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Vol. 37.
(January 2023)
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Vol. 37.
(January 2023)
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Monitoring health and health behaviors among adolescents in Central Catalonia: DESKcohort protocol
Monitorización de la salud y los comportamientos de salud entre los adolescentes de la Cataluña Central: Protocolo DESKcohort
Judit Rogésa, Helena González-Casalsa, Marina Bosque-Prousb,c,
Corresponding author

Corresponding author.
, Cinta Folchd,e, Joan Colomf, Jordi Casabonad,e, Gemma Drou-Rogeta,g, Ester Teixidó-Compañóa, Esteve Fernándezh,i,j,k, Carmen Vives-Casese,g, Albert Espelta,c,e
a Research Group in Epidemiology and Public Health in the Digital Health context (epi4Health), Departament d’Epidemiologia i Metodologia de les Ciències Socials i de la Salut, Facultat de Ciències de la Salut de Manresa, Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Manresa, Barcelona, Spain
b Research Group in Epidemiology and Public Health in the Digital Health context (epi4Health), Facultat de Ciències de la Salut, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
c Research Group in Epidemiology and Public Health in the Digital Health context (epi4Health), Departament de Psicobiologia i Metodologia en Ciències de la Salut, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
d Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya, Agència de Salut Pública de Catalunya, Barcelona, Spain
e CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
f Subdirecció General d’Addiccions, VIH, Infeccions de Transmissió Sexual i Hepatitis Víriques, Agència de Salut Pública de Catalunya, Barcelona, Spain
g Department of Community Nursing, Preventive Medicine and Public Health and History of Science, Universitat d’Alacant, San Vicente del Raspeig (Alacant), Spain
h Tobacco Control Unit, WHO Collaborating Center for Tobacco Control, Institut Català d’Oncologia, Barcelona, Spain
i Tobacco Control Research Group, Epidemiology and Public Health Programme (EPIBELL), Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
j School of Medicine and Health Sciences, Campus of Bellvitge, Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
k CIBER de Enfermedades Respiratorias (CIBERES), Spain
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Tables (2)
Table 1. Distribution of educational centers and total participation by region, titularity of the educational center and level of education provided in the 1st and 2nd wave of DESKcohort project.
Table 2. Description of the sample prevalence of the main health behaviors, from the 1st and 2nd waves of DESKcohort study and stratified by sex.
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The objective of the prospective cohort study (the DESKcohort project) is to describe and monitor health, health behaviors, and their related factors among 12 and 19-year-old adolescents schooled at centers of Compulsory Secondary Education or post-compulsory secondary education in Central Catalonia, considering social determinants of health. The DESKcohort survey is administered biannually between the months of October and June, and the project has been running for three years. We have interviewed 7319 and 9265 adolescents in the academic years 2019/20 and 2021/22, respectively. They responded a questionnaire created by a committee of experts, that included the following variables: sociodemographic factors, physical and mental health, food, physical activity, leisure and mobility, substance use, interpersonal relationships, sexuality, screen use and digital entertainment, and gambling. The results are presented to educational centers, county councils, municipalities, and health and third sector entities to plan, implement, and evaluate prevention and health promotion actions that address the identified needs.

Cohort studies
Research design
Public health surveillance
Health behavior
Social determinants of health

El objetivo de este estudio prospectivo de cohortes (proyecto DESKcohort) es describir y monitorizar la salud, los comportamientos de salud y sus factores asociados en los adolescentes de entre 12 y 19 años escolarizados en centros de Educación Secundaria Obligatoria o secundaria posobligatoria de la Cataluña Central, considerando los determinantes sociales de la salud. La encuesta DESKcohort se realiza bianualmente, entre los meses de octubre y junio, y el proyecto lleva 3 años en marcha. Se ha entrevistado a 7319 y 9265 adolescentes en los cursos 2019/20 y 2021/22, respectivamente. Respondieron un cuestionario creado por un comité de expertos, que incluía las siguientes variables: sociodemográficas, salud física y mental, alimentación, actividad física, ocio y movilidad, consumo de sustancias, relaciones interpersonales, sexualidad, uso de pantallas y entretenimiento digital, y juegos de azar. Los resultados son presentados a los centros educativos, las diputaciones, los municipios y las entidades sanitarias y del tercer sector para planificar, implementar y evaluar acciones de prevención y promoción de la salud que aborden las necesidades identificadas.

