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Yao T, Lea Watkins S, Sung HY, Wang Y, Gu D, Chen Lyu J, Lightwood J, Max W. Association between tobacco product use and respiratory health and asthma-related interference with activities among U.S. Adolescents. Prev Med Rep 2024; 41:102712. [PMID: 38586468 PMCID: PMC10995971 DOI: 10.1016/j.pmedr.2024.102712] [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: 09/06/2023] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 04/09/2024] Open
Abstract
Tobacco use adversely affects long-term respiratory health. We examined the relationship between sole and dual tobacco product use and both respiratory health and respiratory-related quality of life during adolescence in the U.S. Using adolescent data (baseline age 12-17) from Waves 4.5 (data collected from December 2017-December 2018) and 5 (data collected from December 2018-November 2019) of the Population Assessment of Tobacco and Health Study, we examined the associations between combustible (i.e., cigarette or cigar), vaped, and dual (i.e., both cigar/cigarette and e-cigarette) tobacco/nicotine use at baseline and two respiratory symptoms (all adolescents, n = 11,748) and new asthma diagnosis (adolescents with no baseline diagnosis, n = 9,422) at follow-up. Among adolescents with asthma (Wave 5, n = 2,421), we estimated the association between current tobacco use and the extent to which asthma interfered with daily activities. At follow-up, 12.3 % of adolescents reported past 12-month wheezing/whistling, 17.4 % reported past 12-month dry cough, and 1.9 % reported newly diagnosed asthma. Baseline current cigarette/cigar smoking was associated with subsequent wheezing/whistling and baseline report of another tobacco product use pattern was associated with subsequent asthma diagnosis. Among adolescents with asthma, 5.7 % reported it interfering with activities some of the time and 3.1 % reported interference most/all of the time in the past 30 days. Past 30-day sole cigarette/cigar smoking and dual use was positively associated with asthma-related interference with activities compared to never tobacco use and sole e-cigarette use. Combustible and dual tobacco use pose direct risk to respiratory health and indirect risk to quality of life through respiratory health.
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Affiliation(s)
- Tingting Yao
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA
| | - Shannon Lea Watkins
- Department of Community and Behavioral Health, University of Iowa, Iowa City, Iowa, USA
| | - Hai-Yen Sung
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA
| | - Yingning Wang
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA
| | - Dian Gu
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA
| | - Joanne Chen Lyu
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA
| | - James Lightwood
- Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, San Francisco, CA, USA
| | - Wendy Max
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA
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2
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Flor LS, Anderson JA, Ahmad N, Aravkin A, Carr S, Dai X, Gil GF, Hay SI, Malloy MJ, McLaughlin SA, Mullany EC, Murray CJL, O'Connell EM, Okereke C, Sorensen RJD, Whisnant J, Zheng P, Gakidou E. Health effects associated with exposure to secondhand smoke: a Burden of Proof study. Nat Med 2024; 30:149-167. [PMID: 38195750 PMCID: PMC10803272 DOI: 10.1038/s41591-023-02743-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/28/2023] [Indexed: 01/11/2024]
Abstract
Despite a gradual decline in smoking rates over time, exposure to secondhand smoke (SHS) continues to cause harm to nonsmokers, who are disproportionately children and women living in low- and middle-income countries. We comprehensively reviewed the literature published by July 2022 concerning the adverse impacts of SHS exposure on nine health outcomes. Following, we quantified each exposure-response association accounting for various sources of uncertainty and evaluated the strength of the evidence supporting our analyses using the Burden of Proof Risk Function methodology. We found all nine health outcomes to be associated with SHS exposure. We conservatively estimated that SHS increases the risk of ischemic heart disease, stroke, type 2 diabetes and lung cancer by at least around 8%, 5%, 1% and 1%, respectively, with the evidence supporting these harmful associations rated as weak (two stars). The evidence supporting the harmful associations between SHS and otitis media, asthma, lower respiratory infections, breast cancer and chronic obstructive pulmonary disease was weaker (one star). Despite the weak underlying evidence for these associations, our results reinforce the harmful effects of SHS on health and the need to prioritize advancing efforts to reduce active and passive smoking through a combination of public health policies and education initiatives.
