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Guerra-Tort C, López-Vizcaíno E, Santiago-Pérez MI, Rey-Brandariz J, Candal-Pedreira C, Varela-Lema L, Schiaffino A, Ruano-Ravina A, Perez- Rios M. Validation of a small-area model for estimation of smoking prevalence at a subnational level. Tob Induc Dis 2023; 21:112. [PMID: 37664442 PMCID: PMC10472341 DOI: 10.18332/tid/169683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/05/2023] [Accepted: 07/16/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION Small-area estimation methods are an alternative to direct survey-based estimates in cases where a survey's sample size does not suffice to ensure representativeness. Nevertheless, the information yielded by small-area estimation methods must be validated. The objective of this study was thus to validate a small-area model. METHODS The prevalence of smokers, ex-smokers, and never smokers by sex and age group (15-34, 35-54, 55-64, 65-74, ≥75 years) was calculated in two Spanish Autonomous Regions (ARs) by applying a weighted ratio estimator (direct estimator) to data from representative surveys. These estimates were compared against those obtained with a small-area model applied to another survey, specifically the Spanish National Health Survey, which did not guarantee representativeness for these two ARs by sex and age. To evaluate the concordance of the estimates, we calculated the intraclass correlation coefficient (ICC) and the 95% confidence intervals of the differences between estimates. To assess the precision of the estimates, the coefficients of variation were obtained. RESULTS In all cases, the ICC was ≥0.87, indicating good concordance between the direct and small-area model estimates. Slightly more than eight in ten 95% confidence intervals for the differences between estimates included zero. In all cases, the coefficient of variation of the small-area model was <30%, indicating a good degree of precision in the estimates. CONCLUSIONS The small-area model applied to national survey data yields valid estimates of smoking prevalence by sex and age group at the AR level. These models could thus be applied to a single year's data from a national survey, which does not guarantee regional representativeness, to characterize various risk factors in a population at a subnational level.
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Affiliation(s)
- Carla Guerra-Tort
- Área de Medicina Preventiva e Saúde Pública, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Esther López-Vizcaíno
- Servizo de Difusión e Información, Instituto Galego de Estatística, Xunta de Galicia, Santiago de Compostela, Spain
| | - María I. Santiago-Pérez
- Servizo de Epidemioloxía, Dirección Xeral de Saúde Pública, Xunta de Galicia, Santiago de Compostela, Spain
| | - Julia Rey-Brandariz
- Área de Medicina Preventiva e Saúde Pública, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Cristina Candal-Pedreira
- Área de Medicina Preventiva e Saúde Pública, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Leonor Varela-Lema
- Área de Medicina Preventiva e Saúde Pública, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Epidemiología y Salud Pública, Centro de Investigación Biomédica en Red (CIBERESP), Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Anna Schiaffino
- Departament de Salut, Direcció General de Planificació en Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Alberto Ruano-Ravina
- Área de Medicina Preventiva e Saúde Pública, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Epidemiología y Salud Pública, Centro de Investigación Biomédica en Red (CIBERESP), Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Monica Perez- Rios
- Área de Medicina Preventiva e Saúde Pública, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Epidemiología y Salud Pública, Centro de Investigación Biomédica en Red (CIBERESP), Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Carreras G, Lugo A, Gallus S, Cortini B, Fernández E, López MJ, Soriano JB, López-Nicolás A, Semple S, Gorini G. Burden of disease attributable to second-hand smoke exposure: A systematic review. Prev Med 2019; 129:105833. [PMID: 31505203 DOI: 10.1016/j.ypmed.2019.105833] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/30/2019] [Accepted: 09/05/2019] [Indexed: 10/26/2022]
Abstract
Our aim was to provide a systematic review of studies on the burden of disease due to second-hand smoke (SHS) exposure, reviewing methods, exposure assessment, diseases causally linked to SHS, health outcomes, and estimates available to date. A literature review of studies on the burden of disease from SHS exposure, available in PubMed and SCOPUS, published 2007-2018 in English language, was carried out following the PRISMA recommendations. Overall, 588 studies were first identified, and 94 were eligible. Seventy-two studies were included in the systematic review. Most of them were based on the comparative risk assessment approach, assessing SHS exposure using mainly surveys on exposure at home/workplaces. Diseases more frequently studied were: lung cancer, ischemic heart disease, stroke, chronic obstructive pulmonary disease, asthma and breast cancer in adults; lower respiratory tract infection, otitis media, asthma, sudden infant death syndrome and low birth weight in children. The SHS exposure assessment and the reported population attributable fractions (PAF) were largely heterogeneous. As an example, the PAF from lung cancer varied between 0.6% and 20.5%. Moreover, PAF were estimated applying relative risks and SHS exposures with no consistent definitions or with different age classes. The research gap on the SHS exposure burden is shrinking. However, estimates are not yet available for a number of countries, particularly the Middle Eastern and African countries, and not all diseases with the strongest evidence of causation, such as sudden infant death syndrome, have been explored. Moreover, in some cases the applied methodology revealed relatively low quality of data.
