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Kauczor HU, Baird AM, Blum TG, Bonomo L, Bostantzoglou C, Burghuber O, Čepická B, Comanescu A, Couraud S, Devaraj A, Jespersen V, Morozov S, Nardi Agmon I, Peled N, Powell P, Prosch H, Ravara S, Rawlinson J, Revel MP, Silva M, Snoeckx A, van Ginneken B, van Meerbeeck JP, Vardavas C, von Stackelberg O, Gaga M. ESR/ERS statement paper on lung cancer screening. Eur Respir J 2020; 55:13993003.00506-2019. [PMID: 32051182 DOI: 10.1183/13993003.00506-2019] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/16/2019] [Indexed: 12/18/2022]
Abstract
In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.
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Kauczor HU, Baird AM, Blum TG, Bonomo L, Bostantzoglou C, Burghuber O, Čepická B, Comanescu A, Couraud S, Devaraj A, Jespersen V, Morozov S, Agmon IN, Peled N, Powell P, Prosch H, Ravara S, Rawlinson J, Revel MP, Silva M, Snoeckx A, van Ginneken B, van Meerbeeck JP, Vardavas C, von Stackelberg O, Gaga M. ESR/ERS statement paper on lung cancer screening. Eur Radiol 2020; 30:3277-3294. [PMID: 32052170 DOI: 10.1007/s00330-020-06727-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/16/2019] [Indexed: 12/17/2022]
Abstract
In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.Key Points• Pulmonologists and radiologists both have key roles in the set up of multidisciplinary LCS teams with experts from many other fields.• Pulmonologists identify people eligible for LCS, reach out to family doctors, share the decision-making process and promote tobacco cessation.• Radiologists ensure appropriate image quality, minimum dose and a standardised reading/reporting algorithm, together with a clear definition of a "positive screen".• Strict algorithms define the exact management of screen-detected nodules and incidental findings.• For LCS to be (cost-)effective, it has to target a population defined by risk prediction models.
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Nelson JL, Kennedy EN, Aldosari M, Agaku I, Vardavas C. Patient-reported receipt of oral cancer screenings and smoking cessation counseling from US oral health care providers: National Health and Nutrition Examination Survey, 2015-2016. J Am Dent Assoc 2019; 150:995-1003. [PMID: 31761028 DOI: 10.1016/j.adaj.2019.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 07/05/2019] [Accepted: 07/09/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Oral health care providers are encouraged to screen for oral cancer (OC) and oropharyngeal cancer (OP) and promote smoking cessation to their patients. In this study, the authors investigated the prevalence and correlates of receiving OC and OP screening and tobacco and OC and OP counseling from oral health care providers. METHODS The authors analyzed self-reported survey data from the National Health and Nutrition Examination Survey 2015-2016 for participants who reported a dental visit. They created different samples for each subanalysis and categorized them according to smoking status. The authors calculated weighted proportions and adjusted odds for receiving tobacco counseling and screening for OC and OP in a dental office. RESULTS Overall, 25.85% of US adults 30 years or older who had ever visited an oral health care professional received OC and OP screening. Odds of receiving an OC and OP screening were lower among current cigarette smokers than among never cigarette smokers (adjusted odds ratio [AOR], 0.47; 95% confidence interval [CI], 0.30 to 0.74) and among non-Hispanic blacks (AOR, 0.36; 95% CI, 0.22 to 0.59), Mexican Americans (AOR, 0.23; 95% CI, 0.10 to 0.53), non-Hispanic Asians (AOR, 0.21; 95% CI, 0.13 to 0.35), and those of other races (AOR, 0.39; 95% CI, 0.24 to 0.65), than among non-Hispanic whites. Participants with a high school education or more had higher odds of receiving an OC and OP screening (AOR, 1.88; 95% CI, 1.04 to 3.43) and counseling for screening (AOR, 1.64; 95% CI, 1.07 to 2.51) than did those with less than a high school education. Participants with family incomes of 400% or more of the federal poverty guideline had higher odds of receiving OC and OP screening (AOR, 5.17; 95% CI, 2.06 to 12.94) but lower odds of receiving tobacco counseling (AOR, 0.45; 95% CI, 0.24 to 0.82) than did participants with family incomes of less than 100% of the federal poverty guideline. CONCLUSIONS Oral health care providers underscreen for OC and OP among high-risk groups, including current cigarette smokers, minorities, and people of low socioeconomic status. The authors charge oral health care educators to include OC and OP screening and smoking cessation counseling in training and continuing education programs to increase the confidence of oral health care providers. PRACTICAL IMPLICATIONS Potential to influence change on current pre-doctoral clinical training programs and to increase opportunities for continuing education courses that review the importance of, as well as, how to successfully complete smoking cessation counseling.
