Montse Ballbè

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.

Attitudes towards Electronic Cigarettes Regulation in Indoor Workplaces and Selected Public and Private Places: A Population-Based Cross-Sectional Study

Background Currently, there is an intensive debate about the regulation of the use of electronic cigarettes (e-cigarettes) in indoor places. The aim of this study was to assess the attitudes toward e-cigarette use in indoor workplaces and selected public and private venues among the general population in Barcelona (Spain) in 2013–2014. Methods This is a cross-sectional study of a representative sample of the population of Barcelona (n = 736). The field work was conducted between May 2013 and February 2014. We computed the prevalence and the adjusted odds ratios (OR) derived from multivariable logistic regression models. Results The awareness of e-cigarettes was 82.3%. Forty five percent of respondents did not agree with the use of e-cigarettes in public places and 52.3% in workplaces. The proportion of disapproval of the use of e-cigarettes in indoor places was higher at 71.5% for schools and 65.8% for hospitals and health care centers; while the prevalence of disapproval of e-cigarette use in homes and cars was lower (18.0% and 32.5%, respectively). Respondents who disagreed on the use of e-cigarettes in indoor workplaces were more likely to be older (OR = 1.64 and 1.97 for groups 45–64 and ≧65 years old, respectively), those with a high educational level (OR = 1.60), and never and former smokers (OR = 2.34 and 2.16, respectively). Increased scores in the Fagerström test for cigarette dependence were also related to increased support for their use. Conclusions Based on this population based study, half of the general population of Barcelona does not support the use of e-cigarettes in indoor workplaces and public places, with the percentage reaching 65% for use in schools, hospitals and health care centers. Consequently, there is good societal support in Spain for the politicians and legislators to promote policies restricting e-cigarettes use in workplaces and public places, including hospitality venues.

Perception of electronic cigarettes in the general population: does their usefulness outweigh their risks?

Objective To describe and compare the perceptions of the general population about the harmful effects of electronic cigarettes (e-cigarettes) on users and on those passively exposed to e-cigarettes and the perceptions about e-cigarette usefulness for reducing or eliminating tobacco smoking. Design, setting, and participants We analysed cross-sectional data from a longitudinal study of a representative sample of the general adult (≥16 years) population of Barcelona, Spain (336 men and 400 women). The fieldwork was conducted between May 2013 and February 2014. We computed the percentages, adjusted OR and their corresponding 95% CI among participants with some awareness of e-cigarettes (79.2% of the sample). Primary and secondary outcome measures We assessed the perception about harmfulness for e-cigarette users and for passively exposed non-e-cigarette users, as well as the perception of usefulness for smokers of cigarette cessation and reduction. Results In this sample, 40.1% thought that e-cigarettes had a harmful effect on users, and 27.1% thought that e-cigarettes had a harmful effect on passively exposed bystanders (p<0.001). Particularly, more never-smokers perceived that e-cigarettes had harmful effects on passively exposed bystanders than current smokers (34.4% vs 20.6%; OR=1.93, 95% CI 1.02 to 3.63). More people perceived e-cigarettes as being useful for reducing smoking than for quitting (50.6% vs 29.9%, p<0.001), as well as for reducing smoking than as being harmful to users (50.6% vs 40.1%, p=0.044). Discussion The perception that e-cigarettes are useful for reducing tobacco consumption was more prevalent than the perception that e-cigarettes are harmful to users and to those passively exposed to e-cigarettes. Advertisements and messages about the use of e-cigarettes and their harmful effects should be regulated and based on scientific evidence to avoid creating erroneous ideas about their use.

Smoke-free policies in psychiatric services: identification of unmet needs

Introduction Smoke-free policies have been extended to enclosed workplaces in many countries; however, smoking continues to be commonly allowed on psychiatric premises. The aim of this study was to describe tobacco control strategies undertaken in psychiatric inpatient services and day centres in Spain. Methods This cross-sectional survey included all psychiatric service centres that offered public services in Catalonia, Spain (n=192). Managers responded to a questionnaire of 24 items that covered four dimensions, including clinical intervention, staff training and commitment, smoking area management and communication of smoke-free policies. Results A total of 186 managers (96.9%) completed the questionnaire. Results showed low tobacco control in psychiatric services: 41.0% usually intervened in patient tobacco use, 34.1% had interventional pharmacotherapy available and 38.9% had indoor smoking areas. Day centres showed the lowest implementation of tobacco control measures. Out of 186 managers, 47.3% stated that the staff had insufficient knowledge on smoking cessation interventions. Conclusions The former Spanish partial law has not been sufficiently successful in promoting tobacco control in psychiatric services. There is room for improvement in tobacco control policies, specifically in smoking interventions, staff training and resource availability.