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Affiliation(s)
- Giulia Carreras
- Oncologic Network, Prevention and Research Institute (ISPRO), via Cosimo il Vecchio 2, 50139 Florence, Italy.
| | - Alessandra Lugo
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), Via La Masa 19, 20156 Milan, Italy
| | - Silvano Gallus
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), Via La Masa 19, 20156 Milan, Italy
| | - Barbara Cortini
- Oncologic Network, Prevention and Research Institute (ISPRO), via Cosimo il Vecchio 2, 50139 Florence, Italy
| | - Esteve Fernández
- Catalan Institute of Oncology (ICO), Granvia de L'Hospitalet, 199-203, PC 08908 L'Hospitalet de Llobregat, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Granvia de L'Hospitalet, 199, PC 08908 L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, Campus de Bellvitge, School of Medicine and Health Sciences, University of Barcelona, Feixa Llarga, s/n, PC 08907 L'Hospitalet de Llobregat, Spain
| | - Maria José López
- Public Health Agency of Barcelona (ASPB). Pl. Lesseps, 1, PC 08023 Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0. PC 28029, Madrid, Spain; Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret, 167, PC 08025 Barcelona, Spain
| | - Joan B Soriano
- Hospital Universitario La Princesa (IISP), Diego de León, 62 1st floor, PC 28006 Madrid, Spain
| | - Angel López-Nicolás
- Polytechnic University of Cartagena (UPCT), Plaza Cronista Isidoro Valverde, s/n, PC 30202 Cartagena, Spain
| | - Sean Semple
- Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, Scotland, UK
| | - Giuseppe Gorini
- Oncologic Network, Prevention and Research Institute (ISPRO), via Cosimo il Vecchio 2, 50139 Florence, Italy
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Exposure to environmental tobacco smoke in Chaves after the implementation of the law 37/2007. A cross-sectional study in two healthcare settings. REVISTA PORTUGUESA DE PNEUMOLOGIA 2013; 19:168-74. [PMID: 23623407 DOI: 10.1016/j.rppneu.2013.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 02/11/2013] [Accepted: 02/11/2013] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Environmental tobacco smoke (ETS) is currently the main indoor pollutant and causes a high morbility and mortality. A partial restriction came into force in Portugal, in 2008, law 37/2007, trying to control, define and regulate smoke-free environments. OBJECTIVE To assess exposure and perceived impact of the law 37/2007 on exposure to ETS among adults attending to the two health care facilities of Chaves (Portugal). METHOD A cross-sectional survey on tobacco consumption and exposure to ETS was undertaken in Chaves (Northern Portugal) between November 2009 and February 2010. All the patients, over 17, attending to any of the Chaves Primary Care Facilities were interviewed. Patient enrolment was done on a rolling basis covering all days of the week. A face to face interview was carried out and a carbon monoxide was measured. Prevalence and means are shown with 95% confidence intervals. RESULTS 287 patients participated in the survey, 56% were males and the mean age was 54 years. Smoking prevalence was 23,6%, significantly higher in males (31% vs 17%). 46,2% reported exposure tobacco smoke elsewhere (53% in males vs. 40% in females). Smokers declared to be more exposed to ETS than non-smokers. 16.2% of the population declared to be exposed at home, 14% at work and 33% at leisure places. The highest decrease in perception of passive exposure was found for restaurants (95%). In nightclubs 68% of the participants stated that exposure has remained unchanged. CONCLUSION The tobacco control law offered protection against tobacco smoke in several closed public spaces. However, a significant proportion of the population remains exposed. This study highlights the ineffectiveness of a partial ban. A comprehensive law is, therefore, required in Portugal.
