Manufactured and roll-your-own cigarettes: A changing pattern of smoking in Barcelona, Spain

Future intentions and beliefs about roll-your-own cigarettes in adolescents

OBJECTIVE

To determine the predisposition to use roll-your-own (RYO) cigarettes and the beliefs about RYO cigarettes of all the students of 3°-4° of ESO during the years 2016-17 and 2018-19. A cross-sectional study.

SETTING

Bisaura High School from Sant Quirze de Besora. Primary Health Care in the Catalan Health Institute, Catalunya, Spain.

PARTICIPANTS

111 3rd and 4th of ESO (14-16 years).

MAIN MEASUREMENTS

Dependent variables used were future intentions of smoking and beliefs regarding RYO cigarettes. Independent variables were sex, course and ever smoked. The prevalence of the different dependent variables was described and compared according to the different independent variables with Pearson's Khi-square test.

RESULTS

26.6% of the adolescents intended to smoke in the future of which 17.4% intended to smoke RYO cigarettes and 13.8% manufactured cigarettes (MC). Around 30% of adolescents express at least one wrong belief regarding RYO cigarettes. For example, the 26.7% believed that smoking RYO cigarettes generated less addiction than MC and the 32.1% that was less harmful. Those who had smoked at some time in their life had a greater intention to smoke in the future (54.5%), to smoke MC (27.3%) and RYO cigarettes (40.9%) than those who had never smoked (7.7%, 4.6% and 1.5% respectively) (p<0.005). Some misconceptions differed depending on whether adolescents had ever smoked in life, sex and course. The boys believed that smoking RYO cigarettes was more natural than smoking MC (p<0.005).

CONCLUSIONS

Educational activities to improve the information that young people have regarding RYO cigarettes are needed.

Perceptions, Predictors of and Motivation for Quitting among Smokers from Six European Countries from 2016 to 2018: Findings from EUREST-PLUS ITC Europe Surveys

The European Tobacco Products Directive (TPD) was introduced in 2016 in an effort to decrease prevalence of smoking and increase cessation in the European Union (EU). This study aimed to explore quitting behaviours, motivation, reasons and perceptions about quitting, as well as predictors (reported before the TPD implementation) associated with post-TPD quit status. A cohort study was conducted involving adult smokers from six EU countries (n = 3195). Data collection occurred pre-(Wave 1; 2016) and post-(Wave 2; 2018) TPD implementation. Bivariate and logistic regression analyses of weighted data were conducted. Within this cohort sample, 415 (13.0%) respondents reported quitting at Wave 2. Predictors of quitting were moderate or high education, fewer cigarettes smoked per day at baseline, a past quit attempt, lower level of perceived addiction, plans for quitting and the presence of a smoking-related comorbidity. Health concerns, price of cigarettes and being a good example for children were among the most important reasons that predicted being a quitter at Wave 2. Our findings show that the factors influencing decisions about quitting may be shared among European countries. European policy and the revised version of TPD could emphasise these factors through health warnings and/or campaigns and other policies.

Comparison of TSNAs concentration in saliva according to type of tobacco smoked

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.

Prevalence and determinants of tobacco, e-cigarettes, and cannabis use among nursing students: A multicenter cross-sectional study

BACKGROUND

Nurses are important agents in public health, which includes being active in tobacco control. Studies show that nurses who smoke are less inclined to offer smoking cessation aid. Nursing students, as the future labor force of nursing, are one of the key groups to monitor.

OBJECTIVES

To identify the prevalence and determinants of use of several tobacco products, e-cigarettes, and cannabis among nursing students in Catalonia.

DESIGN

Cross-sectional multicenter study.

SETTINGS

15 university nursing schools in Catalonia (Spain) in 2015-2016.

PARTICIPANTS

Nursing students attending class at the day of the survey.