Palabras clave:
Estudio de cohortes
Diseño de investigación
Vigilancia de salud pública
Comportamientos de salud
Determinantes sociales de la salud
Full Text

Adolescence is characterized by risk-taking and experimentation of new environments and behaviors, and health habits developed during this period have an impact on long-term health and well-being.1,2 These behaviors, such as alcohol consumption or tobacco use, are not only related to individual factors, but also to social factors.3-5

However, adolescents have the potential for successful and healthy development because human development is not predefined.6 In this sense, it is important to collect information on the health status of the population and its determinants.7 Although health behavior monitoring tools for young people have been used over the years, they have mostly focused in urban populations.8 However, in rural environments, the social, demographic, and geographic characteristics are distinct, and adolescents behave differently from their peers in urban areas.9 In this context, there is a need to create a surveillance system to monitor health behaviors and their determinants among adolescents in rural settings. Also, health behaviors are mostly investigated through cross-sectional surveys; therefore, it is important to implement longitudinal studies to analyze current health behaviors, how they change in the same adolescents, and their determinants over time. As proposed, in order to carry out a good surveillance of the determinants of health, the social determinants of health must be taken into account.7 The conceptual framework of reference is the Conceptual Framework of the determinants of social inequalities in health of the Commission for the Reduction of Health Inequalities in Spain.

The objective of the prospective cohort study (the DESKcohort project) is to describe and monitor health, health behaviors, and their related factors among 12 and 19-year-old adolescents schooled at centers of Compulsory Secondary Education or post-compulsory secondary education in Central Catalonia (Spain), considering social determinants of health.


The Determinants of Health in Secondary School Students in Central Catalonia (DESKcohort) project is a prospective longitudinal study with successive waves that provide comparable cross-sectional information and allow longitudinal assessment of changes in health behaviors (see table I in online Appendix). Participants are interviewed biannually (Table 1), creating a cohort of adolescents. To link students from one wave to the next and do a follow-up, a unique identifier was created for each student.

Table 1.

Distribution of educational centers and total participation by region, titularity of the educational center and level of education provided in the 1st and 2nd wave of DESKcohort project.

  1st wave (2019-2020)2nd wave (2021-2022)
  Total high schools  Participating high schools  Total high schools  Participating high schools 
Anoia  20  11  55.0  23  13  56.5 
Bages  30  23  76.7  31  29  93.5 
Berguedà  85.7  100.0 
Solsonès  66.7  100.0 
Osona  29  22  75.9  32  30  93.8 
Moianès  50.0  100.0 
Titularity of educational center
Public  54  40  74.1  61  55  90.2 
Subsided  37  25  67.6  37  29  78.4 
Education provided
Compulsory  43  26  60.5  49  40  81.6 
Compulsory and post-compulsory  46  38  82.6  47  42  89.3 
Post compulsory  50.0  100.0 
Total  91a  65  71.4  98b  84  85.7 

In the 1st wave there were a total of 99 schools in Central Catalonia. Due to non-compliance with some requirements of academic level, the project sample consists of 91 schools, which were invited to participate.


In the 2nd wave there were a total of 101 schools in Central Catalonia. Due to non-compliance with some academic level requirements, the project sample consists of 98 schools, which were invited to participate.

The geographical scope of the survey is Central Catalonia, which comprises the counties of Anoia, Bages, Berguedà, Moianès, Osona, and Solsonès, including 165 of the 947 municipalities in Catalonia. In this territory, there are currently 96 educational centers of Compulsory Secondary Education and two centers of post-compulsory education (baccalaureate and formative cycles). The study population consists of students in 2nd and 4th of compulsory secondary education (CSE); 2nd of post-compulsory secondary education (PCSE); and 2nd of Intermediate Level Training Cycles (ILTC). The DESKcohort project is a collaborative project led by the Fundació Universitària del Bages (FUB) with the participation of the Subdirectorate General for Addictions, HIV, Sexually Transmitted Infections and Viral Hepatitis; the Departament d’Educació; the Centre d’Estudis Epidemiològics sobre el VIH/SIDA de Catalunya (CEEISCAT); the Universitat Oberta de Catalunya (UOC); the Autonomous University of Barcelona; the Universidad de Alicante (UA); and the Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP).

