1
|
López MJ, Fu M, Fernández E, Henderson E, Continente X. [How is the compliance with the tobacco control law in hospitaty terraces?]. GACETA SANITARIA 2024; 38:102422. [PMID: 39293184 DOI: 10.1016/j.gaceta.2024.102422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 09/20/2024]
Abstract
OBJECTIVE To describe tobacco consumption and the compliance with the law on hospitality terraces in Barcelona. METHOD Cross-sectional study by observation in a sample of 120 hospitality terraces in Barcelona. 30-minute observations were made using a standardized record sheet. The study variables were number of people smoking, number of cigarettes smoked, cigarette butts, socioeconomic status of the neighborhood, time of observation, consumption regulation, number of chairs and number of persons. RESULTS There were people smoking at the time of the observation in 97.5% of the terraces, with no differences according to socioeconomic level of the neighborhood or the regulation of the terrace. There was no compliance with the law in 100% of the terraces where smoking was banned. CONCLUSIONS The widespread non-compliance with the current law indicates the need to implement a smoking ban without exceptions on hospitality terraces.
Collapse
Affiliation(s)
- M José López
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, España; Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, España.
| | - Marcela Fu
- Institut Català d'Oncologia - Centro Colaborador de la OMS para el Control del Tabaco, L'Hospitalet de Llobregat (Barcelona), España; Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España; Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), España; CIBER de Enfermedades Respiratorias (CIBERES), España
| | - Esteve Fernández
- Institut Català d'Oncologia - Centro Colaborador de la OMS para el Control del Tabaco, L'Hospitalet de Llobregat (Barcelona), España; Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España; Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), España; CIBER de Enfermedades Respiratorias (CIBERES), España
| | - Elisabet Henderson
- Agència de Salut Pública de Barcelona, Barcelona, España; Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, España
| | - Xavier Continente
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, España
| |
Collapse
|
2
|
Sun Y, Wang D, Yi Y, Chen H, Zhou Y, Huang G, Zhao F. Outdoor secondhand smoke exposure in public places frequented by minors in the urban area of Hangzhou City, China: A cross-sectional study. Tob Induc Dis 2024; 22:TID-22-152. [PMID: 39239104 PMCID: PMC11375629 DOI: 10.18332/tid/192129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 08/07/2024] [Accepted: 08/10/2024] [Indexed: 09/07/2024] Open
Abstract
INTRODUCTION Hangzhou Public Places Smoking Control Regulations (2019) have been gradually adopted, which explicitly stipulate that smoking is strictly prohibited in the outdoor areas of educational and healthcare institutions for minors. However, there are few studies reporting the exposure to secondhand smoke (SHS) in outdoor public places for minors in the urban area of Hangzhou City. METHODS We aimed to assess the exposure to SHS in public spaces frequented by minors using on-site observations and questionnaires. In this cross-sectional study, the area was divided into core and non-core areas based on the spatial distribution and development process of the city. The core areas included the West Lake commercial district, extending to the Qiantang River, while non-core areas were located beyond this radius. Using stratified random sampling, 30 public places in each area were selected as observation sites. On-site observations measured SHS exposure and smoking control, and questionnaires were administered to 6 individuals at each site. The results were compared between the two investigation methods. RESULTS Among the 57 valid observation points, 24.6% (14/57) did not display any no-smoking signs. Outdoor SHS exposure rate from on-site observation P1 (observing someone smoking or smelling tobacco smoke), on-site observation P2 (observing someone smoking or smelling tobacco smoke or seeing cigarette butts) and questionnaire survey P3, were 59.6% (95% CI: 45.7-72.2), 91.1% (95% CI: 79.7-96.7) and 41.0% (95% CI: 35.5-46.7), respectively. CONCLUSIONS The outdoor SHS exposure in areas frequented by minors in the urban district of Hangzhou City remains high, coupled with a lack of awareness of SHS risks among underage individuals. Therefore, controlling outdoor SHS exposure in these key areas is a critical public health issue in Hangzhou, requiring further tobacco control efforts. On-site observation is an important and supplementary research method to investigate outdoor SHS exposure, especially to describe the SHS exposure of focus areas.