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Impacto de la Ley 28/2005 de medidas sanitarias frente al tabaquismo en la prevalencia de la exposición al humo ambiental del tabaco en Barcelona. GACETA SANITARIA 2011; 25:495-500. [DOI: 10.1016/j.gaceta.2011.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 06/08/2011] [Accepted: 06/27/2011] [Indexed: 11/24/2022]
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Etter JF. Secondhand smoke in Geneva, 1996-2006: changes in exposure, opinions, and workplace smoking bans in the absence of national legislation. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2009; 15:159-65. [PMID: 19496482 DOI: 10.1179/oeh.2009.15.2.159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Postal surveys were conducted in 1996 and 2006 to assess change in duration of exposure to secondhand tobacco smoke (SHS), frequency of smoking bans at the workplace, and opinions on smokefree measures in Geneva, Switzerland in the absence of national smoke-free legislation. A random sample of 742 participants in 1996 and 1487 in 2006 showed length of exposure to SHS decreased from 7 hours/week to 4 hours/week, with the largest decrease among 26-45 year olds. Workplace smoking bans increased from 33.4% to 66.3% (p < 0.001). Agreement that SHS is dangerous to health increased from 77.5% to 86.0% (p = 0.006). Agreement that all restaurant tables should be reserved to nonsmokers also increased, from 14.8% to 41.4% (p < 0.001). Opinions were more favorable to all smoke-free measures in 2006 than in 1996, except, "More information should be given on the health dangers of SHS," suggesting a level of saturation was reached for information on SHS.
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Affiliation(s)
- Jean Francois Etter
- Institute of Social and Preventative Medicine, University of Geneva, Switzerland.
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Martínez-Sánchez JM, Fernández E, Fu M, Pascual JA, Ariza C, Agudo A, Borràs JM, Schiaffino A, Moncada A, Jané M, Saltó E, Nebot M, Samet JM. Assessment of exposure to secondhand smoke by questionnaire and salivary cotinine in the general population of Barcelona, Spain (2004-2005). Prev Med 2009; 48:218-23. [PMID: 19166873 DOI: 10.1016/j.ypmed.2008.12.020] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Revised: 12/09/2008] [Accepted: 12/18/2008] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Jose M Martínez-Sánchez
- Tobacco Control and Research Unit, Institut Català d'Oncologia (ICO), L'Hospitalet de Llobregat (Barcelona), Spain
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Lushchenkova O, Fernández E, López MJ, Fu M, Martínez-Sánchez JM, Nebot M, Gorini G, Schiaffino A, Twose J, Borràs JM. Exposición al humo ambiental de tabaco en población adulta no fumadora en España tras la Ley de medidas sanitarias frente al tabaquismo. Rev Esp Cardiol 2008. [DOI: 10.1157/13123989] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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López MJ, Pérez-Ríos M, Schiaffino A, Nebot M, Montes A, Ariza C, García M, Juárez O, Moncada A, Fernández E. Mortality attributable to passive smoking in Spain, 2002. Tob Control 2008; 16:373-7. [PMID: 18048612 DOI: 10.1136/tc.2006.019679] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Exposure to environmental tobacco smoke (ETS) is associated with a variety of health effects, including lung cancer and ischaemic heart disease. The objective of this study was to estimate the number of deaths caused by exposure to ETS among non-smokers in Spain during the year 2002 METHODS Prevalence of ETS exposure among never smokers was gathered from three region based health interview surveys. The relative risks of lung cancer and ischaemic heart diseases were selected from three meta-analyses. Population attributable risk (PAR) was computed using a range of prevalences (minimum-maximum). The number of deaths attributable to ETS was calculated by applying PARs to mortality not attributable