Xisca Sureda

Smoking behaviour, involuntary smoking, attitudes towards smoke-free legislations, and tobacco control activities in the European Union.

Background The six most important cost-effective policies on tobacco control can be measured by the Tobacco Control Scale (TCS). The objective of our study was to describe the correlation between the TCS and smoking prevalence, self-reported exposure to secondhand smoke (SHS) and attitudes towards smoking restrictions in the 27 countries of the European Union (EU27). Methods/Principal Findings Ecologic study in the EU27. We used data from the TCS in 2007 and from the Eurobarometer on Tobacco Survey in 2008. We analysed the relations between the TCS and prevalence of smoking, self-reported exposure to SHS (home and work), and attitudes towards smoking bans by means of scatter plots and Spearman rank-correlation coefficients (rsp). Among the EU27, smoking prevalence varied from 22.6% in Slovenia to 42.1% in Greece. Austria was the country with the lowest TCS score (35) and the UK had the highest one (93). The correlation between smoking prevalence and TCS score was negative (rsp = −0.42, p = 0.03) and the correlation between TCS score and support to smoking bans in all workplaces was positive (rsp = 0.47, p = 0.01 in restaurants; rsp = 0.5, p = 0.008 in bars, pubs, and clubs; and rsp = 0.31, p = 0.12 in other indoor workplaces). The correlation between TCS score and self-reported exposure to SHS was negative, but statistically non-significant. Conclusions/Significance Countries with a higher score in the TCS have higher support towards smoking bans in all workplaces (including restaurants, bars, pubs and clubs, and other indoor workplaces). TCS scores were strongly, but not statistically, associated with a lower prevalence of smokers and a lower self-reported exposure to SHS.

Secondhand tobacco smoke exposure in open and semi-open settings: a systematic review.

Background: Some countries have recently extended smoke-free policies to particular outdoor settings; however, there is controversy regarding whether this is scientifically and ethically justifiable. Objectives: The objective of the present study was to review research on secondhand smoke (SHS) exposure in outdoor settings. Data sources: We conducted different searches in PubMed for the period prior to September 2012. We checked the references of the identified papers, and conducted a similar search in Google Scholar. Study selection: Our search terms included combinations of “secondhand smoke,” “environmental tobacco smoke,” “passive smoking” OR “tobacco smoke pollution” AND “outdoors” AND “PM” (particulate matter), “PM2.5” (PM with diameter ≤ 2.5 µm), “respirable suspended particles,” “particulate matter,” “nicotine,” “CO” (carbon monoxide), “cotinine,” “marker,” “biomarker” OR “airborne marker.” In total, 18 articles and reports met the inclusion criteria. Results: Almost all studies used PM2.5 concentration as an SHS marker. Mean PM2.5 concentrations reported for outdoor smoking areas when smokers were present ranged from 8.32 to 124 µg/m3 at hospitality venues, and 4.60 to 17.80 µg/m3 at other locations. Mean PM2.5 concentrations in smoke-free indoor settings near outdoor smoking areas ranged from 4 to 120.51 µg/m3. SHS levels increased when smokers were present, and outdoor and indoor SHS levels were related. Most studies reported a positive association between SHS measures and smoker density, enclosure of outdoor locations, wind conditions, and proximity to smokers. Conclusions: The available evidence indicates high SHS levels at some outdoor smoking areas and at adjacent smoke-free indoor areas. Further research and standardization of methodology is needed to determine whether smoke-free legislation should be extended to outdoor settings.

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.

Impact of the Spanish smoke-free legislation on adult, non-smoker exposure to secondhand smoke: cross-sectional surveys before (2004) and after (2012) legislation.