Collapse
Affiliation(s)
- Yuhuan Sun
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Dahui Wang
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yang Yi
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Hongkun Chen
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yuchen Zhou
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Geyao Huang
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Falin Zhao
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| |
Collapse
|
3
|
Sanz-Mas M, Continente X, Henderson E, Fernández E, Schiaffino A, Pérez-Ríos M, Espelt A, Guxens M, López MJ. Changes in prevalence and socioeconomic inequalities in secondhand smoke exposure in Spanish children, 2016-2019. Tob Induc Dis 2024; 22:TID-22-116. [PMID: 38910916 PMCID: PMC11191057 DOI: 10.18332/tid/189392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/27/2024] [Accepted: 05/30/2024] [Indexed: 06/25/2024] Open
Abstract
INTRODUCTION Children are vulnerable to secondhand smoke (SHS) exposure, especially those with lower socioeconomic status. This study assesses the changes in prevalence and socioeconomic inequalities in SHS exposure in children younger than 12 years old in Spain between 2016 and 2019. METHODS We conducted two cross-sectional studies among representative samples of households with children aged <12 years in Spain, in 2016 (n=2411) and 2019 (n=2412). Families were interviewed to assess children's SHS exposure in private settings and outdoor public venues and their adoption of home and car smoke-free rules. We used the education level of the home main earner as a proxy for socioeconomic position. Changes over time in the prevalence and socioeconomic inequalities of SHS exposure and smoke-free rules were estimated through adjusted Poisson regression models with robust variance according to sociodemographic covariates (adjusted prevalence ratios, APRs). RESULTS In 2019, 70.5% of children were exposed to SHS in Spain. No changes between 2016 and 2019 were found for overall SHS exposure, exposure at home, and at school entrances. SHS exposure increased at public transport stations (APR=1.24; 95% CI: 1.03-1.49) and outdoor hospitality venues (APR=1.17; 95% CI: 1.07-1.29) while it decreased in cars (APR=0.74; 95% CI: 0.56-0.98) and parks (APR=0.87; 95% CI: 0.77-0.98). Households with lower education level had higher prevalence of SHS exposure at home in 2019 compared with those with university studies (primary: APR=1.30; 95% CI: 1.11-1.51; secondary: APR=1.12; 95% CI: 1.00-1.25) and were less likely to adopt home indoor smoke-free rules (primary: APR=0.88; 95% CI: 0.79-0.99; secondary: APR=0.95; 95% CI: 0.89-1.02). Socioeconomic inequalities in SHS exposure at home persisted between 2016 and 2019 (p>0.05), while decreased in smoke-free rules in cars (p=0.039). CONCLUSIONS Reported SHS exposure among children in Spain remained high between 2016 and 2019. Inequalities persisted at home, highlighting the need for measures to reduce such exposure with an equity perspective.
Collapse
Affiliation(s)
- Marta Sanz-Mas
- Servei d’Avaluacio i Metodes d’Intervencio (SAMI), Agencia de Salut Publica de Barcelona (ASPB), Barcelona, Espana
- Departament de Medicina i Ciencies de la Vida (MELIS), Universitat Pompeu Fabra, Barcelona, Espana
| | - Xavier Continente
- Servei d’Avaluacio i Metodes d’Intervencio (SAMI), Agencia de Salut Publica de Barcelona (ASPB), Barcelona, Espana
- Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica (CIBERESP), Madrid, Espana
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Espana
| | - Elisabet Henderson
- Servei d’Avaluacio i Metodes d’Intervencio (SAMI), Agencia de Salut Publica de Barcelona (ASPB), Barcelona, Espana
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Espana
| | - Esteve Fernández
- Institut d’Investigacio Biomedica de Bellvitge (IDIBELL), Institut Catala d’Oncologia (ICO), L’Hospitalet de Llobregat, Barcelona, Espana
- Facultat de Medicina, Universitat de Barcelona, Barcelona, Espana
- Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Espana
| | - Anna Schiaffino
- Institut d’Investigacio Biomedica de Bellvitge (IDIBELL), Institut Catala d’Oncologia (ICO), L’Hospitalet de Llobregat, Barcelona, Espana
- Departament de Salut, Direccio General de Planificacio en Salut, Generalitat de Catalunya, Barcelona, Espana
| | - Mónica Pérez-Ríos
- Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica (CIBERESP), Madrid, Espana
- Area de Medicina Preventiva y Salud Publica, Universidad de Santiago de Compostela, Santiago de Compostela, Espana
| | - Albert Espelt
- Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica (CIBERESP), Madrid, Espana