Participant recruitment

Before the end of the academic year and prior to data collection (around May-June), we send a letter to all educational centers in the region to invite them to participate in the project. To the ones agreeing to participate, we also send informed consent forms to be signed by the adolescents’ legal guardians. Adolescents over 14 years of age can sign the informed consent themselves, according to the Spanish Official Personal Data Protection Act. Then, at the beginning of the academic year in which the data collection will take place (September), we contact the schools to schedule a date for administering the questionnaire.

Data collection tools and procedures

The initial DESKcohort questionnaire was elaborated by was prepared by researchers from the University of Bages Foundation, the Open University of Catalonia, the CEEISCAT and the Public Health Agency of Catalonia on the basis of other questionnaires on health behaviors during adolescence8,10-12 with high validity and reliability, from studies with a long track record (see table II in online Appendix).13-16 The successive versions were produced by the scientific committee ( The questionnaire had different sections: sociodemographic factors, physical and mental health, food, physical activity, leisure and mobility, substance use, interpersonal relationships, sexuality, screen use and digital entertainment, and gambling (see table I in online Appendix). The scientific committee meets every year to review the questionnaire and decide whether to add a section with new questions or the required improvements between waves. For example, in the 2020/21 academic year, questions on COVID-19 were introduced.

Data collection is performed biannually between the months of October and June, corresponding to the academic calendar of the Catalan educational system (1st wave in the academic year 2019-20; 2nd wave in the academic year 2021-22). The questionnaire is online and self-administered in the classrooms. It is built with the Redcap (Research Electronic Data Capture) software.17 Of the students in the 2nd year of ESO and 4th year of ESO, 46.7% were followed.

Ethical aspects

The project was approved by the Ethics Committee of the Universitat de Vic-Universitat Central de Catalunya (UVic-UCC) (96/2019). All the information is stored online in a secure server of the Fundació Universitària del Bages, guaranteeing confidentiality according to the Official Personal Data Protection Act. Data with identification codes are dissociated from the responses to the questionnaire, and only the principal investigator has access to the database with the identification codes.

Data analysis

To analyse the data in the cross-sectional and longitudinal studies we will calculate the prevalence and cumulative incidences of the health conditions or behaviours to be studied, respectively. These prevalence and incidence will be calculated for the total and for each category of the different independent variables. To analyse the relationship between both proportions and the different independent variables we will estimate Poisson regression models with Robust variance obtaining Prevalence Ratios or Relative Risks with their respective 95% confidence intervals.18 All the analyses were performed using STATA17 software.


Sixty-five (71.4%) and 84 (85.7%) centers have participated in the first and second waves, respectively. Table 1 describes the participation rate in each county. In the first wave, 7319 adolescents out of 11943 have participated (61.3%), and in the second wave, 9265 out of 14342 (64.6%). Table 2 describes the characteristics of the participants in the two waves of the DESKcohort project, in terms of sex, course grade, self-reported socioeconomic level, region of residence, and type of educational center (public or private). In the second wave, the prevalence of risky behaviors was higher than in the previous one; in both waves we generally observe that girls have engaged more in less healthy behaviors than boys. Of the 2505 people followed between the 1st and the follow-up period, 56.0% are girls. Also, within the cohort, 56.1% of people have been followed from 2nd to 4th year of CSE, 43.6% from 4th year of CSE to 2nd year of PCSE or 2nd year of ILTC. Therefore, we have included a table (see table III in online Appendix) detailing the sociodemographic characteristics of the people who in the first wave were likely to be followed up in the second wave, and the people who are followed up in the 2nd wave.

Table 2.

Description of the sample prevalence of the main health behaviors, from the 1st and 2nd waves of DESKcohort study and stratified by sex.

