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Marou V, Vardavas CI, Aslanoglou K, Nikitara K, Plyta Z, Leonardi-Bee J, Atkins K, Condell O, Lamb F, Suk JE. The impact of conflict on infectious disease: a systematic literature review. Confl Health 2024; 18:27. [PMID: 38584269 PMCID: PMC11000310 DOI: 10.1186/s13031-023-00568-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/28/2023] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Conflict situations, armed or not, have been associated with emergence and transmission of infectious diseases. This review aims to identify the pathways through which infectious diseases emerge within conflict situations and to outline appropriate infectious disease preparedness and response strategies. METHODS A systematic review was performed representing published evidence from January 2000 to October 2023. Ovid Medline and Embase were utilised to obtain literature on infectious diseases in any conflict settings. The systematic review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis). No geographical restrictions were imposed. FINDINGS Our review identified 51 studies covering AIDS, Hepatitis B, Tuberculosis, Cholera, Coronavirus 2, Ebola, Poliomyelitis, Malaria, Leishmaniasis, Measles, Diphtheria, Dengue and Acute Bacterial Meningitis within conflict settings in Europe, Middle East, Asia, and Africa since October 2023. Key factors contributing to disease emergence and transmission in conflict situations included population displacement, destruction of vital infrastructure, reduction in functioning healthcare systems and healthcare personnel, disruption of disease control programmes (including reduced surveillance, diagnostic delays, and interrupted vaccinations), reduced access by healthcare providers to populations within areas of active conflict, increased population vulnerability due to limited access to healthcare services, and disruptions in the supply chain of safe water, food, and medication. To mitigate these infectious disease risks reported preparedness and response strategies included both disease-specific intervention strategies as well as broader concepts such as the education of conflict-affected populations through infectious disease awareness programmes, investing in and enabling health care in locations with displaced populations, intensifying immunisation campaigns, and ensuring political commitment and intersectoral collaborations between governments and international organisations. CONCLUSION Conflict plays a direct and indirect role in the transmission and propagation of infectious diseases. The findings from this review can assist decision-makers in the development of evidence-based preparedness and response strategies for the timely and effective containment of infectious disease outbreaks in conflict zones and amongst conflict-driven displaced populations. FUNDING European Centre for Disease Prevention and Control under specific contract No. 22 ECD.13,154 within Framework contract ECDC/2019/001 Lot 1B.
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Affiliation(s)
- Valia Marou
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Constantine I Vardavas
- School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | | | | | - Zinovia Plyta
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kirsty Atkins
- Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
| | - Orla Condell
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Favelle Lamb
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jonathan E Suk
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden.
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Vardavas C, Zisis K, Nikitara K, Lagou I, Marou V, Aslanoglou K, Athanasakis K, Phalkey R, Leonardi-Bee J, Fernandez E, Condell O, Lamb F, Sandmann F, Pharris A, Deogan C, Suk JE. Cost of the COVID-19 pandemic versus the cost-effectiveness of mitigation strategies in EU/UK/OECD: a systematic review. BMJ Open 2023; 13:e077602. [PMID: 37907290 PMCID: PMC10619092 DOI: 10.1136/bmjopen-2023-077602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/18/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVES The economic burden of COVID-19 pandemic is substantial, with both direct and indirect costs playing a significant role. DESIGN A systematic literature review was conducted to estimate the cost of the COVID-19 pandemic and the cost-effectiveness of pharmaceutical or non-pharmaceutical interventions. All cost data were adjusted to the 2021 Euro, and interventions compared with null. DATA SOURCES Ovid MEDLINE and EMBASE were searched from January 2020 through 22 April 2021. ELIGIBILITY CRITERIA Studies regarding COVID-19 outbreak or public health preparedness measures or interventions with outcome measures related to the direct and indirect costs for disease and preparedness and/or response in countries of the European Union (EU), the European Economic Area (EEA), the UK and the Organisation for Economic Co-operation and Development (OECD) of all relevant epidemiological designs which estimate cost within the selected time frame were considered eligible. DATA EXTRACTION AND SYNTHESIS Studies were searched, screened and coded independently by two reviewers with high measure of inter-rater agreement. Data were extracted to a predefined data extraction sheet. The risk of bias was assessed using the Consensus on Health Economic Criteria checklist. RESULTS We included data from 41 economic studies. Ten studies evaluated the cost of the COVID-19 pandemic, while 31 assessed the cost-benefit of public health surveillance, preparedness and response measures. Overall, the economic burden of the COVID-19 pandemic was found to be substantial. Community screening, bed provision policies, investing in personal-protective-equipment and vaccination strategies were cost-effective. Physical distancing measures were associated with health benefits; however, their cost-effectiveness was dependent on the duration, compliance and the phase of the epidemic in which it was implemented. CONCLUSIONS COVID-19 pandemic is associated with substantial short-term and long-term economic costs to healthcare systems, payers and societies, while interventions including testing and screening policies, vaccination and physical distancing policies were identified as those presenting cost-effective options to deal with the pandemic, dependent on population vaccination and the Re at the stage of the pandemic.
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Affiliation(s)
- Constantine Vardavas
- School of Medicine, University of Crete, Heraklion, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts, USA
| | - Konstantinos Zisis
- School of Medicine, University of Crete, Heraklion, Greece
- Department of Public Health Policy, University of West Attica, Egaleo, Greece
| | | | - Ioanna Lagou
- School of Medicine, University of Crete, Heraklion, Greece
| | - Valia Marou
- School of Medicine, University of Crete, Heraklion, Greece
| | | | | | - Revati Phalkey
- Public Health England, London, UK
- University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Centre for Evidence-Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
| | - Esteve Fernandez
- Tobacco Control Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
| | - Orla Condell
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Favelle Lamb
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Frank Sandmann
- European Centre for Disease Prevention and Control, Solna, Sweden
| | | | - Charlotte Deogan
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jonathan E Suk
- European Centre for Disease Prevention and Control, Solna, Sweden
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Vardavas C, Nikitara K, Aslanoglou K, Lagou I, Marou V, Phalkey R, Leonardi-Bee J, Fernandez E, Vivilaki V, Kamekis A, Symvoulakis E, Noori T, Wuerz A, Suk JE, Deogan C. Social determinants of health and vaccine uptake during the first wave of the COVID-19 pandemic: A systematic review. Prev Med Rep 2023; 35:102319. [PMID: 37564118 PMCID: PMC10410576 DOI: 10.1016/j.pmedr.2023.102319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
Social determinants of health significantly impact population health status. The aim of this systematic review was to examine which social vulnerability factors or determinants of health at the individual or county level affected vaccine uptake within the first phase of the vaccination program. We performed a systematic review of peer-reviewed literature published from January 2020 until September 2021 in Medline and Embase (Bagaria et al., 2022) and complemented the review with an assessment of pre-print literature within the same period. We restricted our criteria to studies performed in the EU/UK/EEA/US that report vaccine uptake in the general population as the primary outcome and included various social determinants of health as explanatory variables. This review provides evidence of significant associations between the early phases of vaccination uptake for SARS-CoV-2 and multiple socioeconomic factors including income, poverty, deprivation, race/ethnicity, education and health insurance. The identified associations should be taken into account to increase vaccine uptake in socially vulnerable groups, and to reduce disparities in uptake, in particular within the context of public health preparedness for future pandemics. While further corroboration is needed to explore the generalizability of these findings across the European setting, these results confirm the need to consider vulnerable groups and social determinants of health in the planning and roll-out of SARS-CoV-2 vaccination programs and within the context of future respiratory pandemics.
