariate and were performed with the statistical program IBM SPSS Statistics 23. Results: The results demonstrated that 30.65% of girls who had sexual intercourse used ECPs. Noticeable differences in paternal knowledge and communication with the father were observed between girls who used the ECP at least once and those who did not use it. In contrast, differences between girls who used the ECP once and those who used it twice or more were pronounced with regard to parental knowledge, communication with parents, maternal affection, life satisfaction, sense of coherence and depression. Conclusions: This work demonstrates a high prevalence of ECP use and a more positive family and psychological profile for girls who used ECP once compared with those who used it twice or more.
Measuring the socioeconomic position of adolescents: A proposal for a composite index.
Moreno-Maldonado, C., Rivera, F., Ramos, P., & Moreno, C. (2018).
Social Indicators Research, 136(2), 517-538.
JCR (2017) SOCIAL SCIENCE, INTERDISCIPLINARY (27 OF 98) Q2, SOCIOLOGY (42 OF 147) Q2.
FI: 1,648
Enlace
Abstract: Despite evidence that socioeconomic inequalities impact health, studies on adolescents are limited and often show contradictory results depending on the measures employed to evaluate socioeconomic position. Little research has focused on the differential impact of each indicator on adolescent health, and few measures have been developed that provide a global evaluation. In this research, the relationship between classic socioeconomic indicators (education and occupation) and others that have been proposed more recently (family affluence scale and subjective family wealth) is analysed. A composite global score of socioeconomic position is also presented, based on the principal objective dimensions: parental education, parental occupation and family material wealth. Data were collected in Spain, in 2014, within the framework of the Health Behaviour in School-aged Children study, from a representative national sample of 8739 adolescents aged between 11 and 16 (mean = 13.72, SD = 1.71). The results contribute to resolving methodological difficulties associated with the evaluation of adolescent socioeconomic position, showing the unidimensionality of a global measure of objective wealth and demonstrating it to be a useful instrument for assessing the socioeconomic position in health inequalities research. The subjective perception of wealth presented a similar, and even higher, association with health than the objective measures. However, low correlations between perceived family wealth and the objective socioeconomic indicators (oscillating between .110 and .299) proved to measure a different construct, and thus was not included in the composite measure for assessing the adolescents’ objective socioeconomic position. Results highlighted the importance of including different indicators for measuring socioeconomic inequalities in adolescent health.
School Performance Paths: Personal and Contextual Factors Related to Top Performers and Low Achievers in Portugal and Spain. 
Simões, C., Rivera, F., Moreno, C., & Gaspar de Matos, M. (2018). 
 The Spanish Journal of Psychology, 21, E36.
JCR (2017) PSYCHOLOGY (71 OF 78). Q4
FI: 0.629
Enlace
Abstract: School performance is a critical aspect of adolescents’ lives. Several factors have an impact on school performance. The aim of this study is to analyse the relevant personal and contextual variables associated with top performance and low achievement in a sample of Portuguese and Spanish adolescent students. The sample included 1,564 adolescents, mean age 14 years old, and was collected from the HBSC (Health Behaviour in School-aged Children) survey. The questions in this study covered sociodemographic, health and wellbeing, health-related behaviours, family, school and peers. Results show that students with low performance more frequently have worse social-contextual and personal/health-related indicators, while the opposite is the case for top performers. Student-teacher relationships appeared as the most influential variable on school performance paths (χ2(2) = 328.11, p < .001), but other variables within families (e.g. mother studies, χ2(2) = 50.54, p < .001) and schools (e.g. liking the school, χ2(1) = 16.27, p < .001 and χ2(1) = 22.54, p < .01, in the low and high student-teacher relationship branches of a decision tree, respectively), as well as some health and wellbeing variables (e.g. health related-quality of life, χ2(2) = 53.58, p < .001, and χ2(2) = 63.86, p < .001, in the low and high student-teacher relationship branches, respectively) appeared significant in the paths.
Evaluación de las Representaciones Mentales de Apego a través de las Historias Incompletas: Aplicación Española de Story Stem Assessment Profile (SSAP).
M., Hodges, J., Palacios, J., Moreno, C., & Hillman, S. (2018). 
Revista Iberoamericana de Diagnóstico y Evaluación RIDEP, 46, 5-19. 
JCR (2016) PSYCHOLOGY, CLINICAL (121 OF 121). Q4
FI: 0,146 
Enlace
Abstract: Mental representations of attachment are one of the fundamental pillars of emotional functioning. This paper presents the Spanish use of the Story Stem Assessment Profile (SSAP) devised by Hodges et al. (2003) to assess mental representations of attachment in childhood using story stems. Two case studies are used to illustrate the procedure and two profiles derived from mental representations of attachment in a sample of 148 4-8 year-old children from three different groups (normative, adopted and institutionalized children) are identified. Results allow the comparison of the different groups and show the connections between attachment and social adjustment. Data attest the richness and usefulness of SSAP as a resource in psychological assessmen
The utility of salutogenesis for guiding health promotion: the case for young people's well-being.
García-Moya, I. & Morgan, A. (2017).
Health Promotion International 32(4):723-733.
JCR (2016) HEALTH POLICY & SERVICES, PUBLIC (37 OF 77), ENVIRONMENTAL & OCCUPATIONAL (70 OF 1570). Q2
FI: 1,722
Enlace
Abstract: Twenty years have passed since the publication of the seminal paper 'The salutogenic model as a theory to guide health promotion' (Health Promot Int 1996;11:11-18.), in which Antonovsky proposed salutogenesis and its central construct sense of coherence as a way of boosting the theoretical basis for health promotion activities. Since then there has been a notable amount of conceptual and empirical work carried out to further explore its significance. The aim of this paper is to critically assess the current theoretical status of salutogenesis and its utility to advance effective health promotion practice for young people. The assessment was carried out in the context of contemporary international policy agendas on well-being. An analytic framework was developed using the previous literature on the definition and function of theory. This organizing framework comprised four criteria: description, explanation, prediction and measurability. The paper concludes with a perspective on the status of salutogenesis as a theory and how it can be further developed. Specifically, the critical assessment highlighted that salutogenesis has been subjected to considerable empirical testing over the last few decades resulting in convincing evidence of the relevance and subsequent advancement of the idea. However, less emphasis seems to have been placed on a systematic process of testing and iteration to develop its theoretical basis. The paper identifies a number of aspects that should be developed to support the progression of salutogenesis to the next level. A research-practice cycle approach is proposed that can facilitate that important next step. 
Multidimensional poverty among adolescents in 38 countries: Evidence from the Health Behaviour in School-aged Children (HBSC) 2013/14 Study.
Chzhen, Y., Bruckauf, Z., Toczydlowska, E., Elgar, F. J., Moreno-Maldonado, C., Stevens, G. W., ... & Gariépy, G. (2017).