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Mechili EA, Nikitara K, Girvalaki C, Kyriakos C, Vardavas C. Patient journey pain points in spondyloarthritis and
psoriasis: The case of Greece. POPULATION MEDICINE 2019. [DOI: 10.18332/popmed/113401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Przewoźniak K, Zatoński M, Herbeć A, Zatoński W, Janik-Koncewicz K, Mons U, Fong G, Quah A, Driezen P, Demjén T, Tountas Y, Trofor A, Fernández E, McNeill A, Willemsen M, Hummel K, Kyriakos C, Vardavas C, consortium OBOTEURESTPLUS. Attitudes towards tobacco control policies among smokers of menthol, other flavored and unflavored cigarettes: Findings from the EUREST-PLUS ITC Europe Surveys. Tob Induc Dis 2019. [DOI: 10.18332/tid/111545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Filippidis FT, Mechili EA, Girvalaki C, Vardavas C. Cost, prevalence and correlates of cigarillo use in 28 European countries in 2017. Cent Eur J Public Health 2019; 27:182-187. [PMID: 31580551 DOI: 10.21101/cejph.a5583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 07/27/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Although manufactured cigarettes remain the most popular tobacco product worldwide, the use of other products, including little cigar and cigarillo, has been rising in recent years; however, there is a paucity of data on the correlates of current and ever use of cigarillos in Europe. The aim of this study was to explore the extent and determinants of cigarillo use, as well as to describe the cost and affordability of cigarillos across the EU, in light of the current regulatory framework at a European level. METHODS We performed a secondary analysis of data collected across 28 European Union (EU) Member States through wave 87.1 of the Eurobarometer survey, conducted in March 2017 (N = 27,901). A multilevel logistic regression model was fitted to assess the association of current and ever cigarillo use with the above socio-demographic factors. We also analysed Euromonitor International data on cigarillo prices in 2017 from 24 EU Member States. RESULTS Across the EU, 0.46% (95% CI: 0.33-0.63) of those aged ≥ 15 years reported at least weekly current use of cigarillos in 2017, which corresponds to 1,966,516 (95% CI: 1,426,554-2,709,563) people. Finland recorded the highest prevalence (20.51%) of ever cigarillo use in Europe while Ireland had the lowest (1.15%). Male sex, living in urban area and being over 55 years old compared to 15-24 year olds were associated with greater odds of ever cigarillo use. Median cigarillo prices varied widely, ranging from 3.60 Euros in Portugal to 20.40 Euros in Bulgaria per 20 sticks. CONCLUSIONS The use of cigarillos in Europe is associated with several socio-demographic factors such as gender, age and living area. Policy makers of EU countries, especially now under the regulatory framework of the EU Tobacco Products Directive, should work together to enforce more restrictive rules for cigarillos.
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Daivadanam M, Ingram M, Sidney Annerstedt K, Parker G, Bobrow K, Dolovich L, Gould G, Riddell M, Vedanthan R, Webster J, Absetz P, Mölsted Alvesson H, Androutsos O, Chavannes N, Cortez B, Devarasetty P, Fottrell E, Gonzalez-Salazar F, Goudge J, Herasme O, Jennings H, Kapoor D, Kamano J, Kasteleyn MJ, Kyriakos C, Manios Y, Mogulluru K, Owolabi M, Lazo-Porras M, Silva W, Thrift A, Uvere E, Webster R, van der Kleij R, van Olmen J, Vardavas C, Zhang P. The role of context in implementation research for non-communicable diseases: Answering the 'how-to' dilemma. PLoS One 2019; 14:e0214454. [PMID: 30958868 PMCID: PMC6453477 DOI: 10.1371/journal.pone.0214454] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 03/13/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Understanding context and how this can be systematically assessed and incorporated is crucial to successful implementation. We describe how context has been assessed (including exploration or evaluation) in Global Alliance for Chronic Diseases (GACD) implementation research projects focused on improving health in people with or at risk of chronic disease and how contextual lessons were incorporated into the intervention or the implementation process. Methods Using a web-based semi-structured questionnaire, we conducted a cross-sectional survey to collect quantitative and qualitative data across GACD projects (n = 20) focusing on hypertension, diabetes and lung diseases. The use of context-specific data from project planning to evaluation was analyzed using mixed methods and a multi-layered context framework across five levels; 1) individual and family, 2) community, 3) healthcare setting, 4) local or district level, and 5) state or national level. Results Project teams used both qualitative and mixed methods to assess multiple levels of context (avg. = 4). Methodological approaches to assess context were identified as formal and informal assessments, engagement of stakeholders, use of locally adapted resources and materials, and use of diverse data sources. Contextual lessons were incorporated directly into the intervention by informing or adapting the intervention, improving intervention participation or improving communication with participants/stakeholders. Provision of services, equipment or information, continuous engagement with stakeholders, feedback for personnel to address gaps, and promoting institutionalization were themes identified to describe how contextual lessons are incorporated into the implementation process. Conclusions Context is regarded as critical and influenced the design and implementation of the GACD funded chronic disease interventions. There are different approaches to assess and incorporate context as demonstrated by this study and further research is required to systematically evaluate contextual approaches in terms of how they contribute to effectiveness or implementation outcomes.