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Affiliation(s)
- Constantine Vardavas
- School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | | | | | - Ioanna Lagou
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Valia Marou
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Revati Phalkey
- Health Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Health Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
| | - Esteve Fernandez
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L’Hospitalet de Llobregat (Barcelona), Spain
- Tobacco Control Research Group, Institut d’Investigació Biomèdica de. Ellvitge-IDIBELL, L’Hospitalet de Llobregat (Barcelona), Spain
- School of Medicine and Health Sciences, Campus of Bellvitge, Universitat de Barcelona, Spain
- Centre of Biomedical Research Network on Respiratory Diseases (CIBERES de Enfermedaes Respiratorias), Insituto de Salud Carlos III, Madrid, Spain
| | | | | | | | - Teymur Noori
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Andrea Wuerz
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jonathan E. Suk
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Charlotte Deogan
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
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4
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Vardavas CI, Nikitara K, Aslanoglou K, Kamekis A, Puttige Ramesh N, Symvoulakis E, Agaku I, Phalkey R, Leonardi-Bee J, Fernandez E, Condell O, Lamb F, Deogan C, Suk JE. Systematic review of outbreaks of COVID-19 within households in the European region when the child is the index case. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001718. [PMID: 36649374 PMCID: PMC9835947 DOI: 10.1136/bmjpo-2022-001718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/07/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES This systematic review aims to identify the secondary attack rates (SAR) to adults and other children when children are the index cases within household settings. METHODS This literature review assessed European-based studies published in Medline and Embase between January 2020 and January 2022 that assessed the secondary transmission of SARS-CoV-2 within household settings. The inclusion criteria were based on the Population, Exposure, Outcome framework for systematic reviews. Thus, the study population was restricted to humans within the household setting in Europe (population), in contact with paediatric index cases 1-17 years old (exposure) that led to the transmission of SARS-CoV-2 reported as either an SAR or the probability of onward infection (outcome). RESULTS Of 1819 studies originally identified, 19 met the inclusion criteria. Overall, the SAR ranged from 13% to 75% in 15 studies, while there was no evidence of secondary transmission from children to other household members in one study. Evidence indicated that asymptomatic SARS-CoV-2 index cases also have a lower SAR than those with symptoms and that younger children may have a lower SAR than adolescents (>12 years old) within household settings. CONCLUSIONS SARS-CoV-2 secondary transmission from paediatric index cases ranged from 0% to 75%, within household settings between January 2020 and January 2022, with differences noted by age and by symptomatic/asymptomatic status of the index case. Given the anticipated endemic circulation of SARS-CoV-2, continued monitoring and assessment of household transmission is necessary.
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Affiliation(s)
- Constantine I Vardavas
- School of Medicine, University of Crete School of Medicine, Heraklion, Greece.,Department of Oral Health Policy and Epidemiology, Harvard University, Cambridge, Massachusetts, USA
| | - Katerina Nikitara
- School of Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Katerina Aslanoglou
- School of Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Apostolos Kamekis
- School of Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Nithya Puttige Ramesh
- Department of Oral Health Policy and Epidemiology, Harvard University, Cambridge, Massachusetts, USA
| | | | - Israel Agaku
- Department of Oral Health Policy and Epidemiology, Harvard University, Cambridge, Massachusetts, USA
| | - Revati Phalkey
- Centre for Evidence Based Healthcare, University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, University of Nottingham, Nottingham, UK
| | - Esteve Fernandez
- Tobacco Control Unit, Catalan Institute of Oncology Institut Català d'Oncologia (ICO), L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvithe (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,CIBER Respiratory Diseases (CIBERES), Madrid, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Orla Condell
- European Centre for Disease Prevention and Control (ECDC), Solna, Stockholm, Sweden
| | - Favelle Lamb
- European Centre for Disease Prevention and Control (ECDC), Solna, Stockholm, Sweden
| | - Charlotte Deogan
- European Centre for Disease Prevention and Control (ECDC), Solna, Stockholm, Sweden
| | - Jonathan E Suk
- European Centre for Disease Prevention and Control (ECDC), Solna, Stockholm, Sweden
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Vardavas CI, Mathioudakis AG, Nikitara K, Stamatelopoulos K, Georgiopoulos G, Phalkey R, Leonardi-Bee J, Fernandez E, Carnicer-Pont D, Vestbo J, Semenza JC, Deogan C, Suk JE, Kramarz P, Lamb F, Penttinen P. Prognostic factors for mortality, intensive care unit and hospital admission due to SARS-CoV-2: a systematic review and meta-analysis of cohort studies in Europe. Eur Respir Rev 2022; 31:220098. [PMID: 36323422 PMCID: PMC9724816 DOI: 10.1183/16000617.0098-2022] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND As mortality from coronavirus disease 2019 (COVID-19) is strongly age-dependent, we aimed to identify population subgroups at an elevated risk for adverse outcomes from COVID-19 using age-/gender-adjusted data from European cohort studies with the aim to identify populations that could potentially benefit from booster vaccinations. METHODS We performed a systematic literature review and meta-analysis to investigate the role of underlying medical conditions as prognostic factors for adverse outcomes due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including death, hospitalisation, intensive care unit (ICU) admission and mechanical ventilation within three separate settings (community, hospital and ICU). Cohort studies that reported at least age and gender-adjusted data from Europe were identified through a search of peer-reviewed articles published until 11 June 2021 in Ovid Medline and Embase. Results are presented as odds ratios with 95% confidence intervals and absolute risk differences in deaths per 1000 COVID-19 patients. FINDINGS We included 88 cohort studies with age-/gender-adjusted data from 6 653 207 SARS-CoV-2 patients from Europe. Hospital-based mortality was associated with high and moderate certainty evidence for solid organ tumours, diabetes mellitus, renal disease, arrhythmia, ischemic heart disease, liver disease and obesity, while a higher risk, albeit with low certainty, was noted for chronic obstructive pulmonary disease and heart failure. Community-based mortality was associated with a history of heart failure, stroke, diabetes and end-stage renal disease. Evidence of high/moderate certainty revealed a strong association between hospitalisation for COVID-19 and solid organ transplant recipients, sleep apnoea, diabetes, stroke and liver disease. INTERPRETATION The results confirmed the strong association between specific prognostic factors and mortality and hospital admission. Prioritisation of booster vaccinations and the implementation of nonpharmaceutical protective measures for these populations may contribute to a reduction in COVID-19 mortality, ICU and hospital admissions.