Child Indicators Research. Online first.
JCR (2016) SOCIAL SCIENCES, INTERDISCIPLINARY (36 OF 96). Q2
FI: 1,194
Enlace
Abstract: This study applied UNICEF’s Multiple Overlapping Deprivation Analysis (MODA) framework to adolescents (aged 11, 13 and 15) in 37 European countries and Canada using data from the 2013/14 Health Behaviour in School-aged Children survey. It is one of the first applications of MODA based entirely on data collected from adolescents themselves rather than from household reference persons on their behalf. Unlike most other multidimensional child poverty studies, the present analysis focuses on non-material, relational aspects of child poverty. Substantial cross-country variation was found in the prevalence of adolescent deprivations in nutrition, perceived health, school environment, protection from peer violence, family environment and information access. These single dimensions of poverty did not closely relate to national wealth and income inequality. However, when we looked at deprivation in three or more dimensions (i.e., multidimensional poverty), we found association with income inequality. In most countries, girls were at a higher risk of multidimensional poverty than boys. In addition, adolescents who lived with both parents in the household or reported higher family wealth were consistently less poor than other adolescents, in both single and multiple dimensions. The results of this study show the interconnectedness of social (family, school support) and psychological (health and violence) dimensions of poverty for adolescents in higher income countries. Children poor in the domains of family and school environment are also likely to be poor in terms of perceived health and protection from peer violence. 
Social support from developmental contexts and adolescent substance use and well-being: A comparative study of Spain and Portugal.
Jiménez-Iglesias, A., Camacho, I., Rivera, F., Moreno, C. y Matos, M. G. (2017).
The Spanish Journal of Psychology, 20, e64
JCR (2016) PSYCHOLOGY (70 OF 77). Q4
FI: 0,502
Enlace
Abstract: The aim of this study was to analyse the contribution of social support from family, friend and school (teacher and classmate) contexts in substance use (tobacco and alcohol use) and well-being (life satisfaction and health-related quality of life). Participants were 5,784 Portuguese and 22,610 Spanish adolescents aged 11 to 16 years, from the 2014 edition of the Health Behavior in School-aged Children (HBSC) study in Portugal and Spain. Results showed that for a higher life satisfaction, family (p < .001, partial η2 = .032), teacher (p < .001, partial η2 = .018) and classmate (p < .001, partial η2 = .031) support were important in Portugal, and family (p < .001, partial η2 = .056) and friend (p < .001, partial η2 = .015) support in Spain. Similarly, for a better health-related quality of life, all the social support variables were relevant in Portugal (family: p < .001, partial η2 = .063; teacher: p < .001, partial η2 = .032; classmate: p < .001, partial η2= .054; friend: p < .001, partial η2 = .034) and in Spain (family: p < .001, partial η2 = .054; teacher: p < .001, partial η2 = .014; classmate: p < .001, partial η2 = .018; friend: p < .001, partial η2 = .040). In contrast, only family support (p < .001, partial η2 = .014) was relevant in Portugal for tobacco use. Therefore, social support was more relevant for adolescent well-being than for adolescent substance use, and the most relevant source of support was family support, in both Spain and Portugal.
Communication in single- and two-parent families and their influence on Portuguese and Spanish adolescents’ life satisfaction.
Camacho, I., Jiménez-Iglesias, A., Rivera, F., Moreno, C. y Matos, M. G. (2017).
Journal of Family Studies
JCR (2016) FAMILY STUDIES (30 OF 43). Q3
FI: 0,690
Enlace
Abstract: The aim of this study was to analyse the influence of family type on communication with parents and family, as well as to analyse the contribution of communication in single- and two-parents families to adolescent life satisfaction in Portugal and Spain. Methodology: Participants were 5005 Portuguese and 21,423 Spanish adolescents aged 11–16 years, from the 2014 edition of the Health Behaviour in School-aged Children study in Portugal and Spain. Results: Results showed that communication with parents and communication with family, in general, were higher in two-parent families than in single-parent families and was relevant to predict adolescent life satisfaction from single- and two-parent families in Portugal and Spain. Conclusion: The results prove that communication with family is essential to predict life satisfaction in both countries. It is important to work on improving conditions of family life, as well as to implement programmes that promote better communication between all family members, especially in single-parent families. 
Parent-child relationships and adolescents’ life satisfaction across the first decade of the new millennium.
Jiménez-Iglesias, A., García-Moya, I. y Moreno, C. (2017).
Family Relations, 66(3), 512-526
JCR (2016) FAMILY STUDIES (21 OF 43), SOCIAL WORK (11 OF 42). Q2
FI: 1,426
Enlace
Abstract: To examine whether changes occurred in parent–child relationships (maternal and paternal affection, ease of communication with the mother and father, maternal and paternal knowledge, and family activities) between 2002 and 2010 in boys and girls and to examine the contributions of these family dimensions to life satisfaction. Background: Although parent–child relationships may be affected by social change, there are few investigations of change in parent–child relationships over time. Method: The sample consisted of 46,593 adolescents between 11 to 18 years of age who participated in the 2002, 2006, or 2010 editions of the Health Behaviour in School-aged Children (HBSC) study in Spain. Trend analysis including univariate analyses of variance (ANOVAs) and factorial ANOVAs were conducted separately for boys and girls, and effect size tests were calculated. Results: Communication with fathers and family activities statistically increased across HBSC editions and parent–child relationships were positively associated with life satisfaction across the examined period. Conclusion:There were small positive changes in some family dimensions, and some of them were increasingly important for adolescent life satisfaction over time. Implications: Interventions for strengthening parent–child relationships and promoting adolescent well-being should include mothers and fathers and emphasize affection, communication, and family activities.. 
Emotional and psychosocial factors associated with drunkenness and the use of tobacco and cannabis in adolescence: Independent or interactive effects?
García-Moya, I., Ortiz Barón, M. J, y Moreno, C. (2017).
Substance Use & Misuse, 52(8), 1039-1050
JCR (2016) SUBSTANCE ABUSE (26 OF 34) Q4.
FI: 1,234
Enlace
Abstract: BACKGROUND: Although previous research has examined emotional and psychosocial factors associated with substance use, there is a paucity of studies examining both at the same time, and insufficient attention has been paid to how these factors may interact. OBJECTIVES: The aim of this study was to simultaneously examine the contributions from emotional (emotional control and depression) and psychosocial (peers' conventional behavior, peers' substance use and parent-child relationships) factors to drunkenness and the use of tobacco and cannabis in adolescence. METHODS: Sample consisted of 1,752 adolescents aged 15 to 16 years who had participated in the 2014 edition of the WHO Health Behaviour in School-aged Children survey in Spain. Data were collected by means of anonymous online questionnaires, and hierarchical multiple regression models (with sex and age as controls and including interactions among the examined predictors) were used for statistical analysis. RESULTS: Emotional and psychosocial factors showed significant interactive effects on substance use. Emotional control, which tended to buffer the effects of potential risk factors, and peers' substance use were consistent predictors of substance use. In contrast, the role of other factors depended on the substance under study, with depression and peers' conventional behavior being part of interactive terms for tobacco use and cannabis use only, and the quality of parent-child relationships being absent from the final model on cannabis use. Conclusions/Importance: Exploring interactions and potential substance-specific effects is fundamental to reach a better understanding of how emotional and psychosocial factors work in concert relative to substance use in adolescence. 