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Kyriakos C, Vardavas A, Tzatzarakis M, Girvalaki C, Tsatsakis A, Vardavas C. Establishing a reference group of tobacco products representative of the EU market to support the decision on whether a tobacco product has a characterising flavour: Findings from the EUREST-FLAVOURS project. Tob Prev Cessat 2019. [DOI: 10.18332/tpc/105193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Przewoźniak K, Zatoński M, Herbeć A, Zatoński W, Janik-Koncewicz K, Mons U, Fong G, Quah A, Driezen P, Demjén T, Tountas Y, Trofor A, Fernández E, McNeill A, Willemsen M, Hummel K, Kyriakos C, Vardavas C, EUREST-PLUS consortium OBOT. Characterizing smoking, cessation behaviours and attitudes toward tobacco control policies among smokers of menthol and flavored cigarettes: the EUREST-PLUS ITC Europe Surveys. Tob Prev Cessat 2019. [DOI: 10.18332/tpc/105386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Girvalaki C, Tzatzarakis M, Vardavas A, Kyriakos C, Karzi V, Stivaktakis P, Tsatsakis A, Vardavas C. Flavors, additives and nicotine levels detected among the most popular e-cigarette refill liquids across 9 European countries after the implementation of Tobacco Products Directive (TPD). Tob Prev Cessat 2019. [DOI: 10.18332/tpc/105201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nogueira S, Fu M, Fernandez E, Vardavas C, Fong G. Cigarette brand attachment among smokers in six European countries. Tob Prev Cessat 2019. [DOI: 10.18332/tpc/105159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kyriakos C, Driezen P, Girvalaki C, Kahnert S, Hitchman S, Fernandez E, Mons U, Trofor A, Demjén T, Tountas Y, Przewoźniak K, Zatoński W, Fong G, Vardavas C. Awareness of changes to tobacco product content and packaging design after implementation of the EU Tobacco Products Directive among smokers: Findings from the EUREST-PLUS ITC Europe Surveys. Tob Prev Cessat 2019. [DOI: 10.18332/tpc/105208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Girvalaki C, Tzatzarakis M, Kyriakos CN, Vardavas AI, Stivaktakis PD, Kavvalakis M, Tsatsakis A, Vardavas C. Composition and chemical health hazards of the most common electronic cigarette liquids in nine European countries. Inhal Toxicol 2018; 30:361-369. [PMID: 30369275 DOI: 10.1080/08958378.2018.1527879] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The aim of the present study was to identify the composition and reported chemical health hazards of the most common electronic cigarette liquids (e-liquids) in nine European Union (EU) Member States (MS) prior to adoption of the Tobacco Product Directive (TPD). MATERIALS AND METHODS Within the Horizon2020, EUREST-PLUS study, 122 of the most commonly sold e-liquids in 9 EU MS were randomly selected and purchased. A quantitative and qualitative chemical analysis was performed using a previously validated based gas chromatography-mass spectrometry and liquid chromatography-mass spectrometry method. The most commonly detected compounds were then divided according to the Danger Globally Harmonized System of Classification and Labelling of Chemicals (GHS) and Warning GHS codes. RESULTS Within our qualitative analysis, 171 different compounds were detected. Discrepancies in measured versus reported nicotine concentration were identified. Forty-one (85.4%) of the most commonly detected compounds were registered with Warning GHS codes, 11 with Danger GHS codes and 9 with both codes. Of the total number of the detected compounds, 293 were attributable to fruits flavor, followed by tobacco flavor (204), nonalcoholic drinks (n = 64), desserts-sweets (n = 50), menthol - mint (n = 42) and alcohol (n = 39). Menthol which is classified as a strong irritant to skin and eye was the most frequently detected compound. CONCLUSION A large plethora of compounds with varying warning codes was identified in e-cigarette samples. The systematic monitoring and chemical evaluation of e-liquids are warranted, so as to ensure consumer protection.
