Sofia Belo Ravara

Compliance and enforcement of a partial smoking ban in Lisbon taxis: an exploratory cross-sectional study

BackgroundResearch evaluating enforcement and compliance with smoking partial bans is rather scarce, especially in countries with relative weak tobacco control policies, such as Portugal. There is also scarce evidence on specific high risk groups such as vehicle workers. In January 2008, Portugal implemented a partial ban, followed by poor enforcement. The purpose of this study was to explore the effectiveness of a partial smoking ban in a pro-smoking environment, specifically transportation by taxi in the city of Lisbon. Ban effectiveness was generally defined by ban awareness and support, compliance and enforcement.MethodsExploratory cross-sectional study; purposive sampling in selected Lisbon streets. Structured interviews were conducted by trained researchers while using taxi services (January 2009-December 2010). Participants: 250 taxi drivers (98.8% participation rate). Chi-square, McNemar, Man Whitney tests and multiple logistic regression were performed.ResultsOf the participants, 249 were male; median age was 53.0 years; 43.6% were current smokers. Most participants (82.8%) approved comprehensive bans; 84.8% reported that clients still asked to smoke in their taxis; 16.8% allowed clients to smoke. Prior to the ban this value was 76.9% (p < 0.001). The major reason for not allowing smoking was the legal ban and associated fines (71.2%). Of the smokers, 66.1% admitted smoking in their taxi. Stale smoke smells were detected in 37.6% of the cars. None of the taxi drivers did ever receive a fine for non-compliance. Heavy smoking, night-shift and allowing smoking prior the ban predicted non-compliance.ConclusionsDespite the strong ban support observed, high smoking prevalence and poor enforcement contribute to low compliance. The findings also suggest low compliance among night-shift and vehicle workers. This study clearly demonstrates that a partial and poorly-enforced ban is vulnerable to breaches, and highlights the need for clear and strong policies.

Portuguese children's exposure to second-hand tobacco smoke in the family car

OBJECTIVES To assess the prevalence of childrens exposure to second-hand smoke in the family car; to compare exposure among children with smoking and non-smoking parents. METHODS In 2011, a self-administered questionnaire was applied to a 4th grade Portuguese children national sample (N=3187, mean age 9.5 ± 0.7, 51.1% boys). Prevalence rates and chi-square tests were computed. RESULTS Of the participants, 52.0% reported having, at least, one smoking parent. Overall exposure in the car was 28.9% (95% CI 27.3-30.5). Childrens exposure among those reporting smoking parents was 46.9% (95% CI 44.4-49.4); and 8.6% (95% CI 7.1-10.1) among those reporting non-smoking parents (p<.001). Therefore, children with smoking parents were 5.44 times more likely to be exposed. CONCLUSIONS Childrens exposure to second-hand smoke in the family car is frequent, especially if one or both parents smoke. This highlights the need for effective tobacco control measures to prevent this severe health hazard.

Smoking behaviour trends among Portuguese physicians: are they role models? A conference-based survey

Tobacco is the single most preventable cause of premature death and a leading cause of disease and disability. One of the most powerful tobacco control tools is to decrease tobacco use by physicians and other healthcare providers (HCPs) and engage them in tobacco control activities. All HCPs, and specially physicians, can be positive role models as nonsmokers and promote smoking cessation. In recent decades, the worldwide rate of smoking among physicians has declined. Nevertheless, physicians smoking rates remain high in several developed and in developing countries, including Eastern and Southern Europe. Although WHO has stressed the importance of surveying tobacco use among HCPs, few studies have compared smoking behaviour trends among physicians with the general population, according to gender,

Delivery and recording of smoking cessation advice in a Portuguese teaching hospital: the need for a systemic approach

Background: Smoking cessation should be a top priority in hospitals. In November 2007, a Portuguese teaching hospital carried out a survey to evaluate cessation attitudes, clinical practices and cessation training needs among hospital-based healthcare providers (HCPs). The study also aimed to identify factors associated with cessation attitudes and practices, self-confidence to intervene and awareness of training programs. Method: This is a cross sectional questionnaire-based study including all HCPs. Sample: The study sample covers 424 HCPs, of which 65.4% were females. Mean age of these HCPs was 38.7 ± 10.1 years and the overall response rate was 50.5%. For data analyses, chi-squared tests, McNemar tests and multiple logistic regression models were used. Results: Most physicians and nurses reported “Asking” and “Advising” always or often. Other HCPs reported low frequencies of “Asking” and “Advising” (p < 0.001). Systematic “Asking” was reported less often than “Advising” (p < 0.001). Most HCPs did not record cessation practices, lacked specific training, and were not aware of their training needs. Reported self-confidence, positive attitudes and being a physician or non-smoker were the factors that influenced cessation practices the most. Conclusion: The findings suggest that there is reason to doubt that cessation practices are being undertaken effectively. Hospitals should audit smoking status recording, delivery of effective cessation advice and post-discharge support. Cessation indicators should be mandatory in all healthcare settings. To achieve these goals, undergraduate and graduate cessation training must be given higher priority.