The contribution from relationships with parents and teachers to the adolescent sense of coherence (SOC). Do prosociality and hyperactivity-inattention also play a significant role?
García-Moya, I., Jiménez-Iglesias, A. y Moreno, C. (2017) 
Young, 25(4), 391–406.
JJCR (2016) SOCIAL SCIENCE, INTERDISCIPLINARY (61 OF 96) Q3, SOCIOLOGY (94 OF 143) Q3.
FI: 0,707
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Abstract: Sense of coherence (SOC) is receiving increasing attention from a number of disciplines interested in the study of adolescent positive development. Given the significant links between SOC and well-being, attention is now moving to the precursors of SOC. The aim of this study was to analyze the contribution of relationships with parents and teachers (contextual factors) to young people’s SOC while taking into account the potential role of individual differences in prosociality and hyperactivity-inattention (individual factors). The sample consisted of 2,979 adolescents aged 15–18 who had participated in the 2010 edition of the World Health Organization (WHO) survey ‘Health Behaviour in School-aged Children’ (HBSC) in Spain. Data were collected by means of anonymous online questionnaires, and statistical analyses included factorial analysis of variance (ANOVA) and analysis of covariance (ANCOVA). Both contextual and individual factors made significant contributions to the adolescents’ SOC. Importantly, the significance of relationships with parents and teachers remained once prosociality and hyperactivity-inattention were taken into account. 
Measuring the socioeconomic position of adolescents: A proposal for a composite index.
Moreno-Maldonado, C., Rivera, F., Ramos, P., & Moreno, C. (2017).
Social Indicators Research. 136(2), 517-538.
JCR (2016) SOCIAL SCIENCE, INTERDISCIPLINARY (15 OF 96) Q1, SOCIOLOGY (31 OF 143) Q1.
FI: 1,743
Enlace
Abstract: Despite evidence that socioeconomic inequalities impact health, studies on adolescents are limited and often show contradictory results depending on the measures employed to evaluate socioeconomic position. Little research has focused on the differential impact of each indicator on adolescent health, and few measures have been developed that provide a global evaluation. In this research, the relationship between classic socioeconomic indicators (education and occupation) and others that have been proposed more recently (family affluence scale and subjective family wealth) is analysed. A composite global score of socioeconomic position is also presented, based on the principal objective dimensions: parental education, parental occupation and family material wealth. Data were collected in Spain, in 2014, within the framework of the Health Behaviour in School-aged Children study, from a representative national sample of 8739 adolescents aged between 11 and 16 (mean = 13.72, SD = 1.71). The results contribute to resolving methodological difficulties associated with the evaluation of adolescent socioeconomic position, showing the unidimensionality of a global measure of objective wealth and demonstrating it to be a useful instrument for assessing the socioeconomic position in health inequalities research. The subjective perception of wealth presented a similar, and even higher, association with health than the objective measures. However, low correlations between perceived family wealth and the objective socioeconomic indicators (oscillating between .110 and .299) proved to measure a different construct, and thus was not included in the composite measure for assessing the adolescents’ objective socioeconomic position. Results highlighted the importance of including different indicators for measuring socioeconomic inequalities in adolescent health. 
Revisión teórica de trabajos realizados dentro del marco del estudio HBSC en España sobre el conocimiento parental en la adolescencia.
Jiménez-Iglesias, A. y Moreno, C. (2016).
Apuntes de Psicología, 34(2-3), 171-176.
JSM (2015) PSYCOLOGY (923 OF 1027), Q4.
Enlace
Abstract: El conocimiento parental es una dimensión familiar relevante en la etapa evolutiva de la adolescencia. Esta dimensión familiar ha sido uno de los objetos de análisis dentro del equipo español del estudio Health Behaviour in School-aged Children (HBSC). El objetivo de este trabajo es realizar una revisión teórica de los principales trabajos publicados y llevados a cabo dentro del estudio HBSC en España en relación con el conocimiento parental. Estos trabajos han permitido estudiar la evolución del conocimiento parental en diferentes ediciones 2002, 2006, 2010 y 2014 del estudio HBSC, analizar las dimensiones familiares implicadas en que padres y madres consigan conocimiento sobre sus hijos e hijas adolescentes y examinar las posibles repercusiones del conocimiento parental sobre el consumo de sustancias y el bienestar de los chicos y las chicas adolescentes. Por tanto, estos trabajos han contribuido a ampliar el conocimiento científico y aportar interesantes implicaciones prácticas en torno al conocimiento parental en la adolescencia.  
Indicadores para detectar y evaluar el impacto de las desigualdades socioeconómicas en los estilos de vida y la salud de los adolescentes españoles.
Moreno-Maldonado, C., Moreno, C. y Rivera, F. (2016).
Apuntes de Psicología, 34(2-3),177-188
JSM (2015) PSYCOLOGY (923 OF 1027), Q4.
Enlace
Abstract: En este estudio se comparan distintos indicadores socioeconómicos en cuanto a su capacidad para predecir desigualdades en la salud y los estilos de vida de la población adolescente. Los resultados muestran que la relación entre los diferentes indicadores socioeconómicos, a pesar de ser significativa, es débil, sugiriendo que cada uno evalúa en cierto grado aspectos distintos del constructo socioeconómico. Además, mientras que el nivel educativo de los progenitores, y especialmente el nivel educativo de las madres, es la variable que muestra mayor capacidad para detectar desigualdades en los estilos de vida adolescentes, la percepción subjetiva de riqueza se revela como el predictor más importante de las desigualdades en salud. Adicionalmente, los resultados de este estudio muestran que no todas las conductas relacionadas con los estilos de vida adolescente y su bienestar están igualmente influenciadas por determinantes socioeconómicos. De esta forma, mientras que las conductas relacionadas con los hábitos de alimentación o la salud adolescente se ven fuertemente influidas por factores socioeconómicos, el efecto de las desigualdades es menos claro en conductas tales como el consumo de tabaco y alcohol. Esta investigación subraya la importancia de la elección de un determinado indicador en estudios que evalúan los efectos de las desigualdades socioeconómicas en los estilos de vida y la salud adolescente. 
When foster care is called “home”: Risk and protective issues.
Camacho, I., Matos, M. G., Mota, C., Tomé, G., Reis, M., & Jiménez-Iglesias, A. (2016).
