Esteve Saltó

Impact of the Spanish Smoking Law on Exposure to Second-Hand Smoke and Respiratory Health in Hospitality Workers: A Cohort Study

Background A smoke-free law came into effect in Spain on 1st January 2006, affecting all enclosed workplaces except hospitality venues, whose proprietors can choose among totally a smoke-free policy, a partial restriction with designated smoking areas, or no restriction on smoking on the premises. We aimed to evaluate the impact of the law among hospitality workers by assessing second-hand smoke (SHS) exposure and the frequency of respiratory symptoms before and one year after the ban. Methods and Finding We formed a baseline cohort of 431 hospitality workers in Spain and 45 workers in Portugal and Andorra. Of them, 318 (66.8%) were successfully followed up 12 months after the ban, and 137 nonsmokers were included in this analysis. We obtained self-reported exposure to SHS and the presence of respiratory symptoms, and collected saliva samples for cotinine measurement. Salivary cotinine decreased by 55.6% after the ban among nonsmoker workers in venues where smoking was totally prohibited (from median of 1.6 ng/ml before to 0.5 ng/ml, p<0.01). Cotinine concentration decreased by 27.6% (p = 0.068) among workers in venues with designated smoking areas, and by 10.7% (p = 0.475) among workers in venues where smoking was allowed. In Portugal and Andorra, no differences between cotinine concentration were found before (1.2 ng/ml) and after the ban (1.2 ng/ml). In Spain, reported respiratory symptom declined significantly (by 71.9%; p<0.05) among workers in venues that became smoke-free. After adjustment for potential confounders, salivary cotinine and respiratory symptoms decreased significantly among workers in Spanish hospitality venues where smoking was totally banned. Conclusions Among nonsmoker hospitality workers in bars and restaurants where smoking was allowed, exposure to SHS after the ban remained similar to pre-law levels. The partial restrictions on smoking in Spanish hospitality venues do not sufficiently protect hospitality workers against SHS or its consequences for respiratory health.

Passive smoking and risk of pulmonary tuberculosis in children immediately following infection. A case-control study

SETTING Passive smoking-related respiratory disorders in children. OBJECTIVES To assess the effect of passive smoking on the development of active pulmonary tuberculosis (PTB) in children immediately following infection by Mycobacterium tuberculosis within the family. DESIGN An unmatched case-control study in which 93 contacts who became cases (active PTB diagnosed) and 95 contacts who did not became cases (tuberculin-positive children without evidence of active disease) were included. All were household contacts of a new case of pulmonary bacillary tuberculosis. Smoking habits were investigated by a questionnaire. Urinary cotinine was analysed. Odds Ratio (OR) was adjusted for age and socio-economic status using multiple logistic regression analysis. RESULTS Passive smoking was a risk factor for PTB (OR: 5.29; 95% confidence interval (CI): 2.33-12.82; P < 0.00005). The adjusted OR was 5.39 (95% CI: 2.44-11.91; P < 0.00001). The risk increased when contacts were passive smokers both at home and outside the home within the family (OR: 6.35; 95% CI: 3.20, 12.72; P < 0.00001). Contacts 0-4 and 5-9 years old showed a significantly higher risk than those aged > or = 10. There was a dose-response relationship between the risk of developing active PTB immediately following infection and the number of cigarettes smoked daily by the household adults (P < 0.001). Mean (SD) urinary continine detectable concentrations (ng/ml) were different between disease contacts (119.46 [68.61]) and non diseased contacts (91.87 [73.10]). The difference was statistically significant (P < 0.001). CONCLUSIONS Passive exposure to tobacco smoke in children was associated with an increased risk of developing pulmonary tuberculosis immediately following infection. This is an association of great concern requiring health education programmes and antitobacco medical advice.

Impact of the Spanish Smoking Law on Exposure to Secondhand Smoke in Offices and Hospitality Venues: Before-and-After Study

Background/objectives A smoking law was passed by the Spanish Parliament in December 2005 and was enforced by 1 January 2006. The law bans smoking in all indoor workplaces but only in some hospitality venues, because owners are allowed to establish a smoking zone (venues > 100 m2) or to allow smoking without restrictions (venues < 100 m2). The objective of the study is to assess the impact of the Spanish smoking law on exposure to secondhand smoke (SHS) in enclosed workplaces, including hospitality venues. Materials and methods The study design is a before-and-after evaluation. We studied workplaces and hospitality venues from eight different regions of Spain. We took repeated samples of vapor-phase nicotine concentration in 398 premises, including private offices (162), public administration offices (90), university premises (43), bars and restaurants (79), and discotheques and pubs (24). Results In the follow-up period, SHS levels were markedly reduced in indoor offices. The median decrease in nicotine concentration ranged from 60.0% in public premises to 97.4% in private areas. Nicotine concentrations were also markedly reduced in bars and restaurants that became smoke-free (96.7%) and in the no-smoking zones of venues with separate spaces for smokers (88.9%). We found no significant changes in smoking zones or in premises allowing smoking, including discotheques and pubs. Conclusions Overall, this study shows the positive impact of the law on reducing SHS in indoor workplaces. However, SHS was substantially reduced only in bars and restaurants that became smoke-free. Most hospitality workers continue to be exposed to very high levels of SHS. Therefore, a 100% smoke-free policy for all hospitality venues is required.