- Departament de Psicobiologia i Metodologia de les Ciencies de la Salut, Universiat Autonoma de Barcelona, Barcelona, Espana
| | - Mònica Guxens
- Departament de Medicina i Ciencies de la Vida (MELIS), Universitat Pompeu Fabra, Barcelona, Espana
- Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica (CIBERESP), Madrid, Espana
- Instituto de Salud Global de Barcelona (ISGlobal), Barcelona, Espana
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Maria José López
- Servei d’Avaluacio i Metodes d’Intervencio (SAMI), Agencia de Salut Publica de Barcelona (ASPB), Barcelona, Espana
- Departament de Medicina i Ciencies de la Vida (MELIS), Universitat Pompeu Fabra, Barcelona, Espana
- Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica (CIBERESP), Madrid, Espana
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Espana
| |
Collapse
|
4
|
Valmayor S, González K, López MJ, Lacera P, Giménez P, Rumín-Caparrós A, Pasarín MI, Henderson E, Díez E. Evaluation of a smoke-free beaches intervention in Barcelona: a quasi-experimental study. Tob Control 2023:tc-2022-057873. [PMID: 37402576 DOI: 10.1136/tc-2022-057873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 06/06/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND We aim to assess the effect of a smoke-free beaches (SFB) intervention in Barcelona on smoking during the 2021 bathing season. METHODS Quasi-experimental pre-post design (pre-intervention period: 15-28 May; post-intervention period: 29 May-12 September). Based on users' profiles and location, four beaches were assigned to the intervention group (IG) and five to the comparison group (CG). The intervention involved: a mayoral decree (29 May), a communication campaign and beach on-site information. We established two 3 m × 3 m transects per beach from the coastline to the promenade. Trained teams collected smoking-related information in the transects through observations and surveys to beach users. Outcomes are as follows: percentage of people reporting witnessing smoking behaviours the last fortnight and percentage of people observed smoking. We calculated and compared prevalence ratios (PRs) with adjusted Poisson regressions. RESULTS 3751 interviews (1721 IG; 2030 CG) and 1108 observations (498 IG, 610 CG) were carried out. SFB were associated with a significant reduction in the percentage of people reporting witnessing smoking (IG (pre: 87.2%; post: 49.7%); CG (pre: 86.2%; post: 74.1%); PR (95% CI): 0.7 (0.6 to 0.8)); and in the users observed smoking in the beach (IG (pre: 3.8%; post: 3.0%); CG (pre: 2.3%; post: 9.9%); PR (95% CI): 0.3 (0.3 to 0.4)). Satisfaction scores were 8.3 (IG) and 8.1 (CG) out of 10. CONCLUSION An SFB intervention is an effective and well-accepted measure to reduce smoking and smokers' visibility. Smoke-free measures should be extended to beaches and other non-regulated outdoor areas.
Collapse
Affiliation(s)
- Sara Valmayor
- Agència de Salut Pública de Barcelona, Barcelona, Spain
| | | | - Maria J López
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Patricia Lacera
- BCASA, Barcelona Cicle de l'Aigua, SA, Barcelona, Spain
- Medi Ambient i Serveis Urbans - Ecologia Urbana, Barcelona, Spain
| | - Patricia Giménez
- BCASA, Barcelona Cicle de l'Aigua, SA, Barcelona, Spain
- Medi Ambient i Serveis Urbans - Ecologia Urbana, Barcelona, Spain
| | - Aitor Rumín-Caparrós
- BCASA, Barcelona Cicle de l'Aigua, SA, Barcelona, Spain
- Medi Ambient i Serveis Urbans - Ecologia Urbana, Barcelona, Spain
| | - Maria Isabel Pasarín
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Elisabet Henderson
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Elia Díez
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| |
Collapse
|
5
|
Henderson E, Rodriguez Guerrero LA, Continente X, Fernández E, Tigova O, Cortés-Francisco N, Semple S, Dobson R, Tzortzi A, Vyzikidou VK, Gorini G, Geshanova G, Mons U, Przewozniak K, Precioso J, Brad R, López MJ. Measurement of airborne nicotine, as a marker of secondhand smoke exposure, in homes with residents who smoke in 9 European countries. ENVIRONMENTAL RESEARCH 2023; 219:115118. [PMID: 36566961 DOI: 10.1016/j.envres.2022.115118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Smoke-free policies are effective in preventing secondhand smoke (SHS) exposure, but their adoption at home remains largely voluntary. This study aimed to quantify SHS exposure in homes with residents who smoke in Europe according to households' characteristics, tobacco consumption habits, and national contextual factors. METHODS Cross-sectional study (March 2017-September 2018) based on measurements of air nicotine inside 