METHODS

An anonymous, self-administered questionnaire based on the Global Health Professional Survey was designed. The questions included information on consumption of several tobacco products (manufactured cigarettes, roll your own cigarettes, etc.), e-cigarettes, and cannabis. We estimated the prevalence of use (%) and computed multilevel logistic regressions models, at two levels, to calculate the odds ratios (OR) and their corresponding 95% confidence intervals (CI), adjusting for several individual sociodemographic variables and the nursing school as a grouping variable.

RESULTS

4381 students participated in the study (57.2% of Nursing students in Catalonia at the time of the survey). 29.7% (95%CI: 27.2-32.2) were smokers (18.4% daily and 11.3% occasionally). 66.4% smoked manufactured cigarettes, 47.0% roll your own cigarettes, 10.0% waterpipe, and 0.4% e-cigarettes. The main predictors of smoking were: being ≥25 years (OR = 2.57, 95%CI: 2.03-3.26) and belonging to other Spanish regions (OR = 1.82, 95%CI: 1.30-2.54). 71.5% had low nicotine dependence as defined by the Heavy Smoking Index. Among 11.5% (95%CI: 10.6-12.4) of students used cannabis (daily or occasionally), and men presented higher odds of use (OR = 2.81, 95%CI: 2.11-3.73) than women.

CONCLUSIONS

Tobacco and cannabis use is high among nursing students. It is necessary to carry out early tobacco and cannabis cessation programs among young nursing students.

Roll-your-own cigarette use in Italy: sales and consumer profile-data from PASSI surveillance, 2015-2016

OBJECTIVES

The use of roll-your-own (RYO) cigarette has substantially increased in most high-income countries recently. This work aims to update Italian trends on loose tobacco sales and to describe the consumer profile of predominant RYO users.

METHODS

Data from the Italian Agency of Customs and State Monopolies and from PASSI (Italian behavioral risk factor surveillance system) were used. Information on 16,858 interviews to current smokers aged 18-69 was analyzed.

RESULTS

Sales of loose tobacco increased more than sevenfold between 2004 and 2017. In 2015-2016, 11.6% of smokers reported smoking predominantly RYO cigarettes, with higher percentages among the youngest where a significant association between use of RYO and education was observed, unlike what happened in older adults. The association between economic difficulties and use of RYO was observed only in older adults.

CONCLUSIONS

A growing trend in RYO cigarette sales was registered between 2004 and 2017. In young smokers, the greater use of RYO was observed among the most educated regardless of financial strain, while in older ones among those with economic difficulties.

Impact of tobacco control policies on smoking prevalence and quit ratios in 27 European Union countries from 2006 to 2014

BACKGROUND

Tobacco use is still highly prevalent in Europe, despite the tobacco control efforts made by the governments. The development of tobacco control policies varies substantially across countries. The Tobacco Control Scale (TCS) was introduced to quantify the implementation of tobacco control policies across European countries OBJECTIVE: To assess the midterm association of tobacco control policies on smoking prevalence and quit ratios among 27 European Union (EU) Member States (EU27).

METHODS

Ecological study. We used the TCS in EU27 in 2007 and the prevalence of tobacco and quit ratios data from the Eurobarometer survey (2006 (n=27 585) and 2014 (n=26 793)). We analysed the relationship between the TCS scores and smoking prevalence and quit ratios and their relative changes (between 2006 and 2014) by means of scatter plots and multiple linear regression models.

RESULTS

In EU27, countries with higher scores in the TCS, which indicates higher tobacco control efforts, have lower prevalence of smokers, higher quit ratios and higher relative decreases in their prevalence rates of smokers over the last decade. The correlation between TCS scores and smoking prevalence (rsp=-0.444; P=0.02) and between the relative changes in smoking prevalence (rsp=-0.415; P=0.03) was negative. A positive correlation was observed between TCS scores and quit ratios (rsp=0.373; P=0.06). The percentage of smoking prevalence explained by all TCS components was 28.9%.

CONCLUSION

EU27 should continue implementing comprehensive tobacco control policies as they are key for reducing the prevalence of smoking and an increase tobacco cessation rates in their population.

