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Peruga A, Martínez C, Fu M, Ballbè M, Tigova O, Carnicer-Pont D, Fernández E. [Electronic cigarette use among high school students during the COVID-19 pandemic]. Gac Sanit 2023; 37:102324. [PMID: 37598581 DOI: 10.1016/j.gaceta.2023.102324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/09/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Armando Peruga
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat (Barcelona), España; Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Lo Barnechea, Región Metropolitana, Chile; Grupo de Investigación en Control del Tabaco, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España; CIBER de Enfermedades Respiratorias (CIBERES), España.
| | - Cristina Martínez
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat (Barcelona), España; Grupo de Investigación en Control del Tabaco, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España; CIBER de Enfermedades Respiratorias (CIBERES), España; Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), España; Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, United States of America
| | - Marcela Fu
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat (Barcelona), España; Grupo de Investigación en Control del Tabaco, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España; CIBER de Enfermedades Respiratorias (CIBERES), España; Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), España
| | - Montse Ballbè
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat (Barcelona), España; Grupo de Investigación en Control del Tabaco, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España; CIBER de Enfermedades Respiratorias (CIBERES), España; Unidad de Adicciones, Servicio de Psiquiatría, Instituto de Neurociencias, Hospital Clínic de Barcelona, Barcelona, España
| | - Olena Tigova
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat (Barcelona), España; Grupo de Investigación en Control del Tabaco, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España; CIBER de Enfermedades Respiratorias (CIBERES), España; Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), España
| | - Dolors Carnicer-Pont
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat (Barcelona), España; Grupo de Investigación en Control del Tabaco, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
| | - Esteve Fernández
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat (Barcelona), España; Grupo de Investigación en Control del Tabaco, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España; CIBER de Enfermedades Respiratorias (CIBERES), España; Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), España
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Melero-Ollonarte JL, Lidón-Moyano C, Perez-Ortuño R, Fu M, Ballbè M, Martín-Sánchez JC, González-Marrón A, Cartanyà-Hueso À, Pascual JA, Fernández E, Martínez-Sánchez JM. Specific biomarker comparison in current smokers, e-cigarette users, and non-smokers. Addict Behav 2023; 140:107616. [PMID: 36680837 DOI: 10.1016/j.addbeh.2023.107616] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/19/2022] [Accepted: 01/06/2023] [Indexed: 01/09/2023]
Abstract
INTRODUCTION This study aims to address the existing gap in the literature, while adding evidence, by comparing tobacco-specific biomarkers (cotinine and nitrosamines: NNK, NNAL, NNN), and other biomarkers of e-cigarette use (humectants: glycerol, 1,2-PD, 1,3-PD) according to five study groups. METHODS A pooling analysis including two different studies was conducted. In both analyses, we took saliva samples from smokers (n = 409) and non-smokers (n = 154), dual tobacco and e-cig users (n = 92), exclusive e-cig user with nicotine (n = 158), and exclusive e-cig users without nicotine (n = 38). We analyzed and compared the geometric means (GM) and geometric standard deviations (GSD) of the concentration of tobacco-specific biomarkers, and e-cigarette biomarkers among groups. We used log-linear models adjusted for sex and age to model the change percentage and their 95% confidence intervals. RESULTS Cotinine was significantly higher in nicotine consumers and in e-cigarette users without nicotine when compared to non-smokers. TSNAs were generally significantly lower in non-smokers and higher in nicotine consumers. NNN and NNAL were lower in e-cigarette users with nicotine comparted to smokers, and NNN was higher in e-cigarette users without nicotine when compared to non-smokers. No differences were found in humectant biomarkers between e-cigarette groups. CONCLUSIONS Although there was a reduction in TSNAs in e-cigarette exclusive users compared to smokers, and a reduction of cotinine concentrations in e-cigarette exclusive users without nicotine compared to smokers, there are still high levels of these biomarkers when compared to non-smokers, which may be a clue towards the harmful effect of e-cigarettes.
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Affiliation(s)
- Juan Luis Melero-Ollonarte
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Cristina Lidón-Moyano
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain.
| | - Raúl Perez-Ortuño
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, l'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Programme, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain; Department of Public Health, Mental Health, and Maternal and Child Health Nursing, Faculty of Medicine and Health Sciences - Bellvitge Campus, Universitat de Barcelona, Barcelona, Spain; Center for Biomedical Research in Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, l'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Programme, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain; Center for Biomedical Research in Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Juan Carlos Martín-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Adrián González-Marrón
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Àurea Cartanyà-Hueso
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain; Group of Perinatal Epidemiology, Environmental Health, and Clinical Research, Department of Medicine, School of Health Sciences, Universitat Jaume I, Av. Vicent Sos Baynat, s/n 12071 Castelló de la Plana, Spain
| | - José A Pascual
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain; Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Esteve Fernández
- Department of Clinical Sciences, Faculty of Medicine and Health Sciences - Bellvitge Campus, Universitat de Barcelona, Barcelona, Spain; Tobacco Control Research Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Programme, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain; Department of Public Health, Mental Health, and Maternal and Child Health Nursing, Faculty of Medicine and Health Sciences - Bellvitge Campus, Universitat de Barcelona, Barcelona, Spain; Center for Biomedical Research in Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose M Martínez-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain; Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, l'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Programme, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain
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Mondon S, Raich A, Martí C, Fernández E, Ballbè M, La Red Catalana de Hospitales Sin Humo GDTDTYSMD. Training mental health residents in tobacco and alcohol: Relationship with their clinical intervention. Adicciones 2023; 0:1837. [PMID: 36975072 DOI: 10.20882/adicciones.1837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
The objective of this study is to describe how mental health professionals in training (residents) apply the brief intervention (5As) on the tobacco and alcohol consumption to their patients, and if this is related to the training received and/or their own consumption. This is a cross-sectional study in which a self-reported questionnaire was administered to first-year residents of mental health professionals in Catalonia (2016-2019) (psychiatrists, psychologists and nurses). We performed a descriptive analysis of the variables and we applied a chi-square test for the comparison of proportions. 154 professionals completed the questionnaire. Half of them had not received any university training on intervention in smoking (46.8%) or in alcohol consumption (53.2%). Those who had received it, advised, assessed and helped their patients to quit smoking more frequently (p = 0.008, p = 0.037 and p = 0.039, respectively). Those who had received training in alcohol intervention gave advice, performed assessments and offered help to quit/reduce alcohol among their patients more frequently (p < 0.001, p = 0.001, and p < 0.001, respectively). Residents usually helped more to quit or reduce alcohol than to quit tobacco (p < 0.001). 60.1% of them never or rarely helped their patients to stop smoking and 34.6% rarely helped in the case of alcohol. In general, nurses did more intervention for tobacco than alcohol use, regardless of the training received. The lack of training of professionals in tobacco and alcohol intervention at university is related to a lack of intervention on patients in their professional practice, regardless of their own consumption.
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Affiliation(s)
- Sílvia Mondon
- Unidad de Adicciones. Servicio de Psiquiatría. Instituto Clínico de Neurociencias, Hospital Clínic de Barcelona.
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Pérez-Martín H, Lidón-Moyano C, González-Marrón A, Fu M, Pérez-Ortuño R, Ballbè M, Martín-Sánchez JC, Pascual JA, Fernández E, Martínez-Sánchez JM. Variation in Nicotine Metabolization According to Biological Factors and Type of Nicotine Consumer. Healthcare (Basel) 2023; 11:healthcare11020179. [PMID: 36673548 PMCID: PMC9859072 DOI: 10.3390/healthcare11020179] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/10/2023] Open
Abstract
This study aims to describe the nicotine metabolite ratio among tobacco smokers and electronic cigarette (e-cigarette) users and nonusers. We analyzed pooled data from a longitudinal and a cross-sectional study of the adult population from the city of Barcelona. The final sample included information on 166 smokers, 164 e-cigarettes users with nicotine, 41 e-cigarette users without nicotine, 95 dual users (users of both products), and 508 nonusers. We used log-linear models to control for the potential confounding effect of the daily number of cigarettes smoked. Salivary nicotine metabolic rate assessment included the rate of nicotine metabolism (cotinine/nicotine) and the nicotine metabolite ratio (trans-3′-hydroxycotinine/cotinine). Exclusive users of e-cigarette without nicotine have the lowest rate of nicotine metabolism (Geometric mean: 0.08, p-values < 0.001) while cigarette smokers have the highest (Geometric mean: 2.08, p-values < 0.001). Nonusers have lower nicotine metabolic rate than cigarette smokers (Geometric means: 0.23 vs. 0.18, p-value < 0.05). Younger individuals (18−44 years) have a higher rate of nicotine metabolism than older individuals (45−64 years and 65−89) (Geometric means: 0.53 vs. 0.42 and 0.31, respectively, p-values < 0.01) and individuals with lower body mass index (21−25 kg/m2) have a higher rate of nicotine metabolism than the rest (26−30 kg/m2 and 31−60 kg/m2) (Geometric means: 0.52 vs. 0.35 and 0.36, respectively-values < 0.01). Nicotine metabolic rates are useful biomarkers when reporting smoking status and biological differences between individuals.
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Affiliation(s)
- Hipólito Pérez-Martín
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Carrer de Josep Trueta s/n, 08195 Barcelona, Spain
| | - Cristina Lidón-Moyano
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Carrer de Josep Trueta s/n, 08195 Barcelona, Spain
- Correspondence: (C.L.-M.); (A.G.-M.)
| | - Adrián González-Marrón
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Carrer de Josep Trueta s/n, 08195 Barcelona, Spain
- Correspondence: (C.L.-M.); (A.G.-M.)
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d’Oncologia, 08908 Barcelona, Spain
- Tobacco Control Research Group, Epidemiology and Public Health Program, Institut d’Investigació Biomèdica de Bellvitge—IDIBELL, 08908 Barcelona, Spain
- School of Medicine and Health Sciences, Universitat de Barcelona, 08007 Barcelona, Spain
- Center for Biomedical Research in Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, 28220 Madrid, Spain
| | - Raúl Pérez-Ortuño
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, 08003 Barcelona, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d’Oncologia, 08908 Barcelona, Spain
- Tobacco Control Research Group, Epidemiology and Public Health Program, Institut d’Investigació Biomèdica de Bellvitge—IDIBELL, 08908 Barcelona, Spain
- Center for Biomedical Research in Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, 28220 Madrid, Spain
- Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Juan Carlos Martín-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Carrer de Josep Trueta s/n, 08195 Barcelona, Spain
| | - José A. Pascual
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona Biomedical Research Park (PRBB), 08003 Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d’Oncologia, 08908 Barcelona, Spain
- Tobacco Control Research Group, Epidemiology and Public Health Program, Institut d’Investigació Biomèdica de Bellvitge—IDIBELL, 08908 Barcelona, Spain
- School of Medicine and Health Sciences, Universitat de Barcelona, 08007 Barcelona, Spain
- Center for Biomedical Research in Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, 28220 Madrid, Spain
| | - Jose M. Martínez-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Carrer de Josep Trueta s/n, 08195 Barcelona, Spain
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Bru S, González-Marrón A, Lidón-Moyano C, Carballar R, Martínez-Láinez JM, Pérez-Martín H, Fu M, Pérez-Ortuño R, Ballbè M, Pascual JA, Fernández E, Clotet J, Martínez-Sánchez JM. Determination of soluble angiotensin-converting enzyme 2 in saliva samples and its association with nicotine. Environ Res 2023; 216:114443. [PMID: 36195157 PMCID: PMC9527194 DOI: 10.1016/j.envres.2022.114443] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The Angiotensin-Converting Enzyme 2 (ACE2) is the main receptor of the SARS-CoV-2. There is contradictory evidence on how the exposure to nicotine may module the concentration of soluble ACE2 (sACE2). The aim of this study was to assess the association between nicotine and sACE2 concentrations in saliva samples. METHODS Pooled analysis performed with data retrieved from two studies (n = 634 and n = 302). Geometric mean (GM) concentrations of sACE2, both total and relative to the total amount of protein in the sample, were compared according to sociodemographic variables and variables associated to nicotine. Multivariable linear regression models were fitted to explore the associations of sACE2 with nicotine adjusting for sex, age and body mass index. Spearman's rank-correlation coefficients were estimated between the concentrations of nicotine and cotinine, and pack-years, the concentration of relative sACE2 and the isoforms of sACE2. RESULTS We observed a significant increase of 0.108‰ and 0.087 ng/μl in the relative and absolute salivary sACE2 GM concentrations, respectively, between the lowest and highest nicotine levels. Similar results were observed for cotinine. These associations did not change in the multivariable linear models. There was a low correlation of nicotine and cotinine concentration with the concentration of relative salivary sACE2 (rs = 0.153 and rs = 0.132, respectively), pack-years (rs = 0.222 and rs = 0.235, respectively) and with the concentration of isoform 40 KDa (rs = 0.193 and rs = 0.140, respectively). CONCLUSION Salivary nicotine concentration seems to be limitedly associated with the concentration of sACE2.
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Affiliation(s)
- Samuel Bru
- Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat Del Vallès, Barcelona, Spain
| | - Adrián González-Marrón
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat Del Vallès, Barcelona, Spain
| | - Cristina Lidón-Moyano
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat Del Vallès, Barcelona, Spain
| | - Reyes Carballar
- Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat Del Vallès, Barcelona, Spain
| | - Joan Marc Martínez-Láinez
- Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat Del Vallès, Barcelona, Spain
| | - Hipólito Pérez-Martín
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat Del Vallès, Barcelona, Spain
| | - Marcela Fu
- Tobacco Control Unit, Catalan Institute of Oncology - ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Raúl Pérez-Ortuño
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital Del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Catalan Institute of Oncology - ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jose A Pascual
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona Biomedical Research Park, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology - ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Josep Clotet
- Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat Del Vallès, Barcelona, Spain.
| | - Jose M Martínez-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat Del Vallès, Barcelona, Spain.
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Ballbè M, Fu M, Masana G, Pérez-Ortuño R, Gual A, Gil F, Olmedo P, García-Algar Ó, Pascual JA, Fernández E. Passive exposure to electronic cigarette aerosol in pregnancy: A case study of a family. Environ Res 2023; 216:114490. [PMID: 36220444 DOI: 10.1016/j.envres.2022.114490] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/20/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Passive exposure to the aerosols of electronic cigarettes (e-cigarettes) has been little studied. We assessed this exposure in late pregnancy in a woman and her 3-year-old child, exposed through e-cigarette use by another household member. METHODS This prospective longitudinal case study involved a family unit consisting of an e-cigarette user, a pregnant woman who delivered an infant during the study, and the couple's older 3-year-old son. At 31, 36, and 40 weeks of the pregnancy, we measured biomarkers (nicotine metabolites, tobacco-specific nitrosamines, propanediols, glycerol, and metals) in the urine and hair of all three participants and in the saliva of the adults, in cord blood at delivery, and in the breast milk at the postpartum period. RESULTS Samples from the e-cigarette user showed quantifiable concentrations of all analytes assessed (maximum urinary cotinine concentration, 4.9 ng/mL). Among samples taken from the mother, nicotine and its metabolites were found mainly in urine and also in saliva and hair, but not in cord blood. During the postpartum period, we found cotinine concentrations of 2.2 ng/mL in the mother's urine and 0.22 ng/mL in breast milk; 1,2-propanediol was generally detected in urine and saliva, but not in cord blood or breast milk. The maximum urinary cotinine concentration in the 3-year-old child was 2.6 ng/mL and propanediols also were detected in his urine. Nitrosamines were not detected in samples taken from the mother or the 3-year-old. Metals found in the refill liquid were detected at low levels in both the mother and the 3-year-old. CONCLUSIONS We detected low but not negligible concentrations of e-cigarette-related analytes (including cord blood and breast milk) in an exposed pregnant non-user and in a 3-year-old child also living in the home. Passive exposure to e-cigarette aerosols cannot be disregarded and should be assessed in larger observational studies.
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Affiliation(s)
- Montse Ballbè
- Tobacco Control Unit, Cancer Control and Prevention Program, WHO Collaborating Center for Tobacco Control, Institut Català d'Oncologia (ICO), Av. Gran Via de l'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat (Barcelona), Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Av. Gran Via de l'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat (Barcelona), Spain; CIBER of Respirarory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036, Barcelona, Spain.
| | - Marcela Fu
- Tobacco Control Unit, Cancer Control and Prevention Program, WHO Collaborating Center for Tobacco Control, Institut Català d'Oncologia (ICO), Av. Gran Via de l'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat (Barcelona), Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Av. Gran Via de l'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat (Barcelona), Spain; CIBER of Respirarory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; School of Medicine and Health Sciences, Universitat de Barcelona, C. Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat (Barcelona), Spain.
| | - Guillem Masana
- Barcelona Clinic Schizophrenia Unit, Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBER of Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Raúl Pérez-Ortuño
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain.
| | - Antoni Gual
- Grup de Recerca en Addiccions Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Fernando Gil
- Department of Legal Medicine and Toxicology, School of Medicine, Universidad de Granada, Granada, Spain.
| | - Pablo Olmedo
- Department of Legal Medicine and Toxicology, School of Medicine, Universidad de Granada, Granada, Spain.
| | - Óscar García-Algar
- Neonatology Unit, ICGON, Hospital Clínic-Maternitat, BCNatal, Barcelona, Spain.
| | - Jose Antonio Pascual
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain; Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona Biomedical Research Park, Barcelona, Spain.