162 homes with residents who smoke from nine European countries. We installed passive samplers for seven consecutive days to monitor nicotine concentrations. Through self-administered questionnaires, we collected sociodemographic information and the number of individuals who smoke, smoking rules, frequency, location, and quantity of tobacco use in households. Country-level factors included the overall score in the Tobacco Control Scale 2016, the smoking prevalence, and self-reported SHS exposure prevalence. Nicotine concentrations were analyzed as continuous and dichotomous variables, categorized based on the limit of quantification of 0.02 μg/m3. RESULTS Overall, median nicotine concentration was 0.85 μg/m3 (interquartile range (IQR):0.15-4.42), and there was nicotine presence in 93% of homes. Participants reported that smoking was not permitted in approximately 20% of households, 40% had two or more residents who smoked, and in 79% residents had smoked inside during the week of sampling. We found higher nicotine concentrations in homes: with smell of tobacco smoke inside (1.45 μg/m3 IQR: 0.32-6.34), where smoking was allowed (1.60 μg/m3 IQR: 0.68-7.63), with two or more residents who smoked (2.42 μg/m3 IQR: 0.58-11.0), with more than 40 cigarettes smoked (2.92 μg/m3 IQR: 0.97-10.61), and where two or more residents smoked inside (4.02 μg/m3 IQR: 1.58-11.74). Household nicotine concentrations were significantly higher in countries with higher national smoking prevalence and self-reported SHS exposure prevalence (p < 0.05). CONCLUSIONS SHS concentrations in homes with individuals who smoke were approximately twenty times higher in homes that allowed smoking compared to those reporting smoke-free household rules. Evidence-based interventions promoting smoke-free homes should be implemented in combination with strengthening other MPOWER measures.
Collapse
Affiliation(s)
- Elisabet Henderson
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain
| | | | - Xavier Continente
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Center for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - Esteve Fernández
- Institut Català d'Oncologia, Av. Granvia de l'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Spain; Institut d'Investigació Biomèdica de Bellvitge, Av. Granvia de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Spain; Universitat de Barcelona, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Spain; Center for Biomedical Research in Respiratory Diseases (CIBERES), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain
| | - Olena Tigova
- Institut Català d'Oncologia, Av. Granvia de l'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Spain; Institut d'Investigació Biomèdica de Bellvitge, Av. Granvia de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Spain; Universitat de Barcelona, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Spain; Center for Biomedical Research in Respiratory Diseases (CIBERES), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain
| | - Nuria Cortés-Francisco
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - Sean Semple
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, Scotland, UK
| | - Ruaraidh Dobson
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, Scotland, UK
| | - Anna Tzortzi
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou str., Athens, 10557, Greece
| | - Vergina K Vyzikidou
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou str., Athens, 10557, Greece
| | - Giuseppe Gorini
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Via Cosimo il Vecchio, 2, 50139, Florence, Italy
| | - Gergana Geshanova
- Smoke-free Life Coalition, Slivnitsa Blvd, 257, 1202, Sofia, Bulgaria
| | - Ute Mons
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50923, Cologne, Germany; Cancer Prevention Unit & WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Im Neuenheimer Feld, 280, 69120, Heidelberg, Germany
| | - Krzysztof Przewozniak
- Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena, 5, 02-781, Warsaw, Poland; The Foundation Smart Health - Health in 3D, Makolągwy 24, 02-811, Warsaw, Poland; Collegium Civitas, 1 Defilad Square, 00-901, Warsaw, Poland
| | - José Precioso
- Research Center in Child Studies, University of Minho, 4710-057, Braga, Portugal
| | - Ramona Brad
- Healthy Romania Generation 2035 Association, Bucharest, Romania
| | - Maria J López
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Center for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain; Universitat Pompeu Fabra, Departament de Ciències Experimentals i de la Salut (DCEXS), Doctor Aiguader, 88, 08003, Barcelona, Spain.