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Girvalaki C, Tzatzarakis M, Kyriakos C, Vardavas A, Stivaktakis P, Kavvalakis M, Tsatsakis A, Vardavas C. Chemical analysis and hazard identification of the most common electronic cigarette liquids in nine European countries. Tob Induc Dis 2018. [DOI: 10.18332/tid/95141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Petroulia I, Kyriakos C, Papadakis S, Tzavara C, Filippidis F, Girvalaki C, Peleki T, Katsaounou P, McNeill A, Mons U, Fernández E, Demjén T, Trofor A, Herbec A, Zatoński W, Tountas Y, Fong G, Vardavas C, Consortium *BOTEURESTPLUS. Quitting behaviors and cessation assistance used among smokers with anxiety or depression: Findings among six countries of the EUREST-PLUS ITC Europe Surveys. Tob Induc Dis 2018. [DOI: 10.18332/tid/95145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Kyriakos C, Filippidis F, Hitchman S, Girvalaki C, Tzavara C, Demjén T, Fernández E, Mons U, Trofor A, Tountas Y, Zatoński M, Zatoński W, Fong G, Vardavas C, consortium *BOTEURESTPLUS. Undesirable events during electronic cigarette use prior to the implementation of Article 20 of the European Union Tobacco Products Directive: Findings from the EUREST-PLUS ITC Europe Surveys. Tob Induc Dis 2018. [DOI: 10.18332/tid/95144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Vardavas C, Bécuwe N, Demjén T, Fernández E, McNeill A, Mons U, Tountas Y, Trofor A, Tsatsakis A, Rohde G, Willemsen M, Przewoźniak K, Zatoński W, Fong G, Consortium* OBOTEURESTPLUS. Evaluating the European Union (EU) Tobacco Products Directive: Findings from the EUREST-PLUS ITC cohort study among six EU Member States (MS). Tob Induc Dis 2018. [DOI: 10.18332/tid/95140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Vardavas C, Kyriakos C, Tsatsakis A, Vardavas A, Tzatzarakis M. EUREST-FLAVOURS: European Regulatory Science on Tobacco to support the assessment of characterising flavours in tobacco products. Tob Induc Dis 2018. [DOI: 10.18332/tid/94776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Vardavas C, Behrakis P, Tzortzi A, Kilibarda B. Ensuring sustainability and dissemination of
TPD and JATC activities in Europe. Tob Induc Dis 2018. [DOI: 10.18332/tid/95251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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70
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Tzatzarakis M, Girvalaki C, Vardavas A, Stivaktakis P, Nosyrev A, Leon G, Tsatsakis A, Vardavas C. Evaluation of e-cigarette liquids on labelling, packaging and technical features prior the adoption of the Tobacco Products Directive (TPD) in multiple European countries. Toxicol Lett 2018. [DOI: 10.1016/j.toxlet.2018.06.1056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mechili E, Girvalaki C, Peto E, Risilia R, Kicaj E, Filippidis F, Vardavas C. Tobacco use and rates of 4As delivery for treating tobacco dependence among Albanian students. A cross-sectional study. Tob Induc Dis 2018. [DOI: 10.18332/tid/95113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Kahnert S, Mons U, Fong G, Quah A, Vardavas C, EUREST-PLUS and ITC Project OBOT. Real-world effectiveness of national tobacco advertising bans among smokers – A comparison of six EU-countries (ITC 6 European Country Project) from the EUREST-PLUS Project. Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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73
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Girvalaki C, Tzatzarakis M, Vardavas AI, Stivaktakis P, Kyriakos C, Papadakis S, Tsatsakis A, Vardavas C. What is the content of the electronic cigarette liquids according to their flavor? An evaluation in nine European Union countries before TPD implementation. Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mechili E, Girvalaki C, Filippidis F, Risilia R, Breshanaj A, Kicaj E, Vardavas C. Lack of Implementation of WHO Framework Convention on Tobacco Control (WHO FCTC) in Albania: An Urgent Issue to Tackle. Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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75