British Journal of Education, Society & Behavioural Science, 15(3), 1-12.
Revista nueva que ha iniciado los trámites para ser indexada en ISI/JCR y PubMed.
Enlace
Abstract: Aim: The aim of this study was to understand in depth the differences that exist between adolescents in foster care and adolescents living with their families (living with mother and father; living with mother or father; living with mother and stepfather; living with father and stepmother). Methodology: The Portuguese HBSC survey included 6026 students (47.7% were boys). Results: Adolescents in foster care when compared with their peers, show more risk behaviours such as: smoking, being drunk and being more violent. These adolescents often report that they are sad, nervous and angry, are more frequently worried, and practice less physical activity. Conclusion: Health promotion interventions with adolescents in foster care, similarly to those living in different types of family structures are important because they may prevent risk behaviours and promote health and well-being.  . 
Characterization of vulnerable and resilient Spanish adolescents in their developmental contexts.
Moreno, C., García-Moya, I., Rivera, F., & Ramos, P., (2016).
Frontiers in Psychology, 7: 983
JCR (2015): PSYCHOLOGY, MULTIDISCIPLINARY (29 OF 129). Q1
FI: 2,463
Enlace
Abstract: Research on resilience and vulnerability can offer very valuable information for optimizing design and assessment of interventions and policies aimed at fostering adolescent health. This paper used the adversity level associated with family functioning and the positive adaptation level, as measured by means of a global health score, to distinguish four groups within a representative sample of Spanish adolescents aged 13–16 years: maladaptive, resilient, competent and vulnerable. The aforementioned groups were compared in a number of demographic, school context, peer context, lifestyles, psychological and socioeconomic variables, which can facilitate or inhibit positive adaptation in each context. In addition, the degree to which each factor tended to associate with resilience and vulnerability was examined. The majority of the factors operated by increasing the likelihood of good adaptation in resilient adolescents and diminishing it in vulnerable ones. Overall, more similarities than differences were found in the factors contributing to explaining resilience or vulnerability. However, results also revealed some differential aspects: psychological variables showed a larger explicative capacity in vulnerable adolescents, whereas factors related to school and peer contexts, especially the second, showed a stronger association with resilience. In addition, perceived family wealth, satisfaction with friendships and breakfast frequency only made a significant contribution to the explanation of resilience. The current study provides a highly useful characterization of resilience and vulnerability phenomena in adolescence. 
Youth mental health in Portugal, Italy and Spain: Key challenges for improving well-being.
Gaspar, M., Tomé, G., Gaspar, T., Cicognani, E., & Moreno, C. (2016).
The European Health Psychologist, 18(3), 128-133.
JCR (2015): PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH (114 OF 165). Q3
FI: 1,186
Enlace
Abstract: Families are the first social context and are of fundamental importance in the development and wellbeing of children and adolescents that is now a widely documented evidence. Parents influence their children by genetic inheritance and particularly by behavioral inheritance, modeling and parenting style. It is known that both neglectful parents as more overprotective, or authoritarian parents, or even worst abusive parents, can cause very negative consequences in the potential, development and wellbeing of children and adolescents. It is known that being a parent is a unique challenge due to the difficulty, but also in general, for the gratification. None is taught to be parents and, as Kundera said, the life of every day is both the “rehearsal” and the “performance” itself. It is known that in times of crisis, conflict, insecurity, children are multiply affected: directly by difficulties, by their attention to the concerns of parents, because parents do not have the same availability to them, because the parents are themselves affected, these effects can have dramatic effects on the daily life of the family.S o what else can be said about families? What is the best way to include parents as partners in the activities of education, health and social security professionals, -being useful and effective while respecting the family cultures? 
Novas e antigas dinâmicas familiares: influência no bem-estar dos adolescentes e seus cuidadores.
Gaspar De Matos, M., Leandro, A., Machado, M.C., Leal, I., Vilar, D., Gonçalves, C., Moreno, C., Schmidlin-Löhr, S. (2015).
. Journal of Child and Adolescent Psychology, 6(1), 15-34.
JCR (2014): PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH (114 OF 165). Q3
FI: 1,186
Enlace
Abstract: Que a família é o primeiro contexto social e tem importância fundamental no desenvolvimento e bem estar das crianças e adolescentes, já está amplamente documentado. Os pais influenciam os filhos, pela herança genética e muito particularmente pela herança comportamental, modelagem e estilo parental. Sabemos que tanto pais negligentes como mais superprotectores , ou ainda pais autoritários, (sem falar de pais abusadores), podem acarretar consequências muito negativas no potencial, no desenvolvimento e no bem estar de crianças e adolescentes. Sabemos que ser pai e mãe é um desafio único pela dificuldade, mas também, em geral, pela gratificação. Não somos ensinados a ser pais e, como dizia Kundera, também neste caso a vida de todos os dias é ao mesmo tempo o “ensaio geral” e a própria “performance”. Sabemos que em tempo de crise, de conflito, de precaridade , os filhos são multiplamente afectados: directamente pelas dificuldades, pela sua preocupação com as preocupações dos pais, porque os pais não tem a mesma disponibilidade para eles, porque os pais ficam eles próprios afectados, podendo estes efeitos ter repercussões dramáticas no dia a dia da família. Então o que mais pode ser dito sobre as famílias? Qual o melhor modo de se incluir os pais como parceiros nas acções dos técnicos de educação, saúde e segurança social, e conseguir-se assim ser útil e eficaz respeitando as culturas famíliares? 
La influencia de las diferencias entre el padre y la madre sobre el ajuste adolescente.
Jiménez-Iglesias, A. & Moreno, C. (2015).
Anales de Psicología, 31(1), 367-377.
JCR (2015): PSYCHOLOGY, MULTIDISCIPLINARY (99 OF 129). Q4
FI: 0,574
Enlace
Abstract: This paper analyzes how the differences between father and mother in affection, promotion of autonomy, disclosure, solicitation and knowledge influence on substance use (tobacco, alcohol and cannabis) and psychological well-being (health-related quality of life and life satisfaction). The sample was composed of 10170 boys and girls aged 13 to 18 years from two-parent families who participated in 2006 edition of Health Behaviour in School-aged Children (HBSC) study. Results indicated that adolescents whose both parents had high values for the different family dimensions used less substance and scored higher in psychological well-being. In contrast, the adjustment of adolescents whose both parents had low values for the different family dimensions was worse. Specifically, the most important dimension for substance use was parental knowledge and for psychological well-being was parental affection; adolescent disclosure was only relevant for alcohol use and quality of life, and parental promotion of autonomy for quality of life.
Subjective well-being in adolescence and teacher connectedness: A health asset analysis.
García-Moya, I., Brooks, F., Morgan, A. & Moreno, C. (2015).
Health Education Journal, 74(6), 641-654.