Prevalencia del consumo de tabaco en España entre 1945 y 1995. Reconstrucción a partir de las Encuestas Nacionales de Salud

Fundamento y objetivo: Analizar la evolucion del consumo de cigarrillos en Espana entre 1945 y 1995. Material y metodo: A partir de la informacion individual sobre consumo de tabaco recogida en las Encuestas de Salud de Espana de 1993, 1995 y 1997 se ha reconstruido la prevalencia de fumadores de cigarrillos diarios para el periodo 1945-1995. Resultados: En los varones, la prevalencia de tabaquismo en 1945 fue del 42,4% (intervalo de confianza [IC] del 95%, 40,1-44,7%), aumento hasta llegar al 59,1% en 1975 (IC del 95%, 58,0-60,2%), se estabilizo a continuacion durante la decada 1975-1985 y disminuyo hasta la actualidad hasta el 48,9% (IC del 95%, 48,1-49,7%) en 1995. En las mujeres, la prevalencia de tabaquismo fue inferior al 5% hasta la decada de los setenta, momento en que empieza a aumentar de manera sostenida hasta el final del periodo de estudio, con una prevalencia en 1995 del 22,5% (IC del 95%, 21,9-23,1%). Conclusiones: Este analisis permite apreciar la diferente dinamica de la epidemia de tabaquismo entre varones y mujeres en Espana.

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.

Prevalencia del tabaquismo en Cataluña, 1982-1998: una perspectiva de género

Fundamento Describir la evolucion del habito tabaquico en la poblacion catalana entre 1982 y1998, a partir de un analisis de perspectiva de genero. Sujetos y metodo Se incluyeron datos de las encuestas llevadas a cabo por el Departament deSanitat i Seguretat Social en 1982, 1986, 1990, 1994 y 1998. Se analizaron el «status» defumador, el numero de cigarrillos diarios fumados, la edad y el sexo, asi como variables relacionadascon el tipo de tabaco fumado, la edad de inicio y la duracion del habito. Los resultadosse presentan como proporciones con sus intervalos de confianza del 95% y como medias consus desviaciones estandar. Resultados La prevalencia global del habito tabaquico en la poblacion de 15-64 anos se mantieneestable entre 1982 y 1998 (variacion porcentual de –1,1%) y se situa en un 37,5% defumadores actuales en 1998. En las mujeres, la prevalencia se incrementa un 53,5% durantedicho periodo y alcanza el 30,7% en 1998. En los varones se reduce un 23,8% y alcanza el44,4%. Entre 1994 y 1998 se rompe la tendencia decreciente que se habia producido hastaentonces en los jovenes de ambos sexos. En 1998, el 26,1% de las mujeres fuma tabaco«light» frente a un 10,4% de los varones; las mujeres fuman una media de 13,8 (8,8) cigarrillosdiarios frente a la media de 19,7 (12,6) cigarrillos que fuman los varones; la media de duraciondel habito entre las mujeres es de 13,9 (10,1) anos mientras que en los varones es de22,6 (16,0). Conclusiones Hasta el ano 1998, la prevalencia del habito tabaquico en Cataluna se mantuvoelevada a pesar de producirse una disminucion importante de la masculina. La situacion fueparticularmente desfavorable para los jovenes de ambos sexos y las mujeres, cuyo habito tabaquicopresenta caracteristicas especificas.

Secondhand smoke levels in public building main entrances: outdoor and indoor PM2.5 assessment