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Control and Prevention Program, WHO Collaborating Center for Tobacco Control, Institut Català d'Oncologia (ICO), Av. Gran Via de l'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat (Barcelona), Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Av. Gran Via de l'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat (Barcelona), Spain; CIBER of Respirarory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; School of Medicine and Health Sciences, Universitat de Barcelona, C. Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat (Barcelona), Spain.
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7
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Amalia B, Fu M, Tigova O, Ballbè M, Paniello-Castillo B, Castellano Y, Vyzikidou VK, O'Donnell R, Dobson R, Lugo A, Veronese C, Pérez-Ortuño R, Pascual JA, Cortés N, Gil F, Olmedo P, Soriano JB, Boffi R, Ruprecht A, Ancochea J, López MJ, Gallus S, Vardavas C, Semple S, Fernández E. Exposure to secondhand aerosol from electronic cigarettes at homes: A real-life study in four European countries. Sci Total Environ 2023; 854:158668. [PMID: 36099951 DOI: 10.1016/j.scitotenv.2022.158668] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 06/15/2023]
Abstract
Electronic cigarette (e-cigarette) use emits potentially hazardous compounds and deteriorates indoor air quality. Home is a place where e-cigarettes may frequently be used amid its increasing prohibition in public places. This study assessed the real-life scenario of bystanders' exposure to secondhand e-cigarette aerosol (SHA) at home. A one-week observational study was conducted within the TackSHS project in four countries (Greece, Italy, Spain, and the United Kingdom) in 2019 including: 1) homes of e-cigarette users living together with a non-user/non-smoker; and 2) control homes with no smokers nor e-cigarette users. Indoor airborne nicotine, PM2.5, and PM1.0 concentrations were measured as environmental markers of SHA. Biomarkers, including nicotine and its metabolites, tobacco-specific nitrosamines, propanediol, glycerol, and metals were measured in participants' saliva and urine samples. E-cigarette use characteristics, such as e-cigarette refill liquid's nicotine concentration, e-cigarette type, place of e-cigarette use at home, and frequency of ventilation, were also collected. A total of 29 e-cigarette users' homes and 21 control homes were included. The results showed that the seven-day concentrations of airborne nicotine were quantifiable in 21 (72.4 %) out of 29 e-cigarette users' homes; overall, they were quite low (geometric mean: 0.01 μg/m3; 95 % CI: 0.01-0.02 μg/m3) and were all below the limit of quantification in control homes. Seven-day concentrations of PM2.5 and PM1.0 in e-cigarette and control homes were similar. Airborne nicotine and PM concentrations did not differ according to different e-cigarette use characteristics. Non-users residing with e-cigarette users had low but significantly higher levels of cotinine, 3'-OH-cotinine and 1,2-propanediol in saliva, and cobalt in urine than non-users living in control homes. In conclusion, e-cigarette use at home created bystanders' exposure to SHA regardless of the e-cigarette use characteristics. Further studies are warranted to assess the implications of SHA exposure for smoke-free policy.
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Affiliation(s)
- Beladenta Amalia
- Tobacco Control Unit, Catalan Institute of Oncology - ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine and Health Sciences, University of Barcelona - UB, Barcelona, Spain; CIBER Respiratory Diseases - CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - Marcela Fu
- Tobacco Control Unit, Catalan Institute of Oncology - ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine and Health Sciences, University of Barcelona - UB, Barcelona, Spain; CIBER Respiratory Diseases - CIBERES, Instituto de Salud Carlos III, Madrid, Spain.
| | - Olena Tigova
- Tobacco Control Unit, Catalan Institute of Oncology - ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine and Health Sciences, University of Barcelona - UB, Barcelona, Spain; CIBER Respiratory Diseases - CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Catalan Institute of Oncology - ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; CIBER Respiratory Diseases - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Blanca Paniello-Castillo
- Tobacco Control Unit, Catalan Institute of Oncology - ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Yolanda Castellano
- Tobacco Control Unit, Catalan Institute of Oncology - ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine and Health Sciences, University of Barcelona - UB, Barcelona, Spain; CIBER Respiratory Diseases - CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - Vergina K Vyzikidou
- Hellenic Cancer Society - George D. Behrakis Research Lab - HCS, Athens, Greece
| | - Rachel O'Donnell
- Institute for Social Marketing and Health, University of Stirling, Stirling, Scotland, United Kingdom of Great Britain and Northern Ireland
| | - Ruaraidh Dobson
- Institute for Social Marketing and Health, University of Stirling, Stirling, Scotland, United Kingdom of Great Britain and Northern Ireland
| | - Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri - IRCCS, Milan, Italy
| | - Chiara Veronese
- IRCCS Istituto Nazionale dei Tumori - INT Foundation, Milan, Italy
| | - Raúl Pérez-Ortuño
- Hospital del Mar Medical Research Institute - IMIM, Barcelona, Spain
| | - José A Pascual
- Hospital del Mar Medical Research Institute - IMIM, Barcelona, Spain; Department of Experimental and Health Sciences, University Pompeu Fabra - UPF, Barcelona, Spain
| | - Nuria Cortés
- Agència de Salut Pública de Barcelona - ASPB, Barcelona, Spain
| | - Fernando Gil
- Department of Legal Medicine and Toxicology, School of Medicine, University of Granada - UG, Granada, Spain
| | - Pablo Olmedo
- Department of Legal Medicine and Toxicology, School of Medicine, University of Granada - UG, Granada, Spain
| | - Joan B Soriano
- CIBER Respiratory Diseases - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Respiratory Department, Hospital Universitario La Princesa, Madrid, Spain
| | - Roberto Boffi
- IRCCS Istituto Nazionale dei Tumori - INT Foundation, Milan, Italy
| | - Ario Ruprecht
- IRCCS Istituto Nazionale dei Tumori - INT Foundation, Milan, Italy
| | - Julio Ancochea
- CIBER Respiratory Diseases - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Respiratory Department, Hospital Universitario La Princesa, Madrid, Spain
| | - Maria J López
- Agència de Salut Pública de Barcelona - ASPB, Barcelona, Spain; CIBER de Epidemiología y Salud Pública - CIBERESP, Madrid, Spain; Institut d'Investigació Biomèdica Sant Pau - IIB St. Pau, Barcelona, Spain
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri - IRCCS, Milan, Italy
| | - 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, MA, USA
| | - Sean Semple
- Institute for Social Marketing and Health, University of Stirling, Stirling, Scotland, United Kingdom of Great Britain and Northern Ireland
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology - ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine and Health Sciences, University of Barcelona - UB, Barcelona, Spain; CIBER Respiratory Diseases - CIBERES, Instituto de Salud Carlos III, Madrid, Spain
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8
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Peruga A, Martínez C, Fu M, Ballbè M, Tigova O, Carnicer-Pont D, Fernández E. [Current use of electronic cigarettes among never smoker high school students]. Gac Sanit 2022; 36:433-438. [PMID: 35477507 DOI: 10.1016/j.gaceta.2022.01.004] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 12/02/2021] [Accepted: 01/12/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To test whether electronic cigarettes use among secondary school students in Spain is associated with initiating nicotine use. METHOD Secondary analysis of the ESTUDES 2019 survey, a cross-sectional study conducted on a representative sample of students aged 14-18 years and selected students who had never smoked (n=16,705). We computed the prevalence and estimated the factors associated with current electronic cigarettes use (at least once in the month before the interview), with and without nicotine. RESULTS The prevalence of current electronic cigarettes use among students who have never smoked is 2.5% (95% confidence interval [95%CI]: 2.2-2.9). 0.1% (95%CI: 0.08-0.2) declared using liquids with nicotine at least sometimes and 2.4% (95%CI: 2.1-2.8) using liquids always without nicotine. Being male and under 17 years of age, reporting binge drinking behavior, and having regular friends who use cannabis, increases the probability of current use of electronic cigarettes. The latter two variables seem to act as contextual variables associated with electronic cigarettes use. CONCLUSIONS The percentage of Spanish never smoker students who currently use electronic cigarettes is lower than in neighboring countries, except for the United Kingdom. Only one in every 1000 Spanish students between 14 and 18 years old who have never smoked initiates the current use of nicotine with an electronic cigarette. However, we must monitor the evolution of this indicator.
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Affiliation(s)
- Armando Peruga
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat (Barcelona), España; Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Lo Barnechea, Región Metropolitana, Chile; Grupo de Investigación en Control del Tabaco, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat (Barcelona), España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Cristina Martínez
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat (Barcelona), España; Grupo de Investigación en Control del Tabaco, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat (Barcelona), España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), España; Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, United States of America.
| | - Marcela Fu
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat (Barcelona), España; Grupo de Investigación en Control del Tabaco, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat (Barcelona), España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), España
| | - Montse Ballbè
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat (Barcelona), España; Grupo de Investigación en Control del Tabaco, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat (Barcelona), España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad de Adicciones, Servicio de Psiquiatría, Instituto de Neurociencias, Hospital Clínic de Barcelona, Barcelona, España
| | - Olena Tigova
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat (Barcelona), España; Grupo de Investigación en Control del Tabaco, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat (Barcelona), España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), España
| | - Dolors Carnicer-Pont
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat (Barcelona), España; Grupo de Investigación en Control del Tabaco, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat (Barcelona), España
| | - Esteve Fernández
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat (Barcelona), España; Grupo de Investigación en Control del Tabaco, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat (Barcelona), España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), España
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9
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Martínez C, Feliu A, Torres N, Nieva G, Pinet C, Raich A, Mondon S, Barrio P, Andreu M, Hernández-Ribas R, Vicens J, Costa S, Suelves JM, Vilaplana J, Enríquez M, Alaustre L, Vilalta E, Subirà S, Bruguera E, Castellano Y, Saura J, Guydish J, Fernández E, Ballbè M. Acceptability and participation predictors for a pragmatic randomized controlled trial to test a smoking cessation intervention after discharge from mental health wards. Drug Alcohol Depend 2022; 234:109390. [PMID: 35278807 DOI: 10.1016/j.drugalcdep.2022.109390] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/25/2022] [Accepted: 02/27/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM Hospitalization is an ideal time to promote smoking cessation, but interventions are limited for supporting cessation maintenance after discharge. This study aimed to evaluate the acceptability of participating in a trial that tested the efficacy of an intensive telephone-based intervention for smokers after discharge. METHODS Adult smokers admitted to mental health wards of six hospitals were invited to participate in the trial. We studied the study acceptance/decline rates by analyzing the characteristics of participants (e.g., sex, age, psychiatric disorder, smoking pattern) and hospitals (e.g., size, tobacco control implementation). We calculated adjusted odds ratios (aOR) to assess predictors of non-participation. RESULTS Of 530 smokers that met the study inclusion criteria, 55.5% (n = 294) agreed to participate. Participant and non-participants were not different in sex, age, or psychiatric diagnosis. Compared to non-participants, participants had made more attempts to quit in the past year (66.1% vs 33.9%; p < 0.001) and reported higher abstinence rates during the hospital stay (66.7% vs. 33.3%; p = 0.05). Participation rates by hospital varied from 30.9% to 82.0% (p < 0.001). Predictors of non-participation were not having attempted to quit in the last year (aOR=2.42; 95%CI: 1.66-3.53) and low level of tobacco control in the hospital (aOR range: 1.79-6.39, p < 0.05). CONCLUSIONS A telephone-based intervention to promote smoking cessation after discharge was accepted by half of the smokers with mental health disorders. Smokers that had attempted to quit previously and those that stayed in hospitals with a strong tobacco control policy were more likely to participate in the trial.
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Affiliation(s)
- Cristina Martínez
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Department of Public Health, Maternal Health and Mental Health, School of Medicine and Health Sciences, Universitat de Barcelona, C. Feixa Llarga s/n, 08907 L'Hospitalet del Llobregat, Barcelona, Spain; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., 7th floor, San Francisco, CA 94158, United States; Center for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Ariadna Feliu
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Department of Public Health, Maternal Health and Mental Health, School of Medicine and Health Sciences, Universitat de Barcelona, C. Feixa Llarga s/n, 08907 L'Hospitalet del Llobregat, Barcelona, Spain; Center for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Núria Torres
- 061 CatSalut Respon, Sistema d'Emergències Mèdiques, C. Pablo Iglesias 115, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Gemma Nieva
- Smoking Cessation Unit, Addictive Behaviors Unit, Psychiatry Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, CIBERSAM, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Cristina Pinet
- Addictive Behaviors Unit, Psychiatry Department, Hospital de la Santa Creu i Sant Pau, C. San Antoni Mª Claret 167, 08025 Barcelona, Spain
| | - Antònia Raich
- Mental Health Department, Althaia Xarxa Assistencial Universitària, C. Dr. Llatjós s/n, 08243 Manresa, Barcelona, Spain
| | - Sílvia Mondon
- Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036 Barcelona, Spain
| | - Pablo Barrio
- Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036 Barcelona, Spain
| | - Magalí Andreu
- Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036 Barcelona, Spain
| | - Rosa Hernández-Ribas
- Alcohol Program, Psychiatry Department, Hospital Universitari de Bellvitge, Institut Català d'Oncologia, IDIBELL, CIBERSAM, Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Vicens
- Psychiatry Department, Hestia Duran i Reynals, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sílvia Costa
- Addictive Behaviors Unit, Psychiatry Department, Hospital de la Santa Creu i Sant Pau, C. San Antoni Mª Claret 167, 08025 Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, C. San Antoni Mª Claret 167, 08025 Barcelona, Spain
| | - Josep Maria Suelves
- Public Health Agency of Catalonia, Health Department, Government of Catalonia, C. Roc Boronat 81-95, 08005 Barcelona, Spain; Universitat Oberta de Catalunya, Rambla del Poblenou, 156, 08018 Barcelona, Spain
| | - Jordi Vilaplana
- Serra Húnter Fellow / Computer Science Department, University of Lleida, Jaume II, 69, 25001 Lleida, Spain
| | - Marta Enríquez
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Alaustre
- 061 CatSalut Respon, Sistema d'Emergències Mèdiques, C. Pablo Iglesias 115, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Eva Vilalta
- 061 CatSalut Respon, Sistema d'Emergències Mèdiques, C. Pablo Iglesias 115, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Susana Subirà
- Psychiatry Department, Hestia Duran i Reynals, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Eugeni Bruguera
- Smoking Cessation Unit, Addictive Behaviors Unit, Psychiatry Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, CIBERSAM, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Yolanda Castellano
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Judith Saura
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, C. Feixa Llarga s/n, 08907 L'Hospitalet del Llobregat, Barcelona, Spain
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., 7th floor, San Francisco, CA 94158, United States
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Center for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain; Department of Clinical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, C. Feixa Llarga s/n, 08907 L'Hospitalet del Llobregat, Barcelona, Spain.
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Center for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain; Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036 Barcelona, Spain.
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10
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Fu M, Carnicer-Pont D, Castellano Y, Ballbè M, Sureda X, Raich A, Martínez-Sánchez JM, Martínez C, Baena A, Riccobene A, Enríquez M, Fernández E. Measuring cigarette dependence: A comparison of two scales in two different groups of smokers. Tob Prev Cessat 2022; 8:15. [PMID: 35515714 PMCID: PMC8988850 DOI: 10.18332/tpc/146714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The Fagerström Test for Cigarette Dependence (FTCD) and the Cigarette Dependence Scale (CDS) are usually used to assess cigarette dependence in clinical- and population-based studies. Our objective was to compare these two scales within groups of smokers from both contexts. METHODS The study was observational with smokers from a representative sample of the adult general population (n=188) and smokers attending a smoking cessation clinic in Barcelona, Spain (n=759). The FTCD and the CDS-5 (short version of 5 items) were used to assess cigarette dependence. We compared the standardized median scores obtained with both scales within each group of smokers by selected variables. To this aim, we re-scaled the scores of both scales to allow their comparison and assess their correlation within both groups. RESULTS The scores obtained with both scales were highly correlated within both groups of smokers (p<0.001), indicating good agreement in the assessment of cigarette dependence. Nevertheless, higher standardized CDS-5 scores were observed more frequently in the population group overall (3.9 vs FTCD score=3.7, p=0.001), among women (4.5 vs 4.2; p<0.001), in the youngest group of smokers (3.9 vs 3.2; p<0.007) and in light smokers (time to the first cigarette >60 min; 1.7 vs 1.1; p<0.001). CONCLUSIONS While the CDS-5 scored higher more frequently in the population group, the FTCD scored higher more frequently in the clinical group. These differences should be considered when designing either clinical- or population-based studies.