to active smoking in 2002. The analyses were stratified by sex, age and source of exposure (home, workplace and both combined). In addition, a sensitivity analysis was performed for different scenarios. RESULTS Among men, deaths attributable to ETS ranged from 408 to 1703. From 247 to 1434 of these deaths would be caused by the exposure only at home, 136-196 by exposure only in the workplace and 25-73 by exposure at both home and the workplace. Among women, the number of attributable deaths ranged from 820 to 1534. Between 807 and 1477 of these deaths would be caused by exposure only at home, 9-32 by exposure only in the workplace and 4-25 by exposure both at home and in the workplace. CONCLUSION Exposure to ETS at home and at work in Spain could be responsible for 1228-3237 of deaths from lung cancer and ischaemic heart disease. These data confirm that passive smoking is an important public health problem in Spain that needs urgent attention.
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Affiliation(s)
- M J López
- Evaluation and Intervention Methods Unit, Public Health Agency of Barcelona, Barcelona, Spain.
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Lushchenkova O, Fernández E, López MJ, Fu M, Martínez-Sánchez JM, Nebot M, Gorini G, Schiaffino A, Twose J, Borràs JM. Secondhand Smoke Exposure in Spanish Adult Non-Smokers Following the Introduction of an Anti-Smoking Law. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1885-5857(08)60205-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Twose J, Schiaffino A, García M, Borras JM, Fernández E. Correlates of exposure to second-hand smoke in an urban Mediterranean population. BMC Public Health 2007; 7:194. [PMID: 17683585 PMCID: PMC1963452 DOI: 10.1186/1471-2458-7-194] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Accepted: 08/05/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To describe the socio-demographic factors associated with exposure to second-hand smoke (SHS) in different settings (home, leisure, and workplace). METHODS We analysed cross-sectional data on self-reported SHS exposure in 1059 non-daily smokers interviewed in the Cornellà Health Interview Survey Follow-up Study in 2002. We calculated age-adjusted prevalence rates and prevalence rate ratios of SHS exposure at home, at the workplace, during leisure time, and in any of these settings. RESULTS The age-standardized prevalence rate of SHS exposure in any setting was 69.5% in men and 62.9% in women. Among men, 25.9% reported passive smoking at home, 55.1% during leisure time, and 34.0% at the workplace. Among women, prevalence rates in these settings were 34.1%, 44.3% and 30.1%, respectively. Overall exposure to SHS decreased with age in both men and women. In men, SHS exposure was related to marital status, physical activity, smoking, and alcohol intake. In women, SHS exposure was related to educational level, marital status, occupational status, self-perceived health, smoking-related illness, and alcohol intake. CONCLUSION The prevalence of SHS exposure in this population was high. The strongest association with exposure were found for age and occupational status in men, and age and educational level in women.
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Affiliation(s)
- Jorge Twose
- Cancer Prevention and Control Unit, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Spain
- Organització Catalana de Transplantaments
| | - Anna Schiaffino
- Cancer Prevention and Control Unit, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain
| | - Montse García
- Cancer Prevention and Control Unit, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain
| | - Josep Maria Borras
- Cancer Prevention and Control Unit, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain
- Department of Clinical Sciences, Universitat de Barcelona, Spain
| | - Esteve Fernández
- Cancer Prevention and Control Unit, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Spain
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