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Affiliation(s)
- Constantine I Vardavas
- School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Revati Phalkey
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Dolors Carnicer-Pont
- Catalan Institute of Oncology, Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvithe (IDIBELL), Barcelona, Spain
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Jan C Semenza
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Charlotte Deogan
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Jonathan E Suk
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Piotr Kramarz
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Favelle Lamb
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
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Martello E, Gillingham EL, Phalkey R, Vardavas C, Nikitara K, Bakonyi T, Gossner CM, Leonardi-Bee J. Systematic review on the non-vectorial transmission of Tick-borne encephalitis virus (TBEv). Ticks Tick Borne Dis 2022; 13:102028. [PMID: 36030646 DOI: 10.1016/j.ttbdis.2022.102028] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/15/2022] [Accepted: 08/10/2022] [Indexed: 12/30/2022]
Abstract
Tick-borne encephalitis (TBE) is an infection caused by the Tick-borne encephalitis virus (TBEv) and it is common in Europe. The virus is predominantly transmitted by ticks, but other non-vectorial modes of transmission are possible. This systematic review synthesises the epidemiological impact of non-vectorial modes of TBEv transmission in Europe. 41 studies were included comprising of 1308 TBE cases. Alimentary (36 studies), handling infected material (3 studies), blood-borne (1 study), solid organ transplant (1 study) were identified as potential routes of TBEv transmission; however, no evidence of vertical transmission from mother to offspring was reported (2 studies). Consumption of unpasteurised milk/milk products was the most common vehicle of transmission and significantly increased the risk of TBE by three-fold (pooled RR 3.05, 95% CI 1.53 to 6.11; 4 studies). This review also confirms handling infected material, blood-borne and solid organ transplant as potential routes of TBEv transmission. It is important to tracing back to find the vehicle of the viral infection and to promote vaccination as it remains a mainstay for the prevention of TBE.
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Affiliation(s)
- Elisa Martello
- Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK.
| | | | - Revati Phalkey
- Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK; Climate Change and Health Group, UK Health Security Agency, UK
| | - Constantine Vardavas
- School of Medicine, University of Crete, Heraklion, Crete, Greece; Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | | | - Tamas Bakonyi
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Céline M Gossner
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
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Vardavas C, Simpson B, Vardavas A, Nikitara K, Lagou I, Tzatzarakis M, Tsatsakis A. Updates in the state of play from the Technical Group on tobacco product flavours. Tob Prev Cessat 2022. [DOI: 10.18332/tpc/151062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
OBJECTIVES School closures have been used as a core non-pharmaceutical intervention (NPI) during the COVID-19 pandemic. This review aims at identifying SARS-CoV-2 transmission in educational settings during the first waves of the pandemic. METHODS This literature review assessed studies published between December 2019 and 1 April 2021 in Medline and Embase, which included studies that assessed educational settings from approximately January 2020 to January 2021. The inclusion criteria were based on the PCC framework (P-Population, C-Concept, C-Context). The study Population was restricted to people 1-17 years old (excluding neonatal transmission), the Concept was to assess child-to-child and child-to-adult transmission, while the Context was to assess specifically educational setting transmission. RESULTS Fifteen studies met inclusion criteria, ranging from daycare centres to high schools and summer camps, while eight studies assessed the re-opening of schools in the 2020-2021 school year. In principle, although there is sufficient evidence that children can both be infected by and transmit SARS-CoV-2 in school settings, the SAR remain relatively low-when NPI measures are implemented in parallel. Moreover, although the evidence was limited, there was an indication that younger children may have a lower SAR than adolescents. CONCLUSIONS Transmission in educational settings in 2020 was minimal-when NPI measures were implemented in parallel. However, with an upsurge of cases related to variants of concern, continuous surveillance and assessment of the evidence is warranted to ensure the maximum protection of the health of students and the educational workforce, while also minimising the numerous negative impacts that school closures may have on children.
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Affiliation(s)
- Constantine Vardavas
- School of Medicine, University of Crete, Heraklion, Greece
- Department of Oral Health Policy and Epidemiology, Harvard University, Cambridge, Massachusetts, USA
| | | | - Alexander G Mathioudakis
- Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Michele Hilton Boon
- WISE Centre for Economic Justice, Glasgow Caledonian University, Glasgow, UK
| | - Revati Phalkey
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Anastasia Pharris
- Epidemic Prone Diseases, Coronavirus and Influenza, Disease Programmes Unit, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Charlotte Deogan
- Epidemic Prone Diseases, Coronavirus and Influenza, Disease Programmes Unit, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jonathan E Suk
- Emergency Preparedness and Response Support, Public Health Functions Unit, European Centre for Disease Prevention and Control, Solna, Sweden
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Vardavas C, Nikitara K, Odani S, Symvoulakis E. The predictors and association between knowledge of vaccines and vaccination among adults and children in 28 European Countries, 2019. Popul Med 2022. [DOI: 10.18332/popmed/147250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Nikitara K, Girvalaki C, Kyriakos C, Driezen P, Filippidis F, Kahnert S, Hitchman S, Mons U, Fernández E, Trofor A, Przewoźniak K, Demjén T, Katsaounou P, Zatoński W, Fong G, Vardavas C, Consortium EURESTPLUS. Changes in electronic cigarette use and label awareness among smokers before and after the European Tobacco Products Directive implementation in six European countries: Findings from the EUREST-PLUS ITC Europe Surveys. Tob Prev Cessat 2021. [DOI: 10.18332/tpc/143675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Agaku I, Tsafa T, Nikitara K, Odani S. Familial secondhand smoke: Tobacco use and adoption of smoke-free home and car rules among US parents. Popul Med 2021. [DOI: 10.18332/popmed/140059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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12
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Vardavas CI, Kyriakos CN, Driezen P, Girvalaki C, Nikitara K, Filippidis FT, Fernández E, Mons U, Przewoźniak K, Trofor AC, Demjén T, Katsaounou PA, Zatoński W, Willemsen M, Fong GT. Transitions in product use during the implementation of the European Tobacco Products Directive: cohort study findings from the EUREST-PLUS ITC Europe Surveys. Eur J Public Health 2021; 30:iii10-iii17. [PMID: 32918817 DOI: 10.1093/eurpub/ckaa023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The emergence of new types of tobacco and tobacco-related products on the European Union (EU) market has precipitated the possibility for both poly-tobacco use and transitions between products. In the EU, the regulatory environment has shifted with the implementation of the European Tobacco Products Directive (TPD) in May 2016, which may influence consumer transitions between products. METHODS The aim of this paper was to examine trends and transitions in tobacco products from 2016 to 2018 -before and after implementation of the TPD in the EU. Data come from Wave 1 (pre-TPD) and Wave 2 (post-TPD) of the EUREST-PLUS ITC Six European Country Survey, a cohort study of adults who at the time of recruitment were smokers from six EU countries- Germany, Greece, Hungary, Poland, Romania, and Spain. D (N = 3195). Bivariate and logistic regression analyses of weighted data was conducted using SAS-callable SUDAAN. RESULTS Overall, among those who smoked factory-made cigarettes (FM) only at Wave 1, 4.3% switched to roll-your-own tobacco (RYO) only. Among RYO only users at Wave 1, 17.0% switched to FM only, however compared to all other countries, respondents from Hungary had the highest percentage of FM only users at Wave 1 switch to RYO only at Wave 2 (18.0%). CONCLUSIONS The most prominent transition overall was from smoking RYO exclusively at Wave 1 to smoking FM tobacco exclusively at Wave 2, however this varied across countries. As the tobacco control regulatory environment of the EU develops, it is important to continue to monitor transitions between types of products, as well as trends in cessation.