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Affiliation(s)
- Marcela Fu
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), WHO Collaborating Centre for Tobacco Control, L’Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Center for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Dolors Carnicer-Pont
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), WHO Collaborating Centre for Tobacco Control, L’Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Center for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Yolanda Castellano
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), WHO Collaborating Centre for Tobacco Control, L’Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Center for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), WHO Collaborating Centre for Tobacco Control, L’Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Center for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
- Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Xisca Sureda
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Center for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
- Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcalá (UAH), Alcalá, Spain
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, New York University, New York, United States
| | - Antònia Raich
- Samis Research Group, Althaia Xarxa Assistencial Universitària de Manresa, Barcelona, Spain
| | - Jose M. Martínez-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya (UIC-Barcelona), Sant Cugat del Vallès, Spain
| | - Cristina Martínez
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), WHO Collaborating Centre for Tobacco Control, L’Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Center for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, California, United States
| | - Antoni Baena
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- eHealth Center, Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Anna Riccobene
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), WHO Collaborating Centre for Tobacco Control, L’Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Center for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Marta Enríquez
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), WHO Collaborating Centre for Tobacco Control, L’Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Center for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), WHO Collaborating Centre for Tobacco Control, L’Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Center for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
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11
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González-Marrón A, Martín-Sánchez JC, Pérez-Ortuño R, Fu M, Ballbè M, Cartanyà-Hueso À, Matilla-Santander N, Pascual JA, Fernández E, Martínez-Sánchez JM. Association between biomarkers of tobacco consumption and lung cancer risk among daily smokers. Expert Rev Respir Med 2021; 16:247-252. [PMID: 34651540 DOI: 10.1080/17476348.2022.1993064] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Biomarkers of tobacco consumption may play a role in the lung cancer risk assessment. However, the role of salivary biomarkers has not been well studied. The aim of this study is to assess the use of salivary biomarkers of tobacco consumption as lung cancer screening criterion. RESEARCH DESIGN AND METHODS Data came from the Determinants of cotinine phase 3 project (Barcelona, 2013-2014). We compared the concentrations of TSNAs, including NNAL, NNN and NNK, and cotinine, in saliva samples of 142 daily smokers from the general population according to their risk of lung cancer. High risk of lung cancer was defined as per the inclusion criteria in the US National Lung Screening Trial (NLST) and in the Dutch-Belgian lung cancer screening trial (NELSON). RESULTS Among daily smokers accomplishing the age criterion for lung cancer screening, salivary concentrations of cotinine, NNAL and NNK adjusted for sex were significantly higher (p-value < 0.05) in daily smokers at high risk of lung cancer compared to smokers not at high risk according to both NELSON and NLST criteria. CONCLUSIONS Saliva concentrations of cotinine, NNAL and NNK may be used as additional criteria for lung cancer screening. Further research on this topic is guaranteed.
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Affiliation(s)
- Adrián González-Marrón
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional De Catalunya, Barcelona, Spain
| | - Juan Carlos Martín-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional De Catalunya, Barcelona, Spain
| | - Raúl Pérez-Ortuño
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital Del Mar Medical Research Institute), Barcelona, Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, Barcelona, Spain.,Tobacco control research group, Epidemiology, public health, cancer prevention and palliative care program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain.,School of Medicine and Health Sciences, Universitat De Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, Barcelona, Spain.,Tobacco control research group, Epidemiology, public health, cancer prevention and palliative care program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España, Spain.,Catalan Network of Smoke-free Hospitals, Barcelona, Spain.,Addictions Unit, Institute of Neurosciences, Barcelona, Spain
| | - Àurea Cartanyà-Hueso
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional De Catalunya, Barcelona, Spain
| | - Nuria Matilla-Santander
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional De Catalunya, Barcelona, Spain
| | - José Antonio Pascual
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital Del Mar Medical Research Institute), Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Parc De Recerca Biomèdica De Barcelona, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, Barcelona, Spain.,Tobacco control research group, Epidemiology, public health, cancer prevention and palliative care program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain.,School of Medicine and Health Sciences, Universitat De Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España, Spain.,Catalan Network of Smoke-free Hospitals, Barcelona, Spain
| | - Jose M Martínez-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional De Catalunya, Barcelona, Spain
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12
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Amalia B, Fu M, Tigova O, Ballbè M, Castellano Y, Semple S, Clancy L, Vardavas C, López MJ, Cortés N, Pérez-Ortuño R, Pascual JA, Fernández E. Environmental and individual exposure to secondhand aerosol of electronic cigarettes in confined spaces: Results from the TackSHS Project †. Indoor Air 2021; 31:1601-1613. [PMID: 33905602 DOI: 10.1111/ina.12841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
Secondhand electronic cigarette (e-cigarette) aerosol (SHA) might impair indoor air quality and expose bystanders. This study aims to investigate exposure to SHA in controlled conditions of enclosed settings simulating real-world scenario. An experiment was performed in a car and in a room, in which SHA was generated during a 30-minute ad libitum use of an e-cigarette. The experiment was replicated on five consecutive days in each setting. We measured PM2.5 , airborne nicotine concentrations, and biomarkers of exposure to SHA, such as nicotine metabolites, tobacco-specific nitrosamines, propylene glycol, and glycerol in bystanders' saliva samples before, during, and after the exposure period. Self-reported health symptoms related to exposure to SHA were also recorded. The results showed that the highest median PM2.5 concentration was recorded during the exposure period, being 21 µg/m3 in the room setting and 16 µg/m3 in the car setting-about twofold increase compared to the baseline. Most concentrations of the airborne nicotine and all biomarkers were below the limit of quantification in both settings. Bystanders in both settings experienced some short-term irritation symptoms, expressed as dry throat, nose, eyes, and phlegm. In conclusion, short-term use of an e-cigarette in confined spaces increased indoor PM2.5 level and caused some irritation symptoms in bystanders.
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Affiliation(s)
- Beladenta Amalia
- Tobacco Control Unit, Catalan Institute of Oncology-ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Marcela Fu
- Tobacco Control Unit, Catalan Institute of Oncology-ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Olena Tigova
- Tobacco Control Unit, Catalan Institute of Oncology-ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Catalan Institute of Oncology-ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
- Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Yolanda Castellano
- Tobacco Control Unit, Catalan Institute of Oncology-ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Sean Semple
- Institute for Social Marketing, University of Stirling, Stirling, Scotland
| | - Luke Clancy
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | | | - Maria J López
- Evaluation and Intervention Methods Service, Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Research group on Evaluation of Public Health Policies and Programs, Institut d'Investigació Biomèdica Sant Pau (IIB St. Pau), Barcelona, Spain
| | - Nuria Cortés
- Laboratory, Agència de Salut Pública de Barcelona, Spain
| | - Raúl Pérez-Ortuño
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - José A Pascual
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology-ICO, WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
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13
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Carreras G, Lachi A, Cortini B, Gallus S, López MJ, López-Nicolás Á, Lugo A, Pastor MT, Soriano JB, Fernandez E, Gorini G, Castellano Y, Fu M, Ballbè M, Amalia B, Tigova O, López MJ, Continente X, Arechavala T, Henderson E, Gallus S, Lugo A, Liu X, Borroni E, Colombo P, Semple S, O’Donnell R, Dobson R, Clancy L, Keogan S, Byrne H, Behrakis P, Tzortzi A, Vardavas C, Vyzikidou VK, Bakelas G, Mattiampa G, Boffi R, Ruprecht A, De Marco C, Borgini A, Veronese C, Bertoldi M, Tittarelli A, Gorini G, Carreras G, Cortini B, Verdi S, Lachi A, Chellini E, López-Nicolás Á, Trapero-Bertran M, Guerrero DC, Radu-Loghin C, Nguyen D, Starchenko P, Soriano JB, Ancochea J, Alonso T, Pastor MT, Erro M, Roca A, Pérez P, García-Castillo E. Burden of disease from exposure to secondhand smoke in children in Europe. Pediatr Res 2021; 90:216-222. [PMID: 33149260 DOI: 10.1038/s41390-020-01223-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Secondhand smoke (SHS) exposure at home and fetal SHS exposure during pregnancy are a major cause of disease among children. The aim of this study is quantifying the burden of disease due to SHS exposure in children and in pregnancy in 2006-2017 for the 28 European Union (EU) countries. METHODS Exposure to SHS was estimated using a multiple imputation procedure based on the Eurobarometer surveys, and SHS exposure burden was estimated with the comparative risk assessment method using meta-analytical relative risks. Data on deaths and disability-adjusted life years (DALYs) were collected from National statistics and from the Global Burden of Disease Study. RESULTS Exposure to SHS and its attributable burden stalled in 2006-2017; in pregnant women, SHS exposure was 19.8% in 2006, 19.1% in 2010, and 21.0% in 2017; in children it was 10.1% in 2006, 9.6% in 2010, and 12.1% in 2017. In 2017, 35,633 DALYs among children were attributable to SHS exposure in the EU, mainly due to low birth weight. CONCLUSIONS Comprehensive smoking bans up to 2010 contributed to reduce SHS exposure and its burden in children immediately after their implementation; however, SHS exposure still occurs, and in 2017, its burden in children was still relevant. IMPACT Exposure to secondhand smoke at home and in pregnancy is a major cause of disease among children. Smoking legislation produced the adoption of voluntary smoking bans in homes; however, secondhand smoke exposure at home still occurs and its burden is substantial. In 2017, the number of deaths and disability-adjusted life years in children attributable to exposure to secondhand smoke in the European Union countries were, respectively, 335 and 35,633. Low birth weight caused by secondhand smoke exposure in pregnancy showed the largest burden. Eastern European Union countries showed the highest burden.
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Affiliation(s)
- Giulia Carreras
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy.
| | - Alessio Lachi
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Barbara Cortini
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Silvano Gallus
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), Milan, Italy
| | - Maria José López
- Public Health Agency of Barcelona (ASPB), Barcelona, Spain.,CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain.,IIB Sant Pau, Barcelona, Spain
| | | | - Alessandra Lugo
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), Milan, Italy
| | | | - Joan B Soriano
- Hospital Universitario La Princesa (IISP), Madrid, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Esteve Fernandez
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain.,Catalan Institute of Oncology (ICO), L'Hopitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hopitalet de Llobregat, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Giuseppe Gorini
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
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14
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Lidón-Moyano C, Fu M, Pérez-Ortuño R, Ballbè M, Garcia E, Martín-Sánchez JC, Pascual JA, Fernández E, Martínez-Sánchez JM. Third-hand exposure at homes: Assessment using salivary cotinine. Environ Res 2021; 196:110393. [PMID: 33129855 DOI: 10.1016/j.envres.2020.110393] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND/OBJECTIVES While exposure to secondhand smoke (SHS) is a well-established problem, exposure to third-hand smoke (THS) is scanty known and needs to be studied. The objective of this work is to characterize salivary cotinine concentrations among people who self-reported exposure to SHS and THS at home. METHODS Cross-sectional study of a representative sample (n = 736) of the adult population (≥16 years) from the city of Barcelona carried out in 2013-2014. A questionnaire on tobacco use and passive exposure was administered, and a saliva sample was collected for cotinine determination. For this study, the information of the non-smoker participants who provided saliva sample (n = 519) was used. The geometric means (GM) and geometric standard deviations (GSD) of the cotinine concentration were compared according to the type of self-reported exposure at home: (1) Not exposed to SHS or THS; (2) Exposed to SHS and THS; and (3) Only exposed to THS. We used log-linear models to compare the cotinine concentration of each exposed group with respect to the unexposed group, adjusting for sex, age, educational level, and tobacco exposure in other settings. RESULTS The GM of the salivary cotinine concentration was 0.34 ng/ml (GSD = 0.16) among individuals reporting SHS and THS exposure, 0.22 ng/ml (GSD = 0.15) among those reporting only THS exposure and 0.11 ng/ml (GSD = 0.04) among those who declared not to be exposed to SHS nor THS (p-value for trend <0.001). The regression model showed a statistically significant increase in cotinine concentration among those exposed to SHS and THS (188% higher, 95% CI: 153%; 223%), and only exposed to THS (106% higher, IC95. %: 74.5%; 137.0%) when comparing with the unexposed group. No statistically significant differences in cotinine concentration were observed between those exposed to SHS and THS compared to the THS group (-25.8%, 95% CI: -69.5%; 17.9%). CONCLUSIONS/RECOMMENDATIONS People exposed to third-hand smoke at home had quantifiable cotinine levels in saliva. No differences in cotinine levels were found between those exposed to second-hand and third-hand smoke at home. The reduction of exposure to third-hand smoke at home should be put into the agenda of tobacco control.
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Affiliation(s)
- Cristina Lidón-Moyano
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat Del Vallès, Spain.
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Epidemiology and Public Health Program, Institut D'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain; Consortium for Biomedical Research in Respiratory Diseases, Madrid, Spain
| | - Raúl Pérez-Ortuño
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital Del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Epidemiology and Public Health Program, Institut D'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Consortium for Biomedical Research in Respiratory Diseases, Madrid, Spain; Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital Del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain; Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Esteve Garcia
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat Del Vallès, Spain
| | - Juan Carlos Martín-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat Del Vallès, Spain
| | - José A Pascual
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital Del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Epidemiology and Public Health Program, Institut D'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain; Consortium for Biomedical Research in Respiratory Diseases, Madrid, Spain
| | - Jose M Martínez-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat Del Vallès, Spain; Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Epidemiology and Public Health Program, Institut D'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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15
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Freiburghaus T, Raffing R, Ballbè M, Gual A, Tönnesen H. The right to smoke and the right to smoke-free surroundings: international comparison of smoke-free psychiatric clinic implementation experiences. BJPsych Open 2021; 7:e81. [PMID: 33858559 PMCID: PMC8086391 DOI: 10.1192/bjo.2021.35] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In Scandinavia, people with a severe mental disorder have a reduced life expectancy of 15-20 years compared with the general public. Smoking is a major contributor, and smoke-free policies are increasingly adopted in psychiatric clinics around the world. We compared potential facilitators and barriers among staff and management, for the implementation of smoke-free psychiatric clinics. AIMS To investigate the attitudes and experiences regarding smoke-free policies among managers and staff involved in the implementation processes of smoke-free psychiatric clinics at hospitals in Malmö (Sweden) and Barcelona (Spain). METHOD We used a qualitative methodology, with 15 semi-structured interviews. The interviews were conducted with each participant individually, and were subsequently transcribed. The data were analysed with systematic text condensation. RESULTS There were notable differences in how the smoke-free policies were carried out and experienced, and attitudes regarding the policy changes differed in the two settings. Key differences were the views on the right to smoke in compulsory care and to stay in smoke-free surroundings supported by smoking cessation intervention; the prioritisation of staff facilitation of smoking breaks; and views on smoking and smoke-free psychiatry. In contrast, participants agreed on the importance of staff education and management support. A smoking ban by law and belonging to a network of smoke-free hospitals were also relevant. CONCLUSIONS Staff education, and support from staff and management for the patients' right to stay in smoke-free surroundings, facilitated successful implementation of smoke-free policies in the psychiatric clinics, whereas supporting the right to smoke was a barrier.
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Affiliation(s)
- Tove Freiburghaus
- WHO Collaborating Centre for Implementation of Evidence-based Clinical Health Promotion, Clinical Health Promotion Centre, Department of Health Sciences, Lund University, Sweden
| | - Rie Raffing
- WHO Collaborating Centre for Evidence-based Health Promotion in Hospitals & Health Services, Clinical Health Promotion Centre, Parker Institute, Bispebjerg and Frederiksberg Hospital, part of the Copenhagen University Hospital, Denmark
| | - Montse Ballbè
- WHO Collaborating Centre for Tobacco Control, Cancer Prevention & Control Programme, Catalan Institute of Oncology, Spain; Tobacco Control Research Unit, Bellvitge Institute for Biomedical Research, Spain; CIBER of Respiratory Diseases, Spain; and Addiction Unit, Department of Psychiatry, Neurosciences Institute, Hospital Clínic de Barcelona, Spain
| | - Antoni Gual
- Addiction Unit, Department of Psychiatry, Neurosciences Institute, Hospital Clínic de Barcelona, Spain
| | - Hanne Tönnesen
- WHO Collaborating Centre for Implementation of Evidence-based Clinical Health Promotion, Clinical Health Promotion Centre, Department of Health Sciences, Lund University, Sweden; and WHO Collaborating Centre for Evidence-based Health Promotion in Hospitals & Health Services, Clinical Health Promotion Centre, Parker Institute, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Denmark
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16
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Nieva G, Ballbè M, Cano M, Carcolé B, Fernández T, Martínez À, Mondon S, Raich A, Roig P, Serra I, Serrano J, Pinet C. Smoking cessation interventions in substance use disorders treatment centers of Catalonia: The abandoned addiction. Adicciones 2021; 34:227-234. [PMID: 33768256 DOI: 10.20882/adicciones.1492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Substance use disorders (SUD) treatment centers are an optimal setting for delivering smoking cessation interventions (SCI). This study aimed to examine the adoption of SCI in SUD treatment centers in Catalonia (Spain) as well as to assess their managers' views on the appropriateness and feasibility of providing SCI. Managers directly in charge of SUD treatment centers (n = 57) answered a 30-item on-line questionnaire. Data was obtained of 50 centers (87.7% response rate). Forty-six per cent of the centers provided some kind of SCI, but only 4.8% of the new patients were treated for smoking cessation. Managers reported that 73.3% of mental health professionals working in SUD centers had not been trained in SCI. Sixty-four per cent of managers agreed that all health professionals should deliver SCI. Those centers offering SCI attended more patients and were more likely to have professionals trained in SCI than those not offering SCI. The implementation of SCI in SUD treatment centers in Catalonia was suboptimal. Continuing education and training should be provided for all health professionals working in SUD centers. Not systematically delivering SCI to patients in treatment for other SUD means missing opportunities to reduce health and economic costs while perpetuating a smoking culture.