  1st wave2nd wave1st wave2nd wave
  CI95%  CI95%  CI95%  CI95% 
Total  3505  47.9  46.8-49.0  4558  49.2  48.2-50.2  3814  52.1  50.9-53.3  4707  50.8  49.8-51.8 
Region of residence
Anoia  660  18.8  17.6-20.2  752  16.5  15.4-17.6  767  20.1  18.9-21.4  731  15.5  14.5-16.6 
Bages  1226  35.0  33.4-36.6  1497  32.8  31.5-34.2  1277  33.5  32.0-35.0  1651  35.1  33.7-36.5 
Berguedà  324  9.2  8.3-10.2  392  8.6  7.8-9.4  304  8.0  7.2- 8.9  347  7.4  6.7-8.2 
Solsonès  46  1.3  1.0- 1.7  87  1.9  1.5-2.3  69  1.8  1.4- 2.3  79  1.7  1.3-2.1 
Moianès  81  2.3  1.9- 2.9  156  3.4  2.9-4.0  117  3.1  2.6- 3.7  169  3.6  3.1-4.2 
Osona  1087  31.0  29.5-32.6  1581  34.7  33.3-36.1  1173  30.8  29.3-32.2  1623  34.5  33.1-35.9 
Othersa  81  2.3  1.9- 2.9  93  2.0  1.7-2.5  107  2.8  2.3- 3.4  107  2.3  1.9-2.7 
2nd CSE  1296  37.0  35.4-38.6  1458  32.0  30.6-33.4  1382  36.2  34.7-37.8  1428  30.3  29.0-31.7 
4th CSE  1316  37.5  36.0-39.2  1752  38.4  37.0-39.9  1374  36.0  34.5-37.6  1773  37.7  36.3-39.1 
2nd PCSE  649  18.5  17.3-19.8  883  19.4  18.3-20.5  863  22.6  21.3-24.0  1203  25.6  24.3-26.8 
2nd ILTC  244  7.0  6.2- 7.9  465  10.2  9.4-11.1  195  5.1  4.5- 5.9  303  6.4  5.8-7.2 
Type of schoolc
Subsided  1087  31.0  29.5-32.6  1398  30.7  29.3-32.0  994  26.1  24.7-27.5  1301  27.6  26.4-28.9 
Public  2418  69.0  67.4-70.5  3160  69.3  68.0-70.7  2820  73.9  72.5-75.3  3406  72.4  71.1-73.6 
Socioeconomic positiond
Lower  1221  34.8  33.3-36.4  1581  34.7  33.3-36.1  1375  36.1  34.5-37.6  1657  35.2  33.9-36.6 
Medium  1180  33.7  32.1-35.2  1533  33.6  32.3-35.0  1239  32.5  31.0-34.0  1512  32.1  30.8-33.5 
High  1104  31.5  30.0-33.1  1444  31.7  30.3-33.0  1200  31.5  30.0-33.0  1538  32.7  31.3-34.0 
Self-perceived health
Excellent or very good  2290  65.3  63.7-66.9  3206  70.3  69.0-71.6  1911  50.1  48.5-51.7  2292  48.7  47.3-50.1 
Good, fair or poor  1215  34.7  33.1-36.3  1352  29.7  28.4-31.0  1903  49.9  48.3-51.5  2415  51.3  49.9-52.7 
State of mind
Good mood  3075  87.7  86.6-88.8  3789  83.1  82.0-84.2  2829  74.1  72.8-75.5  2734  58.1  56.7-59.5 
Low mood  430  12.3  11.2-13.4  769  16.9  15.8-18.0  985  25.8  24.5-27.2  1973  41.9  40.5-43.3 
Spanish Healthy Eating Index
Health  186  5.3  4.6- 6.1  353  7.7  7.0- 8.6  416  10.9  10.0-11.9  658  14.0  13.0-15.0 
Needs changes  3070  87.6  86.5-88.6  3800  83.4  82.3-84.4  3168  83.1  81.8-84.2  3671  78.0  76.8-79.2 
Unhealthy  249  7.1  6.3- 8.0  405  8.9  8.1- 9.7  230  6.0  5.3- 6.8  378  8.0  7.3- 8.8 
Physical activitye
Comply WHO  1968  60.0  58.3-61.7  2615  60.9  59.4-62.3  1303  37.2  35.6-38.8  1752  38.8  37.4-40.2 
Not complying WHO  1310  40.0  38.3-41.7  1682  39.1  37.7-40.6  2200  62.8  61.2-64.4  2762  61.2  59.8-62.6 
Daily smoking tobacco
No  3271  93.3  92.4-94.1  4308  94.5  93.8-95.1  3497  91.7  90.8-92.5  4330  92.0  91.2-92.7 
Yes  234  6.7  5.9- 7.6  250  5.5  4.9- 6.2  317  8.3  7.5- 9.2  377  8.0  7.3- 8.8 
Hazardous drinkingf
No  2691  76.8  75.3-78.1  3379  74.1  72.8-75.4  2869  75.2  73.8-76.6  3390  72.0  70.7-73.3 
Yes  814  23.2  21.9-24.7  1179  25.9  24.6-27.2  945  24.8  23.4-26.2  1317  28.0  26.7-29.3 
Hazardous cannabis consumptiong
No  3355  95.7  95.0-96.3  4426  97.1  96.6-97.6  3677  96.4  95.8-97.0  4576  97.2  96.7-97.7 
Yes  150  4.3  3.7- 5.0  132  2.9  2.4- 3.4  137  3.6  3.0- 4.2  131  2.8  2.3- 3.3 
Having suffered bullying
No  3064  91.2  90.2-92.1  3901  85.6  84.5-86.6  3349  92.6  91.7-93.4  3804  80.8  79.7-81.9 
Yes  296  8.8  7.9- 9.8  657  14.4  13.4-15.5  268  7.4  6.6- 8.3  903  19.2  18.1-20.3 
Condom use
Yes  446  70.2  66.6-73.7  412  53.6  50.1-57.2  501  61.9  58.5-65.2  458  46.0  42.9-49.1 
No  189  29.8  26.3-33.4  356  46.4  42.8-49.9  308  38.1  34.8-41.5  538  54.0  50.9-57.1 
No  313  86.9  83.0-90.1  3989  88.4  87.5-89.3  415  91.6  88.7-93.8  4439  95.1  94.4-95.7 
Yes  47  13.1  9.9-17.0  522  11.6  10.7-12.5  38  8.4  6.2-11.3  229  4.9  4.3- 5.6 

