Cristina Lidón-Moyano

Correlation between tobacco control policies, consumption of rolled tobacco and e-cigarettes, and intention to quit conventional tobacco, in Europe

Objective To analyse the correlation between the implementation of tobacco control policies and tobacco consumption, particularly rolling tobacco, electronic cigarettes (e-cigarettes) users and the intent to quit smoking in 27 countries of the European Union. Design Ecological study with the country as the unit of analysis. Data sources We used the data from tobacco control activities, measured by the Tobacco Control Scale (TCS), in 27 European countries, in 2010, and the prevalence of tobacco consumption data from the Eurobarometer of 2012. Analysis Spearman correlation coefficients (rsp) and their 95% CIs. Results There was a negative correlation between TCS and prevalence of smoking (rsp=−0.41; 95% CI −0.67 to −0.07). We also found a negative correlation (rsp=−0.31) between TCS and the prevalence of ever e-cigarette users, but it was not statistically significant. Among former cigarette smokers, there was a positive and statistically significant correlation between TCS and the consumption of hand-rolled tobacco (rsp=0.46; 95% CI 0.06 to 0.70). We observed a similar correlation between TCS and other tobacco products (cigars and pipe) among former cigarette smokers. There was a significant positive correlation between TCS and intent to quit smoking in the past 12 months (rsp=0.66; 95% CI 0.36 to 0.87). Conclusions The level of smoke-free legislation among European countries is correlated with a decrease in the prevalence of smoking of conventional cigarettes and an increase in the intent to quit smoking within the past 12 months. However, the consumption of other tobacco products, particularly hand-rolled tobacco, is positively correlated with TCS among former cigarette smokers. Therefore, tobacco control policies should also consider other tobacco products, such as rolling tobacco, cigars and pipes.

Prevalencia y perfil de uso del cigarrillo electrónico en España (2014)

OBJECTIVE To describe the prevalence and user profile of electronic cigarettes among Spanish adults and evaluate the potential dual use of these devices with combustible or conventional tobacco in 2014 in Spain. METHODS Cross-sectional study of a representative sample of the Spanish adult (16-75 years old) population (n=1,016). A computer-assisted telephone survey was conducted in 2014. The prevalence and 95% confidence intervals (95% CI) for the use of electronic cigarettes stratified by gender, age, tobacco consumption and social status were calculated. The sample was weighted and a logistic regression model adjusted to obtain the crude odds ratios (OR) adjusted by gender, age and social status. RESULTS 10.3% (95% CI: 8.6-12.4) of the Spanish adult population stated being ever users of electronic cigarettes (2% current users, 3.2% past users and 5.1% experimental users). Among current electronic cigarette users, 57.2% also smoked combustible or conventional tobacco, 28% had never smoked and 14.8% were former smokers. The prevalence of electronic cigarette use was higher in the younger population (adjusted OR=23.8; 95% CI: 2.5-227.7) and smokers of combustible tobacco (adjusted OR=10.1; 95% CI: 5.8-17.5). CONCLUSIONS The use of electronic cigarettes in Spain is scarce and is most prevalent among young people and tobacco smokers. Nevertheless, one out of four current electronic cigarette users have never smoked. Hence, the regulation of these devices should be reinforced to avoid a possible gateway to nicotine products among never smokers.

Sex and Age Specific Projections of Smoking Prevalence in Spain: A Bayesian Approach

