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Schiavone S, Anderson C, Mons U, Winkler V. Prevalence of second-hand tobacco smoke in relation to smoke-free legislation in the European Union. Prev Med 2022; 154:106868. [PMID: 34740674 DOI: 10.1016/j.ypmed.2021.106868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
Exposure to second-hand smoke (SHS) is an important public health problem. We assessed SHS exposure in restaurants and bars across the European Union (EU) and studied associations with country-level smoke-free legislation. Data of Eurobarometer surveys 2014 and 2017 were used to estimate country-specific prevalence of observing smoking in restaurants and bars, which can be considered a marker of SHS exposure. Additionally, we used multilevel logistic regression models to study associations with comprehensiveness of national smoke-free regulations in restaurants and bars, which were derived from the Tobacco Control Scale. In total, 44,809 people from all 28 EU member states were included in the analysis. The results of the multilevel logistic analysis show that in countries with complete and extensive bans, respondents were less likely to have observed people smoking inside restaurants than in countries with partial bans, which represented the lowest level of smoke-free policy implementation (OR 0.24, 95%CI 0.10-0.57 for complete ban and OR 0.23, 95%CI 0.10-0.54 for incomplete but extensive ban). Also, the prevalence of seeing people smoking in a bar was lower in the countries with an extensive ban (OR 0.23 95%CI 0.11-0.45) and with a complete ban (OR 0.20 95%CI 0.10-0.40). Between 2014 and 2017, SHS exposure in restaurants and bars decreased significantly. Our results confirm that in countries with extensive or complete smoking bans, people were less exposed to SHS in restaurants and bars; and that partial bans are less effective in reducing SHS exposure.
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Affiliation(s)
- Sara Schiavone
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Carrie Anderson
- Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Ute Mons
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Cancer Prevention Unit, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Volker Winkler
- Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany.
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2
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Neuberger M. Tobacco, Nicotine and Health. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:740. [PMID: 34440946 PMCID: PMC8398791 DOI: 10.3390/medicina57080740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022]
Abstract
Recent studies have explored improvements in smoking prevention and cessation to reduce smoking prevalence, however, in Europe, only Finland has already set a date to become nicotine free. Studies reporting on central, eastern and southern Europe have mostly focused on combustible cigarettes up to now. In young people, correlations were found between traditional smoking, the "vaping" of e-cigarettes, experimentation with alcohol intoxication, and the use of illicit drugs. Prevention and cessation should include strategies against active and passive exposures to new nicotine products. This is a prerequisite for a successful public health policy and a future end-game against the business interests of the tobacco industry and its allies.
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Affiliation(s)
- Manfred Neuberger
- Commission on Climate and Air Quality, Austrian Academy of Science, 1010 Vienna, Austria;
- Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria
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Axelsson Fisk S, Lindström M, Perez-Vicente R, Merlo J. Understanding the complexity of socioeconomic disparities in smoking prevalence in Sweden: a cross-sectional study applying intersectionality theory. BMJ Open 2021; 11:e042323. [PMID: 33574148 PMCID: PMC7880088 DOI: 10.1136/bmjopen-2020-042323] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Socioeconomic disparities in smoking prevalence remain a challenge to public health. The objective of this study was to present a simple methodology that displays intersectional patterns of smoking and quantify heterogeneities within groups to avoid inappropriate and potentially stigmatising conclusions exclusively based on group averages. SETTING This is a cross-sectional observational study based on data from the National Health Surveys for Sweden (2004-2016 and 2018) including 136 301 individuals. We excluded people under 30 years of age, or missing information on education, household composition or smoking habits. The final sample consisted on 110 044 individuals or 80.7% of the original sample. OUTCOME Applying intersectional analysis of individual heterogeneity and discriminatory accuracy (AIHDA), we investigated the risk of self-reported smoking across 72 intersectional strata defined by age, gender, educational achievement, migration status and household composition. RESULTS The distribution of smoking habit risk in the population was very heterogeneous. For instance, immigrant men aged 30-44 with low educational achievement that lived alone had a prevalence of smoking of 54% (95% CI 44% to 64%), around nine times higher than native women aged 65-84 with high educational achievement and living with other(s) that had a prevalence of 6% (95% CI 5% to 7%). The discriminatory accuracy of the information was moderate. CONCLUSION A more detailed, intersectional mapping of the socioeconomic and demographic disparities of smoking can assist in public health management aiming to eliminate this unhealthy habit from the community. Intersectionality theory together with AIHDA provides information that can guide resource allocation according to the concept proportionate universalism.
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Affiliation(s)
- Sten Axelsson Fisk
- Unit for Social Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Martin Lindström
- Unit for Social Medicine and Health Policy, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Center for Primary Health Care Research, Region Skåne, Malmö, Sweden
| | - Raquel Perez-Vicente
- Unit for Social Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Juan Merlo
- Unit for Social Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Center for Primary Health Care Research, Region Skåne, Malmö, Sweden
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Ekezie W, Murray RL, Agrawal S, Bogdanovica I, Britton J, Leonardi-Bee J. Quality of smoking cessation advice in guidelines of tobacco-related diseases: An updated systematic review. Clin Med (Lond) 2020; 20:551-559. [PMID: 33199319 PMCID: PMC7687319 DOI: 10.7861/clinmed.2020-0359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Tobacco smoking is a major risk factor for a wide range of diseases, and smoking cessation significantly reduces these risks. Clinical guidelines for diseases associated with smoking should therefore include guidance on smoking cessation. This review updated evidence on the proportion of clinical guidelines that do so. We conducted a systematic review investigating clinical guidelines and recommendations developed by UK national or European transnational medical specialty associations and societies between January 2014 and October 2019 on 16 diseases to be at least twice as common among smokers than non-smokers. Outcomes of interest were the reporting of smoking as a risk factor, and the inclusion either of smoking cessation advice or referral to other cessation guidance. We compared our findings with an earlier review of guidelines published between 2000 and 2013. We identified 159 clinical guidelines/recommendations. Over half (51%) made no mention of smoking, while 43% reported smoking as a risk factor for the development of the disease, 31% recommended smoking cessation and 19% provided detailed information on how to deliver smoking cessation support. These proportions were similar to those in our earlier review. Smoking cessation continues to be neglected in clinical management guidance for diseases caused by smoking.