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Lidón-Moyano C, Fu M, Perez-Ortuño R, Ballbè M, Garcia E, Martín-Sánchez JC, Pascual JA, Fernández E, Martínez-Sánchez JM. Toward a correct measure of third-hand exposure. Environ Res 2021; 194:110686. [PMID: 33385392 DOI: 10.1016/j.envres.2020.110686] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Cristina Lidón-Moyano
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat Del Vallès, Spain.
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català D'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Epidemiology and Public Health Program, Institut D'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Raúl Perez-Ortuño
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital Del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català D'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Epidemiology and Public Health Program, Institut D'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain; Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital Del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain; Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Esteve Garcia
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat Del Vallès, Spain
| | - Juan Carlos Martín-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat Del Vallès, Spain
| | - José A Pascual
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català D'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Epidemiology and Public Health Program, Institut D'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Jose M Martínez-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat Del Vallès, Spain; Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català D'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Epidemiology and Public Health Program, Institut D'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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Ballbè M, Nieva G, Mondon S, Pinet C, Bruguera E, Saltó E, Fernández E, Gual A. Tobacco control strategies in psychiatric services in catalonia (Spain). Eur Psychiatry 2020. [DOI: 10.1016/s0924-9338(11)71756-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IntroductionMortality and morbidity due to smoking in people with mental illnesses are higher than in the general population. However, smoking continues to be allowed in psychiatric premises of many countries despite being prohibited in workplaces including health care services.ObjectiveTo describe tobacco control strategies undertaken in psychiatric inpatient services and day centers in Catalonia.AimsTo study tobacco control strategies in psychiatric services in order to identify unmet needs.MethodsA cross-sectional study including all psychiatric services offering public service in Catalonia (n = 192). The managers answered an on-line questionnaire with 24 items grouped in four dimensions: staff's training & commitment, clinical intervention, management of smoking areas, and communication of smoke-free policies.Results186 of the managers (96.9%) responded to the questionnaire. Results showed low levels of implementation of tobacco control strategies, especially in the training and intervention dimensions. 41.0% of the services usually intervened in their patients’ tobacco use but an overall 65.9% didn’t have pharmacotherapy for smoking cessation available. 47.3% of the managers stated that their staff had not enough knowledge on smoking cessation interventions. 38.9% of the services had smoking indoor areas. Day Centers showed the lowest implementation of tobacco control measures while services belonging to the Network of Smoke-free Hospitals showed the highest implementation.ConclusionsCurrent Spanish partial law has failed to promote a desirable tobacco control in psychiatric services. There is a need to extend tobacco control policies, specifically in terms of smoking intervention and training, together with a higher availability of resources.
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Campeny E, López-Pelayo H, Nutt D, Blithikioti C, Oliveras C, Nuño L, Maldonado R, Florez G, Arias F, Fernández-Artamendi S, Villalbí JR, Sellarès J, Ballbè M, Rehm J, Balcells-Olivero MM, Gual A. The blind men and the elephant: Systematic review of systematic reviews of cannabis use related health harms. Eur Neuropsychopharmacol 2020; 33:1-35. [PMID: 32165103 DOI: 10.1016/j.euroneuro.2020.02.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 02/17/2020] [Indexed: 01/24/2023]
Abstract
Cannabis is the third most used psychoactive substance worldwide. The legal status of cannabis is changing in many Western countries, while we have very limited knowledge of the public health impact of cannabis-related harms. There is a need for a summary of the evidence of harms and risks attributed to cannabis use, in order to inform the definition of cannabis risky use. We have conducted a systematic review of systematic reviews, aiming to define cannabis-related harms. We included systematic reviews published until July 2018 from six different databases and following the PRISMA guidelines. To assess study quality we applied the AMSTAR 2 tool. A total of 44 systematic reviews, including 1,053 different studies, were eligible for inclusion. Harm was categorized in three dimensions: mental health, somatic harm and physical injury (including mortality). Evidence shows a clear association between cannabis use and psychosis, affective disorders, anxiety, sleep disorders, cognitive failures, respiratory adverse events, cancer, cardiovascular outcomes, and gastrointestinal disorders. Moreover, cannabis use is a risk factor for motor vehicle collision, suicidal behavior and partner and child violence. Cannabis use is a risk factor for several medical conditions and negative social consequences. There is still little data on the dose-dependency of these effects; evidence that is essential in order to define, from a public health perspective, what can be considered risky use of cannabis. This definition should be based on quantitative and qualitative criteria that informs and permits the evaluation of current approaches to a regulated cannabis market.
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Affiliation(s)
- E Campeny
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain.
| | - H López-Pelayo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - D Nutt
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Faculty of Medicine, Imperial College London, London W12 0NN, UK
| | - C Blithikioti
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - C Oliveras
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - L Nuño
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - R Maldonado
- Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain
| | - G Florez
- Hospital Universitario de Ourense, Ourense, Spain
| | - F Arias
- Hospital Doce de Octubre, Madrid, Spain
| | | | - J R Villalbí
- Public Health Agency of Barcelona, Barcelona, Spain
| | - J Sellarès
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - M Ballbè
- Catalan Institute of Oncology, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
| | - J Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, (CAMH), Canada; Campbell Family Mental Health Research Institute, CAMH, Canada; Addiction Policy, Dalla Lana School of Public Health, University of Toronto (UofT), Canada; Department of Psychiatry, Faculty of Medicine, UofT, Canada; Epidemiological Research Unit, Klinische Psychologie & Psychotherapie, Technische Universität Dresden, Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - M M Balcells-Olivero
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - A Gual
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
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Martínez C, Castellano Y, Fu M, Riccobene A, Feliu A, Tigova O, Ballbè M, Anton L, Fernández P, Cabrera-Jaime S, Puig-Llobet M, Moreno C, Falcó-Pegueroles A, Galimany J, Estrada JM, Guydish J, Fernández E. Patient perceptions of tobacco control after smoke-free hospital grounds legislation: Multi-center cross-sectional study. Int J Nurs Stud 2019; 102:103485. [PMID: 31862532 DOI: 10.1016/j.ijnurstu.2019.103485] [Citation(s) in RCA: 4] [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] [Received: 04/07/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine patient perceptions of the role of health care providers in tobacco control and tobacco-related services they should provide after the introduction of national smoke-free hospital grounds legislation in Spain. DESIGN Multi-center cross-sectional study. SETTING Thirteen hospitals in Barcelona province in 2014-2015. PARTICIPANTS A total of 1,047 adult hospital patients, with a stay ≥ 24 h were randomly selected. METHOD We explored participants' perceptions of the role of health professionals and hospitals in tobacco control by asking about their agreement with several statements after the introduction of national legislation on smoke-free hospital grounds: (i) health professionals "should set an example and not smoke" and "should provide smoking cessation support"; (ii) hospitals "should provide smoking cessation treatments" and are "role model organizations in compliance with the smoke-free legislation", and (iii) "hospitalization is a perfect moment to quit smoking". Responses were described overall and according to participant and hospital characteristics: patient sex and age, type of hospital unit, number of beds, and smoking prevalence among hospital staff. RESULTS The majority of participants considered that health professionals should be role models in tobacco cessation (75.3%), should provide smoking cessation support to patients (83.0%), and that hospitalization is a good opportunity for initiating an attempt to quit (71.5%). Inpatients admitted to general hospitals where smoking cessation was not given as part of their portfolio, with a low level of implementation in tobacco control, and who stayed in surgical units had higher expectations of receiving smoking cessation interventions. CONCLUSIONS Inpatients strongly support the role of hospitals and health professionals in tobacco control and expect to receive smoking cessation interventions during their hospital stay. Systematically providing smoking cessation services in hospitals may have a relevant impact on health outcomes among smokers and on health care system expenditures.
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Affiliation(s)
- Cristina Martínez
- Tobacco Control Unit, Institut Català d'Oncologia (ICO). Av. Granvia de L'Hospitalet 199-203, E-08908 L'Hospitalet de Llobregat (Barcelona), Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL). Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain; School of Medicine and Health Sciences, Campus of Bellvitge, University of Barcelona, Feixa llarga s/n, 08907 L'Hospitalet del Llobregat (Barcelona), Spain; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, United States.
| | - Yolanda Castellano
- Tobacco Control Unit, Institut Català d'Oncologia (ICO). Av. Granvia de L'Hospitalet 199-203, E-08908 L'Hospitalet de Llobregat (Barcelona), Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL). Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain
| | - Marcela Fu
- Tobacco Control Unit, Institut Català d'Oncologia (ICO). Av. Granvia de L'Hospitalet 199-203, E-08908 L'Hospitalet de Llobregat (Barcelona), Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL). Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain; School of Medicine and Health Sciences, Campus of Bellvitge, University of Barcelona, Feixa llarga s/n, 08907 L'Hospitalet del Llobregat (Barcelona), Spain
| | - Anna Riccobene
- Tobacco Control Unit, Institut Català d'Oncologia (ICO). Av. Granvia de L'Hospitalet 199-203, E-08908 L'Hospitalet de Llobregat (Barcelona), Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL). Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain
| | - Ariadna Feliu
- Tobacco Control Unit, Institut Català d'Oncologia (ICO). Av. Granvia de L'Hospitalet 199-203, E-08908 L'Hospitalet de Llobregat (Barcelona), Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL). Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain; School of Medicine and Health Sciences, Campus of Bellvitge, University of Barcelona, Feixa llarga s/n, 08907 L'Hospitalet del Llobregat (Barcelona), Spain
| | - Olena Tigova
- Tobacco Control Unit, Institut Català d'Oncologia (ICO). Av. Granvia de L'Hospitalet 199-203, E-08908 L'Hospitalet de Llobregat (Barcelona), Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL). Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain
| | - Montse Ballbè
- Tobacco Control Unit, Institut Català d'Oncologia (ICO). Av. Granvia de L'Hospitalet 199-203, E-08908 L'Hospitalet de Llobregat (Barcelona), Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL). Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain; Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona. C/ Villarroel 170, 08036 Barcelona, Spain
| | - Laura Anton
- Tobacco Control Unit, Institut Català d'Oncologia (ICO). Av. Granvia de L'Hospitalet 199-203, E-08908 L'Hospitalet de Llobregat (Barcelona), Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL). Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain
| | - Paz Fernández
- School of Medicine and Health Sciences, Campus of Bellvitge, University of Barcelona, Feixa llarga s/n, 08907 L'Hospitalet del Llobregat (Barcelona), Spain; Nursing Research Unit, Institut Català d'Oncologia (ICO). Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain
| | - Sandra Cabrera-Jaime
- Nursing Research Unit, Institut Català d'Oncologia (ICO). Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain
| | - Montse Puig-Llobet
- School of Medicine and Health Sciences, Campus of Bellvitge, University of Barcelona, Feixa llarga s/n, 08907 L'Hospitalet del Llobregat (Barcelona), Spain
| | - Carmen Moreno
- School of Medicine and Health Sciences, Campus of Bellvitge, University of Barcelona, Feixa llarga s/n, 08907 L'Hospitalet del Llobregat (Barcelona), Spain
| | - Anna Falcó-Pegueroles
- School of Medicine and Health Sciences, Campus of Bellvitge, University of Barcelona, Feixa llarga s/n, 08907 L'Hospitalet del Llobregat (Barcelona), Spain
| | - Jordi Galimany
- School of Medicine and Health Sciences, Campus of Bellvitge, University of Barcelona, Feixa llarga s/n, 08907 L'Hospitalet del Llobregat (Barcelona), Spain
| | - Joan María Estrada
- School of Medicine and Health Sciences, Campus of Bellvitge, University of Barcelona, Feixa llarga s/n, 08907 L'Hospitalet del Llobregat (Barcelona), Spain
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, United States
| | - Esteve Fernández
- Tobacco Control Unit, Institut Català d'Oncologia (ICO). Av. Granvia de L'Hospitalet 199-203, E-08908 L'Hospitalet de Llobregat (Barcelona), Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL). Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain; School of Medicine and Health Sciences, Campus of Bellvitge, University of Barcelona, Feixa llarga s/n, 08907 L'Hospitalet del Llobregat (Barcelona), Spain
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Cartanyà-Hueso À, Lidón-Moyano C, Fu M, Ballbè M, Martín-Sánchez JC, González-Marrón A, Matilla-Santander N, Martínez-Sánchez JM. [Support to smoking regulation in private vehicles and public outdoor spaces]. Rev Esp Salud Publica 2019; 93:e201907056. [PMID: 31337747] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/22/2019] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE To know the support of tobacco regulation is a very important issue to advance in the tobacco control policies and reduce the passive exposure to tobacco. The aim of this study was to describe the attitudes towards forbidding smoking in private vehicles and public outdoor spaces. METHODS This is a cross-sectional study of a representative sample (n=736) of the adult population (24+ years old) from Barcelona, Spain in 2013-2014. We calculated the percentages of individuals who had a favourable attitude towards smoking regulation in private vehicles and public outdoor spaces, their adjusted Odds ratios (aOR) and their 95% confidence intervals (95%CI) according to sex, age, educational level and smoking status through logistic regression. We used weighted data for all analyses in order to keep the representativeness of the population of Barcelona in 2013-2014. RESULTS 61.7% of participants supported forbidding smoking in private vehicles and 89.5% supported forbidding it only in the presence of minors. The support to smoking regulation in public outdoor spaces varied from 42.5% to 84.7% in different settings. Smokers showed a less favourable attitude towards an extension of the smoking regulation to other settings: outdoor areas of university centres, outdoor areas of shopping centres and beaches and outdoor pools. CONCLUSIONS A wide support exists to extend the smoking regulation to private vehicles, especially in the presence of children, and public outdoor spaces. This wide support could favour the extension of smoking regulation to these places to improve the population's health and to contribute to denormalise tobacco use among the population.
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Affiliation(s)
- Àurea Cartanyà-Hueso
- Grupo de Evaluación de Determinantes en Salud y Políticas Sanitarias. Universitat Internacional de Catalunya. Sant Cugat del Vallès. Barcelona. España
| | - Cristina Lidón-Moyano
- Grupo de Evaluación de Determinantes en Salud y Políticas Sanitarias. Universitat Internacional de Catalunya. Sant Cugat del Vallès. Barcelona. España
| | - Marcela Fu
- Unidad de Control del Tabaquismo, Programa de Prevención y Control del Cáncer. Institut Català d'Oncologia. L'Hospitalet de Llobregat. Barcelona. España
- Grupo de Prevención y Control del Cáncer. Institut d'Investigació Biomèdica de Bellvitge - IDIBELL. L'Hospitalet de Llobregat. Barcelona. España
- Departamento de Ciencias Clínicas. Facultad de Medicina y Ciencias de la Salud. Universitat de Barcelona. Barcelona. España
| | - Montse Ballbè
- Unidad de Control del Tabaquismo, Programa de Prevención y Control del Cáncer. Institut Català d'Oncologia. L'Hospitalet de Llobregat. Barcelona. España
- Grupo de Prevención y Control del Cáncer. Institut d'Investigació Biomèdica de Bellvitge - IDIBELL. L'Hospitalet de Llobregat. Barcelona. España
- Departamento de Ciencias Clínicas. Facultad de Medicina y Ciencias de la Salud. Universitat de Barcelona. Barcelona. España
- Red Catalana de Hospitales Sin Humo. L'Hospitalet de Llobregat. Barcelona. España
- Unidad de Adicciones. Instituto de Neurociencias. Hospital Clínic de Barcelona. Barcelona. España
| | - Juan Carlos Martín-Sánchez
- Grupo de Evaluación de Determinantes en Salud y Políticas Sanitarias. Universitat Internacional de Catalunya. Sant Cugat del Vallès. Barcelona. España
| | - Adrián González-Marrón
- Grupo de Evaluación de Determinantes en Salud y Políticas Sanitarias. Universitat Internacional de Catalunya. Sant Cugat del Vallès. Barcelona. España
| | - Nuria Matilla-Santander
- Grupo de Evaluación de Determinantes en Salud y Políticas Sanitarias. Universitat Internacional de Catalunya. Sant Cugat del Vallès. Barcelona. España
| | - Jose M Martínez-Sánchez
- Grupo de Evaluación de Determinantes en Salud y Políticas Sanitarias. Universitat Internacional de Catalunya. Sant Cugat del Vallès. Barcelona. España
- Unidad de Control del Tabaquismo, Programa de Prevención y Control del Cáncer. Institut Català d'Oncologia. L'Hospitalet de Llobregat. Barcelona. España
- Grupo de Prevención y Control del Cáncer. Institut d'Investigació Biomèdica de Bellvitge - IDIBELL. L'Hospitalet de Llobregat. Barcelona. España
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Cartanyà-Hueso À, Lidón-Moyano C, Fu M, Perez-Ortuño R, Ballbè M, Matilla-Santander N, Martín-Sánchez JC, Pascual JA, Fernández E, Martínez-Sánchez JM. Comparison of TSNAs concentration in saliva according to type of tobacco smoked. Environ Res 2019; 172:73-80. [PMID: 30771628 DOI: 10.1016/j.envres.2018.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To compare tobacco-specific nitrosamines (TSNAs) measured in saliva according to different types of tobacco smoked in a sample of smokers of the city of Barcelona (Spain). METHODS We used data from a cross-sectional study of a sample of the adult smoking population of Barcelona, Spain in 2013-2014 (n = 165). We classified smokers in five groups according to the type of tobacco smoked: a) manufactured cigarettes only, b) roll-your-own (RYO) cigarettes only, c) dual smokers (both manufactured and RYO cigarettes), d) manufactured plus other types of tobacco products different from RYO and e) other types of tobacco products different from manufactured and RYO cigarettes. We calculated the geometric mean (GM) and geometric standard deviation (GSD) of TSNAs concentration in saliva (pg/mL), including N'-nitroaonornicotine (NNN), 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) according to the five tobacco groups. We also described all TSNAs concentration in each tobacco group stratified by the number of cigarettes smoked per day. RESULTS Smokers from the RYO cigarette group had higher TSNAs concentration than smokers from the manufactured cigarette group: 13 pg/mL vs 4.9 pg/mL of NNN, 1.9 pg/mL vs 1.7 pg/mL in NNK and 1.1 pg/mL vs 0.9 pg/mL of NNAL. There were significant differences in NNN concentrations between smokers of RYO vs manufactured cigarettes. The higher the number of cigarettes smoked, the higher the TSNAs concentrations. After adjusted by number of cigarettes smoked, there were not statistically significant differences in TSNAs between RYO and manufactured cigarettes. CONCLUSIONS Our data shows that RYO cigarette is at least as hazardous as manufactured cigarettes. Regulating RYO tobacco prices could be an effective strategy to control tobacco use.