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Affiliation(s)
- Luisa S Flor
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
| | - Jason A Anderson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Noah Ahmad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Aleksandr Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Sinclair Carr
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Xiaochen Dai
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Gabriela F Gil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Matthew J Malloy
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Susan A McLaughlin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Erin C Mullany
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Erin M O'Connell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Chukwuma Okereke
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Reed J D Sorensen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Joanna Whisnant
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
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Jarlstrup NS, Thygesen LC, Pisinger C, Vestbo J, Grønbæk M, Tolstrup JS. Trends in smoking-related diseases by socioeconomic position following a national smoking ban in 2007: a nationwide study in the Danish population. BMC Public Health 2023; 23:1648. [PMID: 37641031 PMCID: PMC10463393 DOI: 10.1186/s12889-023-16456-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/03/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND National comprehensive smoke-free legislation has been found to decrease the incidence of several smoking-related diseases. In 2007, Denmark introduced a national smoking ban, which banned smoking indoor in workplaces and public places, although only partial restrictions were applied in certain settings. We examined the impact of the smoking ban on smoking-related diseases and whether this differed across socioeconomic groups. METHODS Interrupted time series analyses of nationwide register data were performed using Poisson regression models to examine the differential impact of the smoking ban on monthly incidence rates of acute myocardial infarction, chronic obstructive pulmonary disease, and smoking-related cancers from 2002 to 2015. Immediate changes in incidence rates after the smoking ban and long-term changes in disease trends were estimated by comparing data from the pre- and post-ban period. Models were stratified by socioeconomic position. RESULTS Overall, we found neither immediate changes in rates of acute myocardial infarction, chronic obstructive pulmonary disease, and smoking-related cancers following the smoking ban nor long-term post-ban changes in disease trends as compared to before the ban. Results did not differ across socioeconomic groups. A pronounced socioeconomic gradient in incidence rates was observed for all outcomes both before and after the smoking ban. CONCLUSION The national smoking ban was not associated with a lower incidence of smoking-related diseases in the post-ban period compared to pre-ban levels and no differences between socioeconomic groups were observed. Future tobacco control in Denmark should consider which measures most effectively target the low socioeconomic groups to decrease the current strong socioeconomic inequality in health.
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Affiliation(s)
- Nanna Schneekloth Jarlstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark
| | - Jørgen Vestbo
- University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - Morten Grønbæk
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark.
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Akter S, Islam MR, Rahman MM, Rouyard T, Nsashiyi RS, Hossain F, Nakamura R. Evaluation of Population-Level Tobacco Control Interventions and Health Outcomes: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2322341. [PMID: 37418258 PMCID: PMC10329215 DOI: 10.1001/jamanetworkopen.2023.22341] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/22/2023] [Indexed: 07/08/2023] Open
Abstract
Importance Smoking causes considerable noncommunicable diseases, perinatal morbidity, and mortality. Objective To investigate the associations of population-level tobacco-control policies with health outcomes. Data Sources PubMed, EMBASE, Web of Science, Cumulated Index to Nursing and Allied Health Literature, and EconLit were searched from inception to March 2021 (updated on 1 March 2022). References were manually searched. Study Selection Studies reporting on associations of population-level tobacco control policies with health-related outcomes were included. Data were analyzed from May to July 2022. Data Extraction and Synthesis Data were extracted by 1 investigator and cross-checked by a second investigator. Analyses were conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Main Outcomes and Measures The primary outcomes were respiratory system disease (RSD), cardiovascular disease (CVD), cancer, mortality, hospitalization, and health care utilization. The secondary outcomes were adverse birth outcomes, such as low birth weight and preterm birth. Random-effects meta-analysis was used to estimate pooled odds ratios (ORs) and 95% CIs. Results Of 4952 records identified, 144 population-level studies were included in the final analysis; 126 studies (87.5%) were of high or moderate quality. The most frequently reported policies were smoke-free legislation (126 studies), followed by tax or price increases (14 studies), multicomponent tobacco control programs (12 studies), and a minimum cigarette purchase age law (1 study). Smoke-free legislation was associated with decreased risk of all CVD events (OR, 0.90; 95% CI, 0.86-0.94), RSD events (OR, 0.83; 95% CI, 0.72-0.96), hospitalization due to CVD or RSD (OR, 0.91; 95% CI, 0.87-0.95), and adverse birth outcomes (OR, 0.94; 95% CI, 0.92-0.96). These associations persisted in all sensitivity and subgroup analyses, except for the country income category, for which a significant reduction was only observed in high-income countries. In meta-analysis, there was no clear association of tax or price increases with adverse health outcomes. However, for the narrative synthesis, all 8 studies reported statistically significant associations between tax increases and decreases in adverse health events. Conclusions and Relevance In this systematic review and meta-analysis, smoke-free legislation was associated with significant reductions in morbidity and mortality related to CVD, RSD, and perinatal outcomes. These findings support the need to accelerate the implementation of smoke-free laws to protect populations against smoking-related harm.