| |
Collapse
|
6
|
Xiao H, Li M, Li A, Amaerjiang N, Zunong J, Vermund SH, Pérez-Escamilla R, Song M, Hu Y, Jiang G. Passive Smoking Exposure Modifies Cardiovascular Structure and Function: Beijing Child Growth and Health Cohort (PROC) Study. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:14585-14593. [PMID: 36094430 DOI: 10.1021/acs.est.2c00991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Passive smoking exposure in children is prevalent worldwide and exposes children to respiratory and systemic toxins. In this study, we enrolled 568 children to study how secondhand smoke (SHS) might affect children's cardiovascular health in China. The measurement of nicotine and its metabolites in urine showed that 78.9% of children were exposed to SHS. Children exposed to SHS had greater interventricular septum thickness (p = 0.005) and left ventricular mass index (p = 0.008) than nonexposed children. Urinary norcotinine levels were associated with increased ascending aorta diameter (β = 0.10, 95%CI 0.02-0.17) and decreased left ventricular end systolic diameter (β = -0.10, 95%CI -0.19 to -0.01). The effects of SHS exposure on cardiovascular function: norcotinine levels associated with lower left ventricular mass index (β = -0.32, 95%CI -0.59 to -0.05), left ventricular end diastolic volume index (β = -0.43, 95%CI -0.85 to -0.02), and left ventricular end systolic volume index (β = -0.20, 95%CI -0.37 to -0.03). Moreover, there no no significant associations of nicotine, cotinine, and trans-3'-hydroxycotinine with cardiovascular health. Overall, SHS exposure in children remains prevalent in Beijing and may affect children's cardiovascular development, in both structure and function. It suggests that stricter and practical measures are needed toward the elimination of tobacco use in children's environments.
Collapse
Affiliation(s)
- Huidi Xiao
- Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing 100069, People's Republic of China
| | - Menglong Li
- Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing 100069, People's Republic of China
| | - Aijing Li
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Science, Beijing 100085, People's Republic of China
- University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
| | - Nubiya Amaerjiang
- Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing 100069, People's Republic of China
| | - Jiawulan Zunong
- Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing 100069, People's Republic of China
| | - Sten H Vermund
- Yale School of Public Health, Yale University, New Haven, Connecticut 06510-3201, United States
| | - Rafael Pérez-Escamilla
- Yale School of Public Health, Yale University, New Haven, Connecticut 06510-3201, United States
| | - Maoyong Song
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Science, Beijing 100085, People's Republic of China
- University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
| | - Yifei Hu
- Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing 100069, People's Republic of China
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing 100069, People's Republic of China
| | - Guibin Jiang
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Science, Beijing 100085, People's Republic of China
| |
Collapse
|
7
|
Effects on Health of Passive Smoking and Vape on Terraces in the COVID-19 Pandemic: A Review. OPEN RESPIRATORY ARCHIVES 2022. [PMID: 37496956 PMCID: PMC9467932 DOI: 10.1016/j.opresp.2022.100204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The health damage caused by passive smoking is well known in closed public spaces such as workplaces, inside homes and restaurants. However, at present, the number of smokers in open public spaces such as terraces has increased and consequently a loss of the quality of the air breathed, increasing the concentration of particles and other contaminating agents, affecting the health of workers and customers, of these spaces. Multiple studies show that high exposure to tobacco smoke in these environments augments the risk of developing cardiorespiratory diseases, especially in the vulnerable population, but also respiratory infections. Tobacco smoke can be an excellent vehicle for transmitting viral particles, favoring coronavirus disease 2019 (COVID-19).