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Tigova O, Castellano Y, Fu M, Agar T, Fong G, Quah A, Vardavas C, Fernández E, and ITC Projects OBOTEURESTPLUS. Use of e-cigarettes and second-hand exposure to their aerosols in Europe: findings from the ITC 6 European country survey (EUREST-PLUS project). Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Demi M, Vyzikidou VK, Teloniatis S, Matiampa G, Evangelopoulou V, Vardavas C, Tzortzi A, Behrakis P. Attitudes of the Greek Public towards the implementation of the smoking ban law. TOBACCO PREVENTION & CESSATION 2018. [DOI: 10.18332/tpc/90472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Fernández E, Tigova O, Castellano Y, Fu M, Agar T, Fong G, Quah A, Vardavas C, and ITC Projects OBOTEURESTPLUS. Compliance with smoke-free legislation in six European countries (2016): findings from the ITC 6 European country survey (EUREST-PLUS project). Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Vardavas C. Assessing e-cigarette product compliance to the TPD. Tob Prev Cessat 2018. [DOI: 10.18332/tpc/91103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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79
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Fu M, Tigova O, Castellano Y, Agar T, Fong G, Quah ACK, Vardavas C, Fernández E, and ITC Projects OBOTEURESTPLUS. Do European smokers opt for partial or total bans on smoking in homes and cars? Findings from the ITC 6 European country survey (EUREST-PLUS project). Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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80
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Demi M, Teloniatis S, Vyzikidou VK, Bakelas G, Evangelopoulou V, Vardavas C, Tzortzi A, Behrakis P. Smoking Prevalence in Greece. Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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81
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Mechili E, Girvalaki C, Kicaj E, Risilia R, Breshanaj A, Filippidis F, Vardavas C. Tobacco Addiction in Young Population and Factors Associated with Motivation to Quit; The Case of University of Vlora, Albania Students. Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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82
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Filippidis F, Jawad M, Vardavas C. Trends and correlates of waterpipe use in the European Union, 2009-2017. Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Vardavas C. The role of ENSP and European cooperation for improving research in the field of tobacco control in Central and Eastern Europe. Tob Prev Cessat 2018. [DOI: 10.18332/tpc/91126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Girvalaki C, Papadakis S, Vardavas C, Pipe AL, Petridou E, Tsiligianni I, Lionis C. Training General Practitioners in Evidence-Based Tobacco Treatment: An Evaluation of the Tobacco Treatment Training Network in Crete (TiTAN-Crete) Intervention. HEALTH EDUCATION & BEHAVIOR 2018; 45:888-897. [PMID: 29862845 DOI: 10.1177/1090198118775481] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rates of tobacco treatment delivery in primary care are suboptimal. AIMS We report on the effectiveness of the TiTAN Crete intervention on rates of patient-reported 4As (ask, advise, assist, arrange) tobacco treatment and general practitioner's (GP) knowledge, attitudes, self-efficacy, and intentions. METHODS A quasi-experimental pilot study with pre-post evaluation was conducted in Crete, Greece (2015-2016). GPs ( n = 24) intervention and control group and a cross-sectional sample of their patients ( n = 841) were surveyed before the implementation of the intervention. GPs in the intervention group received training, practice, and patient tools to support the integration of the 4As treatment into clinical routines. Intervention group GPs ( n = 14) and a second cross-sectional sample of patients ( n = 460) were surveyed 4 months following the intervention to assess changes in outcomes of interest. Multilevel modeling was used to analyze data. RESULTS Among GPs exposed to the intervention, significant increases in knowledge, self-efficacy, and rates of 4As delivery were documented between the pre- and postassessment and compared with those of the control group. Specifically, the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for 4As delivery between the pre-and postassessment among GPs exposed to the TiTAN intervention were as follows: Ask AOR 3.66 (95% CI [2.61, 5.14]); Advise AOR 4.21 (95% CI [3.02, 5.87]); Assist AOR 13.10 (95% CI [8.83, 19.42]) and Arrange AOR 4.75 (95% CI [2.67, 8.45]). CONCLUSION We found significant increases in rates at which GPs delivered evidence-based tobacco treatment following exposure to the TiTAN intervention. Future research should examine methods for supporting broader dissemination of well-designed training interventions in general practice.