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Affiliation(s)
- Shamima Akter
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Md. Rashedul Islam
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Md. Mizanur Rahman
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Thomas Rouyard
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | | | - Fahima Hossain
- Global Public Health Research Foundation, Dhaka, Bangladesh
| | - Ryota Nakamura
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
- Graduate School of Economics, Hitotsubashi University, Tokyo, Japan
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Galor A, Britten-Jones AC, Feng Y, Ferrari G, Goldblum D, Gupta PK, Merayo-Lloves J, Na KS, Naroo SA, Nichols KK, Rocha EM, Tong L, Wang MTM, Craig JP. TFOS Lifestyle: Impact of lifestyle challenges on the ocular surface. Ocul Surf 2023; 28:262-303. [PMID: 37054911 DOI: 10.1016/j.jtos.2023.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/15/2023]
Abstract
Many factors in the domains of mental, physical, and social health have been associated with various ocular surface diseases, with most of the focus centered on aspects of dry eye disease (DED). Regarding mental health factors, several cross-sectional studies have noted associations between depression and anxiety, and medications used to treat these disorders, and DED symptoms. Sleep disorders (both involving quality and quantity of sleep) have also been associated with DED symptoms. Under the domain of physical health, several factors have been linked to meibomian gland abnormalities, including obesity and face mask wear. Cross-sectional studies have also linked chronic pain conditions, specifically migraine, chronic pain syndrome and fibromyalgia, to DED, principally focusing on DED symptoms. A systematic review and meta-analysis reviewed available data and concluded that various chronic pain conditions increased the risk of DED (variably defined), with odds ratios ranging from 1.60 to 2.16. However, heterogeneity was noted, highlighting the need for additional studies examining the impact of chronic pain on DED signs and subtype (evaporative versus aqueous deficient). With respect to societal factors, tobacco use has been most closely linked to tear instability, cocaine to decreased corneal sensitivity, and alcohol to tear film disturbances and DED symptoms.
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Affiliation(s)
- Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; Surgical Services, Miami Veterans Administration, Miami, FL, USA.
| | - Alexis Ceecee Britten-Jones
- Department of Optometry and Vision Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
| | - Yun Feng
- Department of Ophthalmology, Peking University Eye Center, Peking University Third Hospital, Beijing, China
| | - Giulio Ferrari
- Cornea and Ocular Surface Unit, Eye Repair Lab, San Raffaele Scientific Institute, Milan, Italy
| | - David Goldblum
- Pallas-Kliniken, Olten, Bern, Zurich, Switzerland; University of Basel, Basel, Switzerland
| | - Preeya K Gupta
- Triangle Eye Consultants, Raleigh, NC, USA; Department of Ophthalmology, Tulane University, New Orleans, LA, USA
| | - Jesus Merayo-Lloves
- Instituto Universitario Fernandez-Vega, Universidad de Oviedo, Principality of Asturias, Spain
| | - Kyung-Sun Na
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Shehzad A Naroo
- College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Kelly K Nichols
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eduardo M Rocha
- Department of Ophthalmology, Othorynolaringology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Louis Tong
- Cornea and External Eye Disease Service, Singapore National Eye Center, Ocular Surface Research Group, Singapore Eye Research Institute, Eye Academic Clinical Program, Duke-National University of Singapore, Singapore
| | - Michael T M Wang
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
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Strassmann A, Çolak Y, Serra-Burriel M, Nordestgaard BG, Turk A, Afzal S, Puhan MA. Nationwide indoor smoking ban and impact on smoking behaviour and lung function: a two-population natural experiment. Thorax 2023; 78:144-150. [PMID: 35277448 PMCID: PMC9872239 DOI: 10.1136/thoraxjnl-2021-218436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/10/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Many countries have implemented indoor smoking bans over the past two decades. Although smoking bans have been shown to reduce cardiovascular outcomes, little is known about their impact on respiratory health. This study investigated the impact of a nationwide indoor smoking ban on smoking behaviour and lung function. METHODS We used repeated cross-sectional data from two large cohorts of the general population comprising 31 807 Swiss and 62 093 Danish adults. We compared associations between smoking ban and smoking prevalence and prebronchodilator lung function trends in Denmark (indoor smoking ban introduced in 2007) and Switzerland (indoor smoking ban introduced in 2010) from 2005 to 2010 using a quasi-experimental study design. We performed difference-in-difference analyses with linear regression models adjusted for age, sex, weight and height. RESULTS Denmark had a stronger decrease in active smokers compared with Switzerland. Also, forced expiratory volume in the first second was higher in Danish adults than in Swiss adults: 26 mL (95% CI 2.4 to 49) 1 year, 88 mL (65 to 112) 2 years, and 74 mL (51 to 98) 3 years after smoking ban implementation. Correspondingly, forced vital capacity was higher in Danish adults compared with Swiss adults (80 mL (50 to 109) after 1 year and 126 mL (97 to 155) after two and 3 years). Improvements were observed in both never-smokers and ever-smokers, most pronounced in ever-smokers. CONCLUSIONS Nationwide indoor smoking ban is associated with less smoking and improved lung function in the general population. Implementing an indoor smoking ban can improve lung function by influencing smoking behaviour and reducing secondhand smoke.