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Affiliation(s)
- Àurea Cartanyà-Hueso
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Carrer de Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Cristina Lidón-Moyano
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Carrer de Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Raúl Perez-Ortuño
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain; Catalan Network of Smoke-free Hospitals, L'Hospitalet de Llobregat, Barcelona, Spain; Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Nuria Matilla-Santander
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Carrer de Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Juan Carlos Martín-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Carrer de Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - José A Pascual
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain; Catalan Network of Smoke-free Hospitals, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jose M Martínez-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Carrer de Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona, Spain; Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
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23
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Martínez C, Castellano Y, Andrés A, Fu M, Feliu A, Antón L, Ballbè M, Fernández P, Cabrera S, Riccobene A, Gavilan E, Baena A, Margalef M, Tigova O, Quirós N, Guillen O, Company A, Fernández E. Impact of an Online Training Program in Smoking Cessation Interventions in Hospitals. J Nurs Scholarsh 2019; 51:449-458. [PMID: 30874373 DOI: 10.1111/jnu.12469] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/27/2022]
Abstract
PURPOSE To assess changes in the self-reported performance of smoking cessation interventions according to the 5A's model (Ask; Advise; Assess; Assist; and Arrange follow-up) among clinicians; and to identify the main barriers and facilitators in smoking cessation implementation before and after an online smoking cessation training program. DESIGN Pre-post evaluation. METHODS We assessed self-reported smoking cessation interventions in the implementation of the 5A's model among clinicians working in Catalan hospitals (Spain). In addition, we assessed individual-, behavioral-, and organizational-level factors that act as barriers and facilitators in the implementation of the 5A's model. We used a questionnaire of 63 items reflecting each of the 5A's performance (scored from 0 = none to 10 = most possible). The questionnaire was completed both immediately before and 6 months after the training. We analyzed the data of those participants who had a clinical role and answered pre- and post-questionnaires. We used the nonparametric test for paired data (Wilcoxon) to examine changes in scores. FINDINGS A total of 127 clinicians completed the pre-post questionnaire; 63.0% were registered nurses, 17.3% were nursing assistants, 7.9% were physicians, and 11.8% were other professionals (p < .001). Overall, there were significant increases in the implementation of the assist component (from a score of 4.5 to 5.2; p < .003) and arrange a follow-up component (from 3.6 to 4.5; p < .001) of the intervention. Scores in the perception of the level of overall preparation, preparedness in using smoking cessation drugs, level of competence, and organizational recognition improved (p < .001) at the follow-up; however, the score in the perception that implementing smoking cessation is part of their job decreased (from 6.3 to 4.4; p < .001). CONCLUSIONS The online training had a positive impact on the implementation of assist and arrange follow-up components. Although self-preparedness in the management of smokers increased, the motivation and involvement of key professionals decreased. Organizational factors related to the incorporation of resources (such as protocols, records, etc.) should be improved for the correct progression of smoking cessation interventions within the institutions. CLINICAL RELEVANCE Smoking cessation training programs should incorporate some motivational content to increase the engagement of health professionals in smoking cessation interventions in their clinical practice.
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Affiliation(s)
- Cristina Martínez
- Associate Researcher, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL; and Department of Public Health, Mental Health and Perinatal Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Yolanda Castellano
- Statistician, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Granvia de L'Hospitalet; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Ana Andrés
- Lecturer and Researcher, Faculty of Psychology, Education and Sport Sciences, Ramon Llull Universityl, Barcelona, Spain
| | - Marcela Fu
- Researcher, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Ariadna Feliu
- Predoctoral student, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL; and Clinical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Laura Antón
- Program coordinator, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Montse Ballbè
- Program Coordinator and Associate Researcher, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, and Cancer Control; and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL; and Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Paz Fernández
- Coordinator of Nursing Research, Nursing Research Unit, Institut Català d'Oncologia-ICO, Barcelona, Spain
| | - Sandra Cabrera
- Coordinator of Nursing Researcher, Nursing Research Unit, Institut Català d'Oncologia-ICO, Barcelona, Spain
| | - Ana Riccobene
- Nurse, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Eva Gavilan
- Nurse and Predoctoral student, Medicine and Health Sciences School, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Antoni Baena
- Associate Researcher, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Mercè Margalef
- Project Manager, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Olena Tigova
- Project Manager, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO. Av; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Núria Quirós
- Administrative support, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Olga Guillen
- Program Coordinator, E_oncologia Unit, Institut Català d'Oncologia-ICO, Barcelona, Spain
| | - Assumpta Company
- Director E-oncologia, E_oncologia Unit, Institut Català d'Oncologia-ICO, Barcelona, Spain
| | - Esteve Fernández
- Director of the Tobacco Control Unit, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL; and Department of Clinical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
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24
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Ballbè M, Martínez C, Feliu A, Torres N, Nieva G, Pinet C, Raich A, Mondon S, Barrio P, Hernández-Ribas R, Vicens J, Costa S, Vilaplana J, Alaustre L, Vilalta E, Blanch R, Subirà S, Bruguera E, Suelves JM, Guydish J, Fernández E. Effectiveness of a telephone-based intervention for smoking cessation in patients with severe mental disorders: study protocol for a randomized controlled trial. Trials 2019; 20:38. [PMID: 30635072 PMCID: PMC6329054 DOI: 10.1186/s13063-018-3106-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/04/2017] [Accepted: 12/05/2018] [Indexed: 01/01/2023] Open
Abstract
Background Up to 75% of inpatients with mental disorders smoke, and their life expectancy is decreased by up to 25 years compared to the general population. Hospitalized patients without monitoring after discharge quickly return to prehospitalization levels of tobacco use. The aim of the 061 QuitMental study is to assess the effectiveness of a multicomponent and motivational telephone-based intervention to stop smoking through a quitline addressed to smokers discharged from mental health hospital wards. Methods A pragmatic randomized controlled trial, single blinded, will include 2:1 allocation to the intervention group (IG) and the control group (CG). The IG will receive telephone assistance to quit smoking (including psychological and psychoeducational support, and pharmacological treatment advice if required) proactively for 12 months, and the CG will receive only brief advice after discharge. The sample size, calculated with an expected difference of 15 points on smoking abstinence between groups (IG, 20% and CG, 5%), α = 0.05, β = 0.10, and 20% loss, will be 334 participants (IG) and 176 participants (CG). Participants are adult smokers discharged from psychiatric units of five acute hospitals. Measurements include dependent variables (self-reported 7-day point prevalence smoking abstinence (carbon monoxide verified), duration of abstinence, number of quit attempts, motivation, and self-efficacy to quit) and independent variables (age, sex, and psychiatric diagnoses). In data analysis, IG and CG data will be compared at 48 h and 1, 6, and 12 months post discharge. Multivariate logistic regression (odds ratio; 95% confidence interval) of dependent variables adjusted for potential confounding variables will be performed. The number needed to treat to achieve one abstinence outcome will be calculated. We will compare the abstinence rate of enrolled patients between groups. Discussion This trial evaluates an innovative format of a quitline for smokers with severe mental disorders regardless of their motivation to quit. If effective, the pragmatic nature of the study will permit transfer to routine clinical practice in the National Health System. Trial registration ClinicalTrials.gov, NCT03230955. Registered on 24 July 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-3106-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Montse Ballbè
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain.,Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036, Barcelona, Spain
| | - Cristina Martínez
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain. .,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain. .,Medicine and Health Sciences School, Universitat Internacional de Catalunya, C. Josep Trueta s/n, 08915 Sant Cugat del Valles, Barcelona, Spain. .,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, L'Hospitalet del Llobregat, 08907, Barcelona, Spain.
| | - Ariadna Feliu
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, L'Hospitalet del Llobregat, 08907, Barcelona, Spain
| | - Núria Torres
- 061 CatSalut Respon, Sistema d'Emergències Mèdiques, C. Pablo Iglesias 115, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Gemma Nieva
- Smoking Cessation Unit, Addictive Behaviors Unit, Psychiatry Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, CIBERSAM, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Cristina Pinet
- Addictive Behaviors Unit, Psychiatry Department, Hospital de la Santa Creu i Sant Pau, C. San Antoni Ma Claret 167, 08025, Barcelona, Spain
| | - Antònia Raich
- Mental Health Department, Althaia Xarxa Assistencial Universitària, C. Dr. Llatjós s/n, Manresa, 08243, Barcelona, Spain
| | - Sílvia Mondon
- Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036, Barcelona, Spain
| | - Pablo Barrio
- Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036, Barcelona, Spain
| | - Rosa Hernández-Ribas
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, L'Hospitalet del Llobregat, 08907, Barcelona, Spain.,Alcohol Program, Psychiatry Department, Hospital Universitari de Bellvitge, Institut Català d'Oncologia, IDIBELL, CIBERSAM, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Jordi Vicens
- Psychiatry Department, Hestia Duran i Reynals, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Sílvia Costa
- Addictive Behaviors Unit, Psychiatry Department, Hospital de la Santa Creu i Sant Pau, C. San Antoni Ma Claret 167, 08025, Barcelona, Spain.,Institut d'Investigació Biomèdica Sant Pau, C. San Antoni Mª Claret 167, 08025, Barcelona, Spain
| | - Jordi Vilaplana
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, Universitat de Lleida, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Spain
| | - Laura Alaustre
- 061 CatSalut Respon, Sistema d'Emergències Mèdiques, C. Pablo Iglesias 115, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Eva Vilalta
- 061 CatSalut Respon, Sistema d'Emergències Mèdiques, C. Pablo Iglesias 115, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Roser Blanch
- 061 CatSalut Respon, Sistema d'Emergències Mèdiques, C. Pablo Iglesias 115, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Susana Subirà
- Psychiatry Department, Hestia Duran i Reynals, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Eugeni Bruguera
- Smoking Cessation Unit, Addictive Behaviors Unit, Psychiatry Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, CIBERSAM, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Josep Maria Suelves
- Public Health Agency of Catalonia, Health Department, Government of Catalonia, C. Roc Boronat 81-95, 08005, Barcelona, Spain
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA, 94118, USA
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, L'Hospitalet del Llobregat, 08907, Barcelona, Spain
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25
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Andrés A, Castellano Y, Fu M, Feliu A, Ballbè M, Antón L, Baena A, Fernández E, Martínez C. Exploring individual and contextual factors contributing to tobacco cessation intervention implementation. Addict Behav 2019; 88:163-168. [PMID: 30205255 DOI: 10.1016/j.addbeh.2018.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Previous research suggests that smoking cessation interventions are poorly implemented. This study reports the development and testing of a questionnaire including knowledge, attitude, behavioral, and organizational (KABO) factors affecting the implementation of smoking cessation practices in hospitals by health care providers and organizations. METHODS An initial pool of 44 items was developed to assess the individual knowledge, attitudes, and beliefs of health professionals towards smoking cessation practices according to the 5 A's intervention model, as well as organizational barriers and opportunities for its implementation. Items were measured in a scale from 0="Not at all/Never" to 10 = "Completely/Always". Data were collected from health workers (n = 702) in Catalonia. The validity of the instrument was measured by: (a) analyzing the items, (b) assessing the internal structure, (c) estimating the internal consistency, and (d) analyzing the relationship between this tool and the 5 A's intervention model. RESULTS Seven domains were extracted: individual skills, positive organizational support, attitudes and beliefs, individual commitment, organizational resources, beliefs about patient desire/readiness to quit, and organizational endorsement. These domains explained 69.7% of the variance, and allowed for the development of a refined 26-item version of the questionnaire. Both the seven domains and the total scale showed adequate internal consistency. CONCLUSIONS Psychometric testing indicates that the KABO questionnaire is a reliable and valid instrument for assessing the main barriers and facilitators to smoking cessation intervention implementation. Individual factors better explained the implementation of smoking cessation interventions in hospitals, and the seven identified domains can be used for further investigations into how the implementation of evidence-based practices impacts smoking cessation performance.
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26
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Raich A, Pinet C, Ballbè M, Mondon S, Tejedor R, Arnau A, Fernández E. Multimodal treatment for smoking cessation with varenicline in alcoholic, methadone-maintained, and psychotic patients: A one-year follow-up. Tob Induc Dis 2018; 16:58. [PMID: 31516455 PMCID: PMC6659506 DOI: 10.18332/tid/99541] [Citation(s) in RCA: 5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Numerous studies have evaluated the efficacy and safety of varenicline for smoking cessation in smokers in the general population and, to a lesser extent, among the psychiatric population. However, few studies have evaluated varenicline in patients with other addictions. The present study was conducted to assess outcomes of a multimodal treatment for smoking cessation intervention with varenicline in a sample of alcohol and substance use disorders and patients with psychotic disorders. METHODS This was a prospective, multicenter study. The patient sample comprised alcoholics in remission, methadone-maintained patients, and patients with psychotic disorders, all of whom wanted to stop smoking. All participants received multimodal treatment for smoking cessation therapy (psychological therapy plus varenicline). Smoking abstinence and changes in the psychopathological state of patients were assessed at predefined time points during a 12-month follow-up. The probability of tobacco abstinence after one year of treatment was computed using Kaplan-Meier life tables. RESULTS The probability of abstinence at one year was 0.225 (95% CI: 0.1430-0.319). By group, the probabilities were as follows: patients with psychotic disorders 0.254 (95% CI: 0.118-0.415); alcoholics 0.237 (95% CI: 0.098-0.409); and methadone-maintained patients 0.177 (95% CI: 0.065-0.335). Patients with previous quit attempts had a higher probability of achieving abstinence at one year (p<0.01). CONCLUSIONS The results of this study support the use of multimodal treatment with varenicline in patients with alcohol addiction in remission, patients on methadone maintenance, and patients with stable psychotic disorders. Previous smoking cessation attempts were predictive of smoking cessation success in these patients.
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Affiliation(s)
- Antonia Raich
- Group of Research SAMIS, Mental Health Department, Althaia Xarxa Assistencial Universitària de Manresa, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Cristina Pinet
- Addiction Unit, Mental Health Department, Hospital de Sant Pau, Barcelona, Spain
| | - Montse Ballbè
- Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain.,Tobacco Control Unit, Institut Català d'Oncologia, IDIBELL, Barcelona, Spain
| | - Silvia Mondon
- Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - Rosa Tejedor
- Group of Research SAMIS, Mental Health Department, Althaia Xarxa Assistencial Universitària de Manresa, Barcelona, Spain
| | - Anna Arnau
- Research Department, Althaia Xarxa Assistencial Universitària de Manresa, Barcelona, Spain
| | - Esteve Fernández
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain.,Tobacco Control Unit, Institut Català d'Oncologia, IDIBELL, Barcelona, Spain
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27
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Lidón-Moyano C, Fu M, Pérez-Ortuño R, Ballbè M, Feliu A, Martín-Sánchez JC, Matilla-Santander N, Pascual JA, Fernández E, Martínez-Sánchez JM. Impact of the Spanish smoking legislation among smokers: A longitudinal study with biomarkers in Barcelona (Spain). Addict Behav 2018; 87:101-108. [PMID: 29975878 DOI: 10.1016/j.addbeh.2018.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 06/12/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The aim of this study is to assess the impact of the Spanish tobacco control legislation on smoking behavior and salivary cotinine concentration among smokers. METHODS We used data from a longitudinal study, before (2004-2005) and after (2013-2014) the implementation of the two national smoking bans (in 2006 and 2011), in a representative sample of adults (≥16 years old) from Barcelona (Spain). We only analyzed a subsample of continuing smokers (n = 116). We conducted a survey on smoking behavior and obtained saliva sample for cotinine analyses. For this report, we analyzed a subsample of continuing smokers (n = 116). We calculated geometric means (GM). RESULTS Among continuing smokers, salivary cotinine concentration significantly increased by 28.7% (GM from 91.7 ng/ml to 117.3 ng/ml, p = 0.015) after the implementation of the two Spanish smoke-free bans. Nonetheless, no pattern of change was observed in the self-reported number of cigarettes smoked daily. CONCLUSIONS Our study shows a significant increase in the salivary cotinine concentration among adult continuing smokers after both Spanish legislations. This increase could be due to differences in smoking topography (increase in the depth of inhalation when smoking) along with changes in the type of tobacco smoked (increase in smoking roll-your-own cigarettes or mixed use of roll-your-own and manufactured cigarettes). Our results suggest the need to extend tobacco control policies, focusing on the reduction of use of any type of tobacco product and implementing better treatment to help smokers stop smoking.