Safety belt and mobile phone usage in vehicles in Barcelona (Spain)

OBJECTIVES To describe the prevalence and correlates of safety belt and mobile phone usage in vehicles in the city of Barcelona (Spain). METHODS We performed a study using direct observation with a cross-sectional design. We selected 2,442 private cars, commercial vehicles, and taxis from all districts of Barcelona. RESULTS The prevalence of people not wearing safety belt was 10.5% among drivers, 4.6% among front seat passengers, and 32.2% among some of the rear passengers. It was higher among the passengers than among the drivers, regardless of the type of the vehicle. The prevalence of mobile phone usage while driving during a moment of the trip was 3.8%. CONCLUSION Our study shows noticeably high prevalence of people not wearing safety belt in the rear seats. Moreover, four out of one hundred drivers still use the mobile phone while driving during a moment of the trip.

Second-hand smoke in mental healthcare settings: time to implement total smoke-free bans?

BACKGROUND Second-hand smoke is associated with adverse health effects. Many countries have extended smoke-free policies to public buildings and workplaces such as hospitals, but mental health units have usually been exempted from complete smoke-free bans. The objective of this study was to evaluate second-hand smoke levels in mental health units with different types of smoking bans. Method We conducted a cross-sectional study to evaluate second-hand smoke in 64 mental health inpatient units (95.5% of the all such units) in Catalonia, Spain. We measured air concentrations of particulate matter <2.5 μm (PM2.5) as a marker of second-hand smoke in different locations at each unit. RESULTS The geometric mean (95% confidence interval) of the PM2.5 concentration was 8.81 μg/m(3) (8.06-9.56) in units with indoor and outdoor smoking bans, 13.80 μg/m(3) (13.23-14.36) in units with indoor smoking bans that allowed smoking in outdoor areas, 24.29 μg/m(3) (23.50-25.03) in units with indoor smoking rooms and 51.00 μg/m(3) (49.83-52.04) in units that allowed smoking in common indoor areas (P < 0.05). The regression model adjusted for confounding variables showed a linear increase of PM2.5. The PM2.5 concentration in smoking rooms was 286.50 μg/m(3) (283.95-288.89). CONCLUSIONS Only units with indoor and outdoor smoking bans had PM2.5 levels below the standard recommended WHO levels of 10 μg/m(3). Units with more permissive smoking policies had PM2.5 levels from second-hand smoke that have harmful health effects.

Exposure to secondhand smoke in the home and mental health in children: a population-based study

Objectives To examine the association between exposure to secondhand smoke (SHS) in the home and mental health among children. Methods Cross-sectional study of 2357 children representative of the Spanish population aged 4–12 years in 2011–2012. Duration of SHS exposure in children was reported by parents. Probable mental disorder was defined as a score >90th centile in the parental version of the Strengths and Difficulties Questionnaire (SDQ). Statistical analysis was performed with logistic regression and adjusted for sociodemographic variables, lifestyle, neighbourhood environment and family characteristics, including parental mental health. Results Among study participants, 6.9% (95% CI 5.7% to 8.0%) were exposed to SHS in the home for <1 h/day and 4.5% (95% CI 3.5% to 5.5%) for ≥1 h/day. Compared to children not habitually exposed to SHS, the multivariate ORs for probable mental disorder were 1.49 (95% CI 0.85 to 2.62) for SHS exposure <1 h/day and 2.73 (95% CI 1.38 to 5.41) for SHS exposure ≥1 h/day (p for linear trend=0.002). The corresponding ORs for attention-deficit and hyperactivity disorder (ADHD) were 2.18 (95% CI 1.30 to 3.64) for <1 h/day exposure and 3.14 (95% CI 1.63 to 6.04) for ≥1 h/day exposure (p for linear trend <0.001). No association was found between SHS and the rest of the components of the SDQ. Conclusions Among children, SHS exposure in the home during ≥1 h/day is associated with a higher frequency of mental disorder. This association was mostly due to the impact of SHS on ADHD.

