Rodrigo Córdoba

El proceso en España de la adopción de una legislación eficaz para la prevención del tabaquismo

The prevention movement has been the key agent involved in smoking control policies. This study describes the context and the process in which Law 28/2005 was passed in Spain with a synthesis of its substance. It provides the background of the events leading up to Spains current smoking control law in addition to an analysis of the role played by the different social actors in the process and the arguments and strategies employed in opposition by the tobacco industry. A review is also provided of the political agents, highlighting that decentralized countries have further problems in enforcing regulations. This case offers lessons for the future.

Lecciones aprendidas en el control del tabaquismo en España

En Espana ha sido visible la creciente implicacion de la sociedad civil en la demanda de politicas de control del tabaquismo. Las bases para la creacion del Comite Nacional para la Prevencion del Tabaquismo (CNPT) fueron asentadas en 2004. A finales de ese ano la intensa actuacion para concretar las acciones reguladoras del incipiente Plan Nacional para la Prevencion del Tabaquismo culmino en una ley que permitio un salto cualitativo, aprovechando la trasposicion legal de la directiva europea de publicidad: la Ley 28/2005, que, en un clima de amplio consenso politico y mediatico, dispone medidas sanitarias frente al tabaquismo y regula la venta, el suministro, el consumo y la publicidad de los productos del tabaco. El objetivo declarado por esta ley es evitar el inicio del consumo de tabaco particularmente entre los jovenes, garantizar el derecho de los no fumadores a respirar aire sin humo del tabaco y hacer mas facil el abandono de este habito a las personas que lo deseen. Sus temas principales son la prohibicion de la publicidad del tabaco y la limitacion de su consumo en centros de trabajo y espacios publicos cerrados. La nueva ley ha substituido a la normativa previa en Espana, que era una de las mas permisivas de la Union Europea en temas como la venta de tabaco, limitacion de la publicidad y restricciones de lugares de consumo. No obstante, esta claro que aun queda mucho por hacer. En este momento hace falta generar apoyo social a la nueva regulacion y hacer un esfuerzo importante de sensibilizacion y educacion del publico.

Impacto de la nueva legislación sobre tabaquismo (Ley 42/2010) en los niveles de humo ambiental de tabaco en locales de hostelería

OBJECTIVE To evaluate pollution by second-hand smoke in a sample of hospitality venues before and after the implementation of smoke-free legislation. METHODS A cross sectional, before-after study was conducted in 2008 and 2011 after the total ban. A SidePack Aerosol monitor was used both inside and outside the hospitality venues to measure fine breathable particles (PM2.5). A total of 43 places with pre- and post-legislation measurements were included. RESULTS The median indoor pollution in hospitality venues was 204.2μg/m(3) in 2008 and 18.82μg/m(3) in 2011; the average outdoor PM2.5 concentration was 47.04μg/m(3) in 2008 and 18.82μg/m(3) in 2011. Pollution was higher in bars and cafeterias, followed by pubs and discos. Before the law was implemented, pollution was 4.34 times higher indoors than outdoors; in 2011 the average indoor PM2.5 concentration decreased by 90.88%. CONCLUSIONS Only a complete ban is able to protect workers and customers against the health risks of second-hand smoke exposure.

Medición del nivel de partículas finas respirables (PM2.5) como marcador del humo ambiental del tabaco en locales de hostelería de Zaragoza

OBJECTIVE To estimate the levels of small breathable suspended particles (PM(2.5)) as atmospheric markers of environmental tobacco smoke in catering establishments in Zaragoza, Spain. MATERIAL AND METHOD An observational study was conducted between October 2006 and April 2008 in various catering establishments in Zaragoza. A SidePack Aerosol Monitor (AM510 model) was used to sample and record the levels of breathable suspended particles (PM(2.5)) indoors and outdoors, and the following variables were collected: smoking policy (smoking allowed, completely banned, or partially banned with non-smoking sections, physically separated or not); percentage of smokers and presence of cigarette ends, ashtrays or smokers in non-smoking sections. RESULTS A total of 111 venues were sampled. The level of PM(2.5) was eight times higher in smoking venues than in non-smoking ones and also higher than outdoors. The correlation between the level of particles and percentage of smokers was 0.61 (P<.01). In the non-smoking sections without physical separation the level of particles was twice as much as outdoors and similar to physically separated smokers sections. CONCLUSION Only a complete ban on smoking in all workplaces, including leisure venues, has been shown to have a positive effect on workers and customers health. The measurement of PM(2.5) can be a simple method to assess the presence of environmental tobacco smoke.

Estrategias de reducción de riesgos en tabaquismo: ¿oportunidad o amenaza?

The smoking control policies recommended by the World Health Organisation have achieved a slight decrease in smoking prevalence in the developed countries, although associated mortality is still very high. The use of tobacco products other than cigarettes and even medicinal nicotine (known as nicotine replacement therapy (NRT)) has been proposed as a risk reduction strategy. Among the tobacco products with less individual risk than cigarettes would be any type of tobacco without smoke (smokeless) with a low content in nitrosamines and modified cigarettes; both forms included under the PREP (Potentially Reduced Exposure Products) concept. The idea would be to promote these products among those who cannot quit smoking or wish to reduce their risk without giving up nicotine intake. The possible effects of risk reduction strategies, including PREP, on the decreased prevalence and morbidity and mortality are reviewed, and the possible implications that this measure could have in our country are analysed. Tobacco control measures in Spain are recent and still insufficient. Therefore, the current priority in Spain is the development of policies of control that have shown to more than effective. The marketing and advertising of new tobacco products, even with reduced potential risk, seems more a serious threat than an opportunity for the development of smoking control policies.

Strategies for Reducing Risks in Smoking: Opportunity or Threat?

Abstract The smoking control policies recommended by the World Health Organisation have achieved a slight decrease in smoking prevalence in developed countries, although associated mortality is still very high. The use of tobacco products other than cigarettes and even medicinal nicotine (known as nicotine replacement therapy [NRT]) has been proposed as a risk reduction strategy. Among the tobacco products with less individual risk than cigarettes would be any type of tobacco without smoke (smokeless) with a low content in nitrosamines and modified cigarettes; both forms included under the PREP (Potentially Reduced Exposure Products) concept. The idea would be to promote these products among patients who cannot quit smoking or wish to reduce their risk without giving up nicotine intake. The possible effects of risk reduction strategies, including PREP, on the decreased prevalence and morbidity and mortality are reviewed, and the possible implications that this measure could have in Spain are analysed. Tobacco control measures in Spain have only been made recently and are still insufficient. Therefore, the current priority in Spain is to develop control policies that have proven to be more than effective. The marketing and advertising of new tobacco products, even with reduced potential risk, seems more a serious threat than an opportunity for developing smoking control policies.