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Martínez-Sánchez JM, Ballbè M, Pérez-Ortuño R, Fu M, Sureda X, Pascual JA, Peruga A, Fernández E. Secondhand exposure to aerosol from electronic cigarettes: pilot study of assessment of tobacco-specific nitrosamine (NNAL) in urine. Gac Sanit 2018; 33:575-578. [PMID: 30377020 DOI: 10.1016/j.gaceta.2018.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 07/02/2018] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess the levels of a tobacco-specific nitrosamine (NNAL) in non-smokers passively exposed to the second-hand aerosol (SHA) emitted from users of electronic cigarettes (e-cigarettes). METHOD We conducted an observational study involving 55 non-smoking volunteers divided into three groups: 25 living at home with conventional smokers, 6 living with e-cigarette users, and 24 in control homes (smoke-free homes). We obtained urine samples from all volunteers to determine NNAL. RESULTS We detected NNAL in the urine of volunteers exposed to e-cigarettes (median:0.55 pg/mL; interquartile range: 0.26-2.94 pg/mL). The percentage of urine samples with quantifiable NNAL differed significantly among the three groups of homes: 29.2%, 66.7% and 76.0%, respectively (p=0.004). CONCLUSIONS We found NNAL nitrosamine in urine samples from people exposed to SHA from e-cigarettes. However, these results could be confirmed with more studies with larger sample sizes.
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Affiliation(s)
- Jose M Martínez-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), Spain; Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat (Barcelona), Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain.
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat (Barcelona), Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain; Catalan Network of Smoke-free Hospitals, L'Hospitalet de Llobregat (Barcelona), Spain; Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain; Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Raúl Pérez-Ortuño
- Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares (Madrid), Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat (Barcelona), Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain; Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Xisca Sureda
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat (Barcelona), Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain; Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares (Madrid), Spain
| | - José A Pascual
- Hospital del Mar Medical Research Institute - IMIM, Barcelona, Spain; Department of Experimental and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Armando Peruga
- Tobacco Free Initiatives, World Health Organization, Geneva, Switzerland
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat (Barcelona), Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain; Catalan Network of Smoke-free Hospitals, L'Hospitalet de Llobregat (Barcelona), Spain; Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain
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Pinet M, Antón L, Ballbè M, Carcolé B, Feria I, Nieva G, Mondon S, Fernández E, Gual A, Palau N, and Mental Health Group ATS. Psychiatric inpatient unit. A good place for smoking cessation? Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90695] [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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Bunch K, Fu M, Ballbè M, Matilla-Santader N, Lidón-Moyano C, Martin-Sanchez JC, Fernandez E, Martínez-Sánchez JM. Motivation and main flavour of use, use with nicotine and dual use of electronic cigarettes in Barcelona, Spain: a cross-sectional study. BMJ Open 2018; 8:e018329. [PMID: 29567840 PMCID: PMC5875655 DOI: 10.1136/bmjopen-2017-018329] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 12/14/2017] [Accepted: 02/05/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study seeks to describe current e-cigarette users' patterns of use including primary motivation for use, dual use, use with nicotine and principal flavour used, according to individuals' sociodemographic characteristics and conventional tobacco consumption in Barcelona, Spain. DESIGN, SETTING AND PARTICIPANTS This is a cross-sectional study of adult (≥18) current e-cigarette users of Barcelona (n=600), recruited in 2015. Researchers calculated percentages and ORs with their 95% CIs of users' e-cigarette use with nicotine, primary motivation for use and preferred flavour. The analyses were stratified by sociodemographic variables including sex, age and level of education and by patterns of e-cigarette use and past and current conventional tobacco use. RESULTS The most prevalent motivation for using e-cigarettes was to reduce tobacco smoking (48%, n=288), followed by quitting smoking (39.2%, n=235), and to use e-cigarettes in places where tobacco smoking was prohibited (10.2%, n=61). The most prevalent primary flavour used was tobacco (49%, n=294), followed by fruit (19.5%, n=117). People younger than 25 years old (OR=4.36, 95% CI 1.99 to 9.57) were more likely than older people to use them where smoking cigarettes was prohibited. A greater proportion of those in the youngest age group preferred fruit flavour compared with older individuals (29.3%, n=41). CONCLUSIONS Younger users of e-cigarettes and non-smokers are more likely to use flavours other than tobacco and to use e-cigarettes mainly for recreational purposes.
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Affiliation(s)
- Kailey Bunch
- Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
- Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Nuria Matilla-Santader
- Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain
| | - Cristina Lidón-Moyano
- Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain
| | - Juan Carlos Martin-Sanchez
- Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain
| | - Esteve Fernandez
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Jose M Martínez-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
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Martínez-Sáchez JM, Matilla-Santander N, Bunch K, Fu M, Ballbè M, Lidón-Moyano C, Martín-Sánchez JC, Fernández E. Patterns of use of electronic cigarettes and use in public and private settings in Barcelona (Spain). Tob Induc Dis 2018. [DOI: 10.18332/tid/84173] [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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Margalef M, Ballbè M, Antón L, Guillén O, Martínez C, Fu M, Suelves JM, Fernández E. Tobacco Control Training Programme for health professionals of the Catalan Network of Smoke-Free Hospitals: 11-year experience. Tob Induc Dis 2018. [DOI: 10.18332/tid/84215] [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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Lidón-Moyano C, Fu M, Ballbè M, Martín-Sánchez JC, Matilla-Santander N, Martínez C, Fernández E, Martínez-Sánchez JM. Impact of the Spanish smoking laws on tobacco consumption and secondhand smoke exposure: A longitudinal population study. Addict Behav 2017; 75:30-35. [PMID: 28683343 DOI: 10.1016/j.addbeh.2017.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/27/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND In Spain, two smoke-free laws have been passed after the approval of the WHO-FCTC. This study assesses the impact of these Spanish smoking legislations on the active and passive smoking through a population cohort in Barcelona (Spain). METHODS This is a longitudinal study before and after the implementation of two national smoking bans in Spain in a representative sample (n=1245) of adults (≥16years old) from Barcelona (Spain) surveyed in 2004-2005 and followed-up in 2013-2014. The final sample analyzed was 736 individuals. Both questionnaires (before and after the two laws) included the same variables about active and passive smoking. We calculated the prevalence and the prevalence ratio (PR, with their 95% confidence intervals, 95% CI) of smoking cigarettes and hand-rolled tobacco and also the prevalence of exposure to secondhand smoke (SHS) at home, work, public transport, leisure time and at any setting after vs. before Spanish legislations. RESULTS After the implementation of the two Spanish smoke-free bans, a significant decrease was observed in the smoking prevalence (from 34.5% to 26.1%, PR=0.76, p<0.001), in the average cigarettes per day (median from 15.2 to 10.0, p<0.001), and in the percentage of conventional tobacco consumption (from 92.6% to 74.4%, PR=0.80, p<0.001). Furthermore, a significant increase in the use of hand-rolled tobacco (from 6.1% to 30.9%, PR=5.07, p<0.001) and other tobacco products (from 17.1% to 32.8%, PR=1.92, p<0.001) was observed. In addition, a significant decrease in the self-reported SHS exposure was observed in all the assessed settings (home, work, transport, and leisure time). CONCLUSIONS The implementation of the two smoke-free legislations in Spain is related to a reduction in smoking prevalence and SHS exposure. However, the smoking of other tobacco products, particularly hand-rolled tobacco, has increased among young population.
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Lidón-Moyano C, Fu M, Perez-Ortuño R, Ballbè M, Sampedro-Vida M, Martín-Sánchez JC, Pascual JA, Fernández E, Martínez-Sánchez JM. Assessment of salivary cotinine concentration among general non-smokers population: Before and after Spanish smoking legislations. Cancer Epidemiol 2017; 51:87-91. [PMID: 29080448 DOI: 10.1016/j.canep.2017.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/27/2017] [Accepted: 10/16/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND In Spain, two smoke-free laws have been passed (Law 28/2005 and Law 42/2010).This study evaluates the association between Spanish smoking legislations and the second-hand smoke (SHS) exposure in an adult non-smoking population cohort in Barcelona (Spain). METHODS This is a longitudinal study, before and after the implementation of two national smoking bans, in a representative sample of adults (≥16years old) from Barcelona (Spain) surveyed in 2004-2005 and followed up in 2013-2014 (n=736). We only analyzed non-smokers (n=397). We obtained 9ml of saliva sample for analysis of cotinine, a biomarker of recent tobacco exposure. We calculated geometric means of salivary cotinine concentration and their geometric standard deviation. We used linear mixed effect models, with individuals as random effects, to model the percentage change in salivary cotinine concentration and their 95% confidence intervals. RESULTS The percentage of participants with saliva samples with measurable concentrations of cotinine fell from 92.4% to 64.2% after both Spanish smoking legislations. The geometric mean of salivary cotinine concentration significantly decreased 88% (from 0.98ng/mL to 0.12ng/mL, p<0.001) after the implementation of the two Spanish smoke-free legislations. The decrease of the GM salivary cotinine concentration was statistically significant independently of the sociodemographic variables. CONCLUSION There was a large reduction in the salivary cotinine concentration among adult non-smokers and higher cotinine concentrations among those declaring exposure to SHS at home after both legislations. Moreover, after both Spanish smoke-free laws salivary cotinine concentration was homogenized according to sociodemographic variables.
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Affiliation(s)
- Cristina Lidón-Moyano
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Raúl Perez-Ortuño
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain; Catalan Network of Smoke-free Hospitals, L'Hospitalet de Llobregat, Barcelona, Spain; Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marc Sampedro-Vida
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Juan Carlos Martín-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - José A Pascual
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain; Catalan Network of Smoke-free Hospitals, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jose M Martínez-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain; Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
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Martínez C, Castellano Y, Andrés A, Fu M, Antón L, Ballbè M, Fernández P, Cabrera S, Riccobene A, Gavilan E, Feliu A, Baena A, Margalef M, Fernández E. Factors associated with implementation of the 5A's smoking cessation model. Tob Induc Dis 2017; 15:41. [PMID: 29142531 PMCID: PMC5669025 DOI: 10.1186/s12971-017-0146-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 05/21/2017] [Accepted: 10/23/2017] [Indexed: 12/04/2022] Open
Abstract
Background Several health organizations have adopted the 5A’s brief intervention model (Ask, Advise, Assess, Assist, Arrange), based on evidence-based guidelines for smoking cessation. We examine individual, cognitive, behavioral, and organizational factors associated with the 5A’s performance among clinical healthcare workers in Catalonia. We also investigate how these factors interact and potentially predict the implementation of each component of the 5A’s. Methods A cross-sectional survey was conducted among clinical health workers enrolled in an online smoking cessation training course (n = 580). The survey included questions about individual characteristics as well as cognitive, behavioral, and organizational factors previously identified in research. We assessed self-reported performance of the 5A’s, assessed on a scale from 0 to 10, and used Multivariate regression to examine factors associated with its performance. Results The performance means (standard deviation) were moderate for the first 3A’s [Ask: 6.4 (3.1); Advise: 7.1 (2.7); Assess: 6.3 (2.8)] and low for the last 2A’s [Assist: 4.4 (2.9); Arrange: 3.2 (3.3)]. We observed a high correlation between Assist and Arrange (r = 0.704, p < 0.001). Having positive experiences and feeling competent were positively associated with performing the 5A’s model and having organizational support with Assist and Arrange. Personal tobacco use among healthcare workers was negatively associated with Advice and Arrange. Conclusions Our study found that clinical healthcare workers do not perform the 5A’s completely. The main barriers identified suggest the need of training and making available practical guidelines in healthcare services. Organizational support is essential for moving towards the implementation of Assist and Arrange. Electronic supplementary material The online version of this article (10.1186/s12971-017-0146-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Martínez
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet, 199-203, E-08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Medicine and Health Sciences School, C. Josep Trueta s/n, 08915 Sant Cugat del Valles, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa llarga s/n, 08907 L'Hospitalet del Llobregat, Barcelona, Spain
| | - Y Castellano
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet, 199-203, E-08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - A Andrés
- National Institute of Physical Education of Catalonia (INEFC), Av. de l'Estadi, 12-22, 08038 Barcelona, Spain
| | - M Fu
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet, 199-203, E-08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Medicine and Health Sciences School, C. Josep Trueta s/n, 08915 Sant Cugat del Valles, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa llarga s/n, 08907 L'Hospitalet del Llobregat, Barcelona, Spain
| | - L Antón
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet, 199-203, E-08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Ballbè
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet, 199-203, E-08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036 Barcelona, Spain
| | - P Fernández
- Nursing Research Unit, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - S Cabrera
- Nursing Research Unit, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - A Riccobene
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet, 199-203, E-08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - E Gavilan
- Medicine and Health Sciences School, C. Josep Trueta s/n, 08915 Sant Cugat del Valles, Barcelona, Spain
| | - A Feliu
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet, 199-203, E-08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa llarga s/n, 08907 L'Hospitalet del Llobregat, Barcelona, Spain
| | - A Baena
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet, 199-203, E-08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Margalef
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet, 199-203, E-08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - E Fernández
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet, 199-203, E-08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa llarga s/n, 08907 L'Hospitalet del Llobregat, Barcelona, Spain
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Matilla-Santander N, Fu M, Ballbè M, Bunch K, Lidón-Moyano C, Martín-Sánchez JC, Fernández E, Martínez-Sánchez JM. Use of electronic cigarettes in public and private settings in Barcelona (Spain). Environ Res 2017; 158:685-690. [PMID: 28734255 DOI: 10.1016/j.envres.2017.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/29/2017] [Accepted: 07/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To describe the prevalence of e-cigarette users who use them in selected indoor public and workplaces, and private venues in Barcelona (Spain) in 2015. METHODS This is a cross-sectional study of a sample of e-cigarette users (≥ 18 years) from Barcelona (n = 600). We calculated the proportion of e-cigarette users who used the device in public and private settings (in the last 30 days). We fit multivariate logistic regression models adjusted for sex and age to calculate the odds ratios (OR) with their 95% confidence intervals (CI) of e-cigarette use by socio-demographic factors, dual use and nicotine-containing e-cigarettes. RESULTS The highest proportion of e-cigarette users who used them in public places was found at restaurants or bars (69.4%) and nightclubs or pubs (55.4%). Also being current conventional tobacco smokers (dual users) was significantly associated with lower use of e-cigarettes in workplaces (OR = 0.61, 95%CI:0.41-0.91), restaurants (OR = 0.66, 95%CI:0.45-0.97) and nightclubs (OR = 0.56, 95%CI:0.37-0.86). Moreover, being a nicotine-containing e-cigarette user was associated with higher odds of using the device in workplaces (OR = 2.01, 95%CI:1.34-3.01), and lower odds of using it in nightclubs (OR = 0.56, 95%CI:0.39-0.82). 96.8% of the included e-cigarette users declared to use the device at home. Being a current tobacco smoker was associated with increased odds of using e-cigarettes at home (OR = 3.17, 95%CI:1.22-8.22). CONCLUSIONS E-cigarette use in private settings and in public settings where their use is not regulated by law is high. Therefore, the public health administration in Spain should consider expanding the prohibition of e-cigarette use to indoor public places and should take into account the possibility of exposure to aerosol from e-cigarettes.
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Affiliation(s)
- Nuria Matilla-Santander
- Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Kailey Bunch
- Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Cristina Lidón-Moyano
- Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Juan Carlos Martín-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jose M Martínez-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain; Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
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Matilla-Santander N, Fu M, Ballbè M, Lidón-Moyano C, Martín-Sánchez JC, Fernández E, Martínez-Sánchez JM. [Using consumer panels in public health observational studies]. Gac Sanit 2017; 31:436-438. [PMID: 28595990 DOI: 10.1016/j.gaceta.2017.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/02/2017] [Accepted: 03/03/2017] [Indexed: 11/25/2022]
Abstract
Consumer panels are a market research method useful for gathering information about low-frequency or difficult-access customers. The objective of this field-note is to explain our experience using this method in a cross-sectional public health study on the use of electronic cigarettes. After taking into account other non-probabilistic sampling techniques to obtain a huge sample of electronic-cigarette users (n=600), in the end we decided to use consumer panels (recruiters) because of the relative short duration of the field work and the high representativeness of the sample.
