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Hong S, Son Y, Lee H, Kim S, Kim HJ, Jo H, Park J, Lee K, Lee H, Dragioti E, Fond G, Boyer L, López Sánchez GF, Tully MA, Rahmati M, Smith L, Kim S, Woo S, Yon DK. Global association of secondhand smoke exposure locations and smoking behaviour among adolescents in 99 countries. Acta Paediatr 2024; 113:2048-2060. [PMID: 38859709 DOI: 10.1111/apa.17319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/29/2024] [Accepted: 05/27/2024] [Indexed: 06/12/2024]
Abstract
AIM This study classified 99 countries into four income groups and then analysed the impact of secondhand smoke (SHS) exposure at home, in public places and at school, on current cigarette smoking prevalence. METHODS We utilised data from the WHO Global Youth Tobacco Survey and a meta-analysis was conducted to evaluate the prevalence and weighted odds ratios (wORs) of adolescent smoking behaviour and SHS exposure locations. RESULTS Both smoking behaviours increased with higher national income levels. Smoking behaviours in high and upper-middle-income countries (HICs and UMICs) exhibited an association with SHS exposure in public places (HIC: wOR, 3.50 [95% CI, 2.85-4.31]; UMIC: wOR, 2.90 [2.60-3.23]) compared to home. Low- and lower-middle-income countries (LICs and LMICs) showed an association with SHS exposure in the home (LIC: wOR, 5.33 [3.59-7.93]; LMIC: wOR, 2.71 [2.33-3.17]) than public places. The association between current cigarette smoking and SHS exposure at home increased with lower income levels, while anticipated future use of any form of tobacco with SHS exposure in public places rose in lower income countries. CONCLUSIONS Targeted interventions based on income levels are essential, emphasising home strategies in lower income countries and public place efforts in higher income countries.
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Affiliation(s)
- Seohyun Hong
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Yejun Son
- Center for Digital Health, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyeri Lee
- Center for Digital Health, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Soeun Kim
- Center for Digital Health, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyeon Jin Kim
- Center for Digital Health, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Hyesu Jo
- Center for Digital Health, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Jaeyu Park
- Center for Digital Health, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Kyeongmin Lee
- Center for Digital Health, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Hayeon Lee
- Center for Digital Health, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Research Laboratory Psychology of Patients, Families, and Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Guillaume Fond
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Laurent Boyer
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Guillermo F López Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain
| | - Mark A Tully
- School of Medicine, Ulster University, Londonderry, UK
| | - Masoud Rahmati
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Sunyoung Kim
- Department of Family Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Selin Woo
- Center for Digital Health, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Dong Keon Yon
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
- Center for Digital Health, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
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Pan D, Guo J, Wu S, Wang H, Wang J, Wang C, Gu Y. Association of secondhand smoke exposure with all-cause mortality and cardiovascular death in patients with hypertension: Insights from NHANES. Nutr Metab Cardiovasc Dis 2024; 34:1779-1786. [PMID: 38658224 DOI: 10.1016/j.numecd.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND AIM The impact of environmental chemical exposure on blood pressure (BP) is well-established. However, the relationship between secondhand smoke exposure (SHSE) and mortality in hypertensive patients in the general population remains unclear. METHODS AND RESULTS This cohort study included US adults in the National Health and Nutrition Examination Survey from 2007 to 2018. All-cause mortality and cause-specific mortality outcomes were determined by associating them with the National Death Index records. Cox proportional risk models were used to estimate hazard ratios (HRs) for all-cause mortality and cardiovascular disease (CVD) mortality, and 95% confidence intervals (CIs) for SHSE. The cohort included 10,760 adult participants. The mean serum cotinine level was 0.024 ng/mL. During a mean follow-up period of 76.9 months, there were 1729 deaths, including 469 cardiovascular disease deaths recorded. After adjusting for lifestyle factors, BMI, hypertension duration, medication use, and chronic disease presence, the highest SHSE was significantly associated with higher all-cause and CVD mortality. CONCLUSIONS This study demonstrates that higher SHSE is significantly associated with higher all-cause mortality and CVD mortality. Further research is necessary to elucidate the underlying mechanisms.
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Affiliation(s)
- Dikang Pan
- Vascular Department, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Julong Guo
- Vascular Department, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Sensen Wu
- Vascular Department, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Hui Wang
- Vascular Department, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Jingyu Wang
- Renal Division, Peking University First Hospital, Beijing, China.
| | - Cong Wang
- Vascular Department, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Yongquan Gu
- Vascular Department, Xuanwu Hospital, Capital Medical University, Beijing, China.
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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.
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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
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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.
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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.