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González-Salgado IDL, Rivera-Navarro J, Sureda X, Franco M. Qualitative examination of the perceived effects of a comprehensive smoke-free law according to neighborhood socioeconomic status in a large city. SSM Popul Health 2020; 11:100597. [PMID: 32478163 PMCID: PMC7251368 DOI: 10.1016/j.ssmph.2020.100597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/17/2022] Open
Abstract
Smoke-free legislations aim to protect non-smokers from second-hand smoke (SHS) exposure and improve population health outcomes. The aim of this study was to explore residents' perceptions to understand how people living in distinctive SES neighborhoods are differently affected by comprehensive smoke-free laws in a large city like Madrid, Spain. We conducted a qualitative project with 37 semi-structured interviews and 29 focus group discussions in three different SES neighborhoods within the city of Madrid. Constructivist grounded theory was used to analyze the transcripts. One core category arose in our analyses: Neighborhood inequalities in second-hand smoke (SHS) exposure in outdoor places. The enactment of the comprehensive smoke-free law resulted in unintended consequences that affected neighborhoods differently: relocation of smokers to outdoor setting, SHS exposure, noise disturbance and cigarette butt littering. Changes in the urban environment in the three neighborhoods resulted in the denormalization of smoking in outdoor public places, which was more clearly perceived in the high SES neighborhood. Changes in the built environment in outdoor areas of hospitality venues were reported to actually facilitate smoking. Comprehensive smoke-free laws resulted in denormalization of smoking, which might be effective in reducing SHS exposure. Extending smoking bans to outdoor areas like bus stops and hospitality venues is warranted and should include a public health inequalities perspective.
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Affiliation(s)
| | - Jesús Rivera-Navarro
- Sociology and Communication Department, Social Science Faculty, University of Salamanca, Salamanca, Spain
| | - Xisca Sureda
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY 10027, United States
- Tobacco Control Research Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, l’Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Manuel Franco
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY 10027, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Kapan A, Stefanac S, Sandner I, Haider S, Grabovac I, Dorner T. Use of Electronic Cigarettes in European Populations: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1971. [PMID: 32192139 PMCID: PMC7142603 DOI: 10.3390/ijerph17061971] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 12/28/2022]
Abstract
The increasing popularity of electronic cigarettes in past decades has aroused public health concern. This study aims to review the literature on the prevalence of e-cigarette use among the general adult and young populations in Europe. We searched Medline and Google Scholar from September 2019, and included "prevalence of e-cigarettes", "electronic cigarettes" or "e-cigarettes", and "electronic nicotine delivery system" or "vaping". The prevalence of current e-cigarette use ranged from 0.2% to 27%, ever-use ranged from 5.5% to 56.6% and daily use ranged from 1% to 2.9%. Current smokers of conventional cigarettes showed the highest prevalence for the use of e-cigarettes, ranging from 20.4% to 83.1%, followed by ex-smokers, with ranges from 7% to 15%. The following socio-demographic factors were associated with a higher chance of using e-cigarettes: male sex and younger age groups; results for economic status were inconclusive. In European countries, there is a higher prevalence of e-cigarette use among males, adolescents and young adults, smokers of conventional cigarettes, and former smokers.
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Affiliation(s)
- A. Kapan
- Department of Social and Preventive Medicine, Centre of Public Health, Medical University of Vienna, Vienna 1090, Austria; (S.S.); (I.S.); (S.H.); (I.G.); (T.E.D.)
| | - S. Stefanac
- Department of Social and Preventive Medicine, Centre of Public Health, Medical University of Vienna, Vienna 1090, Austria; (S.S.); (I.S.); (S.H.); (I.G.); (T.E.D.)
- Institute of Outcomes Research, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna 1090, Austria
| | - I. Sandner
- Department of Social and Preventive Medicine, Centre of Public Health, Medical University of Vienna, Vienna 1090, Austria; (S.S.); (I.S.); (S.H.); (I.G.); (T.E.D.)
| | - S. Haider
- Department of Social and Preventive Medicine, Centre of Public Health, Medical University of Vienna, Vienna 1090, Austria; (S.S.); (I.S.); (S.H.); (I.G.); (T.E.D.)
| | - I. Grabovac
- Department of Social and Preventive Medicine, Centre of Public Health, Medical University of Vienna, Vienna 1090, Austria; (S.S.); (I.S.); (S.H.); (I.G.); (T.E.D.)
| | - T.E. Dorner
- Department of Social and Preventive Medicine, Centre of Public Health, Medical University of Vienna, Vienna 1090, Austria; (S.S.); (I.S.); (S.H.); (I.G.); (T.E.D.)
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