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Affiliation(s)
- Constantine I Vardavas
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece.,European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,European Respiratory Society, Lausanne, Switzerland
| | - Christina N Kyriakos
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece.,European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | - Pete Driezen
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Charis Girvalaki
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece.,European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | - Katerina Nikitara
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | - Filippos T Filippidis
- European Respiratory Society, Lausanne, Switzerland.,Department of Primary Care and Public Health, Imperial College, London, UK.,Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat (Barcelona), Catalonia, Spain.,Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Catalonia, Spain.,School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L'Hospitalet de Llobregat, Catalonia, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Ute Mons
- German Cancer Research Center (DKFZ), Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, Heidelberg, Germany
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, Warsaw, Poland.,Maria Skłodowska-Curie Institute-Oncology Center (MSCI), Warsaw, Poland.,Collegium Civitas, Warsaw, Poland
| | - Antigona C Trofor
- University of Medicine and Pharmacy 'Grigore T. Popa' Iasi, Iasi, Romania.,Aer Pur Romania, Bucharest, Romania
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation, Budapest, Hungary
| | - Paraskevi A Katsaounou
- European Respiratory Society, Lausanne, Switzerland.,Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Witold Zatoński
- Health Promotion Foundation, Warsaw, Poland.,European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Marc Willemsen
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Geoffrey T Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada.,Ontario Institute for Cancer Research, Toronto, Canada
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Vardavas C, Nikitara K, Zisis K, Athanasakis K, Phalkey R, Leonardi-Bee J, Johnson H, Tsolova S, Ciotti M, Suk JE. Cost-effectiveness of emergency preparedness measures in response to infectious respiratory disease outbreaks: a systematic review and econometric analysis. BMJ Open 2021; 11:e045113. [PMID: 33926982 PMCID: PMC8094385 DOI: 10.1136/bmjopen-2020-045113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Respiratory infectious disease outbreaks pose a threat for loss of life, economic instability and social disruption. We conducted a systematic review of published econometric analyses to assess the direct and indirect costs of infectious respiratory disease outbreaks that occurred between 2003 and 2019. SETTING Respiratory infectious disease outbreaks or public health preparedness measures or interventions responding to respiratory outbreaks in OECD countries (excluding South Korea and Japan) so as to assess studies relevant to the European context. The cost-effectiveness of interventions was assessed through a dominance ranking matrix approach. All cost data were adjusted to the 2017 Euro, with interventions compared with the null. We included data from 17 econometric studies. PRIMARY AND SECONDARY OUTCOME MEASURES Direct and indirect costs for disease and preparedness and/or response or cost-benefit and cost-utility were measured. RESULTS Overall, the economic burden of infectious respiratory disease outbreaks was found to be significant to healthcare systems and society. Indirect costs were greater than direct costs mainly due to losses of productivity. With regard to non-pharmaceutical strategies, prehospitalisation screening and the use of protective masks were identified as both an effective strategy and cost-saving. Community contact reduction was effective but had ambiguous results for cost saving. School closure was an effective measure, but not cost-saving in the long term. Targeted antiviral prophylaxis was the most cost-saving and effective pharmaceutical intervention. CONCLUSIONS Our cost analysis results provide evidence to policymakers on the cost-effectiveness of pharmaceutical and non-pharmaceutical intervention strategies which may be applied to mitigate or respond to infectious respiratory disease outbreaks.
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Affiliation(s)
| | | | | | - Konstantinos Athanasakis
- Department of Public Health Policy, School of Public Health, University of West Attica, Egaleo, Greece
| | - Revati Phalkey
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Helen Johnson
- Epidemiological Methods, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Svetla Tsolova
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Massimo Ciotti
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jonathan E Suk
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
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14
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Nikitara K, Odani S, Demenagas N, Rachiotis G, Symvoulakis E, Vardavas C. Prevalence and correlates of physical inactivity in adults across 28 European countries. Eur J Public Health 2021; 31:840-845. [PMID: 34000007 PMCID: PMC8504996 DOI: 10.1093/eurpub/ckab067] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Physical activity/inactivity is impacted by a plethora of intertwined factors. There are a limited number of studies on physical activity/inactivity that provide a European cross-country perspective. This study aims to present the prevalence and correlates of physical activity in adults across the 28 European Union (EU) member states. Methods This is a secondary dataset analysis of the Special Eurobarometer 472 data on physical activity. The cross-sectional survey was conducted during December 2–11 in 2017 across 28 European countries. The data consisted of ∼1000 respondents aged ≧15 years per country. The current analysis was restricted to adults aged 18–64 years (n = 19 645). Results More than one in three (36.2%, 95% CI: 35.1–37.3) adults in the EU were physically inactive, with substantial cross-country differences noted. Women were less likely than men to be adequately or highly physically active (aOR: 0.86, 95% CI: 0.78–0.95). Similarly, adults at the age of 40–54 (aOR: 0.65, 95% CI: 0.52–0.81) and 55–64 (aOR: 0.61, 95% CI: 0.49–0.77) were less likely to have moderate or high levels of physical activity in comparison with those 18–24 years of age. Finally, high SES was positively associated with physical activity (aOR: 1.4, 95% CI: 1.16–1.69). Conclusions A notable percentage of adults in Europe are physically inactive. Further research is needed to elucidate the factors behind the cross-country differences and identify potential policy actions that may support adopting a physically active lifestyle and decrease the inequalities related to physical activity across Europe.
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Affiliation(s)
| | - Satomi Odani
- School of Medicine, University of Crete, Heraklion, Greece
| | | | - George Rachiotis
- Department of Hygiene and Epidemiology, Medical Faculty, University of Thessaly, Larissa, Greece
| | | | - Constantine Vardavas
- School of Medicine, University of Crete, Heraklion, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
- Correspondence: C. Vardavas, University of Crete, School of Medicine, Heraklion, Crete 71003, Greece, Tel: +30 6937281680, Fax: 2810-542098, e-mail:
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15
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Vardavas C, Odani S, Nikitara K, El Banhawi H, Kyriakos C, Taylor L, Becuwe N. Public perspective on the governmental response, communication and trust in the governmental decisions in mitigating COVID-19 early in the pandemic across the G7 countries. Prev Med Rep 2020; 21:101252. [PMID: 33364149 PMCID: PMC7753973 DOI: 10.1016/j.pmedr.2020.101252] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/14/2020] [Accepted: 11/08/2020] [Indexed: 11/19/2022] Open
Abstract
The COVID-19 pandemic poses a threat to global health and security inciting governments with the responsibility to respond with measures that ensure the health and safety of their communities. We assessed public attitudes towards governmental actions to combat the COVID-19 pandemic in the G7 countries. Data were collected during 19th-21st March 2020, from 7005 Kantar's online panelists aged >16 years across the G7 countries: Canada, France, Great Britain, Germany, Italy, Japan, and the United States. Data were post-stratified and weighted to match population distributions of the respective countries. Descriptive and multivariable analyses were conducted. Amongst the G7, Japan had the lowest level of approval of governmental response to the pandemic, rating governmental communication as good, and trusting governmental decisions (35.0%, 33.6%, and 38.0%, respectively), followed by the U.S. (52.9%, 64.6%, and 59.9%, respectively). Understanding of which measures one can personally take to help limit the spread of the coronavirus was significantly associated with approving governmental response (aOR = 2.88), rating government communication as good (aOR = 2.70) and trust in future governmental decisions (aOR = 2.73). Those who reported government/politicians and friends/family as their most trusted information source were more likely to report approval, higher rating, and/or trust toward governmental actions. Public attitudes towards governmental actions against COVID-19 varied substantially across the G7 countries and were associated with the understanding of measures and source of information that respondents most trusted. Timely and accurate communication is essential to enhance public engagement to control the COVID-19 pandemic.