Objectives To project future smoking prevalence rates in Spain by sex and age groups using Bayesian methods and to estimate the probability of a 30% relative reduction between 2010 and 2025. Methods We used the data from the Spanish National Health Surveys (2003, 2006, and 2011) to obtain information about current and former smoking. We reconstructed annual smoking rates from 1989 through 2011 by sex and 5-year age groups. The prevalence were projected for the period 2012-2025 using a Bayesian logistic binomial model and estimated the probability to achieve the 30% relative reduction endorsed by the WHO. We calculated the 95% credible interval (CrI) of the posterior distribution, which includes a 95% of the distribution of potential smoking prevalences. Results In men, the projections show a decline for crude (-2.64% annually, 95% CrI: -3.32; -1.97) and adjusted (-2.50%, 95% CrI:-3.14; -1.87) prevalence. In women, the projections show a decline for crude prevalence (-0.36%, 95% CrI: -1.02; -0.30)) and the age-adjusted prevalence (-1.02%, 95% CrI: -1.61, -0.47). By age groups, the decline is greater among women aged 15-39 years (-3.92%, 95% CrI: -4.92; -2.96)) while for women aged 40-64 years an increase (1.84%, 95% CrI: 1.06; 2.58) is expected. In men, the probability to achieve the WHO target is 0.728 and in women is less than 0.001. The age group 15-39 shows the highest probability to achieve the target. Conclusions The results suggest smoking prevalence will decrease during 2012-2025 in all age groups for both sexes except for women aged 40-64. We found that the WHO target of a 30% reduction in prevalence is likely to be achieved overall and in the 15-39 years age groups for both sexes, but not achieved for older women and it is uncertain whether it will be achieved for older men. These results highlight the need to strengthen public health interventions that focus on reducing tobacco use in adult women aged 40-64 years old. Implications We project a decrease in smoking prevalence in during 2012-2025 except for women aged 40-64. The WHO Target of a 30% relative reduction could be achieved in the population aged 15-39; but not in women and the results are inconclusive in men. These results highlight the need to strengthen public health interventions that focus on reducing tobacco use in adult women aged 40-64 years old.

Impact of the Spanish smoking legislations in the adoption of smoke-free rules at home: a longitudinal study in Barcelona (Spain)

Objective To assess the impact of two Spanish smoking legislations in the adoption of voluntary smoke-free-homes rules in Spain. Methods This is a longitudinal study, before and after the implementation of two national smoking bans (in 2005 and 2010), in a representative sample (n=1245) of non-institutionalised adults (≥16 years) from Barcelona (Spain) surveyed in 2004–2005 and followed up in 2013–2014. The final sample analysed was 736 individuals (400 women and 336 men). We defined smoking rules in the houses as complete (when smoking was not allowed in the household), partial (when smoking was allowed in some places inside the house) or absent (when smoking was allowed everywhere). We calculated relative changes in the prevalence of smoking rules in homes before and after 2 national smoking legislations by means of prevalence ratios (PRs) and their 95% CIs. Results The households with voluntary smoke-free rules (complete or partial) relatively increased 31% after Spanish smoking bans (from 55.6% to 72.6%, p<0.001). The houses with complete rules relatively increased 57% (from 23.9% to 37.6%, p<0.001) whereas the houses with partial rules increased 11% (from 31.7% to 35.0%, p=0.148). The increase of any type of rules (complete and partial) was statistically significantly independent of sex (PR between 1.29 and 1.33), age (PR between 1.24 and 1.33), educational level (PR between 1.19 and 1.47) and minimum age in house (PR between 1.12 and 1.40). However, this increase was statistically and significantly higher only among never smokers (PR=1.46) at baseline. Conclusions The implementation of the smoke-free regulations in public and work places in Spain was associated with an increasing of voluntary adoption of smoke-free rules in homes. According to our data, the Spanish smoking bans did not shift the tobacco consumption from public and work places to private places (homes).

Impact of the Spanish smoking laws on tobacco consumption and secondhand smoke exposure: A longitudinal population study

BACKGROUND In Spain, two smoke-free laws have been passed after the approval of the WHO-FCTC. This study assesses the impact of these Spanish smoking legislations on the active and passive smoking through a population cohort in Barcelona (Spain). METHODS This is a longitudinal study before and after the implementation of two national smoking bans in Spain in a representative sample (n=1245) of adults (≥16years old) from Barcelona (Spain) surveyed in 2004-2005 and followed-up in 2013-2014. The final sample analyzed was 736 individuals. Both questionnaires (before and after the two laws) included the same variables about active and passive smoking. We calculated the prevalence and the prevalence ratio (PR, with their 95% confidence intervals, 95% CI) of smoking cigarettes and hand-rolled tobacco and also the prevalence of exposure to secondhand smoke (SHS) at home, work, public transport, leisure time and at any setting after vs. before Spanish legislations. RESULTS After the implementation of the two Spanish smoke-free bans, a significant decrease was observed in the smoking prevalence (from 34.5% to 26.1%, PR=0.76, p<0.001), in the average cigarettes per day (median from 15.2 to 10.0, p<0.001), and in the percentage of conventional tobacco consumption (from 92.6% to 74.4%, PR=0.80, p<0.001). Furthermore, a significant increase in the use of hand-rolled tobacco (from 6.1% to 30.9%, PR=5.07, p<0.001) and other tobacco products (from 17.1% to 32.8%, PR=1.92, p<0.001) was observed. In addition, a significant decrease in the self-reported SHS exposure was observed in all the assessed settings (home, work, transport, and leisure time). CONCLUSIONS The implementation of the two smoke-free legislations in Spain is related to a reduction in smoking prevalence and SHS exposure. However, the smoking of other tobacco products, particularly hand-rolled tobacco, has increased among young population.

