Albert Moncada

Assessment of exposure to secondhand smoke by questionnaire and salivary cotinine in the general population of Barcelona, Spain (2004-2005).

OBJECTIVES To estimate the prevalence of self-reported exposure to secondhand smoke (SHS) in different settings and to describe salivary cotinine concentration and its determinants among non-smokers. METHODS Cross-sectional study of a representative sample (N=775) of adult non-smokers in Barcelona, Spain (years 2004-2005). We assessed exposure to SHS using a questionnaire and measurement of salivary cotinine concentration. We calculated prevalence rates of self-reported exposure and medians and geometric means of salivary cotinine concentration. We adjusted for potential confounding factors with multinomial logistic regression models. RESULTS The prevalence rate of self-reported exposure to SHS among non-smokers in any setting was 75.7% (95% CI: 72.7%-78.8%). The prevalence of exposure to SHS tended to decrease with age. The geometric mean of cotinine concentrations among non-smokers was 1.49 ng/ml (95% CI: 1.39-1.60 ng/ml) among all subjects, and 1.80 ng/ml (95% CI: 1.37-2.35 ng/ml) in subjects who reported exposure to SHS in all settings. In bivariate and multivariate analyses, the cotinine concentration increased with the number of smokers and the number of cigarettes smoked per day in the presence of non-smokers in the household. CONCLUSIONS In this population, self-reported exposure to SHS is very high. Salivary cotinine concentrations in non-smokers are associated with exposure at home.

Impact of the 2011 Spanish smoking ban in hospitality venues: indoor secondhand smoke exposure and influence of outdoor smoking.

INTRODUCTION The Spanish tobacco control law of 2006 was modified in January 2011, banning smoking in all hospitality venues. The objective of the study was to assess the impact of the 2011 Spanish smoking ban on secondhand smoke (SHS) exposure in hospitality venues, and to analyze the potential impact of outdoor smokers close to entrances on indoor SHS levels after the law came into force. METHODS Before-and-after evaluation study with repeated measures. The study was carried out in three regions of Spain (Catalonia, Galicia, and Madrid) and included a random sample of 178 hospitality venues. We measured vapor-phase nicotine and particulate matter 2.5 micrometers or less in diameter (PM2.5) as SHS markers at baseline (November-December 2010) and at follow-up (April-June 2011). We also recorded tobacco consumption variables such as the presence of butts, ashtrays, and smokers. In the posttest assessment, we also recorded the number of outdoor smokers close to the entrance. RESULTS A total of 351 nicotine and 160 PM2.5 measurements were taken. Both nicotine and PM2.5 concentrations decreased by more than 90% (nicotine from 5.73 to 0.57 µg/m(3), PM2.5 from 233.38 to 18.82 µg/m(3)). After the law came into force, both nicotine and PM2.5 concentrations were significantly higher in venues with outdoor smokers close to the entrance than in those without outdoor smokers. All the observational tobacco consumption variables significantly decreased (p < .001). CONCLUSIONS SHS exposure in hospitality venues dramatically decreased after the 2011 Spanish smoking ban. SHS from outdoor smokers close to entrances seems to drift inside venues. Smoking control legislation should consider outdoor restrictions to ensure complete protection against SHS.

Questionnaire-based second-hand smoke assessment in adults

BACKGROUND Numerous studies have assessed second-hand smoke (SHS) exposure but a gold standard remains to be established. This study aimed to review how SHS exposure has been assessed in adults in questionnaire-based epidemiological studies. METHODS A literature search of original papers in English, French, Italian or Spanish published from January 2000 to May 2011 was performed using PubMed. The variables recorded for each study included target population, sample size, validation of the SHS questions, study design and phrasing of every question used to assess SHS exposure. For each item, information such as the setting where exposure was assessed or the indicator used to ascertain SHS exposure was extracted. RESULTS We retrieved 977 articles, of which 335 matched the inclusion criteria. The main objective of 75.8% of the studies was to assess SHS exposure.The proportion of validated questions aiming to ascertain SHS exposure was 17.9%. Most studies collected data only for one (40.3%) or two settings (33.4%), most frequently the home (83.9%) and workplace (57%). The most commonly used indicator to ascertain exposure was the presence of smokers and 68.9% of the studies included an item to assess the intensity of SHS exposure. CONCLUSIONS The variability in the indicators and items used to ascertain SHS exposure is very high, whereas the use of items derived from validated studies remains low. Identifying the diverse settings where SHS exposure may occur is essential to accurately assess exposure over time. A standard set of items to identify SHS exposure in distinct settings is needed.