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Affiliation(s)
- Constantine Vardavas
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, United States
- Corresponding author.
| | - Satomi Odani
- School of Medicine, University of Crete, Heraklion, Greece
| | | | | | | | | | - Nicholas Becuwe
- Kantar, Public Division, United Kingdom
- Kantar, Public Division, Belgium
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16
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Vardavas CI, Girvalaki C, Odani S, Nikitara K, de Vries I, van Riel A, van Sommeren-de Potter I, Grass JN, Grassi MC, Deim S, Balázs A, Fosztó S, Schiel H, Arif T, Eronen AK, Alonso AA, Menor JLC, Arrieta RM, Babić Ž, Turk R, Vardavas AI, Tsatsakis A. Profile of incidental exposures to e-cigarette liquids in Europe, 2018-2019. Hum Exp Toxicol 2020; 40:1045-1050. [PMID: 33272061 DOI: 10.1177/0960327120975828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Following the implementation of the European Union Tobacco Product Directive (EU TPD) regulations on e-cigarette products in 2016, we assessed the current profile of e-cigarette liquid exposure incidents and their associated health outcomes. METHODS De-identified data were received from poison centers in eight EU Member States (Sweden, the Netherlands, Italy, Hungary Austria, Finland, Spain and Croatia) reporting on e-cigarette liquid exposure incidents between August 2018 to December 2019. Descriptive analysis was conducted to present incident characteristics and health outcomes. Chi-square tests and multivariable logistic regression analysis were used to test associations. RESULTS Of the 223 e-liquid exposure incidents recorded by poison centers in multiple EU MS, 64.7% of the cases were unintentional exposures, ranging from 48.4% among adults aged ≥19 years to 100.0% among children aged 0-5 years (p < 0.05). The most frequent route of exposure was ingestion (73.5%) while55.2% experienced any clinical symptoms, including nausea (16.6%), vomiting (11.1%), and dizziness (9.0%). 57.8% of the cases were treated at the residence or on-site. CONCLUSION Further monitoring is warranted, using uniform reporting requirements, to ensure the continued compliance to the EU TPD and assess its long-term impact on related incident characteristics.
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Affiliation(s)
- Constantine I Vardavas
- Laboratory of Toxicology, 37778Medical School, University of Crete, Voutes, Heraklion, Crete, Greece
| | - Charis Girvalaki
- Laboratory of Toxicology, 37778Medical School, University of Crete, Voutes, Heraklion, Crete, Greece
| | - Satomi Odani
- Laboratory of Toxicology, 37778Medical School, University of Crete, Voutes, Heraklion, Crete, Greece
| | - Katerina Nikitara
- Laboratory of Toxicology, 37778Medical School, University of Crete, Voutes, Heraklion, Crete, Greece
| | - Irma de Vries
- Dutch Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Antoinette van Riel
- Dutch Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Maria Caterina Grassi
- Clinical Toxicology-Poison Control Centre and Drug Dependence Unit, Policlinico Umberto I-"Sapienza University of Rome", Rome, Italy
| | - Szilvia Deim
- National Public Health Center, Department for Chemical Safety and Competent Authority, Unit for Health Toxicological Information Service and Notification, Hungary
| | - Andrea Balázs
- National Public Health Center, Department for Chemical Safety and Competent Authority, Unit for Health Toxicological Information Service and Notification, Hungary
| | - Szabolcs Fosztó
- National Public Health Center, Department for Chemical Safety and Competent Authority, Unit for Health Toxicological Information Service and Notification, Hungary
| | | | - Tara Arif
- Poisons Information Centre, Vienna, Austria
| | | | | | | | | | - Željka Babić
- Croatian Poison Control Centre at Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Rajka Turk
- Croatian Poison Control Centre at Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Alexander I Vardavas
- Laboratory of Toxicology, 37778Medical School, University of Crete, Voutes, Heraklion, Crete, Greece
| | - Aristidis Tsatsakis
- Laboratory of Toxicology, 37778Medical School, University of Crete, Voutes, Heraklion, Crete, Greece
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17
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Kyriakos C, Vardavas C, Driezen P, Girvalaki C, Nikitara K, Filippidis F, Fernández E, Mons U, Przewoźniak K, Trofor A, Demjén T, Katsaounou P, Zatoński W, Willemsen M, Fong G, the EUREST-PLUS Consortium OBO. Product transitions among smokers before and after implementation of the European Tobacco Products Directive: Cohort study findings from the EUREST-PLUS ITC Europe Surveys. Tob Prev Cessat 2020. [DOI: 10.18332/tpc/128455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Kyriakos CN, Driezen P, Girvalaki C, Hitchman SC, Filippidis FT, Gravely S, Balmford J, Nikitara K, Mons U, Fernández E, Przewoźniak K, Trofor AC, Demjén T, Zatoński W, Tountas Y, Fong GT, Vardavas CI. Awareness and correlates of noticing changes to cigarette packaging design after implementation of the European Tobacco Products Directive: findings from the EUREST-PLUS ITC Europe Surveys. Eur J Public Health 2020; 30:iii98-iii107. [PMID: 32918819 PMCID: PMC7526785 DOI: 10.1093/eurpub/ckaa057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The European Tobacco Products Directive (TPD), which went into effect in May 2016, regulates packaging design and labelling of cigarettes and roll-your-own (RYO) tobacco. The aim of the current study was to examine whether smokers and recent quitters in six European Union (EU) countries (Germany, Greece, Hungary, Poland, Romania and Spain) reported noticing TPD-related changes to packaging, and correlates of noticing these changes. METHODS Cross-sectional data from the Wave 2 of the ITC 6 European Country Survey in 2018 after implementation of the TPD. Bivariate analyses included adult smokers (n = 5597) and recent quitters (n = 412). Adjusted logistic regression analyses were restricted to the subset of current smokers (n = 5597) and conducted using SAS-callable SUDAAN. RESULTS Over half of smokers (58.2%) and 30% of quitters noticed at least one of five types of TPD-related pack changes. Over one-quarter of all respondents noticed changes to health warnings (30.0%), standardized openings (27.7%), minimum pack unit size (27.9%), and the removal of tar, nicotine and carbon monoxide information (26.7%) on packaging. Cross-country differences were observed across all measures, with noticing all pack changes markedly lower in Spain than the other countries. Correlates of noticing specific pack changes included sociodemographic characteristics, smoking behaviours and related to packaging. CONCLUSIONS This is one of the first cross-country studies to examine the extent to which TPD changes to cigarette and RYO tobacco packaging are being noticed by smokers and recent quitters. Findings indicate that the majority of smokers noticed at least one type of pack change, but this varied across countries and sub-populations.