Diferencias entre hombres y mujeres en la tendencia temporal de la mortalidad por cáncer de pulmón en España (1980-2013)

INTRODUCTION The main risk factor for lung cancer is smoking, a habit that varies according to age and sex. The objective of this study was to explore trends in lung cancer mortality by sex and age from 1980 to 2013 in Spain. METHODS We used lung cancer mortality (International Classification of Diseases code 162 for the 9th edition, and codes C33 and C34 for 10th edition) and population data from the Spanish National Statistics Institute. Crude, truncated, age-adjusted mortality and age-specific mortality rates were assessed through joinpoint regression to estimate the annual percent change (APC). RESULTS Age-adjusted mortality rate significantly increased from 1980 to 1991 among men (APC=3.12%) and significantly decreased between 2001 and 2013 (APC=-1.53%), a similar pattern was observed in age-specific rates. Among women, age-adjusted mortality rate increased from 1989 (APC 1989-1997=1.82%), with the greatest increase observed from 1997 until the end of the study in 2013 (APC=4.41%). CONCLUSIONS Diverging trends in the prevalence of smoking could explain the increase in the rate of lung cancer-related mortality among Spanish women since the early 1990s. Public health policies should be implemented to reduce tobacco consumption in women and halt the increase in lung cancer mortality.

Uso de paneles de consumidores en estudios observacionales de salud pública

Consumer panels are a market research method useful for gathering information about low-frequency or difficult-access customers. The objective of this field-note is to explain our experience using this method in a cross-sectional public health study on the use of electronic cigarettes. After taking into account other non-probabilistic sampling techniques to obtain a huge sample of electronic-cigarette users (n=600), in the end we decided to use consumer panels (recruiters) because of the relative short duration of the field work and the high representativeness of the sample.

Smoke-free homes and attitudes towards banning smoking in vehicles carrying children in Spain (2016)

Objective To describe the voluntary adoption of smoke‐free homes and social attitudes in Spain towards banning smoking in vehicles in which children are present. Methods Cross‐sectional study of a representative sample of the adult Spanish population age range, 18–75 years (n=1036). The field work was conducted via a computer‐assisted telephone survey in March and April 2016. Survey respondents answered questions about smoking rules at home and attitudes towards a smoking ban in cars with or without children. Home smoking rules were defined as complete (smoking not allowed anywhere in the house), partial (smoking allowed in some areas inside the house) or absent (smoking allowed everywhere). Results Most (83.0%) of the surveyed population had some type of smoking restriction in place at home (45.6% complete and 37.5% partial). There were significant differences between groups according to age group (the highest prevalence was 86.1% from 66 to 75 years and the lowest prevalence was 77.8% from 46 to 65 years) and smoking status (the highest prevalence was 89.4% in people who had never been smokers and the lowest prevalence was 75.0% in current smokers) with regards to the prevalence of smoke‐free homes (p<0.05), with partial bans more prevalent in smoking households (49.0%). Most (61.6%) of the population favored banning smoking in cars, and 90.1% supported a ban in cars carrying minors. Attitudes towards smoking regulation in cars (with or without children) varied significantly by age group (the highest prevalence was 81.9% from 66 to 75 years and the lowest prevalence was 54.5% from 18 to 45 years) and smoking status (the highest prevalence was 71.4% in people who had never been smokers and the lowest prevalence was 46.0% in current smokers). However, no significant differences were found with regard to attitudes towards smoking regulation in cars carrying children, regardless of sex, age, social class, or smoking status. Conclusion Approximately half of the adult population in Spain have implemented a complete smoke‐free rule at home. More than 9 out of 10 adults favor regulating smoking in cars in the presence of minors. These findings support the expansion of smoke‐free regulations to include private vehicles, particularly when minors are in the car. HighlightsDescribe the adoption of voluntary smoke‐free homes in Spain.Describe attitudes toward smoking regulation in vehicles with children.In Spain, around 80% of population has some type of smoke‐free homes.90% of the Spanish population support banning smoking in cars carrying minors.Our findings support the creation of smoke‐free regulations in private vehicles.