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Affiliation(s)
- Alexandra Strassmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Yunus Çolak
- Department of Respiratory Medicine, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.,The Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Miquel Serra-Burriel
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Børge G Nordestgaard
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | | | - Shoaib Afzal
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Wu Y, Wang Z, Zheng Y, Wang M, Wang S, Wang J, Wu J, Wu T, Chang C, Hu Y. Trends in Hospital Admissions for Chronic Obstructive Pulmonary Diseases After Comprehensive Tobacco Control Policies in Beijing, China. Nicotine Tob Res 2022; 24:1978-1984. [PMID: 35808957 DOI: 10.1093/ntr/ntac137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/12/2022] [Accepted: 05/30/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Only a few studies have examined the effectiveness of tobacco control policies on respiratory conditions, and the results were less consistent. The 2015 Beijing tobacco control policy package incorporating all six components of MPOWER has been implemented since Jun 2015. The present study aimed to evaluate the impact of a comprehensive tobacco control policy package on hospital admissions for chronic obstructive pulmonary disease (COPD) in Beijing, China. AIMS AND METHODS An interrupted time-series study was conducted based on the hospital admission information for about 18 million residents, who were covered by the Beijing Medical Claim Data for Employees from January 2013 to June 2017. The average percentage change of COPD hospital admission rates and reductions in hospital admission numbers were estimated by segmented Poisson regression models. RESULTS There were 54 040 COPD hospital admissions with a crude rate of 67.2 per 100 000 residents during the observational period. After the implementation of the policy package, the hospital admission rates of COPD were reduced by -14.7% (95%CI: -17.8%, -11.5%) immediately. The secular trend was slowed down by -3.0% (95% CI: -5.6%, -0.4%) annually. A total of 5 581 reductions in COPD hospital admissions were estimated during the 25 months post-law period, accounting for 17.5% (95% CI: 12.5%, 22.5%) of overall COPD hospital admissions. More reductions were shown in males and those aged over 65 years old. CONCLUSIONS The results indicated significant protections against hospitalization of COPD after the 2015 Beijing comprehensive tobacco control policy package. The results provide support for public health benefits for respiratory conditions from WHO-recommended tobacco control measures. IMPLICATIONS Only a few studies have examined the effectiveness of tobacco control policies on respiratory conditions, and the results were less consistent. Based on medical records for about 18 million residents, this study showed an association between comprehensive tobacco control policies and significant reductions of hospital admissions for chronic obstructive pulmonary disease. The results provide support for public health benefits for respiratory conditions from WHO-recommended tobacco control measures.
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Affiliation(s)
- Yiqun Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
| | - Zijing Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
| | - Yunting Zheng
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
| | - Mengying Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
| | - Siyue Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
| | - Jiating Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
| | - Junhui Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
| | - Tao Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
| | - Chun Chang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
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8
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Hamadi H, Stallings-Smith S, Apatu E, Peterson B, Spaulding A. Smoke-Free Policies and 30-Day Mortality Rates for Chronic Obstructive Pulmonary Disease. Int J Health Policy Manag 2022; 11:1695-1702. [PMID: 34380194 PMCID: PMC9808222 DOI: 10.34172/ijhpm.2021.74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 06/23/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Smoke-free policies have been shown to impact 30-day readmission rates due to chronic obstructive pulmonary disease (COPD) among adults aged ≥65 years. However, little is known about the association between smokefree policies and 30-day mortality rates for COPD. Therefore, we investigated the association between comprehensive smoke-free policies and 30-day mortality rates for COPD. METHODS We used a cross-sectional study design and retrospectively examined risk-adjusted 30-day mortality rates for COPD across US hospitals in 1171 counties. Data were sourced from Centers for Medicare and Medicaid Services (CMS) Hospital Value-Based Purchasing (HVBP) Program, American Hospital Association (AHA) Annual Surveys, US Census Bureau Current Population Survey, and US Tobacco Control Laws Database from the American Nonsmokers' Rights Foundation (ANRF). Data were averaged at the county level for years 2015-2018. Hierarchical Poisson models adjusted for differences in hospital characteristics and accounted for the clustering of hospitals within a county were used. RESULTS Our findings show a consistent association between stronger smoke-free policies and a reduction in COPD mortality. When evaluating smoke-free policy, county characteristics, and hospital characteristics individually, we found that counties with full coverage or partial coverage had a reduced incidence rate of COPD mortality compared to no coverage counties. After adjusting for the county and hospital characteristics, counties with full coverage of smoke-free policies had a reduced rate of 30-day COPD mortality (adjusted incidence rate ratio [IRR]: 0.87, 95% CI: 0.79, 0.96) compared to counties with no policy coverage. CONCLUSION Comprehensive smoke-free policies are associated with a reduction in 30-day mortality following hospital admission for COPD. Partial smoke-free legislation is an insufficient preventative measure. These findings have strong implications for hospital policy-makers, suggesting that policy interventions to reduce COPD-related 30-day mortality should include implementing smoke-free policies and public health policy-makers to incentivize comprehensive smokefree policies.