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Affiliation(s)
- Christina N Kyriakos
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Charis Girvalaki
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | | | - Filippos T Filippidis
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - James Balmford
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Katerina Nikitara
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat (Barcelona), Catalonia, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Catalonia, Spain
- School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L'Hospitalet de Llobregat, Catalonia, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), Madrid, Spain
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, Warsaw, Poland
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Collegium Civitas, Warsaw, Poland
| | - Antigona C Trofor
- University of Medicine and Pharmacy 'Grigore T. Popa' Iasi, Iasi, Romania
- Aer Pur Romania, Bucharest, Romania
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation, Budapest, Hungary
| | - Witold Zatoński
- Health Promotion Foundation, Warsaw, Poland
- European Observatory of Health Inequalities, President Stanislaw, Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Yannis Tountas
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Geoffrey T Fong
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
- Department of Psychology, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Constantine I Vardavas
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
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Nikitara K, Girvalaki C, Kyriakos CN, Driezen P, Filippidis FT, Kahnert S, Hitchman SC, Mons U, Fernández E, Trofor AC, Przewoźniak K, Demjén T, Katsaounou PA, Zatoński W, Fong GT, Vardavas CI. Changes in electronic cigarette use and label awareness among smokers before and after the European Tobacco Products Directive implementation in six European countries: findings from the EUREST-PLUS ITC Europe Surveys. Eur J Public Health 2020; 30:iii62-iii67. [PMID: 32918814 DOI: 10.1093/eurpub/ckaa081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Article 20 of the European Tobacco Product Directive (TPD), which went into effect in May 2016, regulates electronic cigarettes (e-cigarettes) in the European Union (EU). The aim of this study was to evaluate changes in e-cigarette use, design attributes of the products used and awareness of e-cigarette labelling and packaging among smokers from six EU Member States (MS) before and after TPD implementation. METHODS Data come from Wave 1 (2016, pre-TPD) and Wave 2 (2018, post-TPD) of the ITC Six European Country Survey among a sample of smokers and recent quitters who use e-cigarettes from six EU MS. Weighted logistic generalized estimating equations regression models were estimated to test the change in binary outcomes between Waves 1 and 2 using SAS-callable SUDAAN. RESULTS In 2018, current daily/weekly e-cigarette use among adult smokers was just over 2%, but this varied from the highest in Greece (4%) to lowest in Poland (1.2%). From Waves 1 to 2, there was a significant increase in respondents reporting noticing and reading health and product safety information on leaflets inside e-cigarette packaging (8.39-11.62%, P < 0.001). There were no significant changes between waves of respondents reporting noticing or reading warning labels on e-cigarette packages/vials. CONCLUSIONS e-cigarette use among smokers in these six EU countries is low. Although reported noticing and reading leaflets included in the packaging of e-cigarettes increased significantly from before to after the TPD, there was no significant change in reported noticing and reading of warning labels. Findings indicate the importance of continued monitoring of TPD provisions around e-cigarettes.
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Affiliation(s)
- Katerina Nikitara
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | - Charis Girvalaki
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,School of Medicine, University of Crete, Heraklion, Greece
| | - Christina N Kyriakos
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,School of Medicine, University of Crete, Heraklion, Greece
| | - Pete Driezen
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Filippos T Filippidis
- Department of Primary Care and Public Health, Imperial College London, London, UK.,Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Sarah Kahnert
- German Cancer Research Center (DKFZ), Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, Heidelberg, Germany.,Medical Faculty, Heidelberg University, Heidelberg, Germany
| | | | - Ute Mons
- German Cancer Research Center (DKFZ), Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, Heidelberg, Germany
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat (Barcelona), Catalonia, Spain.,Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Catalonia, Spain.,School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L'Hospitalet de Llobregat, Catalonia, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), Madrid, Spain
| | - Antigona C Trofor
- University of Medicine and Pharmacy 'Grigore T. Popa' Iasi, Iasi, Romania.,AerPur Romania, Bucharest, Romania
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, Warsaw, Poland.,Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Collegium Civitas, Warsaw, Poland
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation, Budapest, Hungary
| | - Paraskevi A Katsaounou
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Witold Zatoński
- Health Promotion Foundation, Warsaw, Poland.,European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Geoffrey T Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,School of Medicine, University of Crete, Heraklion, Greece
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20
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Vardavas C, Odani S, Nikitara K, El Banhawi H, Kyriakos C, Taylor L, Lown G, Becuwe N. Perceptions and practice of personal protective behaviors to prevent COVID-19 transmission in the G7
nations. Popul Med 2020. [DOI: 10.18332/popmed/123821] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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21
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Girvalaki C, Mechili EA, Papadakis S, Nikitara K, Demin A, Trofor A, Lila A, Harutyunyan A, Saliaj A, Dimitrievska D, Lozano FR, Bakh-Turidze G, Ayesta J, Przewozniak K, Cattaruzza MS, Zdraveska M, Lovše M, Kilibarda B, Stoyka O, Behrakis P, Bizel P, Starchenko P, Spahija S, Radu-Loghin C, Vardavas CI. Current practices and perceived barriers to tobacco-treatment delivery among healthcare professionals from 15 European countries. The EPACTT Plus project. Tob Prev Cessat 2020; 6:6. [PMID: 32548343 PMCID: PMC7291907 DOI: 10.18332/tpc/115033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The latest evidence-based Guidelines for Treating Tobacco Dependence highlight the significant role of healthcare professionals in supporting smokers interested to quit. This study aimed to identify the current practices of healthcare professionals in Europe and perceived barriers in delivering tobacco treatment to their patients who smoke. METHODS In the context of EPACTT-Plus, collaborating institutions from 15 countries (Albania, Armenia, Belgium, Italy, France, Georgia, Greece, Kosovo, Romania, North Macedonia, Russia, Serbia, Slovenia, Spain, Ukraine) worked for the development of an accredited eLearning course on Tobacco Treatment Delivery available at http://elearning-ensp.eu/. In total, 444 healthcare professionals from the wider European region successfully completed the course from December 2018 to July 2019. Cross-sectional data were collected online on healthcare professionals’ current practices and perceived barriers in introducing tobacco-dependence treatment into their daily clinical life. RESULTS At registration, 41.2% of the participants reported having asked their patients if they smoked. Advise to quit smoking was offered by 47.1% of the participants, while 29.5% reported offering assistance to their patients who smoked in order to quit. From the total number of participants, 39.9% regarded the lack of patient compliance as a significant barrier. Other key barriers were lack of: interest from the patients (37.4%), healthcare professionals training (33.1%), community resources to refer patients (31.5%), and adequate time during their everyday clinical life (29.7%). CONCLUSIONS The identification of current practices and significant barriers is important to build evidence-based guidelines and training programs (online and/or live) that will improve the performance of healthcare professionals in offering tobacco-dependence treatment for their patients who smoke.