Secondhand smoke risk perception and smoke-free rules in homes: a cross-sectional study in Barcelona (Spain)

Objective To describe the voluntary adoption of smoke-free homes in Spain among general population and to identify variables associated with its voluntary adoption. Methods Cross-sectional study of a representative sample (n=731) of the adult population (>26 years) of Barcelona, Spain, in 2013–2014. We defined smoking rules inside the households as complete indoor rules (when smoking was not allowed inside the house), and partial or absent indoor rules (when smoking was allowed in some designated places inside the house or when smoking was allowed everywhere) and described them according to the perceived risk of the secondhand smoke (SHS) exposure. We calculated the prevalence and prevalence ratios (PR) according to sociodemographic variables. Results 57.4% of households had complete indoor smoke-free rules. The prevalence of households with complete indoor rules was higher among women (PRa: 1.15; 95% CI 1.00 to 1.33), married (PRa: 1.18; 95% CI 1.01 to 1.38), never-smokers (PRa: 2.68; 95% CI 2.06 to 3.50) and in households where a minor lived (PRa: 1.40; 95% CI: 1.20–1.65). Believe that breathing tobacco smoke from smokers is dangerous for non-smokers (PRa: 1.77; 95% CI: 1.06–2.97) is associated with the voluntary adoption of complete indoor smoke-free home. Conclusions Risk perceptions of SHS exposure were associated with the voluntary adoption of indoor smoke-free homes.

Update on thirdhand smoke: A comprehensive systematic review

Objective: The objective of this study is to perform a comprehensive review of the literature about thirdhand smoke (THS). Methods: Systematic review of all aspects of THS. Standard methodological procedures were used to search the following databases through April 2018: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science (WOS) in Indo‐European languages. To identify published grey literature, the first 200 hits from Google Scholar™ were evaluated. Clinical trial databases, conference proceedings, and reference lists from the identified articles were also searched. Two unblinded review authors independently assessed trials for inclusion in the review. These same reviewers also extracted study data in accordance with PRISMA guidelines. The study protocol was registered with PROSPERO (CRD42018083619). Results: Sixty‐eight articles were included in this systematic review. Of these, 28 analyzed the concentration of nicotine as a component of THS (the most commonly‐used method to measure THS in those studies was chromatography, followed by the mass spectrometry), 21 evaluated the exposure and impact of THS on health (11 studies analyzed the effect of THS in cells [human and animal], 4 in animals, 1 in adults, and 5 in children), 16 investigated the beliefs, behaviours, and policies related to THS, and 3 evaluated other aspects such as THS in e‐cigarettes or hookahs. In these 68 studies, THS was determined by measuring the following components: nicotine (30 studies), nitrosamines (17 studies) and cotinine (15 studies). The findings from most of these studies suggest a potential health impact of THS exposure (i.e.: cytotoxicity, metabolic alterations in metabolism, in glycemia; or cell structure; alterations in liver, lung, skin and behaviour in mice), and low awareness about the risks of THS among the general population. Conclusions: Numerous specific biomarkers of THS were evaluated, with the most common being nicotine, nitrosamines, and cotinine. The most common method of preparing THS dust samples were cotton wipes, while chromatography, used alone or coupled with mass spectrometry, was the most common analytical technique. We have tried to establish common bases after reviewing all the current literature of the THS although, there is great heterogeneity between the studies and we have not always succeeded. The studies in this review demonstrate the harmful effects of THS on health in cells, in animal models, and in people including children. However, in people, the long‐term effects remain unknown and more research is needed. These studies show that knowledge about THS and its potential harmful effects are poorly understood among the general population. For this reason, THS should receive greater emphasis in education and awareness policies. HighlightsTHS consists of tobacco pollutants that remain in dust, air and on surfaces.A systematic literature review was done for thirdhand smoke as a term.Thirdhand smoke exposure results in toxicity.‐Long‐term effects of THS exposure remain unknown and more research is needed.