JCR (2014): EDUCATION & EDUCATIONAL RESEARCH (100 OF 224). Q2 / PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH (112 OF 147) Q4
FI: 0,821
Enlace
Abstract: Teacher connectedness is an important factor for young people’s well-being. The aim of this paper was to examine teacher connectedness in detail and its potential association with emotional well-being. More specifically, we set out to analyse whether teacher connectedness acted as a universal asset for boys and girls of different ages and countries as well as across adolescents with differing perceptions of their performance at school. Methods: The study sample consisted of 9,444 young people aged 11, 13 and 15 years who had taken part in the World Health Organization (WHO) collaborative survey Health Behaviour in School-aged Children in Spain and England. After examining differences in teacher connectedness associated with demographic factors, we used general linear models to analyse the relationship between teacher connectedness and emotional well-being (including interaction teacher connectedness by country) across different age and performance-derived groups. Results: Results indicated some significant differences in teacher connectedness associated with age, country and perceived performance, but a consistent positive association between teacher connectedness and emotional well-being regardless of demographic factors, country and perceptions of school performance. Older adolescents and low achievers reported lower level of connectedness to their teachers, but the association between teacher connectedness and emotional well-being operated irrespective of adolescents’ age and perceived performance at school. Conclusion: Results support the perspective that teacher connectedness can act as a significant health asset that operates irrespective of key demographic factors, while they point to some inequalities in teacher connectedness associated with age and performance at school. These findings have significant implications for health promotion interventions. 
What family dimensions are important for health-related quality of life in adolescence?
Jiménez-Iglesias, A., Moreno, C., Ramos, P. y Rivera, F. (2015).
Journal of Youth Studies, 18(1), 53-67.
JCR (2015): SOCIAL SCIENCES, INTERDISCIPLINARY (40 OF 95). Q2
FI: 0,973
Enlace
Abstract: Adolescence is a relevant life stage in which to study a global well-being measure, health-related quality of life, in order to analyse the impact of important determinants in adolescents' health-related quality of life (e.g., the quality of family relationships). This study aimed to examine the impact of several family dimensions (parental affection, parental promotion of autonomy, family activities, adolescent disclosure, parental solicitation and parental knowledge) on adolescents' health-related quality of life. Additionally, this study investigated whether demographic variables (adolescents' gender and age) influenced health-related quality of life and moderated the relationship between family dimensions and health-related quality of life. The sample was composed of 14,825 adolescents, aged 13–14, 15–16, and 17–18, from the 2006 edition of Spain's Health Behaviour in School-aged Children study. The results showed that parental promotion of autonomy, family activities and especially parental affection were the most important dimensions influencing health-related quality of life. Boys reported higher health-related quality of life than girls, and younger adolescents reported higher health-related quality of life than older adolescents. The discussion explains how the aforementioned family dimensions encourage better health-related quality of life in adolescents. 
Obtaining a hierarchy of contextual factors in shaping the sense of coherence of male and female adolescents.
García-Moya, I., Moreno, C. & Rivera, F. (2014). 
Journal of Happiness Studies, 15, 1267-1287.
JCR: PSYCHOLOGY, MULTIDISCIPLINARY (42 OF 129). Q2 / SOCIAL SCIENCES, INTERDISCIPLINARY (17 OF 97). Q1
FI: 1,683
Enlace
Abstract: Sense of coherence (SOC) is an important predictor of health and subjective well-being, but research on the factors that shape SOC development is scarce. Using structural equation modeling, this study obtained a hierarchy of the contributions of several contextual factors to SOC in a representative sample of adolescents (N = 4,943, M age = 15.43) selected for the Health Behaviour in School-aged Children survey in Spain. Goodness-of-fit indices consistent with good fit, logical parameter estimates and a level of explained variability of 38.2 % were found in the final model. The examination of parameter estimates provided a hierarchy of contextual factors in shaping SOC. Quality of parent–child relationships was the most influential factor and appeared at the top of the hierarchy. Positive models of behavior in the peer group, neighborhood assets and classmate support occupied intermediate positions, and teacher support appeared at the bottom of the hierarchy. Multi-group analysis revealed more commonalities than differences between male and female adolescents, with the exception of teacher support, which seemed to have a higher significance for the SOC of females. 
Bullying Victimization Prevalence and Its Effects on Psychosomatic Complaints. Can Sense of Coherence Make a Difference?
García-Moya, I., Suominen, S. & Moreno, C. (2014).
Journal of School Health, 84(10), 646-653
JCR: EDUCATION, SCIENTIFIC DISCIPLINES (11 OF 37). Q2 / HEALTH CARE SCIENCES & SERVICES (57 OF 88). Q3 / PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH (92 OF 165). Q3
FI: 1,434
Enlace
Abstract: Background: The aim of this study was to examine the prevalence of bullying victimization and its impact on physical and psychological complaints in a representative sample of adolescents and to explore the role of sense of coherence (SOC) in victimization prevalence and consequences. Methods: A representative sample of Spanish adolescents (N = 7580, mean age = 15.41) was selected as part of the Health Behaviour in School-aged Children study. Bullying victimization, physical and psychological symptoms, and SOC were measured, and comparisons were made between strong- and weak-SOC adolescents regarding their likelihood of being a victim of bullying and the negative effects of bullying victimization on their health. Results: Weak-SOC adolescents were significantly more likely to suffer from bullying victimization regardless of type (nonphysical vs physical and nonphysical) or means (traditional vs cyberbullying). In addition, bullying victimization showed significant increasing effects on weak-SOC adolescents' physical and psychological symptoms whereas in strong-SOC adolescents it was not significantly associated with increases in physical complaints and its effects on psychological complaints seemed to be weaker. Conclusions: Weak-SOC adolescents seem to be at higher risk of becoming bullying victims and victimization experiences appear to have increased negative effects on them when compared to strong-SOC students. 
Sense of coherence and biopsychosocial health in Spanish adolescents.
García-Moya, I., Moreno, C., & Rivera, F. (2013).
The Spanish Journal of Psychology, 16(1), 1138-7416.
JCR: MULTIDISCIPLINARY PSYCHOLOGY (81 OF 129). Q3
FI: 0,706
Enlace
Abstract: The aim of this study was to analyse the effect of the SOC on the main components of biopsychosocial health separately, thereby contributing to a better understanding of the relationship between the SOC and health in adolescence. The sample consisted of 7,580 Spanish adolescents aged 13 to 18 who had participated in the 2009/10 edition of the WHO international survey Health Behaviour in School-aged Children. Using multivariate analysis of variance, the effects of the SOC and demographic variables (including interaction effects between them) on different health components were analysed. A higher SOC was associated with better self-rated health, lower frequency of somatic and psychological complaints and higher quality of life and life satisfaction. Thus, results support the association between SOC and positive health outcomes, especially for the psychological components of health. In addition, the effect of SOC on the various health components was homogeneous among all of the adolescents, regardless of gender and age. 