Background In 2006, Spain implemented a national smoke-free legislation that prohibited smoking in enclosed public places and workplaces (except in hospitality venues). In 2011, it was extended to all hospitality venues and selected outdoor areas (hospital campuses, educational centers, and playgrounds). The objective of the study is to evaluate changes in exposure to secondhand smoke among the adult non-smoking population before the first law (2004-05) and after the second law (2011–12). Methods Repeated cross-sectional survey (2004–2005 and 2011–2012) of a representative sample of the adult (≥16 years) non-smoking population in Barcelona, Spain. We assess self-reported exposure to secondhand smoke (at home, the workplace, during leisure time, and in public/private transportation vehicles) and salivary cotinine concentration. Results Overall, the self-reported exposure to secondhand smoke fell from 75.7% (95%CI: 72.6 to 78.8) in 2004-05 to 56.7% (95%CI: 53.4 to 60.0) in 2011–12. Self-reported exposure decreased from 32.5% to 27.6% (−15.1%, p<0.05) in the home, from 42.9% to 37.5% (−12.6%, p = 0.11) at work/education venues, from 61.3% to 38.9% (−36.5%, p<0.001) during leisure time, and from 12.3% to 3.7% (−69.9%, p<0.001) in public transportation vehicles. Overall, the geometric mean of the salivary cotinine concentration in adult non-smokers fell by 87.2%, from 0.93 ng/mL at baseline to 0.12 ng/mL after legislation (p<0.001). Conclusions Secondhand smoke exposure among non-smokers, assessed both by self-reported exposure and salivary cotinine concentration, decreased after the implementation of a stepwise, comprehensive smoke-free legislation. There was a high reduction in secondhand smoke exposure during leisure time and no displacement of secondhand smoke exposure at home.

Second-hand smoke in hospitals in Catalonia (2009): a cross-sectional study measuring PM2.5 and vapor-phase nicotine.

OBJECTIVES To describe second-hand smoke in the hospitals of the Catalan Network for Smoke-free Hospitals using Particulate Matter (PM(2.5)) and to assess the association between second-hand smoke exposure in main entrances (outdoors) and halls and between PM(2.5) and airborne nicotine concentrations. METHODS Cross-sectional study carried out in 2009 in the 53 hospitals affiliated with the network. We measured PM(2.5) (μg/m(3)) in all hospitals and measured airborne nicotine concentrations (μg/m(3)) in a subsample of 11 hospitals. For each assessment, we measured nine locations within the hospitals, computing medians, means, geometric means, interquartile ranges (IQRs), and 95% confidence intervals (CI) of the means and the geometric means. Further, we used Spearmans linear correlation coefficient r(sp)) to explore the association between PM(2.5) concentrations in halls and main entrances and between PM(2.5) and nicotine concentrations. RESULTS The overall median of the 429 PM(2.5) measurements was 12.48 μg/m(3) (IQR: 8.84-19.76 μg/m(3)). The most exposed locations were outdoor smoking points (16.64 μg/m(3)), cafeterias (14.82 μg/m(3)), and main entrances (14.04 μg/m(3)); dressing rooms were the least exposed (6.76 μg/m(3)). PM(2.5) concentrations in halls were positively correlated with those in main entrances (r(sp)=0.591, 95% CI: 0.377-0.745), as were PM(2.5) values and nicotine concentrations (r(sp)=0.644, 95% CI: 0.357-0.820). CONCLUSIONS Second-hand smoke levels in hospitals were low in most locations, with the highest levels observed in outdoor locations where smoking is allowed (smoking points and entrances). Smoking in main entrances was associated with increased second-hand smoke levels in halls. Use of PM(2.5) to evaluate second-hand smoke is feasible and shows a good correlation with airborne nicotine values.

Variability in the correlation between nicotine and PM2.5 as airborne markers of second-hand smoke exposure.