Manufactured and roll-your-own cigarettes: A changing pattern of smoking in Barcelona, Spain

Aims: The objectives of the present study were to describe smoking prevalence and compare the smoking attributes of adult smokers according to the type of tobacco product consumed. Methods: Repeated cross‐sectional surveys (2004–2005 and 2011–2012) of a representative sample of the adult (≥16 years) population in Barcelona, Spain, were used to assess self‐reported tobacco consumption, smoking attributes, and salivary cotinine concentration. The survey conducted in 2004–2005 included information on 1245 subjects and the survey in 2011–2012 on 1307 individuals. Results: Smoking prevalence decreased over the study period (from 26.6% to 24.1% in self‐reported daily smokers). The prevalence of daily smokers who reported the use of manufactured cigarettes declined from 23.7% in 2004–2005 to 17.3% in 2011–2012. The prevalence of roll‐your‐own cigarette users increased from 0.4% to 3.7%. According to data obtained in 2011–2012, the proportion of self‐reported roll‐your‐own cigarette users was higher among men (19.8% vs. 9.5% of women), participants aged 16–44 years (22.9% vs. 5.8% of participants aged 45–65 years and 4.0% of participants aged ≥65 years), and participants with secondary and university education (17.7% and 18.5% vs. 7.9% of participants with less than primary and primary education). We did not observe differences in cotinine concentrations according to the type of tobacco product consumed. Conclusions: Systematic collection of data on smoking prevalence and smoker attributes from representative samples of the population is necessary for policymakers to develop efficient tobacco control interventions. Considering the increase of roll‐your‐own cigarette users and the unclear health consequences of their use, policymakers should aim to implement tax policies to equalize the prices of different types of tobacco products. HighlightsThis is the first study in Spain that focus on the type of tobacco consumed, using a biomarker of tobacco consumption.We observed an important increase on roll‐your‐own cigarettes, especially remarkable among people in younger ages.Cotinine levels were similar independently of the type of tobacco smoked.

Conocimiento y percepción de la nocividad del cigarrillo electrónico en población adulta de Barcelona

OBJECTIVE To describe knowledge of electronic cigarettes (e-cigarettes) and their perceived harmfulness in the population of Barcelona in 2013-2014. METHODS We used participants from a longitudinal study of a representative sample of the adult population in the city of Barcelona (n=736). The field work was conducted between May 2013 and February 2014. RESULTS Awareness of e-cigarette was 79.2%. The average level of knowledge was 4.4 points out of 10; there were statistically significant differences according to age, educational level, tobacco consumption, and nicotine dependence. Most participants had learned about e-cigarettes through traditional media (57.8%). Nearly half (47.2%) of the participants believed that e-cigarettes are less harmful than conventional cigarettes. CONCLUSION Advertising of e-cigarettes in the media should be regulated because there is still scarce scientific evidence about the usefulness and harmful effects of these devices.

Impact of tobacco control policies in hospitals: Evaluation of a national smoke-free campus ban in Spain

Introduction On January 2, 2011, the Spanish government passed a new smoking law that banned smoking in hospital campuses. The objective of this study was to evaluate the implementation of smoke-free campuses in the hospitals of Catalonia based on both airborne particulate matter and observational data. Methods This cross-sectional study included the hospitals registered in the Catalan Network of Smoke-free Hospitals. We measured the concentration of particulate matter < 2.5 µm in μg/m3 at different locations, both indoors and outdoors before (2009) and after (2011) the implementation of the tobacco law. During 2011, we also assessed smoke-free zone signage and indications of smoking in the outdoor areas of hospital campuses. Results The overall median particulate matter < 2.5 µm concentration fell from 12.22 μg/m3 (7.80–19.76 μg/m3) in 2009 to 7.80 μg/m3 (4.68–11.96 μg/m3) in 2011. The smoke-free zone signage within the campus was moderately implemented after the legislation in most hospitals, and 55% of hospitals exhibited no indications of tobacco consumption around the grounds. Conclusions After the law, particulate matter < 2.5 µm concentrations were much below the values obtained before the law and below the annual guideline value recommended by the World Health Organization for outdoor settings (10 μg/m3). Our data showed the feasibility of implementing a smoke-free campus ban and its positive effects.