CSE: Compulsory Secondary Education; ILTC: Intermediate Level Training Cycles; PCSE: Post-Compulsory Secondary Education; WHO: World Health Organization.


The “Others” category includes those people who live in a region that does not belong to the territory of Central Catalonia.


Self-reported data recorded from the question of the DESKcohort questionnaire “What course do you go to?”.


Self-reported data recorded from the question of the DESKcohort questionnaire “Which high school do you go to?”. The Departament d’Educació de la Generalitat de Catalunya provides the data on the ownership of the educational centers of Central Catalonia updated annually, and from them the researchers create this variable by assigning the type of school of the educational center to each participating institute.


Terciles obtained from McArthur Scale results, which inquired for neighborhood self-perceived socioeconomic position.


WHO recommendations for the practice of physical activity in adolescents. The recommendation for children and adolescents is 60minutes of moderate to vigorous physical activity per day.


Identified with AUDIT-C, a cut-off of ≥3 points indicates hazardous alcohol consumption.


Identified with CAST-F, a cut-off of ≥7 points indicates hazardous consumption of cannabis. Not all the variables were responded by the total sample. Percentages might slightly differ from 100 because of approximation.

Expected outcomes

Young people have different health-related behaviors from adults, but there are few data about youth health needs over the years. The DESKcohort project contributes to the characterization of health behaviors and their changes throughout adolescence and studies the determinants of these changes. Our initial descriptive results indicate that with age, behaviors become less healthy in terms of mental health, wellbeing, physical activity, and diet; and risky behaviors like problematic use of addictive substances increase. Several scientific papers have already been published with DESK data. They have estimated poly-consumption of cannabis and tobacco,19 found socio-economic differences in nutrition during COVID-19 confinement,20 found social inequalities in skipping breakfast21 and reported a decrease in substance use during COVID-1922 confinement as well as changes in their mental health and social conditions.23,24 So, it is important to identify in what groups and at what ages these changes occur and to detect risk factors to promote healthy behaviors and prevent risky behaviors at later stages.

The DESKcohort is expected to be a leading monitoring project in Catalonia. Between the 1st and 2nd waves, the participation increased by 14.3%, and it is expected to continue increasing in the successive ones. This will allow to increase the sample size, increase variability of the sample, and make more accurate inferences on the population.


During the first three years of the DESKcohort project, data from 7319 and 9265 students in Central Catalonia have been analyzed for the 2019/20 and 2021/22 school years, respectively. Specifically, we performed a descriptive cross-sectional analysis and an analytic longitudinal analysis of the health behaviors of students in 2nd and 4th year of CSE, 2nd year of PCSE, and 2nd year of ILTC.