Collapse
|
8
|
Boey CPH, Quaye SED, Cook AR, Seow WJ, van der Eijk Y. Secondhand smoke in the densely populated urban setting: A cross-sectional survey of exposure, knowledge, attitudes, and respiratory symptoms. INDOOR AIR 2022; 32:e13069. [PMID: 35762238 DOI: 10.1111/ina.13069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/10/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
Secondhand smoke (SHS) remains a common health threat in densely populated, urban settings. We estimated the prevalence of exposure and associated respiratory symptoms, knowledge, attitudes, and behaviors in a multi-ethnic, weighted sample of Singapore residents using a cross-sectional survey of 1806 adults. We weighted data to match the national population in terms of gender, ethnicity, and education level and analyzed data using descriptive statistics, bivariate analyses, multiple linear and logistic regressions, and a multinomial logistic regression model. About 88% of respondents reported regular SHS exposure. Nearly 57% reported exposure to neighbors' SHS at home. Respiratory symptoms were reported by 32.5% and significantly associated with exposure to daily (AOR = 2.63, 95% CI = 1.62-4.36), non-daily (AOR = 1.75, 95% CI = 1.14-2.77), and neighbors' (AOR = 1.37, 95% CI = 1.07-1.76) SHS. More knowledge of SHS was associated with male gender (β = 0.28, p = 0.0009) and higher household income (linear trend; p = 0.0400). More negative attitudes to SHS were associated with older age (linear trend; p < 0.0001). Engaging in behaviors to avoid SHS was associated with a more negative attitude to SHS (AOR = 1.09-1.23). SHS exposure is common in Singapore's densely populated setting and associated with respiratory symptoms, even if exposure is non-daily or from neighboring homes.
Collapse
Affiliation(s)
- Clement Peng Hee Boey
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Sharon Esi Duoduwa Quaye
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Wei Jie Seow
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| |
Collapse
|
9
|
James PB, Bah AJ, Kabba JA, Kassim SA, Dalinjong PA. Prevalence and correlates of current tobacco use and non-user susceptibility to using tobacco products among school-going adolescents in 22 African countries: a secondary analysis of the 2013-2018 global youth tobacco surveys. Arch Public Health 2022; 80:121. [PMID: 35422011 PMCID: PMC9009031 DOI: 10.1186/s13690-022-00881-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/07/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Our study examined the prevalence and associated factors of tobacco product use and non-users' susceptibility to using tobacco products among school-going adolescents in 22 African countries. METHODS We analyzed the cross-sectional 2013-2018 Global Youth Tobacco Survey (GYTS) data from 22 African countries. We conducted complex sampling descriptive and logistic regression analyses. RESULTS The overall prevalence of current use of any tobacco product among adolescents was 19.1%, with more males (23.7%) than females (13.7%) being current users. Zimbabwe and Morocco were the highest (47.1%) and least (12.6%) reported prevalence, respectively. Being male (AOR = 1.93;95%CI:1.61-2.32), being 16 and older(AOR = 1.37;95%CI:1.01-1.86), exposure to secondhand smoke within (AOR = 1.98;95%CI:1.69-2.32) and outside (AOR = 1.37;95%CI:1.13-1.65) the home, not knowledgeable about the harmful effect of secondhand smoke (AOR = 1.44;95%CI:1.20-1.74), exposure to tobacco industry promotion (AOR = 3.05;95%CI:2.68-3.47) and not in favour of banning smoking in enclosed places (AOR = 1.32;95%CI:1.08-1.60) were associated with current use of any tobacco product. The prevalence of the susceptibility to using tobacco products among never users of tobacco products was 12.2%, with no significant gender difference. Mozambique (24.6%) and Algeria (4.5%) had the highest and least prevalence of susceptibility to using tobacco products among never users, respectively. Exposure to tobacco industry promotion (AOR = 1.54;95%CI:1.31-1.82), those not in favour of banning smoking in enclosed places (AOR = 1.29;95%CI:1.14-1.45) and those not exposed to anti-smoking school education (AOR = 1.24;95%CI:1.06-1.46) were associated with susceptibility to using any tobacco product among never users of tobacco products. CONCLUSION Our study reports that tobacco use and non-user susceptibility to using tobacco products among school-going adolescents in the 22 African countries is high. As part of public health efforts, governments and other stakeholders need to fully implement anti-tobacco use campaigns, enforce a complete ban on tobacco promotion and advertising, institute educational programs for families, and anti-tobacco use education for the general public and in schools in line with WHO Framework Convention on Tobacco Control guidelines.
Collapse
Affiliation(s)
- Peter Bai James
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, New South Wales, 2480, Australia.