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Affiliation(s)
| | | | - Emma Apatu
- McMaster University, Hamilton, ON, Canada
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9
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Córdoba García R. [About the New Comprehensive Tobacco Control Plan]. Aten Primaria 2022; 54:102290. [PMID: 35135670 PMCID: PMC8841813 DOI: 10.1016/j.aprim.2022.102290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Rodrigo Córdoba García
- Centro de Salud Delicias Sur, Zaragoza Coordinador GdT educación sanitaria y Promoción de la Salud de semFYC.
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10
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Bakhturidze G, Peikrishvili N, Gvinianidze K. Impact of comprehensive smoke-free policy compliance on SHS exposure and health condition of the Georgian population. Tob Prev Cessat 2021; 7:70. [PMID: 34901565 PMCID: PMC8619785 DOI: 10.18332/tpc/143329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Georgia made steps forward in 2017 and adopted new amendments to its tobacco control legislation, which mostly correspond to the FCTC requirements. Among other changes in the regulations is a ban on smoking in public buildings and public transport, with a few exemptions (casinos, big slot clubs, performances in theatres, taxis). The regulation entered into force on 1 May 2018. METHODS The aim of the study is to assess the outcomes of the comprehensive smoke-free legislation in Georgia. We used a logical model for data collection and analysis. Our evaluation focuses on smoking prevalence related survey data, SHS exposure, monitoring results on compliance of new tobacco control regulations, Quitline data, and air quality measurement results. RESULTS The indoor air quality improved by 91% in the hospitality sector (from 1408 to 126 μg/m3 in 2018 and 117 μg/m3 in 2019), by 80% in public settings (from 531 to 112 μg/m3 in 2018 and 98 μg/m3 in 2019) and sufficiently in healthcare facilities (from 219 to 97-98 μg/m3 in 2018-2019). Demand for Quitline services increased by 30%. New cases of AMI declined by 32% during 2017-2019. CONCLUSIONS A comprehensive smoke-free policy with a high level of compliance (≥95%) had a positive impact on the decline of SHS exposure and tremendous improvement of indoor air quality in public places and promotes a decrease in illnesses related to the cardiovascular system in Georgia. Also, demand increased for smoking-cessation services.
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Affiliation(s)
- George Bakhturidze
- Framework Convention on Tobacco Control Implementation and Monitoring Center, Tbilisi, Georgia
| | - Nana Peikrishvili
- Framework Convention on Tobacco Control Implementation and Monitoring Center, Tbilisi, Georgia
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11
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Tweed EJ, Mackay DF, Boyd KA, Brown A, Byrne T, Conaglen P, Craig P, Demou E, Graham L, Leyland AH, McMeekin N, Pell JP, Sweeting H, Hunt K. Evaluation of a national smoke-free prisons policy using medication dispensing: an interrupted time-series analysis. Lancet Public Health 2021; 6:e795-e804. [PMID: 34537108 PMCID: PMC8554387 DOI: 10.1016/s2468-2667(21)00163-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Internationally, smoking prevalence among people in prison custody (ie, people on remand awaiting trial, awaiting sentencing, or serving a custodial sentence) is high. In Scotland, all prisons implemented a comprehensive smoke-free policy in 2018 after a 16-month anticipatory period. In this study, we aimed to use data on medication dispensing to assess the impact of this policy on cessation support, health outcomes, and potential unintended consequences among people in prison custody. METHODS We did an interrupted time-series analysis using dispensing data for 44 660 individuals incarcerated in 14 closed prisons in Scotland between March 30, 2014, and Nov 30, 2019. We estimated changes in dispensing rates associated with the policy announcement (July 17, 2017) and full implementation (Nov 30, 2018) using seasonal autoregressive integrated moving average models. Medication categories of primary interest were treatments for nicotine dependence (as an indicator of smoking cessation or abstinence attempts), acute smoking-associated illnesses, and mental health (antidepressants). We included antiepileptic medications as a negative control. FINDINGS A 44% step increase in dispensing of treatments for nicotine dependence was observed at implementation (2250 items per 1000 people in custody per fortnight, 95% CI 1875 to 2624) due primarily to a 42% increase in dispensing of nicotine replacement therapy (2109 items per 1000 people in custody per fortnight, 1701 to 2516). A 9% step decrease in dispensing for smoking-related illnesses was observed at implementation, largely accounted for by respiratory medications (-646 items per 1000 people in custody per fortnight, -1111 to -181). No changes associated with announcement or implementation were observed for mental health dispensing or antiepileptic medications (control). INTERPRETATION Smoke-free prison policies might improve respiratory health among people in custody and encourage smoking abstinence or cessation without apparent short-term adverse effects on mental health dispensing. FUNDING National Institute of Health Research Public Health Research programme, Scottish Government Chief Scientist Office, and UK Medical Research Council.