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Affiliation(s)
- Nuria Matilla-Santander
- Grupo de Evaluación de Determinantes de Salud y Políticas Sanitarias, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | - Marcela Fu
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Instituto Catalán de Oncología (ICO), L'Hospitalet de Llobregat, Barcelona, España; Grupo de Investigación en Prevención y Control del Cáncer, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España; Departamento de Ciencias Clínicas, Facultad de Medicina, Universitat de Barcelona, Barcelona, España
| | - Montse Ballbè
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Instituto Catalán de Oncología (ICO), L'Hospitalet de Llobregat, Barcelona, España; Grupo de Investigación en Prevención y Control del Cáncer, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España; Unidad de Adicciones, Departamento de Psiquiatría, Instituto de Neurociencias, Hospital Clínic de Barcelona, Barcelona, España
| | - Cristina Lidón-Moyano
- Grupo de Evaluación de Determinantes de Salud y Políticas Sanitarias, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | - Juan Carlos Martín-Sánchez
- Grupo de Evaluación de Determinantes de Salud y Políticas Sanitarias, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | - Esteve Fernández
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Instituto Catalán de Oncología (ICO), L'Hospitalet de Llobregat, Barcelona, España; Grupo de Investigación en Prevención y Control del Cáncer, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España; Unidad de Adicciones, Departamento de Psiquiatría, Instituto de Neurociencias, Hospital Clínic de Barcelona, Barcelona, España
| | - José M Martínez-Sánchez
- Grupo de Evaluación de Determinantes de Salud y Políticas Sanitarias, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, España; Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Instituto Catalán de Oncología (ICO), L'Hospitalet de Llobregat, Barcelona, España; Grupo de Investigación en Prevención y Control del Cáncer, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España.
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Lidón-Moyano C, Martínez-Sánchez JM, Fu M, Ballbè M, Martín-Sánchez JC, Martínez C, Fernández E. Secondhand smoke risk perception and smoke-free rules in homes: a cross-sectional study in Barcelona (Spain). BMJ Open 2017; 7:e014207. [PMID: 28104712 PMCID: PMC5253536 DOI: 10.1136/bmjopen-2016-014207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe the voluntary adoption of smoke-free homes in Spain among general population and to identify variables associated with its voluntary adoption. METHODS Cross-sectional study of a representative sample (n=731) of the adult population (>26 years) of Barcelona, Spain, in 2013-2014. We defined smoking rules inside the households as complete indoor rules (when smoking was not allowed inside the house), and partial or absent indoor rules (when smoking was allowed in some designated places inside the house or when smoking was allowed everywhere) and described them according to the perceived risk of the secondhand smoke (SHS) exposure. We calculated the prevalence and prevalence ratios (PR) according to sociodemographic variables. RESULTS 57.4% of households had complete indoor smoke-free rules. The prevalence of households with complete indoor rules was higher among women (PRa: 1.15; 95% CI 1.00 to 1.33), married (PRa: 1.18; 95% CI 1.01 to 1.38), never-smokers (PRa: 2.68; 95% CI 2.06 to 3.50) and in households where a minor lived (PRa: 1.40; 95% CI: 1.20-1.65). Believe that breathing tobacco smoke from smokers is dangerous for non-smokers (PRa: 1.77; 95% CI: 1.06-2.97) is associated with the voluntary adoption of complete indoor smoke-free home. CONCLUSIONS Risk perceptions of SHS exposure were associated with the voluntary adoption of indoor smoke-free homes.
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Affiliation(s)
- Cristina Lidón-Moyano
- Biostatistics Unit, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Jose M Martínez-Sánchez
- Biostatistics Unit, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
- Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Juan Carlos Martín-Sánchez
- Biostatistics Unit, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Cristina Martínez
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Medicine and Health Sciences School, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
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Pérez-Ortuño R, Martínez-Sánchez JM, Fu M, Ballbè M, Quirós N, Fernández E, Pascual JA. Assessment of tobacco specific nitrosamines (TSNAs) in oral fluid as biomarkers of cancer risk: A population-based study. Environ Res 2016; 151:635-641. [PMID: 27619208 DOI: 10.1016/j.envres.2016.08.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 08/05/2016] [Accepted: 08/31/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Smoke-free laws are expected to reduce smoking habits and exposure to secondhand smoke. The objective of this study was the measurement of tobacco specific carcinogens (TSNAs) in oral fluid to assess the most suitable biomarker of cancer risk associated with tobacco smoke. METHODS TSNAs, N'-nitrosonornicotine (NNN), 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), as well as nicotine and cotinine were measured in oral fluid samples from 166 smokers and 532 non-smokers of the adult population of Barcelona, Spain. A simple method with an alkaline single liquid-liquid extraction with dichloromethane/isopropanol was used and lower limits of quantification for cotinine, NNN, NNK and NNAL were set at 0.10ng/mL, 1.0, 2.0 and 0.50pg/mL respectively. The NNN/cotinine ratio was also calculated. RESULTS NNN was the most abundant TSNA present in oral fluid with a significant difference between smokers and non-smokers (mean concentrations of 118 and 5.3pg/mL, respectively, p<0.001). NNK and NNAL were detectable in fewer samples. NNN and cotinine concentrations had a moderate correlation within both groups (Spearman's rank correlation coefficient of 0.312, p<0.001 in smokers and 0.279, p=0.022 in non-smokers). NNN/cotinine ratio was significantly higher (p<0.001) in non-smokers than in smokers, in line with equivalent findings for the NNAL/cotinine ratio in urine. CONCLUSIONS TSNAs are detectable in oral fluid of smokers and non-smokers. NNN is the most abundant, in line with its association with esophageal and oral cavity cancers. The NNN/cotinine ratio confirms the relative NNN increase in second hand smoke. Findings provide a new oral fluid biomarker of cancer risk associated with exposure to tobacco smoke.
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Affiliation(s)
- Raúl Pérez-Ortuño
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Doctor Aiguader 88, 08003 Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Doctor Aiguader, 88, 08003 Barcelona, Spain.
| | - Jose M Martínez-Sánchez
- Biostatistic Unit, Department of Basic Science, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Carrer Josep Trueta s/n, 08915 Sant Cugat del Valles, Barcelona, Spain; Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia, WHO Collaborating Center for Tobacco Control, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-201, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Marcela Fu
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia, WHO Collaborating Center for Tobacco Control, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-201, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Ctra. de la Feixa llarga s/n, 08907 L'Hospitalet del Llobregat, Barcelona, Spain.
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia, WHO Collaborating Center for Tobacco Control, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-201, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Ctra. de la Feixa llarga s/n, 08907 L'Hospitalet del Llobregat, Barcelona, Spain; Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036 Barcelona, Spain.
| | - Núria Quirós
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia, WHO Collaborating Center for Tobacco Control, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-201, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia, WHO Collaborating Center for Tobacco Control, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-201, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Ctra. de la Feixa llarga s/n, 08907 L'Hospitalet del Llobregat, Barcelona, Spain.
| | - José A Pascual
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Doctor Aiguader 88, 08003 Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Doctor Aiguader, 88, 08003 Barcelona, Spain.
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Martínez C, Ballbè M, Vilardell M, Fu M, Fernández E. The role of middle managers in tobacco control after a national smoke-free hospital campus ban. BMC Health Serv Res 2016; 16:517. [PMID: 27663779 PMCID: PMC5035500 DOI: 10.1186/s12913-016-1764-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 07/05/2015] [Accepted: 09/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Much of the recent health services research on tobacco control implementation has explored general views and perceptions of health professionals and has rarely taken into account middle management's perspectives. We state that middle managers may facilitate the implementation of smoke-free campus bans and thereby improve their effectiveness. The aim of this study was to assess middle managers' behaviors to enforce a new national smoke-free hospital campus ban, to evaluate their perceptions of the level of compliance of the new regulation, and to explore their attitudes towards how smoking affects the work environment. METHODS We used a cross-sectional survey, conducted online to evaluate middle managers of a general hospital in Catalonia, Spain. Close-ended and open-ended questions were included. Results were analyzed by using quantitative and qualitative methods. The managers' open opinions to the proposed topics were assessed using UCINET, and a graph was generated in NetDraw. RESULTS Sixty-three of the invited managers (78.7 %) participated in the survey. 87.2 % of them agreed that the hospital complied with the smoke-free campus ban and 79.0 % agreed that managers have an important role in enforcing the ban. They also perceived that smoking disturbs the dynamics of work, is a cause of conflict between smokers and non-smokers, and harms both the professional and the organization images. However, 96.8 % of respondents have never given out fines or similar measures and their active role in reminding others of the policy was limited; in addition, 68.2 % considered that hospitals should provide tobacco cessation treatments. Smoker middle managers were more likely than non-smokers to perceive that smoking has little impact on work. CONCLUSIONS Middle managers play a limited role in controlling tobacco consumption; smokers are less prone to think that smoking disturbs work dynamics than non-smokers. Tailored training and clear proceedings for middle managers could encourage more active roles.
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Affiliation(s)
- Cristina Martínez
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain. .,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain. .,Medicine and Health Sciences School, Universitat Internacional de Catalunya, C. Josep Trueta s/n, 08915, Sant Cugat del Valles, Barcelona, Spain. .,Tobacco Control Unit, Institut Català d'Oncologia, Av. Gran Via de L'Hospitalet, 199-203, E-08908, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain.,Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa llarga s/n, 08907, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Miquel Vilardell
- Department of Prevention, Hospital de Vic, Vic, Barcelona, Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain.,Medicine and Health Sciences School, Universitat Internacional de Catalunya, C. Josep Trueta s/n, 08915, Sant Cugat del Valles, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa llarga s/n, 08907, L'Hospitalet del Llobregat, Barcelona, Spain
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Lidón-Moyano C, Martínez-Sánchez JM, Fu M, Ballbè M, Martín-Sánchez JC, Martínez C, Saltó E, Fernández E. Impact of the Spanish smoking legislations in the adoption of smoke-free rules at home: a longitudinal study in Barcelona (Spain). Tob Control 2016; 26:557-562. [DOI: 10.1136/tobaccocontrol-2016-053114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/01/2016] [Accepted: 08/24/2016] [Indexed: 11/04/2022]
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Fu M, Fernández E, Martínez-Sánchez JM, San Emeterio N, Quirós N, Sureda X, Ballbè M, Muñoz G, Riccobene A, Centrich F, Saltó E, López MJ. Second-hand smoke exposure in indoor and outdoor areas of cafés and restaurants: Need for extending smoking regulation outdoors? Environ Res 2016; 148:421-428. [PMID: 27131796 DOI: 10.1016/j.envres.2016.04.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 05/15/2023]
Abstract
Smoke-free legislation in indoor public places has concentrated smokers in the areas outside building entrances or other outdoor areas. This study assessed the drift of second-hand smoke between outdoor and indoor areas of cafés and restaurants in Barcelona, Spain, and characterized the exposure on outdoor terraces. Using a cross-sectional design, we monitored vapor-phase nicotine in indoor areas and outside entrances simultaneously (n=47), and on some outdoor terraces (n=51). We computed the median nicotine concentration and interquartile range (IQR) to describe the data and performed multivariate analysis to describe nicotine concentration and its determinants. The overall median nicotine concentration indoors was 0.65µg/m(3) (IQR: 0.29-1.17µg/m(3)), with significant differences based on the number of smokers at the entrance (p=0.039). At outside entrances, the overall median nicotine concentration was 0.41µg/m(3) (IQR: 0.21-1.17µg/m(3)). The nicotine concentrations indoors and at the corresponding outside entrances were not significantly different, and the multivariate analysis confirmed the relationship between these variables. On terraces, the overall median nicotine concentration was 0.54µg/m(3) (IQR: 0.25-1.14µg/m(3)), but it increased to 0.60µg/m(3) when a tobacco smell was perceived, 0.72µg/m(3) on closed terraces, 1.24µg/m(3) when there were >6 smokers, and 1.24µg/m(3) when someone smoked >20min. Multivariate analysis confirmed the outdoor terrace area, the season, the type of enclosure, and the number of smokers as the most relevant variables explaining nicotine concentration (R(2)=0.396). These findings show that second-hand smoke exposure exists in indoor areas due to smokers smoking at the outside entrances. In addition, exposure may occur on outdoor terraces when smokers are present and the terrace is enclosed to some extent. Thus, the current Spanish law does not fully protect non-smokers from second-hand smoke and supports extending regulation to some outdoor areas.
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Affiliation(s)
- Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia - ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia - ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
| | - Jose M Martínez-Sánchez
- Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia - ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Noemi San Emeterio
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Nuria Quirós
- Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia - ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Xisca Sureda
- Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia - ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia - ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain; Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036 Barcelona, Spain
| | - Glòria Muñoz
- Chemistry Area, Agència de Salut Pública de Barcelona, Av. Drassanes, 13, 08001 Barcelona, Spain; Biomedical Research Centre Network for Epidemiology and Public Health - CIBERESP, Parc de Recerca Biomèdica de Barcelona, C. Doctor Aiguader 88 Pl. 1, 08003 Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, C. Sant Antoni Maria Claret 167 - Pavelló de Sant Frederic 16 Pl. 1, 08025 Barcelona, Spain
| | - Anna Riccobene
- Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia - ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Francesc Centrich
- Chemistry Area, Agència de Salut Pública de Barcelona, Av. Drassanes, 13, 08001 Barcelona, Spain; Biomedical Research Centre Network for Epidemiology and Public Health - CIBERESP, Parc de Recerca Biomèdica de Barcelona, C. Doctor Aiguader 88 Pl. 1, 08003 Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, C. Sant Antoni Maria Claret 167 - Pavelló de Sant Frederic 16 Pl. 1, 08025 Barcelona, Spain
| | - Esteve Saltó
- Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Department of Public Health, School of Medicine, Universitat de Barcelona, C. Casanova 143, 08036 Barcelona, Spain; Health Plan Directorate, Ministry of Health, Generalitat de Catalunya, Trav. Les Corts, 131-159 - Pavelló Ave Maria, 08028 Barcelona, Spain
| | - María J López
- Biomedical Research Centre Network for Epidemiology and Public Health - CIBERESP, Parc de Recerca Biomèdica de Barcelona, C. Doctor Aiguader 88 Pl. 1, 08003 Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, C. Sant Antoni Maria Claret 167 - Pavelló de Sant Frederic 16 Pl. 1, 08025 Barcelona, Spain; Evaluation and Intervention Methods Service, Agència de Salut Pública de Barcelona, Pl. Lesseps 1, 08023 Barcelona, Spain
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Ballbè M, Gual A, Nieva G, Saltó E, Fernández E. Deconstructing myths, building alliances: a networking model to enhance tobacco control in hospital mental health settings. Gac Sanit 2016; 30:389-92. [PMID: 27325123 DOI: 10.1016/j.gaceta.2016.04.017] [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] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/21/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
Abstract
Life expectancy for people with severe mental disorders is up to 25 years less in comparison to the general population, mainly due to diseases caused or worsened by smoking. However, smoking is usually a neglected issue in mental healthcare settings. The aim of this article is to describe a strategy to improve tobacco control in the hospital mental healthcare services of Catalonia (Spain). To bridge this gap, the Catalan Network of Smoke-free Hospitals launched a nationwide bottom-up strategy in Catalonia in 2007. The strategy relied on the creation of a working group of key professionals from various hospitals -the early adopters- based on Rogers' theory of the Diffusion of Innovations. In 2016, the working group is composed of professionals from 17 hospitals (70.8% of all hospitals in the region with mental health inpatient units). Since 2007, tobacco control has improved in different areas such as increasing mental health professionals' awareness of smoking, training professionals on smoking cessation interventions and achieving good compliance with the national smoking ban. The working group has produced and disseminated various materials, including clinical practice and best practice guidelines, implemented smoking cessation programmes and organised seminars and training sessions on smoking cessation measures in patients with mental illnesses. The next challenge is to ensure effective follow-up for smoking cessation after discharge. While some areas of tobacco control within these services still require significant improvement, the aforementioned initiative promotes successful tobacco control in these settings.
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Affiliation(s)
- Montse Ballbè
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, WHO Collaborating Center for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Catalan Network of Smoke-free Hospitals, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona - IDIBAPS, Barcelona, Spain.
| | - Antoni Gual
- Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona - IDIBAPS, Barcelona, Spain
| | - Gemma Nieva
- Addictive Behaviours Unit, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Esteve Saltó
- Health Plan Directorate, Ministry of Health, Generalitat de Catalunya, Barcelona, Spain; Department of Public Health, Universitat de Barcelona, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, WHO Collaborating Center for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Catalan Network of Smoke-free Hospitals, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Campus of Bellvitge, Universitat de Barcelona, Barcelona, Spain
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Lidón-Moyano C, Martínez-Sánchez JM, Fu M, Ballbè M, Martín-Sánchez JC, Fernández E. [Prevalence and user profile of electronic cigarettes in Spain (2014)]. Gac Sanit 2016; 30:432-437. [PMID: 27198921 DOI: 10.1016/j.gaceta.2016.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/20/2016] [Accepted: 03/22/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe the prevalence and user profile of electronic cigarettes among Spanish adults and evaluate the potential dual use of these devices with combustible or conventional tobacco in 2014 in Spain. METHODS Cross-sectional study of a representative sample of the Spanish adult (16-75 years old) population (n=1,016). A computer-assisted telephone survey was conducted in 2014. The prevalence and 95% confidence intervals (95% CI) for the use of electronic cigarettes stratified by gender, age, tobacco consumption and social status were calculated. The sample was weighted and a logistic regression model adjusted to obtain the crude odds ratios (OR) adjusted by gender, age and social status. RESULTS 10.3% (95% CI: 8.6-12.4) of the Spanish adult population stated being ever users of electronic cigarettes (2% current users, 3.2% past users and 5.1% experimental users). Among current electronic cigarette users, 57.2% also smoked combustible or conventional tobacco, 28% had never smoked and 14.8% were former smokers. The prevalence of electronic cigarette use was higher in the younger population (adjusted OR=23.8; 95% CI: 2.5-227.7) and smokers of combustible tobacco (adjusted OR=10.1; 95% CI: 5.8-17.5). CONCLUSIONS The use of electronic cigarettes in Spain is scarce and is most prevalent among young people and tobacco smokers. Nevertheless, one out of four current electronic cigarette users have never smoked. Hence, the regulation of these devices should be reinforced to avoid a possible gateway to nicotine products among never smokers.