Neighbourhood perceptions and sense of coherence in adolescence.
García-Moya, I., Moreno, C. y Braun-Lewensohn, O. (2013).
The Journal of Primary Prevention, 34(5), 371-379.
JCR: PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH (78 OF 136). Q3.
FI: 1,250
Enlace
Abstract: The neighbourhood has traditionally been neglected in studies about adolescents’ sense of coherence (SOC). The current study represents the first attempt to analyse the associations between neighbourhood assets, neighbourhood risks, and SOC during adolescence. The sample consisted of 7,580 Spanish adolescents aged 13–18 who were selected for the 2009/10 edition of the Health Behaviour in School-aged Children (HBSC) survey in Spain. The adolescents completed self-report questionnaires that included the SOC-29 scale and separate HBSC scales measuring neighbourhood risks and assets. The results showed that neighbourhood risks were negatively associated with the adolescents’ SOC. In contrast, neighbourhood assets, especially relationships with significant adults, were positively associated with the adolescents’ SOC. Assets explained 6.5 % of the variability in SOC scores after controlling for risks, suggesting that assets may play a significant role, even in neighbourhoods where risks are present. We discuss implications and future research directions. 
Developmental contexts and sense of coherence in adolescence: a systematic review.
Rivera, F., García-Moya, I., Moreno, C. y Ramos, P. (2013).
Journal of Health Psychology, 18(6), 800-812.
JCR: CLINICAL PSYCHOLOGY (50 OF 111). Q2
FI: 1,826
Enlace
Abstract: The salutogenic model has led to revolutionary changes in the study of health. In recent years, a large amount of research has been carried out on the relationship between sense of coherence and health, but relatively little is known about sense of coherence in adolescence. This study is a systematic review of the studies that looked at sense of coherence in adolescent samples. Valuable information is provided regarding the characteristics of the samples, the reliability of the sense of coherence scale versions, the influence of demographic variables and how family, school, peers and neighbourhood impact sense of coherence development. Furthermore, future directions for the study of sense of coherence inadolescence are provided. 
Understanding the joint effects of family and other developmental contexts on the sense of coherence (SOC): A person-focused analysis using the Classification Tree.
García-Moya, I., Moreno, C. & Jiménez-Iglesias, A. (2013).
Journal of Adolescence, 36(5), 913-923.
JCR: DEVELOPMENTAL PSYCHOLOGY (34 OF 65). Q3
FI: 1,638
Enlace
Abstract: Using a person-focused approach, the present study sought to identify meaningful constellations of contextual factors that led to predominantly high and low levels of sense of coherence (SOC). Specifically, the contributions of the quality of parent-child relationships, teacher and classmate support, models of behaviour in the peer group, and neighbourhood assets were examined in a representative sample of Spanish adolescents aged 13 to 18 that had taken part in the 2010 edition of the study Health Behaviour in School-aged Children. The quality of parent-child relationships emerged as the main predictor of SOC for the whole sample, but the remaining factors also made significant contributions, which underlines the importance of the simultaneous analysis of the main contexts in adolescents' lives. Additionally, the identified constellations usually included compensatory effects, so no factor should be considered to be completely determining. Interestingly, the role of support at school was different depending on contextual profiles. 
Physical activity and self-reported health status among adolescents: a cross-sectional population-based study.
Galán, I., Boix, R., Medrano, M.J., Ramos, P., Rivera, F., Pastor-Barriuso, R., & Moreno, C. (2013).
BMJ Open 2013; 3:e002644
JCR: GENERAL AND INTERNAL MEDICINE (43 OF 150 IN SCIENCE CITATION INDEX). Q2
FI: 2,063
Enlace
Abstract: Objectives: Little is known about the dose-response relationship between physical activity and health benefits among young people. Our objective was to analyse the association between the frequency of undertaking moderate-to-vigorous physical activity (MVPA) and the self-reportedhealth status of the adolescent population. Design: Cross-sectional study. Setting: All regions of Spain. Participants: Students aged 11-18 years participating in the Spanish Health Behaviour in School-aged Children survey 2006. A total of 375 schools and 21 188 students were selected. Main outcomes: The frequency of undertaking MVPA was measured by a questionnaire, with the following four health indicators: self-ratedhealth, health complaints, satisfaction with life and health-related quality of life. Linear and logistic regression models were used to analyse the association, adjusting for potential confounding variables and the modelling of the dose-response relationship. Results: As the frequency of MVPA increased, the association with health benefits was stronger. A linear trend (p<0.05) was found for self-ratedhealth and health complaints in males and females and for satisfaction with life among females; for health-related quality of life this relationship was quadratic for both sexes (p<0.05). For self-reported health and health complaints, the effect was found to be of greater magnitude in males than in females and, in all scales, the benefits were observed from the lowest frequencies of MVPA, especially in males. Conclusions: A protective effect of MVPA was found in both sexes for the four health indicators studied, and this activity had a gradient effect. Among males, health benefits were detected from very low levels of physical activity and the magnitude of the relationship was greater than that for females.. 
Sense of coherence and substance use in Spanish adolescents. Does the effect of SOC depend on patterns of substance use in their peer group?
García-Moya, I., Jiménez-Iglesias, A., & Moreno, C. (2013).
Adicciones, 25(2), 109-117.
JCR: SUBSTANCE ABUSE (23 OF 35). Q3
FI: 1,167
Enlace
Abstract: The aims of this work were to analyse the relationships between sense of coherence (SOC) and substance use among Spanish adolescents and to examine the potential moderator effect of the patterns of substance use in the peer group. Sample consisted of 5475 Spanish adolescents aged 15 to 18 from the 2010 edition of the Health Behaviour in School-aged Children (HBSC) study. Statistical analysis included cluster analysis to identify groups of adolescents according to their peer group's patterns of substance use and logistic regression with SOC and peers' pattern of consumption as predictors of current tobacco use, current alcohol use, life-time drunkenness and current drunkenness. The results showed that a strong SOCseemed to reduce the adolescents' likelihood of involving in tobacco use and drunkenness, but it was not associated with being a current drinker. In addition, the protective effect of SOC was moderated by peers' patterns of substance use. Specifically, SOC had a significant protective influence inadolescents whose peer group showed either a nonconsumption pattern or a pattern of frequent alcohol use and occasional drunkenness; but the protective effect of SOC disappeared if peers showed a pattern of consumption that included illegal drugs. In conclusion, SOC tends to act as a protective personal variable with respect to substance use during adolescence, but the influence exerted by the peer group seems to moderate the aforementioned protective effect of SOC. 
Calidad de la relación entre los progenitores y sentido de coherencia en sus hijos adolescentes. El efecto de mediación de la satisfacción familiar.