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Affiliation(s)
- Emily J Tweed
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Daniel F Mackay
- Department of Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kathleen A Boyd
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ashley Brown
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Thomas Byrne
- NHS Healthcare Improvement Scotland, Glasgow, UK
| | - Philip Conaglen
- Department of Public Health and Health Policy, NHS Lothian, Edinburgh, UK
| | - Peter Craig
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Evangelia Demou
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Alastair H Leyland
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola McMeekin
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jill P Pell
- Department of Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Helen Sweeting
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kate Hunt
- Department of Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Institute for Social Marketing and Health, University of Stirling, Stirling, UK
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12
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Vallarta-Robledo JR, Sandoval JL, De Ridder D, Ladoy A, Marques-Vidal P, Humair JP, Cornuz J, Probst-Hensch N, Schaffner E, Stringhini S, Joost S, Guessous I. Spatial clusters of daily tobacco consumption before and after a smoke-free policy implementation. Health Place 2021; 70:102616. [PMID: 34225236 DOI: 10.1016/j.healthplace.2021.102616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/17/2021] [Accepted: 06/24/2021] [Indexed: 11/25/2022]
Abstract
This study assessed the spatial dependence of daily tobacco consumption and how it is spatially impacted by individual and neighborhood socioeconomic determinants, and tobacco consumption facilities before and after a smoke-free implementation. Individual data was obtained from the Bus Santé, a cross-sectional survey in Geneva. Spatial clusters of high and low tobacco consumption were assessed using Getis-Ord Gi*. Daily tobacco consumption was not randomly clustered in Geneva and may be impacted by tobacco consumption facilities independently of socioeconomic factors and a smoking ban. Spatial analysis should be considered to highlight the impact of smoke-free policies and guide public health interventions.
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Affiliation(s)
- Juan R Vallarta-Robledo
- Unit of Population Epidemiology, Department of Primary Care, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Group of Geographic Information Research and Analysis in Population Health (GIRAPH), Geneva, Switzerland
| | - José Luis Sandoval
- Group of Geographic Information Research and Analysis in Population Health (GIRAPH), Geneva, Switzerland; Division of Primary Care, Department of Primary Care, Geneva University Hospitals, Geneva, Switzerland; Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - David De Ridder
- Unit of Population Epidemiology, Department of Primary Care, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Group of Geographic Information Research and Analysis in Population Health (GIRAPH), Geneva, Switzerland; Laboratory of Geographic Information Systems (LASIG), School of Architecture, Civil and Environmental Engineering (ENAC), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Anaïs Ladoy
- Group of Geographic Information Research and Analysis in Population Health (GIRAPH), Geneva, Switzerland; Laboratory of Geographic Information Systems (LASIG), School of Architecture, Civil and Environmental Engineering (ENAC), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Group of Geographic Information Research and Analysis in Population Health (GIRAPH), Geneva, Switzerland; Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Jean-Paul Humair
- Division of Primary Care, Department of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Jacques Cornuz
- University Centre for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Emmanuel Schaffner
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Silvia Stringhini
- Unit of Population Epidemiology, Department of Primary Care, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Group of Geographic Information Research and Analysis in Population Health (GIRAPH), Geneva, Switzerland; University Centre for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Stéphane Joost
- Unit of Population Epidemiology, Department of Primary Care, Geneva University Hospitals, Geneva, Switzerland; Group of Geographic Information Research and Analysis in Population Health (GIRAPH), Geneva, Switzerland; Laboratory of Geographic Information Systems (LASIG), School of Architecture, Civil and Environmental Engineering (ENAC), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Idris Guessous
- Unit of Population Epidemiology, Department of Primary Care, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Group of Geographic Information Research and Analysis in Population Health (GIRAPH), Geneva, Switzerland; Division of Primary Care, Department of Primary Care, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Geographic Information Systems (LASIG), School of Architecture, Civil and Environmental Engineering (ENAC), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
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13
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Córdoba-García R. [Fourteen years of tobacco control law in Spain. Current situation and proposals]. Aten Primaria 2020; 52:563-569. [PMID: 32534759 PMCID: PMC7505859 DOI: 10.1016/j.aprim.2020.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/13/2020] [Indexed: 12/04/2022] Open
Abstract
Spain has made progress in tobacco control policies, highlighting the prohibition of tobacco consumption in closed public spaces. A continued decrease in the proportion of smokers is observed. Exposure to environmental tobacco smoke has decreased in entertainment venues, with a reduction of environmental nicotine and particulate levels over 90%, without negative impact at home. There are reductions in hospital admissions and in mortality from heart attack, decrease in hospitalizations for chronic lung disease and asthma, and decrease in the risk of prematurity and low birth weight. We must advance in: plain packaging, advertising campaigns to prevent consumption, equalize the price of different tobacco products, regulate electronic cigarettes in public places, consider new smoke-free spaces where minors and other vulnerable groups may be exposed, expand aid for cessation and promote health professionals training.