The aim of this study was to assess the relationship between particulate matter of diameter≤2.5 µm (PM2.5) and airborne nicotine concentration as markers of second-hand smoke exposure with respect to the setting studied, the intensity of exposure, and the type of environment studied (indoors or outdoors). Data are derived from two independent studies that simultaneously measured PM2.5 and nicotine concentrations in the air as airborne markers of second-hand smoke exposure in public places and workplaces, including health care centres, bars, public administration offices, educational centres, and transportation. We obtained 213 simultaneous measures of airborne nicotine and PM2.5. Nicotine in the air was measured with active samplers containing a sodium bisulphate-treated filter that was analysed by gas chromatography/mass spectrometry. PM2.5 was measured with a SidePak AM510 Personal Aerosol Monitor. We calculated Spearmans rank correlation coefficient and its 95% confidence intervals (95% CI) between both measures for overall data and stratified by setting, type of environment (indoors/outdoors), and intensity of second-hand smoke exposure (low/high, according to the global median nicotine concentration). We also fitted generalized regression models to further explore these relationships. The median airborne nicotine concentration was 1.36 µg/m3, and the median PM2.5 concentration was 32.13 µg/m3. The overall correlation between both markers was high (Spearmans rank correlation coefficient=0.709; 95% CI: 0.635-0.770). Correlations were higher indoors (Spearmans rank correlation coefficient=0.739; 95% CI: 0.666-0.798) and in environments with high second-hand smoke exposure (Spearmans rank correlation coefficient=0.733; 95% CI: 0.631-0.810). The multivariate analysis adjusted for type of environment and intensity of second-hand smoke exposure confirmed a strong relationship (7.1% increase in geometric mean PM2.5 concentration per µg/m3 nicotine concentration), but only in indoor environments in a stratified analysis (6.7% increase; 95% CI: 4.3-9.1%). Although the overall correlation between airborne nicotine and PM2.5 is high, there is some variability regarding the type of environment and the intensity of second-hand smoke exposure. In the absence of other sources of combustion, air nicotine and PM2.5 measures can be used indoors, while PM2.5 should be used outdoors with caution.

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.

Secondhand smoke in outdoor settings: smokers’ consumption, non-smokers’ perceptions, and attitudes towards smoke-free legislation in Spain

Objective To describe where smokers smoke outdoors, where non-smokers are exposed outdoors to secondhand smoke (SHS), and attitudes towards smoke-free outdoor areas after the implementation of national smoke-free legislation. Design This cross-sectional study was conducted between June 2011 and March 2012 (n=1307 participants). Setting Barcelona, Spain. Participants Representative, random sample of the adult (≥16 years) population. Primary and secondary outcomes Proportion of smoking and prevalence of exposure to SHS in the various settings according to type of enclosure. Percentages of support for outdoor smoke-free policies according to smoking status. Results Smokers reported smoking outdoors most in bars and restaurants (54.8%), followed by outdoor places at work (46.8%). According to non-smokers, outdoor SHS exposure was highest at home (42.5%) and in bars and restaurants (33.5%). Among non-smoking adult students, 90% claimed exposure to SHS on university campuses. There was great support for banning smoking in the majority of outdoor areas, which was stronger among non-smokers than smokers. Over 70% of participants supported smoke-free playgrounds, school and high school courtyards, and the grounds of healthcare centres. Conclusions Extending smoking bans to selected outdoor settings should be considered in further tobacco control interventions to protect non-smokers from SHS exposure and to establish a positive model for youth. The majority of public support for some outdoor smoke-free areas suggests that it is feasible to extend smoking bans to additional outdoor settings.

Variabilidad en el consumo de cigarrillos según la fuente de información en España (1993-2009)

OBJECTIVES To assess the variability in the number of cigarettes smoked per person per day in Spain according to the information source (health surveys versus legal sales). METHODS We compared cigarette consumption per person per day (population aged ≥16 years) obtained from the national health surveys in Spain and the official data on legal tobacco sales between 1993 and 2009. RESULTS Cigarette consumption per person per day decreased between 1993 and 2009. Over the entire period, the number of cigarettes smoked per person per day according to legal sales exceeded that reported by national health surveys (up to 46.9%). CONCLUSION The difference in data on the number of cigarettes smoked between national health surveys and legal sales has increased in the last few years in Spain.