Tobacco smoking, exposure to second‐hand smoke, and asthma and wheezing in schoolchildren: a cross‐sectional study

To analyse the association between tobacco smoking, exposure to second‐hand smoke (SHS) and reports of wheezing and asthma in a sample of schoolchildren.

Factores asociados al uso autodeclarado de la anticoncepción de emergencia en la población escolarizada de 14 a 18 años de edad

OBJECTIVE To describe factors associated with self-reported use of emergency contraception in adolescents attending school in the city of Terrassa (Barcelona, Spain) in 2008. METHODS We carried out a cross-sectional study to describe the health habits of teenage girls and boys attending school in Terrassa. A representative sample of adolescents aged between 14 and 18 years (n=1300) was used. The adolescents were administered a questionnaire designed ad hoc. Adolescents who reported having had sexual intercourse at least once were studied (n=390). The outcome variable was self-reported use of emergency contraception at some time. The explanatory variables provided information on sociodemographic characteristics, drug use and sexuality. The odds ratios (OR) and 95% confidence intervals (95% CI) were fitted using multivariate logistic regression models. The results were stratified by sex. RESULTS A total of 390 students, 28.2% girls and 20.1% boys (their partners) had used emergency contraception at some time. Among boys, the final multivariate model showed that emergency contraception was associated with alcohol abuse (OR=2.7; 95% CI:1.0-7.5), having sexual intercourse weekly (OR=2.8; 95% CI: 1.1-7.2) and not having discussed issues about sexuality in the classroom (OR=2.5; 95% CI: 1.0-6.5). Among girls, self-reported emergency contraception was associated with alcohol abuse (OR=2.7; 95% CI: 1.4-5.6), cannabis consumption (OR=3.1; 95% CI:1.6-6.0) and weekly sexual intercourse (OR=2.0; 95% CI: 1.1-3.9). CONCLUSION Promotion and prevention strategies should begin as early as possible. Behavioral differences should be seen from a gender perspective in the fields of both research and program implementation.

Stages of change, smoking characteristics, and cotinine concentrations in smokers: Setting priorities for smoking cessation

OBJECTIVE We assessed whether the salivary cotinine content of daily smokers varied with the readiness to quit and smoking characteristics. METHODS This cross-sectional study was conducted in Barcelona, Spain (n=1245) in 2004-2005. We administered a questionnaire to assess smoking behaviour and collected saliva to determine the cotinine content. We determined the distribution of 278 adult daily smokers across different stages of change and categorised them by individual and smoking characteristics. We used medians and interquartile ranges (IQR) to relate cotinine concentrations to different stages of change, tobacco consumption, and nicotine dependence based on the Fagerström Test for Nicotine Dependence (FTND). RESULTS Around 68%, 22%, and 11% of smokers were in precontemplation, contemplation, and preparation stages, respectively. A mean of 17.0 cigarettes was smoked daily, with no differences among stages of change. The median cotinine concentration was 151.3 ng/ml (IQR: 83.2-227.8 ng/ml), with no differences among stages of change. The cigarette consumption scores, FTND, and time to first cigarette of the day were positively associated with cotinine concentration. CONCLUSIONS The cotinine concentration was similar among the stages of change, but varied within each stage according to the number of cigarettes smoked, time to first cigarette of the day, and nicotine dependence.

Variability in the correlation between nicotine and PM2.5 as airborne markers of second-hand smoke exposure.