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14
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Christian WJ, Walker CJ, Huang B, Hahn EJ. Effect of Local Smoke-Free Ordinances on Smoking Prevalence in Kentucky, 2002-2009. South Med J 2019; 112:369-375. [PMID: 31282965 PMCID: PMC6687407 DOI: 10.14423/smj.0000000000001000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Many local communities in Kentucky, a state with one of the highest smoking prevalence rates in the United States, have enacted smoke-free ordinances that prohibit smoking in workplaces and enclosed buildings open to the public. Research has shown that such ordinances are clearly beneficial for public health, but their influence on smoking prevalence in the populations they cover remains unclear. This study explores the effect of local smoke-free ordinances on smoking prevalence in Kentucky. METHODS We used a database of smoke-free ordinances maintained by the Kentucky Center for Smoke-Free Policy, Kentucky Behavioral Risk Factor Surveillance System survey data, and US Census data. We estimated the proportion of Kentucky adults living in counties with smoke-free ordinances of varying strength; examined bivariate associations between smoke-free ordinances and smoking prevalence; and fit regression models that adjusted for various county-level demographic, socioeconomic, and geographic factors. RESULTS Smoking prevalence was approximately 5% lower in counties with smoke-free ordinances, even after adjusting for other relevant factors, including a trend in decreasing prevalence throughout the study region. There was a slight dose-response effect related to the strength of smoke-free ordinances after adjustment for these covariates. Smoke-free ordinances appear to have a modest effect on smoking prevalence across the span of several years. CONCLUSIONS Findings demonstrate that although smoking prevalence fell throughout the state during the study period, counties with smoke-free ordinances experienced a greater decline. Future research should examine the strength of smoke-free ordinances in greater detail to better understand their influence on smoking prevalence.
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Affiliation(s)
- W Jay Christian
- From the Department of Epidemiology, College of Public Health, the Markey Cancer Center, College of Medicine, and BREATHE, College of Nursing, University of Kentucky, Lexington
| | - Courtney J Walker
- From the Department of Epidemiology, College of Public Health, the Markey Cancer Center, College of Medicine, and BREATHE, College of Nursing, University of Kentucky, Lexington
| | - Bin Huang
- From the Department of Epidemiology, College of Public Health, the Markey Cancer Center, College of Medicine, and BREATHE, College of Nursing, University of Kentucky, Lexington
| | - Ellen J Hahn
- From the Department of Epidemiology, College of Public Health, the Markey Cancer Center, College of Medicine, and BREATHE, College of Nursing, University of Kentucky, Lexington
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Continente X, Arechavala T, Fernàndez E, Pérez-Ríos M, Schiaffino A, Soriano JB, Carreras G, López-Nicolás Á, Gorini G, López MJ. Burden of respiratory disease attributable to secondhand smoke exposure at home in children in Spain (2015). Prev Med 2019; 123:34-40. [PMID: 30817956 DOI: 10.1016/j.ypmed.2019.02.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/12/2019] [Accepted: 02/23/2019] [Indexed: 10/27/2022]
Abstract
This study aimed to estimate the number of incident cases and hospital admissions attributable to secondhand smoke (SHS) exposure at home for asthma, otitis media (OM), and lower respiratory infections (LRI) in children in Spain. The burden of respiratory disease caused by SHS exposure was estimated in terms of incident cases and hospitalized cases for asthma, OM, and LRI. Estimates were calculated using the population attributable fraction. The age-specific (0-1 year, 0-4 years, 5-11 years, and 0-11 years) prevalence of SHS exposure in children was estimated through a telephone survey performed in a representative sample of Spanish households with children in 2016. The risk estimates for all diseases were selected from international meta-analyses. The number of hospitalized cases was obtained for each disease from the Hospital Minimum Data Set provided by the Ministry of Health of Spain. Incident cases were obtained from the Global Health Data Exchange. In 2015, SHS exposure caused an estimated total of 136,403 incident cases of the following respiratory diseases: 9058 (8.5%) cases of asthma, 120,248 (8.5%) of OM, and 7097 (13.5%) of LRI in children aged 0-14 years old in Spain. Likewise, SHS exposure caused a total of 3028 hospitalized cases, with 379 (8.5%) for asthma and 167 (8.5%) for OM in children 0-11 years old, and 2482 (11.6%) for LRI in children <2 years old. The high burden of respiratory disease attributed to SHS exposure supports the need to improve protection of children against SHS exposure by extending smoke-free regulations to homes and cars.