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Abdulai Jawo Bah
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Institute for Global Health and Development, Queen Margaret University Edinburg, Musselburgh, Scotland, UK
| | - John Alimamy Kabba
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, #76 Yanta West Road, Xi'an, 710061, China
| | - Said Abasse Kassim
- Département de Management, Centre de Recherche en Gestion des Services de Sante, Faculté des sciences de l'administration (FSA), Université Laval (UL), Centre Hospitalière Universitaire (CHU) de Québec, Québec, CA, G1V 0A6, Canada
| | | |
Collapse
|
10
|
Nogueira SO, Fu M, Lugo A, Tigova O, Henderson E, López MJ, Clancy L, Semple S, Soriano JB, Fernandez E, Gallus S. Non-smokers' and smokers' support for smoke-free legislation in 14 indoor and outdoor settings across 12 European countries. ENVIRONMENTAL RESEARCH 2022; 204:112224. [PMID: 34717946 DOI: 10.1016/j.envres.2021.112224] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND European countries differ considerably in the scope and the extent of their policies to protect people from the harms of secondhand smoke exposure. Public opinion may have a substantial influence on several stages of policy development, implementation, and compliance. For this reason, we aimed to evaluate the population level of support for smoke-free policies and its correlates. METHODS We used data from the TackSHS Survey (2017-2018), a cross-sectional study with representative samples of the general population aged ≥15 years from 12 European countries. We described the proportion of non-smokers' and smokers' support for the implementation of smoke-free legislation in 14 indoor and outdoor settings and the country-level characteristics associated with it. RESULTS In the total sample (n = 11,902), support for smoke-free legislation were the lowest for restaurants/bar patios (non-smokers = 53.0%; smokers = 29.2%) and the highest for workplaces (non-smokers = 78.5%; smokers = 66.5%). In the country-level analysis, the highest support among non-smokers was for workplaces in Bulgaria (93.1%) and the lowest for restaurants/bars patios in Greece (39.4%). Among smokers, the corresponding estimates were for children's playgrounds in Latvia (88.9%) and for cars in Portugal (21%). For most settings, support for smoke-free legislation was directly related with the countries' prevalence of secondhand smoke presence and reported smoking in each setting. DISCUSSION Our results show that the majority of European adults (including a large proportion of smokers) are supportive of implementing smoke-free legislation in indoor settings and extending it to selected outdoor settings. Such expressive support can be seen as an opportunity to advance legislation and protect the European population from secondhand smoke exposure.
Collapse
Affiliation(s)
- Sarah O Nogueira
- Institut Catala d'Oncologia (ICO), L'Hospitalet de Llobregat, L'Hospitalet de Llobregat, Spain; Institut d'Investigacio Biomedica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain; Universitat de Barcelona (UB), Barcelona, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Marcela Fu
- Institut Catala d'Oncologia (ICO), L'Hospitalet de Llobregat, L'Hospitalet de Llobregat, Spain; Institut d'Investigacio Biomedica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain; Universitat de Barcelona (UB), Barcelona, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Olena Tigova
- Institut Catala d'Oncologia (ICO), L'Hospitalet de Llobregat, L'Hospitalet de Llobregat, Spain; Universitat de Barcelona (UB), Barcelona, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | | | - María José López
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Barcelona, Spain
| | - Luke Clancy
- TobaccoFree Research Institute Ireland, TU Dublin, Ireland
| | - Sean Semple
- Institute for Social Marketing, University of Stirling, Stirling, Scotland, United Kingdom
| | - Joan B Soriano
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain; Hospital Universitario La Princesa (IISP), Madrid, Spain
| | - Esteve Fernandez
- Institut Catala d'Oncologia (ICO), L'Hospitalet de Llobregat, L'Hospitalet de Llobregat, Spain; Institut d'Investigacio Biomedica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain; Universitat de Barcelona (UB), Barcelona, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain.