The aim of this study was to assess the relationship between particulate matter of diameter≤2.5 µm (PM2.5) and airborne nicotine concentration as markers of second-hand smoke exposure with respect to the setting studied, the intensity of exposure, and the type of environment studied (indoors or outdoors). Data are derived from two independent studies that simultaneously measured PM2.5 and nicotine concentrations in the air as airborne markers of second-hand smoke exposure in public places and workplaces, including health care centres, bars, public administration offices, educational centres, and transportation. We obtained 213 simultaneous measures of airborne nicotine and PM2.5. Nicotine in the air was measured with active samplers containing a sodium bisulphate-treated filter that was analysed by gas chromatography/mass spectrometry. PM2.5 was measured with a SidePak AM510 Personal Aerosol Monitor. We calculated Spearmans rank correlation coefficient and its 95% confidence intervals (95% CI) between both measures for overall data and stratified by setting, type of environment (indoors/outdoors), and intensity of second-hand smoke exposure (low/high, according to the global median nicotine concentration). We also fitted generalized regression models to further explore these relationships. The median airborne nicotine concentration was 1.36 µg/m3, and the median PM2.5 concentration was 32.13 µg/m3. The overall correlation between both markers was high (Spearmans rank correlation coefficient=0.709; 95% CI: 0.635-0.770). Correlations were higher indoors (Spearmans rank correlation coefficient=0.739; 95% CI: 0.666-0.798) and in environments with high second-hand smoke exposure (Spearmans rank correlation coefficient=0.733; 95% CI: 0.631-0.810). The multivariate analysis adjusted for type of environment and intensity of second-hand smoke exposure confirmed a strong relationship (7.1% increase in geometric mean PM2.5 concentration per µg/m3 nicotine concentration), but only in indoor environments in a stratified analysis (6.7% increase; 95% CI: 4.3-9.1%). Although the overall correlation between airborne nicotine and PM2.5 is high, there is some variability regarding the type of environment and the intensity of second-hand smoke exposure. In the absence of other sources of combustion, air nicotine and PM2.5 measures can be used indoors, while PM2.5 should be used outdoors with caution.

Impact of a multi-level intervention to prevent secondhand smoke exposure in schoolchildren: A randomized cluster community trial

OBJECTIVE To assess the effectiveness of a multi-level (individual, family, and school) school-based intervention to prevent the exposure to secondhand smoke (SHS) in a population of schoolchildren (12-14 years old). METHOD This was a community trial with cluster randomization of schools to an intervention and comparison group (ClinicalTrials.Gov identifier NCT01881607). The intervention targeted schoolchildren in Terrassa (Catalonia, Spain). We assessed SHS exposure in different settings and tobacco consumption by means of a questionnaire before and one year after the intervention. RESULTS We analyzed data from 1734 students with both baseline and follow-up data. The crude analysis showed that SHS exposure among students in the intervention group significantly decreased at school (-14.0%), at home (-19.9%), and on transportation (-21.8%). In the comparison group, SHS exposure significantly decreased only at home (-16.9%). After adjustment for potential confounders, the good accomplishment of the activities showed a possible trend towards a non-significant reduction in exposure at home, transportation, and leisure time. CONCLUSION While this school-based multi-level intervention had no overall effect in SHS exposure, the improvement of the activities focused on preventing SHS would be needed in order to achieve a significant decrease in the proportion of children exposed to SHS.

Validity of self-reported exposure to second-hand smoke in hospitality venues

The aim was to assess the validity of self-reported exposure to second-hand smoke (SHS) in 50 hospitality venues of Madrid (Spain) in 2010, taking as a reference vapour-phase nicotine measured by active sampling. The questions posed in the questionnaire permitted distinguishing between the different levels of SHS. However, the moderate relationship found (Spearman׳s correlation=0.387, p<0.001) suggests that intensity of exposure to SHS in hospitality venues, based solely on self-reported information, should be used with caution.

Nicotine depedence and salivary cotinine concentration in daily smokers.

There is scant information on nicotine dependence in smokers not seeking cessation treatment. This study analyses the relationship between nicotine dependence, measured by the Fagerström Test for Nicotine Dependence (FTND), and salivary cotinine concentration in a sample of smokers from the general population. We conducted a cross-sectional study (2004–2005) of a representative sample of the general population of Barcelona, Spain (n=1245). The analysis included 196 daily smokers aged more than 16 years. Information on smoking was obtained by questionnaire and cotinine concentration was determined in saliva. Geometric means of cotinine concentration by every single FTND item were computed, and multivariate linear regression was used to explore the relationship among these variables. Participants smoked a mean of 17.0 cigarettes per day, and the mean FTND score was 3.27 (95% confidence interval: 2.92–3.61). Around 17% of subjects (95% confidence interval: 12.0–22.5%) had high nicotine dependence. Cotinine concentration differed significantly by nicotine dependence levels. In a multiple linear regression model including the sum of the FTND items 2, 3, and 6, and the single FTND items 1, 4, and 5, adjusted for sex, the time to first cigarette after waking up (item 1), the number of cigarettes smoked daily (item 4), and smoking more in the first hours of the day (item 5) were significantly related to salivary cotinine concentration (R2=0.414). Salivary cotinine levels were associated with nicotine dependence as measured by the FTND, especially with the items on daily tobacco consumption, time to first cigarette after waking up, and smoking more in the first hours of the day.