Tobacco control progress in Portugal: The need for advocacy and civil society leadership

Formato ISO 690-2 (Articulos de revistas electronicas) Ravara, S.B., Miranda, N., Calheiros, J.M., Berteletti, F., Joossens, L., Tobacco control progress in Portugal: The need for advocacy and civil society leadershipRevista Portuguesa de Pneumologia [en linea] 2014, 20 (Noviembre-Diciembre) : [Fecha de consulta: 18 de diciembre de 2017] Disponible en: ISSN 0873-2159

Emerging challenges in tobacco control – Heated tobacco products, Harm reduction and the Foundation for a Smoke-Free world

Emerging challenges in tobacco control – Heated tobacco products, Harm reduction and the Foundation for a Smoke-Free world Sofia Ravara1,2 1Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal, 2Tobacco, smoking control & health education ERS Group Chair, ERS Tobacco Control Committee In order to warrant tobacco industry’s profits and overcome a declining cigarette market, tobacco companies have recently launched the novel heated tobacco products (HTPs), claiming a 90-95% reduction in harmfulness. While there is robust evidence that studies either performed or funded by the tobacco industry cannot be trusted, public health advocates have stressed that the short and long-term health effects resulting from continued consumption of these addictive products remain unclear. These new products mislead consumers about their safe use, and may potentially attract more users, recruit non-smokers and youths, and postpone quitting in regular smokers while promoting the social acceptability of tobacco use. However, while these products remain largely unregulated, the tobacco industry has been aggressively marketing them as safe products, and cessation and harm reduction tools. This presentation will present the findings from independent research focusing on the potential of HTB to harm human health, while will discuss the need for strict regulation. Finally, it will highlight ERS leadership and engagement in tobacco control and present the ERS statement on the “Foundation for a Smoke-free world” and tobacco emergent products. Tob. Prev. Cessation 2018;4(Supplement):A32 DOI: 10.18332/tpc/91871

Towards a 100% smoke-free Portugal: No more delays

In 2013, a similar survey conducted in Covilhã observed the same trends. Furthermore, several studies have reported: (1) high SHSe in restaurants/casinos/bars/ discos/mental health services; (2) patchy compliance with the ban, specially in settings which allow exemptions; (3) poor ban enforcement (non-published research: Calheiros et al., 2010; Ravara et al., 2012; Reis et al., 2011). Moreover, Portuguese children’s exposure to SHS is high; one of the highest in the EU (non-published research: Reis et al., Democophes 2012), several studies have reported low motivation to quit, few attempts at giving up, and an increasing prevalence among youth and females. These indicators mirror the failure of tobacco control policies enacted by successive governments/legislators. At the moment, the Portuguese government is about to revise the smoke-free policy (SFP). The government has publicly announced its intention to pass a 100% SFP. However, an 8 years moratorium has been proposed for hospitality venues, allowing smoking and ventilation systems, in order to ‘‘compensate for the investment made’’. While governments and legislators are elected to promote the health and well-being of all Portuguese citizens, they have mostly protected tobacco industry and other ‘‘vested interests’’. The consequence of this is a major toll of death, disability, and suffering and it promotes health and social inequalities and threatens the country economy and welfare. WHO clearly emphasises that only 100% SFPs protect against SHSe and stresses that exemptions, such as the moratorium presented by the current Portuguese government, are common tactics of the tobacco industry to block SFP implementation. Moreover, an eminent Portuguese constitutionalist has stated that SFP exemptions are unconstitutional: while failing to protect all citizens, they violate the general principle of health protection of Portuguese law. The Portuguese public health community should publicly denounce the interference of the tobacco industry in policy-making, accordingly to article 5.3 of WHO-FCTC treaty; and demand a 100% smoke-free Portugal without any exemptions or delays; as part of a comprehensive, adequately funded and enforced tobacco control programme. This would comply with the Portuguese government’s obligation following the WHO-FCTC ratification in 2005.