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Nijssen SRR, Müller BCN, Gallinat J, Kühn S. Applying persuasive messages to reduce public outdoor smoking: A pseudo-randomized controlled trial. Appl Psychol Health Well Being 2023; 15:337-353. [PMID: 35768894 PMCID: PMC10083943 DOI: 10.1111/aphw.12382] [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: 04/12/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022]
Abstract
Despite efforts to create dedicated smoking areas and no-smoking signs, many smokers continue to light their cigarettes in front of public building entrances-leading to concerns over health consequences for non-smokers passing by. To increase compliance with no-smoking requests, behavioral interventions that tap into habitual and automatic processes seem promising. A pseudo-randomized controlled trial was conducted to assess the differential impact of seven behavioral interventions based on Cialdini's principles of persuasion. Over a period of 9 weeks, the number of smokers was counted (total n = 17,930 observations) in front of a German University Medical Center. Relative to a baseline and a control condition, interventions based on the principles of reciprocity, scarcity, and authority were most effective in reducing the number of observed smokers in front of the building entrance (41.5%, 45.7%, and 52.1% reduction rates, respectively). Having observed smokers' behavior in vivo, this study provides substantial evidence for the impact of persuasive strategies on outdoor smoking. In the future, this knowledge should be used to protect non-smokers from second-hand smoke by increasing the use of designated smoking areas, leave to another place to smoke, or not smoke at all.
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Affiliation(s)
- Sari R R Nijssen
- Environmental Psychology Group, Faculty of Psychology, University of Vienna, Vienna, Austria.,Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Barbara C N Müller
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, Germany.,Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
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Grant TL, Wood RA. The influence of urban exposures and residence on childhood asthma. Pediatr Allergy Immunol 2022; 33:e13784. [PMID: 35616896 PMCID: PMC9288815 DOI: 10.1111/pai.13784] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 12/19/2022]
Abstract
Children with asthma who live in urban neighborhoods experience a disproportionately high asthma burden, with increased incident asthma and increased asthma symptoms, exacerbations, and acute visits and hospitalizations for asthma. There are multiple urban exposures that contribute to pediatric asthma morbidity, including exposure to pest allergens, mold, endotoxin, and indoor and outdoor air pollution. Children living in urban neighborhoods also experience inequities in social determinants of health, such as increased poverty, substandard housing quality, increased rates of obesity, and increased chronic stress. These disparities then in turn can increase the risk of urban exposures and compound asthma morbidity as poor housing repair is a risk factor for pest infestation and mold exposure and poverty is a risk factor for exposure to air pollution. Environmental interventions to reduce in-home allergen concentrations have yielded inconsistent results. Population-level interventions including smoking bans in public places and legislation to decrease traffic-related air pollution have been successful at reducing asthma morbidity and improving lung function growth. Given the interface and synergy between urban exposures and social determinants of health, it is likely population and community-level changes will be needed to decrease the excess asthma burden in children living in urban neighborhoods.
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Affiliation(s)
- Torie L Grant
- Division of Pediatric Allergy, Immunology, and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert A Wood
- Division of Pediatric Allergy, Immunology, and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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7
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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.
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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
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8
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Henderson E, Continente X, Fernández E, Tigova O, Cortés-Francisco N, Gallus S, Lugo A, Semple S, Dobson R, Clancy L, Keogan S, Ruprecht A, Borgini A, Tzortzi A, Vyzikidou VK, Gorini G, López-Nicolás A, Soriano JB, Geshanova G, Osman J, Mons U, Przewozniak K, Precioso J, Brad R, López MJ. Secondhand smoke exposure assessment in outdoor hospitality venues across 11 European countries. ENVIRONMENTAL RESEARCH 2021; 200:111355. [PMID: 34022230 PMCID: PMC8417816 DOI: 10.1016/j.envres.2021.111355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/20/2021] [Accepted: 05/17/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Due to partial or poorly enforced restrictions secondhand tobacco smoke (SHS) is still present in outdoor hospitality venues in many European countries. This study aimed to assess SHS concentrations in outdoor hospitality venues across Europe and identify contextual exposure determinants. METHODS Cross-sectional study. We measured airborne nicotine and evidence of tobacco use in terraces of bars, cafeterias, and pubs from 11 European countries in 2017-2018. Sites were selected considering area-level socioeconomic indicators and half were visited during nighttime. We noted the smell of smoke, presence of smokers, cigarette butts, ashtrays, and number of physical covers. Contextual determinants included national smoke-free policies for the hospitality sector, the Tobacco Control Scale score (2016), and the national smoking prevalence (2017-2018). We computed medians and interquartile ranges (IQR) of nicotine concentrations and used multivariate analyses to characterize the exposure determinants. RESULTS Nicotine was present in 93.6% of the 220 sites explored. Overall concentrations were 0.85 (IQR:0.30-3.74) μg/m3 and increased during nighttime (1.45 IQR:0.65-4.79 μg/m3), in enclosed venues (2.97 IQR:0.80-5.80 μg/m3), in venues with more than two smokers (2.79 IQR:1.03-6.30 μg/m3), in venues in countries with total indoor smoking bans (1.20 IQR:0.47-4.85 μg/m3), and in venues in countries with higher smoking prevalence (1.32 IQR:0.49-5.34 μg/m3). In multivariate analyses, nicotine concentrations were also positively associated with the observed number of cigarette butts. In venues with more than two smokers, SHS levels did not significantly vary with the venues' degree of enclosure. CONCLUSIONS Our results suggest that current restrictions in outdoor hospitality venues across Europe have a limited protective effect and justify the adoption of total smoking bans in outdoor areas of hospitality venues.