Impact of the Spanish smoking legislation among smokers: A longitudinal study with biomarkers in Barcelona (Spain)

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.

Second-hand smoke exposure in outdoor hospitality venues: Smoking visibility and assessment of airborne markers

INTRODUCTION

After the implementation of smoke-free policies in indoor hospitality venues (including bars, cafeterias, restaurants, and pubs), smokers may have been displaced to their outdoor areas. We aimed to study smoking visibility and second-hand smoke exposure in outdoor hospitality venues.

METHODS

We collected information on signs of tobacco consumption on entrances and terraces of hospitality venues in 2016 in the city of Madrid, Spain. We further measured airborne nicotine concentrations and particulate matter of less than 2.5 µm in diameter (PM2.5) in terraces with monitors by active sampling during 30 min. We calculated the medians and the interquartile ranges (IQR) of nicotine and PM2.5 concentrations, and fitted multivariate models to characterize their determinants.

RESULTS

We found 202 hospitality venues between May and September (summer), and 83 between October and December 2016 (fall) that were opened at the time of observation. We found signs of tobacco consumption on 78.2% of the outdoor main entrances and on 95.1% of outdoor terraces. We measured nicotine and PM2.5 concentrations in 92 outdoor terraces (out of the 123 terraces observed). Overall median nicotine concentration was 0.42 (IQR: 0.14-1.59) μg/m³, and overall PM2.5 concentration was 10.40 (IQR: 6.76-15.47) μg/m³ (statistically significantly higher than the background levels). Multivariable analyses showed that nicotine and PM2.5 concentrations increased when the terraces were completely closed, and when tobacco smell was noticed. Nicotine concentrations increased with the presence of cigarette butts, and when there were more than eight lit cigarettes at a time.

CONCLUSIONS

Outdoor hospitality venues are areas where non-smokers, both employees and patrons, continue to be exposed to second-hand smoke. These spaces should be further studied and considered in future tobacco control interventions.

Impact of tobacco control policies on adolescent smokeless tobacco and cigar use: a difference-in-differences approach

BACKGROUND

While increasing cigarette taxes has been a major policy driver to decrease smoking, taxes on other tobacco products have received less attention. Our aims were to evaluate the impact of chewing tobacco/cigar taxes, cigarette taxes, and smoke-free legislation on adolescent male and female use of smokeless tobacco and cigars.

METHODS

We analyzed data on 499,381 adolescents age 14-18 years from 36 US states in the Youth Risk Behavior Surveys (1999-2013) linked to state-level tobacco control policies. We conducted difference-in-differences regression models to assess whether changes in taxes and the enactment of smoke-free legislation were associated with smokeless tobacco use and, separately, cigar use. Models were stratified by adolescent sex.

RESULTS

We found that chewing tobacco taxes had no effect on smokeless tobacco use and cigar taxes had no effect on cigar use. In contrast, among males a 10% increase in cigarette taxes was associated with a 1.0 percentage point increase (0.0010, 95% CI 0.0003-0.0017) in smokeless tobacco use. A 10% increase in cigarette taxes was also associated with a 1.5 percentage point increase (0.0015, 95% CI 0.0006-0.0024) in cigar use among males and a 0.7 percentage point increase (0.0007, 95% CI 0.0001-0.0013) in cigar use among females. There was some evidence that smoke-free legislation was associated with an 1.1 percentage point increase (0.0105, 95% CI 0.0015-0.0194) in smokeless tobacco use among males only, but no effect of smoke-free legislation on cigar use for males or females.

CONCLUSIONS

Higher state cigarette taxes are associated with adolescents' use of cheaper, alternative tobacco products such as smokeless tobacco and cigars. Reducing tobacco use will require comprehensive tobacco control policies that are applied equally to and inclusive of all tobacco products.

Impact of the Spanish smoking laws on tobacco consumption and secondhand smoke exposure: A longitudinal population study

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.