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
11
|
Bommelé J, Walters BH, van Dorsselaer S, Willemsen MC. Outdoor smoking as a nuisance to non-smokers: The case for smoke-free outdoor public spaces in dense urban areas. Tob Prev Cessat 2022; 8:08. [PMID: 35280520 PMCID: PMC8859987 DOI: 10.18332/tpc/145502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/23/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Despite the growing number of smoke-free spaces, many non-smokers continue to be involuntarily exposed to secondhand smoke outdoors and on public streets. Both theory and research suggest that people living in densely populated urban areas are more likely to smoke than those living in less densely populated areas. Consequently, non-smokers in densely populated urban areas might be more likely to be exposed and feel annoyed by secondhand smoke outdoors. We investigated whether the extent to which non-smokers feel annoyed by secondhand smoke exposure in outdoor public spaces is related to urban population density. METHODS We used cross-sectional survey data from the Netherlands 'Module Substance Use' survey (2020 data, n=9375). This is a nationally representative sample of the adult population in the Netherlands. Using logistic regression models, we investigated whether urban population density predicts both smoking and non-smokers' annoyance to secondhand smoke exposure outdoors. RESULTS We found that smoking rates were associated with urban population density. In the Netherlands, people living in extremely population-dense urban areas were more likely to smoke than those living in non-urban areas (AOR=1.59; 95% CI: 1.25-2.02, p<0.001). Feeling annoyed by secondhand smoke outdoors was also associated with urban population density: non-smokers living in extremely population-dense urban areas were more likely to be annoyed than respondents living in non-urban areas (AOR=1.65; 95% CI: 1.34-2.02, p<0.001). CONCLUSIONS These cross-sectional data highlight the importance of comprehensive local tobacco control policy programs that include creating smoke-free outdoor public spaces. This need for such smoke-free outdoor public spaces might be particularly strong in densely populated areas.
Collapse
Affiliation(s)
- Jeroen Bommelé
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
| | - Bethany Hipple Walters
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
- Massachusetts General Hospital, Boston, United States
| | - Saskia van Dorsselaer
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
| | - Marc C. Willemsen
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
12
|
Breunis LJ, Versteylen M, Radó MK, Dereci N, Boderie NW, de Kroon MLA, Been JV. Pediatric patients’ views regarding smoke-free hospital grounds compared to those of adults: A survey study. Tob Prev Cessat 2022; 8:07. [PMID: 35274066 PMCID: PMC8851833 DOI: 10.18332/tpc/145311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Children are important stakeholders in discussions about regulation of smoking and protection from secondhand smoke, but are rarely acknowledged as such. We explored the opinion of pediatric patients and other key stakeholders regarding the planned smoke-free zone around the Erasmus MC, a large university hospital in the Netherlands. METHODS In 2019, we conducted a survey among pediatric patients and their parents, Erasmus MC employees, visitors, and adult patients, before implementation of the outdoor smoke-free zone, to assess their opinions on smoking and the planned smoke-free policy. Qualitative and quantitative data were collected and analyzed mostly using descriptive statistics and thematic analysis. RESULTS In all, 91 parent-child dyads and 563 employees, visitors, patients and students filled in the questionnaires. Over 90% of children reported that they were regularly exposed to tobacco smoke, most often on the streets. Many underlined the exemplary role of healthcare providers, and 89% felt that nobody should be allowed to smoke near the hospital. Among parents, 89% were (very) positive towards the planned implementation of the smoke-free zone. In addition, 70% of adult patients, 81% of employees, 65% of visitors, 89% of students and 75% of ‘others’ were (very) positive about the new smoke-free policy. Smokers and former smokers generally were less positive about the policy. CONCLUSIONS Children generally disapproved smoking around a hospital and felt that healthcare providers should be a good example concerning not smoking. The majority of adult patients, employees and visitors support a smoke-free zone surrounding the hospital, and virtually all pediatric patients and their parents do. Children should be acknowledged as important stakeholders in smoke-free policies and should be involved in planning and implementation.
Collapse
Affiliation(s)
- Leonieke J. Breunis
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Foetal Medicine, Erasmus MC Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maud Versteylen
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Foetal Medicine, Erasmus MC Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Paediatrics, Division of Neonatology, Erasmus MC Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Márta K. Radó
- Department of Paediatrics, Division of Neonatology, Erasmus MC Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nazmi Dereci
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Foetal Medicine, Erasmus MC Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Paediatrics, Division of Neonatology, Erasmus MC Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nienke W. Boderie
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marlou L. A. de Kroon
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Foetal Medicine, Erasmus MC Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Health Sciences, University of Groningen Medical Centre, Groningen, The Netherlands
- Department of Public Health and Primary Care, Environment and Health, KU Leuven, Leuven, Belgium
| | - Jasper V. Been
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Foetal Medicine, Erasmus MC Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Paediatrics, Division of Neonatology, Erasmus MC Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
13
|
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.
Collapse
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.
| |
Collapse
|