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Girvalaki C, Papadakis S, Vardavas C, Petridou E, Pipe A, Lionis C. Smoking cessation delivery by general practitioners in Crete, Greece. Eur J Public Health 2018; 28:542-547. [PMID: 29140450 DOI: 10.1093/eurpub/ckx201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Tobacco dependence treatment in clinical settings is of prime public health importance, especially in Greece, a country experiencing one of the highest rates of tobacco use in Europe. Methods Our study aimed to examine the characteristics of tobacco users and document rates of tobacco treatment delivery in general practice settings in Crete, Greece. A cross-sectional sample of patients (n = 2, 261) was screened for current tobacco use in 25 general practices in Crete, Greece in 2015/16. Current tobacco users completed a survey following their clinic appointment that collected information on patient characteristics and rates at which the primary care physician delivered tobacco treatment using the evidence-based 4 A's (Ask, Advise, Assist, Arrange) model during their medical appointment and over the previous 12-month period. Multi-level modeling was used to analyze data and examine predictors of 4 A's delivery. Results Tobacco use prevalence was 38% among all patients screened. A total of 840 tobacco users completed the study survey [mean age 48.0 (SD 14.5) years, 57.6% male]. Approximately, half of the tobacco users reported their general practitioner 'asked' about their tobacco use and 'advised' them to quit smoking. Receiving 'assistance' with quitting (15.7%) and 'arranging' follow-up support (<3%) was infrequent. Patient education, presence of smoking-related illness, a positive screen for anxiety or depression and the type of medical appointment were associated with 4 A's delivery. Conclusion Given the fundamental importance of addressing tobacco treatment, increasing the rates of 4 A's treatment in primary care settings in Greece is an important target for improving patient care.
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Papadakis S, Girvalaki C, Vardavas C, Pipe AL, Cole A, Tsiligianni I, Petridou E, Lionis C. Factors associated with rates of tobacco treatment delivery by General Practitioners in Greece: Missed opportunities for prevention? Tob Induc Dis 2018; 16:21. [PMID: 31516421 PMCID: PMC6659564 DOI: 10.18332/tid/90822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION This study investigates the clinic-, provider- and patient-level factors associated with delivery of 4 (Ask, Advise, Assist, Arrange) elements of the 5As approach to smoking cessation in general practice in Greece. METHODS We conducted a secondary analysis of data derived from a quasi-experimental study (The TiTAN Crete study) among general practitioners (GPs) in Crete, Greece in 2015–2016. Twenty-four GPs and a cross-sectional sample of 1301 smokers from their practices were surveyed. This paper reports on the results of the multi-level modelling conducted to examine predictors of 4As delivery. RESULTS Our analysis found clinic characteristics, including the presence of an electronic medical record, being located in a rural setting, and being in private practice were significantly associated with increased rates of tobacco treatment delivery. Female GPs were more likely than males to arrange follow-up (AOR 3.38, 95%CI 1.11, 10.35). Our analysis found a variety of patient-level factors were positively associated with tobacco treatment delivery, including: longer smoking history; presence of a smoking related illness; readiness to quit smoking; and symptoms or a diagnosis of anxiety, depression or other mental health illness. Other patient-level factors were negatively associated with tobacco treatment delivery, including level of education and reason for visit. Patients seen in clinic for episodic care were less likely to be ‘asked’ (AOR 0.22, 95%CI 0.12, 0.39), ‘advised’ (AOR 0.22, 95%CI 0.13, 0.38), and receive ‘assistance’ (AOR 0.36, 95%CI 0.19, 0.66) compared to patients seen in clinic for a medical examination. CONCLUSIONS Providers are significantly more frequently delivering tobacco treatment to a sub-group of high-risk patients compared to other tobacco users in their clinical practice. This results in missed opportunities for early intervention and disease prevention.