Background/Objectives To describe secondhand smoke (SHS) levels in halls and main entrances (outdoors) in different buildings by measurement of PM2.5 and airborne nicotine. Methods Cross-sectional study in a sample of 47 public buildings. The authors studied SHS levels derived from PM2.5 (micrograms per cubic metre) using TSI SidePak Personal Aerosol Monitors. The authors tested four locations within buildings: hall, main entrance (outdoor), control (indoor) and control (outdoor). The authors also measured airborne nicotine concentration (micrograms per cubic metre) in main entrances (outdoor). The authors computed medians and IQRs to describe the data. Spearman correlation coefficient (rsp) was used to explore the association between PM2.5 concentrations simultaneously measured in halls and main entrances as well as between PM2.5 and nicotine concentrations. Results The authors obtained an overall median PM2.5 concentration of hall 18.20 μg/m3 (IQR: 10.92–23.92 μg/m3), main entrance (outdoor) 17.16 μg/m3 (IQR: 10.92–24.96 μg/m3), control (indoor) 10.40 μg/m3 (IQR: 6.76–15.60 μg/m3) and control (outdoor) 13.00 μg/m3 (IQR: 8.32–18.72 μg/m3). The PM2.5 concentration in halls was more correlated with concentration in the main entrances (outdoors) (rsp=0.518, 95% CI 0.271 to 0.701) than with the control indoor (rsp=0.316, 95% CI 0.032 to 0.553). The Spearman correlation coefficient between nicotine and PM2.5 concentration was 0.365 (95% CI −0.009 to 0.650). Conclusions Indoor locations where smoking is banned are not completely free from SHS with levels similar to those obtained in the immediate entrances (outdoors) where smoking is allowed, indicating that SHS from outdoors settings drifts to adjacent indoors. These results warrant a revision of current smoke-free policies in particular outdoor settings.

Estadísticas de alta hospitalaria del infarto agudo de miocardio: declive aparente con la extensión de espacios sin humo

Estudios recientes indican que regulaciones del consumo de tabaco reducen los infartos agudos de miocardio (IAM). Se analiza la evolucion del IAM en la region metropolitana de Barcelona con la ley de 2006. Se obtuvo informacion sobre altas financiadas por el Servicio Catalan de la Salud para 2004-2006. Se incluyo a los pacientes mayores de 24 anos residentes en la zona con diagnostico principal de IAM. Se estimaron tasas anuales de hospitalizacion por IAM estratificadas por edad y sexo con intervalos de confianza (IC) del 95% para cada ano. Las tasas en 2004 son mayores que en 2005 para la mayoria de los estratos, pero los IC se solapan. Las tasas en 2006 son menores que en 2005 para todos los grupos, y los IC no se solapan en varones. Las regulaciones sobre espacios sin humo se acompanan de una disminucion de los IAM hospitalizados.

Electronic cigarette use among adult population: a cross-sectional study in Barcelona, Spain (2013–2014)

Objective This study seeks to analyse the prevalence and correlates of electronic cigarette (e-cigarette) use, purchase location and satisfaction with its use in a sample of the general population of the city of Barcelona, Spain. Design, setting and participants We used participants from a longitudinal study of a representative sample of the adult (≥16 years old) population of Barcelona (336 men and 400 women). The field work was conducted between May 2013 and February 2014. We computed the prevalence, adjusted odds ratios (ORs) and their corresponding 95% confidence interval (CI). Results The prevalence of ever e-cigarette use was 6.5% (95% CI 4.7% to 8.3%): 1.6% current use, 2.2% past use and 2.7% only e-cigarette experimentation. 75% (95% CI 62.8% to 87.3%) of ever e-cigarette users were current cigarette smokers at the moment of the interview. E-cigarette use was more likely among current smokers (OR=54.57; 95% CI 7.33 to 406.38) and highly dependent cigarette smokers (OR=3.96; 95% CI 1.60 to 9.82). 62.5% of the ever users charged their e-cigarettes with nicotine with 70% of them obtaining the liquids with nicotine in a specialised shop. 39.6% of ever e-cigarette users were not satisfied with their use, a similar percentage of not satisfied expressing the smokers (38.9%) and there were no statistically significant differences in the satisfaction between the users of e-cigarettes with and without nicotine. Conclusions E-cigarette use is strongly associated with current smoking (dual use) and most users continue to be addicted to nicotine. Six out of 10 e-cigarette users preferred devices that deliver nicotine. The satisfaction with e-cigarette use is very low.

Secondhand smoke in hospitals of Catalonia (Spain) before and after a comprehensive ban on smoking at the national level.

OBJECTIVE To assess changes in secondhand smoke exposure by means of airborne nicotine concentrations in public hospitals of Catalonia (Spain) before and after a comprehensive national smoking ban. METHODS We monitored vapor-phase nicotine concentrations in 44 public hospitals in Catalonia (Spain) before the smoking ban (September-December 2005) and one year after (September-December 2006). We installed 5-7 sampling devices per hospital for 7 days in different places (228 pairs of samples), and 198 pairs of samples were available for the final analysis. RESULTS The median nicotine concentration declined from 0.23 microg/m(3) (interquartile range: 0.13-0.63) before the law to 0.10 microg/m(3) (interquartile range: 0.02-0.19) after the law (% decline=56.5, p<0.01). We observed significant reductions in the median nicotine concentrations in all hospital locations, although secondhand smoke exposure was still present in some places (main hospital entrance, emergency department waiting rooms, fire escapes, and cafeterias). CONCLUSIONS Secondhand smoke in hospitals has decreased after the ban. Assessment of airborne nicotine concentrations appears to be an objective and feasible system to monitor and reinforce the compliance of smoke-free legislations in this setting.