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Affiliation(s)
- Cristina Lidón-Moyano
- Unidad de Bioestadística, Departamento de Ciencias Básicas, Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Jose M Martínez-Sánchez
- Unidad de Bioestadística, Departamento de Ciencias Básicas, Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), España; Unidad de Control de Tabaco, Programa de Control y Prevención del Cáncer, Instituto Catalán de Oncología (ICO), L'Hospitalet de Llobregat (Barcelona), España; Grupo de Control y Prevención del Cáncer, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat (Barcelona), España.
| | - Marcela Fu
- Unidad de Control de Tabaco, Programa de Control y Prevención del Cáncer, Instituto Catalán de Oncología (ICO), L'Hospitalet de Llobregat (Barcelona), España; Grupo de Control y Prevención del Cáncer, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat (Barcelona), España; Departamento de Ciencias Clínicas, Universitat de Barcelona, Barcelona, España
| | - Montse Ballbè
- Unidad de Control de Tabaco, Programa de Control y Prevención del Cáncer, Instituto Catalán de Oncología (ICO), L'Hospitalet de Llobregat (Barcelona), España; Grupo de Control y Prevención del Cáncer, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat (Barcelona), España; Unidad de Adicciones, Departamento de Psiquiatría, Instituto de Neurociencias, Hospital Clínic de Barcelona, Barcelona, España
| | - Juan Carlos Martín-Sánchez
- Unidad de Bioestadística, Departamento de Ciencias Básicas, Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Esteve Fernández
- Unidad de Control de Tabaco, Programa de Control y Prevención del Cáncer, Instituto Catalán de Oncología (ICO), L'Hospitalet de Llobregat (Barcelona), España; Grupo de Control y Prevención del Cáncer, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat (Barcelona), España; Departamento de Ciencias Clínicas, Universitat de Barcelona, Barcelona, España
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Fernández E, Ballbè M, Sureda X, Fu M, Saltó E, Martínez-Sánchez JM. Particulate Matter from Electronic Cigarettes and Conventional Cigarettes: a Systematic Review and Observational Study. Curr Environ Health Rep 2016; 2:423-9. [PMID: 26452675 DOI: 10.1007/s40572-015-0072-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The aim of this study is to review the literature on the composition of aerosols from electronic cigarettes (e-cigarettes) originated by human vaping and to describe the emission of particulate matter ≤ 2.5 μm in diameter (PM(2.5)) from conventional and e-cigarettes at home in real-use conditions. METHODS We conducted a systematic literature search in PubMed and Web of Science. We measured PM(2.5) in four different homes: one from a conventional cigarette smoker, one from an e-cigarette user, and two from non-smokers. RESULTS The review identified eight previous investigations on the composition of aerosols from e-cigarettes originated by human vaping and indicated that emissions from e-cigarettes can contain potential toxic compounds such as nicotine, carbonyls, metals, and organic volatile compounds, besides particulate matter. In the observational study, the PM(2.5) median concentration was 9.88 μg/m³ in the e-cigarette user home and 9.53 and 9.36 μg/m³ in the smoke-free homes, with PM(2.5) peaks concurrent with the e-cigarette puffs. CONCLUSION Both the literature review and the observational study indicate that e-cigarettes used under real-conditions emit toxicants, including PM(2.5). Further research is needed to characterize the chemicals emitted by different types of e-cigarettes and to assess secondhand exposure to e-cigarette aerosol using biological markers.
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Affiliation(s)
- Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, WHO Collaborating Center for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain. .,Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain. .,School of Medicine, Universitat de Barcelona, Barcelona, Spain.
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, WHO Collaborating Center for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain. .,Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain. .,Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - Xisca Sureda
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, WHO Collaborating Center for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain. .,Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain. .,Department of Preventive Medicine, Universidad de Alcalá, Alcalá de Henares, Spain.
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, WHO Collaborating Center for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain. .,Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain. .,School of Medicine, Universitat de Barcelona, Barcelona, Spain.
| | - Esteve Saltó
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain. .,School of Medicine, Universitat de Barcelona, Barcelona, Spain. .,Health Plan Directorate, Ministry of Health, Generalitat de Catalunya, Spain.
| | - Jose M Martínez-Sánchez
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, WHO Collaborating Center for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain. .,Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain. .,Biostatistics Unit, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain.
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Abstract
UNLABELLED The safety of varenicline in the treatment of tobacco dependence has been questioned, in psychiatric patients. However, most published studies have not included psychiatric patients. OBJECTIVE Assess the safety of varenicline for smoking cessation in patients with psychiatric disorders. METHODS This is a prospective, longitudinal, multicenter study. The sample is composed of three groups (patients with psychotic disorder, patients with alcohol dependence disorder and patients addicts in methadone maintenance treatment). Patients were recruited consecutively between September 2008 and June 2009 from 11 centers. All patients received a standardized smoking cessation program with varenicline and psychological support. Adverse events of the drug were monitored at weeks 1, 2, 4, 6, 8, and 12 of treatment. Bivariate analysis has been used. RESULTS None of the 90 patients included, presented a serious adverse event. The most frequent adverse effect was dry mouth (28.9%), followed by the presence of flatulence (27.8%), abnormal dreams (27.8%), and nausea (22%), especially between weeks 2 and 6 of treatment. None of the patients referred intense suicidal ideation, although two referred to moderate suicidal ideation, which was solved in one case and in the other, treatment was discontinued. Four participants (4.4%) abandoned treatment because of gastrointestinal symptoms. The initial dose of varenicline was reduced in 25% of patients during the study. CONCLUSIONS Gastrointestinal adverse events are the most incident in this sample of psychiatric patients and no exacerbation of psychiatric symptoms was detected, thus indicating a good safety record for varenicline use for smoking cessation in psychiatric patients.
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Affiliation(s)
- Antonia Raich
- a Mental Health Department , Althaia Xarxa Assistencial Universitària , Manresa , Spain.,b Tobacco Control Unit, Institut Català d'Oncologia , L'Hospitalet , Spain (ICO-IDIBELL).,c Department of Clinical Sciences , School of Medicine, Universitat de Barcelona , Barcelona , Spain
| | - Montse Ballbè
- b Tobacco Control Unit, Institut Català d'Oncologia , L'Hospitalet , Spain (ICO-IDIBELL).,d Alcohology and Psychiatry Unit, Hospital Clínic , Barcelona , Spain
| | - Gemma Nieva
- e Psychiatry Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBERSAM , Barcelona , Spain
| | - Margarita Cano
- f Mental Health and Addictions Department , Hospital de Mataró , Mataró , Spain
| | - Teresa Fernández
- f Mental Health and Addictions Department , Hospital de Mataró , Mataró , Spain
| | - Eugeni Bruguera
- e Psychiatry Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBERSAM , Barcelona , Spain
| | - Esteve Fernández
- b Tobacco Control Unit, Institut Català d'Oncologia , L'Hospitalet , Spain (ICO-IDIBELL).,c Department of Clinical Sciences , School of Medicine, Universitat de Barcelona , Barcelona , Spain
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Martínez-Sánchez JM, Fu M, Martín-Sánchez JC, Ballbè M, Saltó E, Fernández E. Perception of electronic cigarettes in the general population: does their usefulness outweigh their risks? BMJ Open 2015; 5:e009218. [PMID: 26534735 PMCID: PMC4636602 DOI: 10.1136/bmjopen-2015-009218] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To describe and compare the perceptions of the general population about the harmful effects of electronic cigarettes (e-cigarettes) on users and on those passively exposed to e-cigarettes and the perceptions about e-cigarette usefulness for reducing or eliminating tobacco smoking. DESIGN, SETTING, AND PARTICIPANTS We analysed cross-sectional data from a longitudinal study of a representative sample of the general adult (≥16 years) population of Barcelona, Spain (336 men and 400 women). The fieldwork was conducted between May 2013 and February 2014. We computed the percentages, adjusted OR and their corresponding 95% CI among participants with some awareness of e-cigarettes (79.2% of the sample). PRIMARY AND SECONDARY OUTCOME MEASURES We assessed the perception about harmfulness for e-cigarette users and for passively exposed non-e-cigarette users, as well as the perception of usefulness for smokers of cigarette cessation and reduction. RESULTS In this sample, 40.1% thought that e-cigarettes had a harmful effect on users, and 27.1% thought that e-cigarettes had a harmful effect on passively exposed bystanders (p<0.001). Particularly, more never-smokers perceived that e-cigarettes had harmful effects on passively exposed bystanders than current smokers (34.4% vs 20.6%; OR=1.93, 95% CI 1.02 to 3.63). More people perceived e-cigarettes as being useful for reducing smoking than for quitting (50.6% vs 29.9%, p<0.001), as well as for reducing smoking than as being harmful to users (50.6% vs 40.1%, p=0.044). DISCUSSION The perception that e-cigarettes are useful for reducing tobacco consumption was more prevalent than the perception that e-cigarettes are harmful to users and to those passively exposed to e-cigarettes. Advertisements and messages about the use of e-cigarettes and their harmful effects should be regulated and based on scientific evidence to avoid creating erroneous ideas about their use.
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Affiliation(s)
- Jose M Martínez-Sánchez
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Biostatistics Unit, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Juan Carlos Martín-Sánchez
- Biostatistics Unit, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
- Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Esteve Saltó
- Health Plan Directorate, Ministry of Health, Generalitat de Catalunya, Barcelona, Spain
- Department of Public Health, Universitat de Barcelona, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
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Ballbè M, Martínez-Sánchez JM, Gual A, Martínez C, Fu M, Sureda X, Padrón-Monedero A, Galán I, Fernández E. Association of second-hand smoke exposure at home with psychological distress in the Spanish adult population. Addict Behav 2015; 50:84-8. [PMID: 26111658 DOI: 10.1016/j.addbeh.2015.06.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 06/03/2015] [Accepted: 06/04/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Second-hand smoke (SHS) exposure has been associated with increased risks of respiratory and heart diseases. However, little is known about the potential effects of SHS on psychological distress. The aim of this study is to examine the association of SHS exposure at home with psychological distress in Spain. METHODS A cross-sectional survey about SHS exposure, socio-demographic and health related variables, and psychological distress, measured with the 12-item version of the General Health Questionnaire (GHQ-12) with a cut-off score ≥ 3, was conducted from 2011-2012 among a representative sample of the adult population (aged ≥ 15 years) of Spain. From the total sample (n = 21,007), we used the subsample of never-smokers (n = 11,214). We computed the odds ratios (OR) and their 95% confidence intervals (95% CI) for scoring ≥ 3 on the GHQ by means of unconditional multiple logistic regression models adjusted for sex and age. RESULTS In the subsample, 9.7% (n = 1,090) responded that they were exposed to SHS at home. The prevalence of subjects scoring ≥ 3 on the GHQ was higher for the sample exposed to SHS (22.7%) than for the non-exposed sample (18.9%; OR: 1.39; CI: 1.19-1.62). This association was also present when stratified for sex, age, marital status, socio-economic status, perceived general health, presence of any chronic disease, and alcohol intake. CONCLUSIONS Exposure to SHS at home is associated with psychological distress. Further investigation is necessary to determine if this association is causal. Avoiding SHS exposure at home could have beneficial effects on psychological distress.
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Affiliation(s)
- Montse Ballbè
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, Av. Granvia de l'Hospitalet de Llobregat, 199-203, L'Hospitalet de Llobregat 08908, Barcelona, Spain; Catalan Network of Smoke-free Hospitals, Av. Granvia de l'Hospitalet de Llobregat, 199-203, L'Hospitalet de Llobregat 08908, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de l'Hospitalet de Llobregat, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona - IDIBAPS, C. Villarroel 170, 08036 Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, 08907 Barcelona, Spain.
| | - Jose M Martínez-Sánchez
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, Av. Granvia de l'Hospitalet de Llobregat, 199-203, L'Hospitalet de Llobregat 08908, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de l'Hospitalet de Llobregat, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Medicine and Health Sciences School, Universitat Internacional de Catalunya, C. Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Antoni Gual
- Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona - IDIBAPS, C. Villarroel 170, 08036 Barcelona, Spain
| | - Cristina Martínez
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, Av. Granvia de l'Hospitalet de Llobregat, 199-203, L'Hospitalet de Llobregat 08908, Barcelona, Spain; Catalan Network of Smoke-free Hospitals, Av. Granvia de l'Hospitalet de Llobregat, 199-203, L'Hospitalet de Llobregat 08908, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de l'Hospitalet de Llobregat, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Medicine and Health Sciences School, Universitat Internacional de Catalunya, C. Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, Av. Granvia de l'Hospitalet de Llobregat, 199-203, L'Hospitalet de Llobregat 08908, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de l'Hospitalet de Llobregat, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, 08907 Barcelona, Spain
| | - Xisca Sureda
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, Av. Granvia de l'Hospitalet de Llobregat, 199-203, L'Hospitalet de Llobregat 08908, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de l'Hospitalet de Llobregat, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, 08907 Barcelona, Spain
| | - Alicia Padrón-Monedero
- University of Miami, Miller School of Medicine, Department of Public Health Sciences, 1600 NW 10th Ave 1140, Miami, FL 33136, USA
| | - Iñaki Galán
- National Centre for Epidemiology, Instituto de Salud Carlos III, C. Monforte de Lemos, 5, Pabellón 12, 28029 Madrid, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, Av. Granvia de l'Hospitalet de Llobregat, 199-203, L'Hospitalet de Llobregat 08908, Barcelona, Spain; Catalan Network of Smoke-free Hospitals, Av. Granvia de l'Hospitalet de Llobregat, 199-203, L'Hospitalet de Llobregat 08908, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Av. Granvia de l'Hospitalet de Llobregat, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, 08907 Barcelona, Spain
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Martínez-Sánchez JM, Fu M, Ballbè M, Martín-Sánchez JC, Saltó E, Fernández E. Conocimiento y percepción de la nocividad del cigarrillo electrónico en población adulta de Barcelona. Gaceta Sanitaria 2015; 29:296-9. [DOI: 10.1016/j.gaceta.2015.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 11/30/2022]
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Padrón A, Galán I, García-Esquinas E, Fernández E, Ballbè M, Rodríguez-Artalejo F. Exposure to secondhand smoke in the home and mental health in children: a population-based study. Tob Control 2015; 25:307-12. [PMID: 25808665 DOI: 10.1136/tobaccocontrol-2014-052077] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 10/01/2014] [Accepted: 03/04/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To examine the association between exposure to secondhand smoke (SHS) in the home and mental health among children. METHODS Cross-sectional study of 2357 children representative of the Spanish population aged 4-12 years in 2011-2012. Duration of SHS exposure in children was reported by parents. Probable mental disorder was defined as a score>90th centile in the parental version of the Strengths and Difficulties Questionnaire (SDQ). Statistical analysis was performed with logistic regression and adjusted for sociodemographic variables, lifestyle, neighbourhood environment and family characteristics, including parental mental health. RESULTS Among study participants, 6.9% (95% CI 5.7% to 8.0%) were exposed to SHS in the home for <1 h/day and 4.5% (95% CI 3.5% to 5.5%) for ≥1 h/day. Compared to children not habitually exposed to SHS, the multivariate ORs for probable mental disorder were 1.49 (95% CI 0.85 to 2.62) for SHS exposure<1 h/day and 2.73 (95% CI 1.38 to 5.41) for SHS exposure≥1 h/day (p for linear trend=0.002). The corresponding ORs for attention-deficit and hyperactivity disorder (ADHD) were 2.18 (95% CI 1.30 to 3.64) for <1 h/day exposure and 3.14 (95% CI 1.63 to 6.04) for ≥1 h/day exposure (p for linear trend<0.001). No association was found between SHS and the rest of the components of the SDQ. CONCLUSIONS Among children, SHS exposure in the home during ≥1 h/day is associated with a higher frequency of mental disorder. This association was mostly due to the impact of SHS on ADHD.
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Affiliation(s)
- Alicia Padrón
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Miami, Florida, USA
| | - Iñaki Galán
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ, Madrid, Spain
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ, Madrid, Spain CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain Department of Clinical Sciences, Universitat de Barcelona, Campus de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ, Madrid, Spain CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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