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Tzortzi A, Teloniatis SI, Matiampa G, Bakelas G, Vyzikidou VK, Vardavas C, Behrakis PK, Fernandez E. Passive exposure to e-cigarette emissions: Immediate respiratory effects. Tob Prev Cessat 2018; 4:18. [PMID: 32411845 PMCID: PMC7205134 DOI: 10.18332/tpc/89977] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 04/16/2018] [Accepted: 04/16/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The present work examined the effect of passive exposure to electronic-cigarette (e-cigarette) emissions on respiratory mechanics and exhaled inflammatory biomarkers. METHODS A cross-over experimental study was conducted with 40 healthy nonsmokers, 18-35 years old with normal physical examination and spirometry, with body mass index <30 kg/m2, who were exposed to e-cigarette emissions produced by a smoker, according to a standardized protocol based on two resistance settings, 0.5 ohm and 1.5 ohm, for e-cigarette use. All participants underwent a 30-minute control (no emissions) and two experimental sessions (0.5 and 1.5 ohm exposure) in a 35 m3 room. The following Impulse Oscillometry (IOS) parameters were measured at pre and post sessions: impedance, resistance, reactance, resonant frequency (fres), frequency dependence of resistance (fdr=R5-R20), reactance area (AX), and fractional exhaled nitric oxide (FeNO). Differences between pre and post measurements were compared using t-tests and Wilcoxon signed rank tests, while analysis of variance (ANOVA) was used for comparisons between experimental sessions (registered under ClinicalTrials.gov ID: NCT03102684). RESULTS IOS and FeNO parameters showed no significant changes during the control session. For IOS during the 1.5 ohm exposure session, fres increased significantly from 11.38 Hz at baseline to 12.16 Hz post exposure (p=0.047). FeNO decreased significantly from 24.16 ppb at baseline to 22.35 ppb post exposure in the 0.5 ohm session (p=0.006). CONCLUSIONS A 30-minute passive exposure to e-cigarette emissions revealed immediate alterations in respiratory mechanics and exhaled biomarkers, expressed as increased fres and reduced FeNO.
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Trofor AC, Papadakis S, Lotrean L, Buculei-Porosnicu I, Vyzikidou VK, Evangelopoulou V, Vardavas C, Behrakis P. Tobacco Treatment Guideline for High Risk Groups: A pilot study in patients with Chronic Obstructive Pulmonary Disease. Tob Induc Dis 2018; 16:13. [PMID: 31516413 PMCID: PMC6659489 DOI: 10.18332/tid/85944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Smoking cessation is a key clinical intervention for reducing progressive lung destruction and lung function deterioration in patients with Chronic Obstructive Pulmonary Disease (COPD). Specialised Tobacco Cessation Guidelines for High-risk Groups (TOB-G) were developed and published in 2017 that present evidence-based recommendations to support smoking cessation in COPD patients. The purpose of this pilot study was to examine the real world effectiveness of the TOB-G guideline recommendations among a sample of COPD patients. METHODS A pilot study was conducted among a sample of COPD patients who smoke and were interested in quitting. Participants were recruited from inpatient and outpatient hospital admissions between October and December 2016 in Iasi, Romania. The intervention program was designed based on the recommendations of the TOB-G guidelines for COPD patients. Patients received a total of four contacts: at baseline, 1, 2, and 6 months. The primary outcome measure was biochemically validated point prevalence smoking abstinence measured at 6 months. RESULTS Fifty patients (74% male; age mean±SD = 60.2±7.8) with diagnosed COPD took part in the pilot study. Self-reported rates of point prevalence smoking abstinence were 30.6%, 44.9% and 64.6% at the 1-, 2-, and 6-month follow-up, respectively. Carbon monoxide testing was completed with 51.6% of the sample at 6 months. The biochemically verified abstinent rate was 33.3% at the 6-month follow-up. CONCLUSIONS This pilot testing of the TOB-G Clinical Practice Guidelines for COPD patients was associated with high rates of patient smoking abstinence, which are of clinical importance. Further research is needed to evaluate the guidelines large-scale effectiveness in clinical practice.
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Agaku I, Odani S, Vardavas C, Neff L. Self-Identified Tobacco Use and Harm Perceptions Among US Youth. Pediatrics 2018; 141:peds.2017-3523. [PMID: 29545271 DOI: 10.1542/peds.2017-3523] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We investigated tobacco-related self-identity and risk perceptions among adolescent tobacco users. METHODS Data were analyzed for 20 675 US sixth- to 12th-graders from the 2016 National Youth Tobacco Survey. Students who reported past-30-day use of a specific tobacco product or ≥2 products but denied having used "any tobacco product" in the past 30 days were classified as not self-identifying as tobacco users. Tobacco product harm perceptions were further assessed across products. Descriptive and multivariable logistic regression analyses were performed. RESULTS Among past-30-day users of ≥1 specific tobacco product type, those denying having used any tobacco products in the past 30 days included single-product users of roll-your-own and/or pipe tobacco (82.2%), electronic cigarettes (e-cigarettes) (59.7%), cigars (56.6%), hookah (44.0%), smokeless tobacco (38.5%), and cigarettes (26.5%) as well as poly-tobacco users (12.7%). The odds of denying using any tobacco products were higher among those without symptoms of nicotine dependence than those with symptoms (adjusted odds ratio = 2.16); and those who access their tobacco products via social sources than those who bought them (adjusted odds ratio = 3.81; all P < .05). Among those believing "all tobacco products" were harmful, single-product users of the following believed their own product was not harmful: e-cigarettes (74.6%), hookah (56.0%), smokeless tobacco (41.8%), and cigarettes (15.5%). CONCLUSIONS Many of those who used certain tobacco products exclusively did not self-identify as tobacco users. Increasing the sensitivity of questions used to assess youth tobacco use in surveys and clinical settings can mitigate nondisclosure or underreporting of true tobacco use status.