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Affiliation(s)
- Elisabet Henderson
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Universitat Pompeu Fabra, Departament de Ciències Experimentals i de la Salut (DCEXS), Doctor Aiguader, 88, 08003, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain
| | - Xavier Continente
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Consortium for Biomedical Research in 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; Consortium 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; Consortium 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
| | - Silvano Gallus
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Department of Environmental Health Sciences, Via Mario Negri 2, 20156, Milan, Italy
| | - Alessandra Lugo
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Department of Environmental Health Sciences, Via Mario Negri 2, 20156, Milan, Italy
| | - 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
| | - Luke Clancy
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | - Sheila Keogan
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | - Ario Ruprecht
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Alessandro Borgini
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - 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
| | - Angel López-Nicolás
- Universidad Politécnica de Cartagena (UPCT), Plaza Cronista Isidoro Valverde, S/n, 30202, Cartagena, Spain
| | - Joan B Soriano
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain; Hospital Universitario La Princesa (IISP), Diego de León, 62, Planta 6, 28006, Madrid, Spain; Universidad Autónoma de Madrid (UAM), Ciudad Universitaria de Cantoblanco, 28049, Madrid, Spain; Instituto Carlos III (ISCIII), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain
| | - Gergana Geshanova
- Smoke-free Life Coalition, Slivnitsa Blvd, 257, 1202, Sofia, Bulgaria
| | - Joseph Osman
- OFT Conseil, Office Français de Santé et Bien-être Au Travail, Rue Gobert, 12, 75011Paris, France
| | - Ute Mons
- Cancer Prevention Unit & WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Im Neuenheimer Feld, 280, 69120, Heidelberg, Germany; Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50923, Cologne, Germany
| | - Krzysztof Przewozniak
- Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena, 5, 02-781, Warsaw, Poland; The Foundation Smart Health - Health in 3D, Warsaw, Poland; Collegium Civitas, 1 Defilad Square, 00-901, Warsaw, Poland
| | - José Precioso
- Instituto de Educação, Universidade do 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; Universitat Pompeu Fabra, Departament de Ciències Experimentals i de la Salut (DCEXS), Doctor Aiguader, 88, 08003, Barcelona, Spain; Consortium for Biomedical Research in 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.
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9
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Alla F. Second-hand tobacco exposure in children: evidence for action. Lancet Public Health 2021; 6:e537-e538. [PMID: 34274046 DOI: 10.1016/s2468-2667(21)00128-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/18/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Francois Alla
- Université de Bordeaux, Inserm U1218, Bordeaux 33000, France; Prevention Department, Centre Hospitalier Universitaire de Bordeaux, France.
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10
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Amalia B, Rodríguez A, Henderson E, Fu M, Continente X, Tigova O, Semple S, Clancy L, Gallus S, Fernández E, López MJ. How widespread is electronic cigarette use in outdoor settings? A field check from the TackSHS project in 11 European countries. ENVIRONMENTAL RESEARCH 2021; 193:110571. [PMID: 33278471 DOI: 10.1016/j.envres.2020.110571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 06/12/2023]
Abstract
Exposure to secondhand aerosol from electronic cigarettes (e-cigarettes) may pose harms to bystanders, but they are used in many indoor settings. Less evidence exists on e-cigarette use in outdoor settings. This study aims to assess the use of e-cigarettes in outdoor settings in Europe. A cross-sectional study was conducted at the entrances of primary schools (N = 200), children's playgrounds (N = 200), and outdoor hospitality venues (N = 220) during 2017-2018 in major cities of 11 European countries. We performed 30-min observations and recorded e-cigarette use at three-time points: at 0 min, 15 min, and 30 min. We described the number and proportion of settings with e-cigarette use observed at any of the three-time points according to country and other contextual variables. Results showed that there were 22 (11.0%) school entrances, eight (4.0%) playgrounds, and 47 (21.3%) outdoor hospitality venues where e-cigarette use was observed at any time point. School entrances and outdoor hospitality venues with observed e-cigarette use were more frequently found in countries with a higher prevalence (≥1.4%) of e-cigarette use (school entrances: 18.0% vs. 4.0%; p = 0.002, outdoor hospitality venues: 26.7% vs. 15.0%, p = 0.036). In conclusion, the outdoor setting with the highest visibility of e-cigarette use was outdoor areas of hospitality venues. Although still limited, e-cigarettes were also used in outdoor settings frequented by children. Governments should consider measures to restrict e-cigarette use outdoors to protect the health of bystanders, particularly in areas where children may be present.
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Affiliation(s)
- Beladenta Amalia
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | | | - Elisabet Henderson
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Marcela Fu
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Xavier Continente
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Barcelona, Spain
| | - Olena Tigova
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Sean Semple
- Institute for Social Marketing, University of Stirling, Stirling, Scotland, United Kingdom
| | - Luke Clancy
- TobaccoFree Research Institute Ireland (TFRI), Dublin, Ireland
| | - Silvano Gallus
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain.
| | - Maria J López
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Barcelona, Spain
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