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Affiliation(s)
- Charis Girvalaki
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Enkeleint A Mechili
- Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Greece.,Department of Healthcare, Faculty of Health, University of Vlora, Vlore, Albania
| | - Sophia Papadakis
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Greece.,Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Katerina Nikitara
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | - Andrey Demin
- Institute of Leadership and Healthcare Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Antigona Trofor
- University of Medicine and Pharmacy 'Grigore T.Popa', Iasi, Romania.,AER PUR Romania, Bucharest, Romania
| | - Arben Lila
- Kosovo Advocacy and Development Center, Prishtina, Kosovo
| | - Arusyak Harutyunyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Aurela Saliaj
- Department of Healthcare, Faculty of Health, University of Vlora, Vlore, Albania
| | | | - Francisco Rodriguez Lozano
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,Comité Nacional de Prevención del Tabaquismo, Madrid, Spain
| | | | | | - Krzysztof Przewozniak
- Foundation 'Smart Health - Health in 3D', Warsaw, Poland.,Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Maria Sofia Cattaruzza
- Department of Public Health & Infectious Diseases, Sapienza University, Rome, Italy.,SITAB, Società Italiana di Tabaccologia, Rome, Italy
| | | | - Mihaela Lovše
- Slovenian Coalition for Tobacco Control, Ljubljana, Slovenia
| | | | | | - Panagiotis Behrakis
- George D. Behrakis Research Laboratory, Athens, Greece.,Hellenic Cancer Society, Athens, Greece
| | | | - Polina Starchenko
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | | | | | - Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,Medical School, University of Crete, Heraklion, Greece
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Girvalaki C, Papadakis S, Mechili EA, Nikitara K, Demin A, Trofor AC, Lila A, Harutyunyan A, Saliaj A, Dimitrievska D, Lozano FR, Bakhturidze G, Ayesta J, Przewoźniak K, Cattaruzza MS, Zdraveska M, Lovše M, Kilibarda B, Stoyka O, Behrakis P, Bizel P, Starchenko P, Spahija S, Radu-Loghin C, Vardavas CI. Impact of the ENSP eLearning platform on improving knowledge, attitudes and self-efficacy for treating tobacco dependence: An assessment across 15 European countries. Tob Induc Dis 2020; 18:40. [PMID: 32435174 PMCID: PMC7233524 DOI: 10.18332/tid/120188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In 2018, the European Network for Smoking Cessation and Prevention (ENSP) released an update to its Tobacco Treatment Guidelines for healthcare professionals, which was the scientific base for the development of an accredited eLearning curriculum to train healthcare professionals, available in 14 languages. The aim of this study was to evaluate the effectiveness of ENSP eLearning curriculum in increasing healthcare professionals' knowledge, attitudes, self-efficacy (perceived behavioral control) and intentions in delivering tobacco treatment interventions in their daily clinical routines. METHODS We conducted a quasi-experimental pre-post design study with 444 healthcare professionals, invited by 20 collaborating institutions from 15 countries (Albania, Armenia, Belgium, Italy, France, Georgia, Greece, Kosovo, Romania, North Macedonia, Russia, Serbia, Slovenia, Spain, Ukraine), which completed the eLearning course between December 2018 and July 2019. RESULTS Healthcare professionals' self-reported knowledge improved after the completion of each module of the eLearning program. Increases in healthcare professionals' self-efficacy in delivering tobacco treatment interventions (p<0.001) were also documented. Significant improvements were documented in intentions to address tobacco use as a priority, document tobacco use, offer support, provide brief counselling, give written material, discuss available medication, prescribe medication, schedule dedicated appointment to develop a quit plan, and be persistent in addressing tobacco use with the patients (all p<0.001). CONCLUSIONS An evidence-based digital intervention can be effective in improving knowledge, attitudes, self-efficacy and intentions on future delivery of tobacco-treatment interventions.
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Affiliation(s)
- Charis Girvalaki
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Medical School, University of Crete, Heraklion, Greece
| | - Sophia Papadakis
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Medical School, University of Crete, Heraklion, Greece
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Enkeleint A. Mechili
- Medical School, University of Crete, Heraklion, Greece
- Department of Health Care, Faculty of Public Health, University ‘Ismail Qemali’ Vlore, Vlora, Albania
| | - Katerina Nikitara
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Medical School, University of Crete, Heraklion, Greece
| | - Andrey Demin
- Institute of Leadership and Healthcare Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Antigona C. Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, Iasi, Romania
- AER PUR Romania, Bucharest, Romania
| | - Arben Lila
- Kosovo Advocacy and Development Center, Pristina, Kosovo
| | - Arusyak Harutyunyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Aurela Saliaj
- Department of Health Care, Faculty of Public Health, University ‘Ismail Qemali’ Vlore, Vlora, Albania
| | | | - Francisco Rodriguez Lozano
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Comité Nacional de Prevención del Tabaquismo, Madrid, Spain
| | | | | | - Krzysztof Przewoźniak
- Foundation ‘Smart Health – Health in 3D’, Warsaw, Poland
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Maria Sofia Cattaruzza
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
- Società Italiana di Tabaccologia (SITAB), Rome, Italy
| | | | - Mihaela Lovše
- Slovenian Coalition for Public Health, Environment and Tobacco Control, Maribor, Slovenia
| | - Biljana Kilibarda
- Institute of Public Health of Serbia ‘Dr Milan Jovanović Batut’, Belgrade, Serbia
| | | | - Panagiotis Behrakis
- George D. Behrakis Research Laboratory, Athens, Greece
- Hellenic Cancer Society, Athens, Greece
| | | | - Polina Starchenko
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | | | | | - Constantine I. Vardavas
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Medical School, University of Crete, Heraklion, Greece
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Vardavas CI, Nikitara K. COVID-19 and smoking: A systematic review of the evidence. Tob Induc Dis 2020. [PMID: 32206052 DOI: 10.18332/tid/119324,] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Constantine I Vardavas
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, United States.,School of Medicine, University of Crete, Heraklion, Greece
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Vardavas CI, Nikitara K. COVID-19 and smoking: A systematic review of the evidence. Tob Induc Dis 2020. [PMID: 32206052 DOI: 10.18332/tid/119324;] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Constantine I Vardavas
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, United States.,School of Medicine, University of Crete, Heraklion, Greece
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Vardavas C, Nikitara K. COVID-19 and smoking: A systematic review of the evidence. Tob Induc Dis 2020. [DOI: 10.18332/tid/119324\] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
COVID-19 is a coronavirus outbreak that initially appeared in Wuhan, Hubei Province, China, in December 2019, but it has already evolved into a pandemic spreading rapidly worldwide1,2. As of 18 March 2020, a total number of 194909 cases of COVID-19 have been reported, including 7876 deaths, the majority of which have been reported in China (3242) and Italy (2505)3. However, as the pandemic is still unfortunately under progression, there are limited data with regard to the clinical characteristics of the patients as well as to their prognostic factors4. Smoking, to date, has been assumed to be possibly associated with adverse disease prognosis, as extensive evidence has highlighted the negative impact of tobacco use on lung health and its causal association with a plethora of respiratory diseases5. Smoking is also detrimental to the immune system and its responsiveness to infections, making smokers more vulnerable to infectious diseases6. Previous studies have shown that smokers are twice more likely than non-smokers to contract influenza and have more severe symptoms, while smokers were also noted to have higher mortality in the previous MERS-CoV outbreak7,8. Given the gap in the evidence, we conducted a systematic review of studies on COVID-19 that included information on patients’ smoking status to evaluate the association between smoking and COVID-19 outcomes including the severity of the disease, the need for mechanical ventilation, the need for intensive care unit (ICU) hospitalization and death. The literature search was conducted on 17 March 2020, using two databases (PubMed, ScienceDirect), with the search terms: [‘smoking’ OR ‘tobacco’ OR ‘risk factors’ OR ‘smoker*’] AND [‘COVID-19’ OR ‘COVID 19’ OR ‘novel coronavirus’ OR ‘sars cov-2’ OR ‘sars cov 2’] and included studies published in 2019 and 2020. Further inclusion criteria were that the studies were in English and referred to humans. We also searched the reference lists of the studies included. A total of 71 studies were retrieved through the search, of which 66 were excluded after full-text screening, leaving five studies that were included. All of the studies were conducted in China, four in Wuhan and one across