One limitation of this project is the exclusion of adolescents outside the formal educational system; therefore, the representativeness of the sample is limited to students enrolled in educational centers of the territory. However, education in our country is compulsory until the age of 16; therefore, this limitation would be relevant only for adolescents in the 2nd year of post-compulsory secondary education, a fact that is minimized by including adolescents in the 2nd year of ILTC. Another limitation is that not all educational centers invited to participate did participate in the end. Moreover, nor all students in the participating educational centers responded to the questionnaire. However, in five of the six counties, in the 2nd wave over 90% of the educational centers decided to participate in the study (Table 1). The fact that participation may vary in each wave makes it difficult to establish a stable cohort that monitors individuals from 2nd year of CSE to 2nd year of PCSE or 2nd year of ILTC. This can lead to a low follow-up rate throughout the entire academic trajectory, and individuals are followed intermittently without sustained progress. Finally, responses to the questionnaire are self-reported and data could suffer some information bias (for example, because of social desirability and recall bias). However, the questionnaire included questions with a high validity for adolescents: for example, CAST and AUDIT-C13,25 in the case of substance use; and other tests in the case of bullying, mental health, and problematic screen use26-29.

As a strength of the DESKcohort project, we highlight the importance for the region to have monitoring data on the health behaviors of adolescents, and to be able to analyze the effect of contextual factors and social determinants on them, besides the high participation rate and sample size. Also, after each wave, we returned the results to participating educational centers and regional institutions. This allows the educational centers to detect and identify health needs to implement programs adapted to these needs among their students. In addition, a general results report is published biannually, which allows the identification of the health needs of the population. Finally, as a longitudinal monitoring tool, the DESKcohort project complements other information systems to understand health and its determinants among adolescents in Catalonia. It represents a crucial source of information for both local (educational centers, county councils, municipalities, and health and third sector entities) and national policy making institutions (Health Department, Education Department). This allows them to improve health promotion strategies and public health programs to address the identified needs and evaluate future interventions.

Availability of databases and material for replication

Data collected and generated in the DESKcohort project are available free of charge for scientific research. Following the data cleaning, processing and the generation variables of each wave, people can ask for obtain some modules of variables. To obtain data, researchers could be addressed DESKcohort website ( Then, DESKcohort checks the purpose of the request and the affiliation of the applicant and provides the database, always without the identification code data created. As of January 2023, data from the first waves 1 and 2 are available (transversal and longitudinal data).

Editor in charge

Mariano Hernán-García.

Authorship contributions

A. Espelt is the principal investigator of the DESKcohort project, and he conceived and led the preparation of the research protocol. M. Bosque-Prous, E. Teixidó-Compañó, C. Folch, J. Colom, J. Casabona, C. Vives-Cases and E. Fernandez reviewed and proposed questions from their respective areas of expertise to be included in the DESKcohort questionnaire. J. Rogés, M. Bosque-Prous, H. González-Casals, G. Drou, E. Teixidó-Compañó and A. Espelt collected the data. J. Rogés, H. González-Casals, G. Drou and A. Espelt performed the data analysis, interpretation of the results and creation of the tables. J. Rogés drafted the article. A. Espelt and M. Bosque-Prous reviewed the structure and design of the manuscript. All the coauthors discussed, reviewed and approved the manuscript in its last version, and made important contributions from their field of expertise that contributed to enriching the manuscript.


The authors wish to thank the educational centers that agreed to collaborate with the project and all the students that participated in the study. We are also thankful for the support of the Departament de Salut and the Departament d’Educació de la Generalitat de Catalunya. Additionally, authors are thankful to CERCA Programme/Generalitat de Catalunya for institutional support. Finally, we want to acknowledge the DESK-Cohort Project Working Group (in alphabetical order): Aguilar, Alicia; Àlvarez, Anaís; Angulo-Brunet, Ariadna; Arechavala, Teresa; Baena, Antoni; Barón-García, Tivy; Bartroli, Montse; Borao, Olga; Caberol, Ariadna; Campoy, Mireia; Clotas, Catrina; Colillas-Malet, Ester; Díaz-Geada, Ainara; Espino, Sandra; Esquius, Laura; Gontié, Rémi; Jubany, Júlia; Majó, Xavier; Manera, Maria; Munné, Carles; Muntaner, Carles; Obradors-Rial, Núria; Puigcorbé, Susanna; Riera, Carlota; Saigí, Francesc; Torralba, Mireia; Torruella, Anna; Vaqué, Cristina.

This paper is part of the doctoral Dissertation of J. Rogés at the Universitat Oberta de Catalunya.

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