García-Moya, I., Rivera, F., Moreno, C. y López, A. (2013).
Anales de Psicología, 29(2), 482-490.
JCR: MULTIDISCIPLINARY PSYCHOLOGY (92 OF 127). Q3
FI: 0,594
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Abstract: The sense of coherence (SOC) is a new construct in Psychology, but related to others that we are more familiar with (as resilience). Adolescence seems to be a particularly suitable developmental stage to explore it. This work, apart from conducting descriptive analysis of SOC and studying its relationship with positive health indicators in Spanish adolescents, was specifically interested in examining the role of marital relationships as influent elements m SOC's development during adolescence. Sample consisted of 7,580 adolescents between the ages of 13 and 18, who had taken part in the 2010 edition of the Health Behaviour in School-aged Children study in Spain. Results showed that the quality of marital relationships had a significant influence on the adolescent children's SOC and that this influence could partially be attributed to their importance in the development of a positive family climate for adolescents. Specifically, satisfaction with family relationships acted as a partial mediator in the relationship between the perception of the quality of marital relationships and adolescents' SOC. 
School context and health in adolescence. The role of sense of coherence.
García-Moya, I., Rivera, F., & Moreno, C. (2013).
Scandinavian Journal of Psychology, 54, 243-249.
JCR: MULTIDISCIPLINARY PSYCHOLOGY (56 DE 127). Q2.
FI: 1,147
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Abstract: The aim of this study was to examine the role of school variables and sense of coherence (SOC) in the explanation of health. For this purpose, data were collected from a representative sample of adolescents, aged 13 to 18 years, selected for the Health Behavior in School-aged Children survey in Spain. Using Structural Equation Modelling, three nested models were tested that represented different hypothesized models of the relationships among school factors, SOC and health. According to goodness-of-fit indices, in the best model, school-related stress and SOC mediated the influence of support from classmates and teachers on health, and SOC had a direct effect on stress. The results supported the idea that a supportive school climate and SOC are relevant to adolescents' health. Furthermore, SOC was the most influential variable; apart from its direct positive effect on health, SOC seemed to condition the degree to which students perceived school demands to be stressful. Specifically, students with a high SOC were less likely to suffer from high levels of school-related stress.
Beneficios del contexto asociativo en las actividades de tiempo libre de los adolescentes españoles.
Ramos, P., Rivera, F., & Moreno, C. (2012).
Infancia y Aprendizaje, 35(3), 365-378.
JCR: DEVELOPMENTAL PSYCHOLOGY (62 OF 65). Q4 / EDUCATIONAL PSYCHOLOGY (42 OF 51). Q4
FI: 0,603
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Abstract: Given the shortage of studies addressing the keys for health of practising leisure activities during adolescence, it is considered necessary to analyse this issue in depth. This research is part of the Health Behaviour in School-aged Children's study (HBSC-2006). The data presented are a sample of 22,811 Spanish adolescents from 11 to 18 years. Through significance tests, effect sizes, cluster analysis and adjusted residuals, we obtained relevant information about the health profits of leisure conducted within an association, as well as practical implications for promotion, that were focused on differences by age, sex and region.. 
Analysis of the importance of family in the development of sense of coherence during adolescence.
García-Moya, I., Rivera, F., Moreno, C., Lindström, B., & Jiménez-Iglesias, A. (2012).
Scandinavian Journal of Public Health, 40(4), 333-339.
JCR: PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH (30 OF 139). Q1
FI: 1,966
Enlace
Abstract: Aims: The aim of this work was to study the influence of several family dimensions on sense of coherence (SOC) in adolescence, controlling the possible effects from the demographic variables, gender and age. Methods: The sample consisted of 7580 adolescents between the ages of 13 and 18, who had taken part in the 2010 edition of the WHO Health Behaviour in School-aged Children study in Spain. Results: The results showed that there were no significant gender differences in SOC levels. However, age had a significant influence on SOC. Higher levels of SOC were found in adolescents aged 13 and 14 compared to older participants. Family variables explained 18% of SOC variability, with affection, easy communication with parents, and parental knowledge as the most outstanding variables. In addition, positive relationships between parents and family affluence had a significant role in explaining SOC levels. Conclusions: The results suggest that the family context plays an important role in providing meaningful experiences for the development of a strong SOC in adolescence. 
Parental Knowledge and Adolescent Adjustment: Substance use and Health-Related Quality of Life.
Jiménez-Iglesias, A., Moreno, C., Granado-Alcón, M.C., & López, A. (2012).
The Spanish Journal of Psychology, 15(1), 132-144.
JCR: MULTIDISCIPLINARY PSYCHOLOGY (73 OF 126). Q3
FI: 0,827
Enlace
Abstract: This study analyses two models (maternal and paternal) in which parental care and sources of parental knowledge moderated the relationship between parents' knowledge about their adolescents' lives and adolescents' substance use and health-related quality of life. The sample was made up of 15942 Spanish adolescents who participated in the 2006 edition of Health Behavior in School-aged Children Study. Results showed that increased parents' knowledge about their adolescents' lives reduced adolescents' substance use and increased their quality of life. With respect to the moderation relationship, a limited effect was found. However, parental care and sources of parental knowledge used by both parents generally had main effects on adolescents' substance use and health-related quality of life, with care being the most relevant variable in the health-related quality of life, while knowledge was the most relevant one for substance use.
Substance use in Portuguese and Spanish adolescents: Highlights from differences and similarities and moderate effects.
Simões, C., Gaspar-Matos, M., Moreno, C., Rivera, F., Batista-Foguet, J. M., & Simons-Morton, B. (2012).
The Spanish Journal of Psychology, 15(3), 1024-1037.
JCR: MULTIDISCIPLINARY PSYCHOLOGY (73 OF 126). Q3
FI: 0,827
Enlace
Abstract: Many behaviors with lasting health impact are initiated in adolescence. Substance use is one such behavior. To analyse the factors involved in adolescent substance use among Portuguese and Spanish boys and girls, an explanatory model was developed using structural equations modelling. The model proposes that the impact of social contexts (family, friends, classmates and teachers) on substance use (tobacco, alcohol and illicit drugs) is mediated by perceptions of well-being (psychological symptoms, well-being and school satisfaction). Data on 1589 Portuguese (mean age = 13.27, SD = .59) and 4191 Spanish adolescents (mean age = 13.21; SD = .47) who took part in the HBSC/WHO survey were analysed. The model fits the data of each country (CFI > .90; RMSEA < .03) and the majority of the relationships proposed in the model have been as expected for both samples. The relations with a major effect, for both countries, were: the negative effect of family on psychological symptoms and the positive effect of family on subjective well-being; the negative effect of classmates on psychological symptoms; the positive effect of teachers on school satisfaction; the effect of psychological symptoms (negative) and school satisfaction (positive) on well-being; the negative effect of school satisfaction on tobacco and alcohol use; and the positive effect of tobacco on alcohol use, and alcohol use on cannabis. For each of the dependent factors studied (tobacco, alcohol and illicit drugs), the levels of explained variance varied between 9% (for tobacco use) and 46% (for alcohol use). Some non-invariant paths were obtained in country comparisons, controlling for gender. In multivariate analyses the paths from tobacco use to cannabis and from alcohol to cannabis were significant, but much stronger for Spanish girls than Portuguese girls. 