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Tigova O, Castellano Y, Fu M, Fong GT, Quah AC, Vardavas C, Fernández E. Do European smokers opt for partial or total bans on smoking in homes and cars? Findings from the ITC 6 European Country Survey (EUREST-PLUS Project). Tob Induc Dis 2018. [DOI: 10.18332/tid/84004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Girvalaki C, Vardavas A, Tzatzarakis M, Stivaktakis P, Tsatsakis A, Behrakis P, Vardavas C. Classification, labelling and packaging of the most popular e-cigarette refill liquids across 9 European countries. Tob Induc Dis 2018. [DOI: 10.18332/tid/84616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Demi M, Evangelopoulou V, Vyzikidou VK, Vogiatzi D, Lyroni A, Tzortzi A, Vardavas C, Behrakis P. Tobacco prevention in Greek school community. Tob Induc Dis 2018. [DOI: 10.18332/tid/84392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Tzortzi A, Teloniatis S, Mattiampa G, Bakellas G, Vyzikidou V, Vardavas C, Fernandez Munoz E, Behrakis P. Passive exposure to e-cigarette emissions: irritation symptoms, severity and duration. Tob Induc Dis 2018. [DOI: 10.18332/tid/84038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Filippidis F, Agaku I, Vardavas C. Transition from experimentation with tobacco and nicotine products to regular smoking in Europe. Tob Induc Dis 2018. [DOI: 10.18332/tid/84024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Petroulia I, Vardavas C, Filippidis F, Peleki T, Behrakis P, Quah AC, Fong GT, Tountas Y. The association between the awareness of the effects of smoking/secondhand smoke and the desire to quit. Tob Induc Dis 2018. [DOI: 10.18332/tid/84622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Vardavas C, Girvalaki C, Vardavas A, Papadakis S, Tzatzarakis M, Behrakis P, Tsatsakis A. Respiratory irritants in e-cigarette refill liquids across nine European countries: a threat to respiratory health? Eur Respir J 2017; 50:50/6/1701698. [DOI: 10.1183/13993003.01698-2017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 09/19/2017] [Indexed: 11/05/2022]
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Vardavas C, Filippidis FT, Ward B, Faure M, Jimenez-Ruiz C, Gratziou C, Katsaounou P, Lozano F, Behrakis P, Radu-Loghin C. Plain packaging of tobacco products in the European Union: an EU success story? Eur Respir J 2017; 50:50/5/1701232. [DOI: 10.1183/13993003.01232-2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 10/02/2017] [Indexed: 11/05/2022]
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Tzatzarakis M, Vardavas A, Girvalaki C, Stivaktakis P, Vardavas C, Tsatsakis A. Flavors and additives detected among the most popular e-cigarette refill liquids across 9 European countries. Toxicol Lett 2017. [DOI: 10.1016/j.toxlet.2017.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Girvalaki C, Vardavas C, Papadakis S, Ayesta J, Arapoglou Y, Bakhturidze G, Bizel P, Cattaruzza M, Demin A, Harutyunyan A, Kilibarda B, Kotarov G, Lila A, Lovse M, Rodriguez Lozano F, Mechili AE, Dumitru M, Peleki T, Przewoźniak K, Saliaj A, Stoyka O, Trofor A, Radu Loghin C, Nguyen D, Behrakis P. EPACTT 2 - Development of a EuroPean Accredited Curriculum on Tobacco Treatment. Tob Prev Cessat 2017. [DOI: 10.18332/tpc/70397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Demi M, Evangelopoulou V, Vyzikidou VK, Vogiatzi D, Lyroni A, Bechraki V, Tzortzi A, Vardavas C, Behrakis P. Outreach of the “SmokeFreeGreece” educational campaign in Greek Schools. Tob Prev Cessat 2017. [DOI: 10.18332/tpc/70395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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