provinces in mainland China. The populations in all studies were patients with COVID-19, and the sample size ranged from 41 to 1099 patients. With regard to the study design, retrospective and prospective methods were used, and the timeframe of all five studies covered the first two months of the COVID-19 pandemic (December 2019, January 2020). Specifically, Zhou et al.9 studied the epidemiological characteristics of 191 individuals infected with COVID-19, without, however, reporting in more detail the mortality risk factors and the clinical outcomes of the disease. Among the 191 patients, there were 54 deaths, while 137 survived. Among those that died, 9% were current smokers compared to 4% among those that survived, with no statistically significant difference between the smoking rates of survivors and non-survivors (p=0.21) with regard to mortality from COVID-19. Similarly, Zhang et al.10 presented clinical characteristics of 140 patients with COVID-19. The results showed that among severe patients (n=58), 3.4% were current smokers and 6.9% were former smokers, in contrast to non-severe patients (n=82) among which 0% were current smokers and 3.7% were former smokers , leading to an OR of 2.23; (95% CI: 0.65–7.63; p=0.2). Huang et al.11 studied the epidemiological characteristics of COVID-19 among 41 patients. In this study, none of those who needed to be admitted to an ICU (n=13) was a current smoker. In contrast, three patients from the non-ICU group were current smokers, with no statistically significant difference between the two groups of patients (p=0.31), albeit the small sample size of the study. The largest study population of 1099 patients with COVID-19 was provided by Guan et al.12 from multiple regions of mainland China. Descriptive results on the smoking status of patients were provided for the 1099 patients, of which 173 had severe symptoms, and 926 had non-severe symptoms. Among the patients with severe symptoms, 16.9% were current smokers and 5.2% were former smokers, in contrast to patients with non-severe symptoms where 11.8% were current smokers and 1.3% were former smokers. Additionally, in the group of patients that either needed mechanical ventilation, admission to an ICU or died, 25.5% were current smokers and 7.6% were former smokers. In contrast, in the group of patients that did not have these adverse outcomes, only 11.8% were current smokers and 1.6% were former smokers. No statistical analysis for evaluating the association between the severity of the disease outcome and smoking status was conducted in that study. Finally, Liu et al.13 found among their population of 78 patients with COVID-19 that the adverse outcome group had a significantly higher proportion of patients with a history of smoking (27.3%) than the group that showed improvement or stabilization (3.0%), with this difference statistically significant at the p=0.018 level. In their multivariate logistic regression analysis, the history of smoking was a risk factor of disease progression (OR=14.28; 95% CI: 1.58–25.00; p= 0.018). We identified five studies that reported data on the smoking status of patients infected with COVID-19. Notably, in the largest study that assessed severity, there were higher percentages of current and former smokers among patients that needed ICU support, mechanical ventilation or who had died, and a higher percentage of smokers among the severe cases12. However, from their published data we can calculate that the smokers were 1.4 times more likely (RR=1.4, 95% CI: 0.98–2.00) to have severe symptoms of COVID-19 and approximately 2.4 times more likely to be admitted to an ICU, need mechanical ventilation or die compared to non-smokers (RR=2.4, 95% CI: 1.43–4.04). In conclusion, although further research is warranted as the weight of the evidence increases, with the limited available data, and although the above results are unadjusted for other factors that may impact disease progression, smoking is most likely associated with the negative progression and adverse outcomes of COVID-19.
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Affiliation(s)
- Constantine I Vardavas
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, United States.,School of Medicine, University of Crete, Heraklion, Greece
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Vardavas C, Nikitara K. COVID-19 and smoking: A systematic review of the evidence. Tob Induc Dis 2020. [DOI: 10.18332/tid/119324 union select null--] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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28
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Vardavas C, Nikitara K. COVID-19 and smoking: A systematic review of the evidence. Tob Induc Dis 2020. [DOI: 10.18332/tid/119324 or 1=1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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29
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Girvalaki C, Tzatzarakis M, Vardavas A, Kyriakos CN, Nikitara K, Stivaktakis P, Tsatsakis A, Vardavas C. Discrepancies in reported versus measured nicotine content of e-cigarette refill liquids across nine European countries before and after the implementation of the EU Tobacco Products Directive. Eur Respir J 2020; 55:13993003.00941-2019. [PMID: 31699845 DOI: 10.1183/13993003.00941-2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 10/26/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Charis Girvalaki
- Laboratory of Toxicology, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Manolis Tzatzarakis
- Laboratory of Toxicology, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Alexander Vardavas
- Laboratory of Toxicology, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Christina N Kyriakos
- Laboratory of Toxicology, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Katerina Nikitara
- Laboratory of Toxicology, Faculty of Medicine, University of Crete, Heraklion, Greece
| | | | - Aristidis Tsatsakis
- Laboratory of Toxicology, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Constantine Vardavas
- Laboratory of Toxicology, Faculty of Medicine, University of Crete, Heraklion, Greece
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Mechili EA, Nikitara K, Girvalaki C, Kyriakos C, Vardavas C. Patient journey pain points in spondyloarthritis and
psoriasis: The case of Greece. Popul Med 2019. [DOI: 10.18332/popmed/113401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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31
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Girvalaki C, Vardavas A, Tzatzarakis M, Kyriakos CN, Nikitara K, Tsatsakis AM, Vardavas CI. Compliance of e-cigarette refill liquids with regulations on labelling, packaging and technical design characteristics in nine European member states. Tob Control 2019; 29:531-536. [PMID: 31519795 DOI: 10.1136/tobaccocontrol-2019-055061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/07/2019] [Accepted: 08/07/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate electronic cigarette (e-cigarette) product compliance with European regulations (Tobacco Products Directive (TPD), Implementing Decisions), with a focus on labelling/packaging practices and technical design/safety features. METHODS Before the implementation of the TPD, in early 2016, we randomly selected e-cigarette refill liquids from the five top-selling companies in France, Poland, Germany, Netherlands, UK, Spain, Romania, Hungary and Greece. Identical products were purchased after the implementation of the TPD (early 2018) and assessment of compliance was performed on self-matched samples (n=107) using a prospective cohort design. Compliance with the Classification, Labelling and Packaging (CLP) regulations was also evaluated. RESULTS Following the implementation of the TPD, improvements were noted with regards to the existence of text-only warnings (32.7% pre vs 86.0% post, p<0.001), child-resistant fastenings (93.3% pre vs 100.0% post, p=0.016), tamper-proof vials (58.9% pre vs 86.9%, post p<0.001) and maximum refill volume ≤10 mL in vials (86.9% pre vs 94.4% post, p=0.008). Lower compliance was noted with regards to the inclusion of a leaflet (26.2% pre vs 53.3% post, p<0.001), refilling instructions (28.0% pre vs 51.4% post, p<0.001) and health warnings on the box, vial or leaflet (32.7% pre vs 86.0%, p<0.001). Overall, 86.0% of products had a warning label in the post-TPD phase in comparison to 32.7% of products before the implementation of the TPD (p<0.001). Compliance with the CLP regulations, also increased in the post TPD follow-up phase. CONCLUSIONS This is the first study to evaluate the level of implementation of the e-cigarette regulations in nine EU member states. Our results indicate that refill liquids had substantial but not full compliance in most of the characteristics evaluated. Further effort is needed to ensure complete compliance.
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Affiliation(s)
- Charis Girvalaki
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,Laboratory of Toxicology, University of Crete School of Medicine, Heraklion, Greece
| | - Alexander Vardavas
- Laboratory of Toxicology, University of Crete School of Medicine, Heraklion, Greece
| | - Manolis Tzatzarakis
- Laboratory of Toxicology, University of Crete School of Medicine, Heraklion, Greece
| | - Christina N Kyriakos
- Laboratory of Toxicology, University of Crete School of Medicine, Heraklion, Greece
| | - Katerina Nikitara
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | | | - Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium .,Laboratory of Toxicology, University of Crete School of Medicine, Heraklion, Greece
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