Análisis de clúster de la actividad física y las conductas sedentarias de los adolescentes españoles, correlación con la salud biopsicosocial.
Ramos, P., Rivera, F., Moreno, C., & Jiménez-Iglesias, A. (2012).
Revista de Psicología del Deporte, 21(1), 99-106.
JCR: APPLIED PSYCHOLOGY (51 OF 73). Q3
FI: 0,897
Enlace
Abstract: This study is part of the 2006 edition of the Health Behaviour in School-Aged Children (HBSC) study. The data presented was drawn from a sample of 21,811 Spanish adolescents ranging from 11 to 18 years of age. Through a cluster analysis, General Lineal Model, significance and effect size tests, we obtained relevant information about the physical activity habits and sedentary behaviours of Spanish adolescents. It is evident that there is a risk situation in older adolescents, especially girls. These results have the advantage of relating to a global health score; clear indicators of the advantages of an active lifestyle for adolescents were obtained. Furthermore, these data provide information that is relevant to the displacement hypothesis, which is widely discussed in the scientific literature. In short, this paper provides interesting keys for theoretical debate and practical action in the field of physical activity during adolescence. 
Analysis of social inequalities in health through an integrated measure of perceived and experienced health in Spanish and Portuguese adolescents.
Ramos, P., Moreno, C., Rivera, F., Gaspar, M., & Morgan, A. (2012).
Journal of Health Psychology, 17(1), 57-67.
JCR: CLINICAL PSYCHOLOGY (44 OF 114). Q2
FI: 1,882
Enlace
Abstract: This article compares the self reported health of a sample of 9854 Spanish and Portuguese adolescents aged 11-15 years using an integratedmeasure of health, which takes account of positive and negative factors that affect overall feelings of health and wellbeing. This improved measuresupports the emergence of health agendas that aim to make wellbeing improvements in populations through a combination of both the promotion of positive protective factors and the need to deal with those risk factors that inhibit individuals, communities and populations to attain good health. 
The classification of Spanish adolescents based on substance consumption patterns and the analysis of the relationships within their social developmental contexts.
Ramos, P., Moreno, C., Rivera, F., & López, A. (2011).
The Spanish Journal of Psychology, 14 (2), 734-745.
JCR: MULTIDISCIPLINARY PSYCHOLOGY (72 OF 125). Q3
FI: 0,740
Enlace
Abstract: This research is part of the 2006 edition of the Health Behavior in School-aged Children (HBSC) study. The data presented were composed of a sample of 15942 adolescents ranging from 13 to 18 years of age. The instruments used included a variety of questions related to substance consumption among adolescents, their bio-psycho-social adjustment and developmental contexts, all of which are part of the HBSC study instrument bank. Through classification analysis, as well as significance and effect size tests, we obtained relevant information about the current epidemiology of substance consumption among Spanish adolescents. These results are representative of the Spanish adolescent population which allows the typical risk profile attributed to young people to be clarified. A gradual adjustment can be seen in terms of substance consumption levels in youth and that same level in their friends. Likewise, the analysis of the developmental context (family, friends and school) provides important information when it comes to preventing substance consumption, thus showing the advantages that coherence and connection have between the different environments where youth live, grow up and develop.
Análisis del Modelo Salutogénico en España: aplicación en salud pública e implicaciones para el modelo de activos en salud.
Rivera, F., Ramos, P., Moreno, C., & Hernán, M. (2011). 
Revista Española de Salud Pública, 85 (2), 137-147
JCR: PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH (107 OF 131). Q4
FI: 0,706
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Abstract: This article seeks to provide an in depth review about one of the most revolutionary and influential methods used in understanding the variables and processes that explain human health. Based on a new vision in the analysis of the consequences of the Nazi Holocaust, a doctor-sociologist--Aaron Antonovsky--managed to influence medicine and behavioral science by facilitating the keys for the optimal development of public health today. Despite the fact that this theory began appearing in the 1970s in the 20th century, its real development and expansion have been seen in recent years. In fact, in Spain, there is little scientific literature that analyses the theoretic keys of the model in depth. This work seek to cover this gap; to achieve this objective, it first presents how the construct of salutogenesis arose, the social-cultural context that promoted it, as well as the importance public health acquires today. This is the aim of this work, which analyses the theoretical bases of the salutogenesis model, with specific emphasis on its background and precursors, as well as its inception, development and current expansion. 
Health and well-being among child immigrants in Europe.
Molcho, M., Cristini, F., Gabhainn, S., N., Santinello, M., Moreno, C., Gaspar De Matos, M., Bjarnson, T., Aldassari, D., & Due, P. (2010). 
Eurohealth, 16 (1), 1-4.
Enlace
Abstract: This study examines health, well being and involvement in risk behaviours of immigrant children across twelve European countries, using data collected in the 2006 Health Behaviour in School-Aged Children study. Findings suggest that immigrant children are significantly more likely to live in less affluent families, but no other cross-national patterns are evident. The lack of clear patterns suggests that no one-size-fits-all programmes are suitable for working with immigrant children. There is a need for more specific research to increase our understanding of the needs and experiences of migrant children in Europe. 
Integrated analysis of the health and social inequalities of Spanish adolescents.
Ramos, P., Moreno, C., Rivera, F., & Pérez, P.J. (2010). 
Child Indicators Research. Online first.
International Journal of Clinical and Health Psychology, 10 (3), 477- 498
JCR: CLINICAL PSYCHOLOGY (38 of 104). Q2
FI: 1,842
Enlace
Abstract: This survey descriptive study presents the process leading up to the creation of a global health score for adolescents. In recent years, the concept of health, which is the bases for this study, has undergone changes to include both dysfunctional elements as well as the individual resources that protect health. The sample was made up of 18,955 adolescents between 11 to 18 years of age, in Spain and with participants in each of the regions making up the kingdom of Spain. Using exploratory and confirmatory factorial analysis techniques, the results showed a global dimension of the health, starting from self-report indicators of life satisfaction, health-related quality of life, perception of the general state of health and psychosomatic complaints. This health score decreased as age increased and more notably among girls, as well as in adolescents from low-income families. The comparative analyses between regions showed differences which were, in principle, not attributable to the economic well-being of the geographic area. Finally, these results and their implications were discussed, as well as the importance of the calculation used in the analysis of the social inequalities in health. 
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