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Affiliation(s)
- Xavier Continente
- Agència de Salut Pública de Barcelona (Public Health Agency, Barcelona), Pl. Lesseps, 1, PC 08023 Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP) (Biomedical Research Centre Network for Epidemiology and Public Health), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, PC 28029 Madrid, Spain; Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau) (Institute of Biomedical Research, Barcelona), Sant Antoni Maria Claret, 167, PC 08025 Barcelona, Spain
| | - Teresa Arechavala
- Agència de Salut Pública de Barcelona (Public Health Agency, Barcelona), Pl. Lesseps, 1, PC 08023 Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra (UPF) (Experimental and Health Sciences Department, Pompeu Fabra University), Dr. Aiguader, 88, PC 08003 Barcelona, Spain
| | - Esteve Fernàndez
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia (ICO), Granvia de L'Hospitalet, 199-203, PC 08908 L'Hospitalet de Llobregat, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Granvia de L'Hospitalet, 199, PC 08908 L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, Campus de Bellvitge, School of Medicine and Health Sciences, Universitat de Barcelona, Feixa Llarga, s/n, PC 08907 L'Hospitalet de Llobregat, Spain
| | - Mónica Pérez-Ríos
- Epidemiology Unit, Galician Directorate for Public Health, Galician Health Authority, Xunta de Galicia, San Caetano, s/n, PC 15704 Santiago de Compostela, Spain; Department of Preventive Medicine and Public Health, School of Medicine, University of Santiago de Compostela, Praza do Obradoiro, s/n, PC 15782 Santiago de Compostela, Spain
| | - Anna Schiaffino
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Granvia de L'Hospitalet, 199, PC 08908 L'Hospitalet de Llobregat, Spain; Direcció General de Planificació en Salut, Departament de Salut, Generalitat de Catalunya, Travessera de les Corts, 131-159 (Pavelló Ave Maria), PC 08028 Barcelona, Spain
| | - Joan B Soriano
- Fundación para la Investigación Biomédica del Hospital Universitario La Princesa (IISP) (The Biomedical Research Foundation of University Hospital La Princesa), Diego de León, 62 1st floor, PC 28006 Madrid, Spain
| | - Giulia Carreras
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO) (Oncological Network, Prevention & Research Institute), Via Cosimo Il Vecchio, 2, PC 50139 Firenze, Italy
| | - Ángel López-Nicolás
- Universidad Politécnica de Cartagena (UPCT) (Polytechnic University of Cartagena), Plaza Cronista Isidoro Valverde, s/n, PC 30202 Cartagena, Spain
| | - Giuseppe Gorini
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO) (Oncological Network, Prevention & Research Institute), Via Cosimo Il Vecchio, 2, PC 50139 Firenze, Italy
| | - Maria José López
- Agència de Salut Pública de Barcelona (Public Health Agency, Barcelona), Pl. Lesseps, 1, PC 08023 Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP) (Biomedical Research Centre Network for Epidemiology and Public Health), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, PC 28029 Madrid, Spain; Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau) (Institute of Biomedical Research, Barcelona), Sant Antoni Maria Claret, 167, PC 08025 Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra (UPF) (Experimental and Health Sciences Department, Pompeu Fabra University), Dr. Aiguader, 88, PC 08003 Barcelona, Spain.
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Muñoz-Cifuentes P, Córdoba R, Altisent R, Delgado-Marroquín MT. [Autonomy and heteronomy, a necessary alliance to address smoking cessation. Views of professionals and patients]. GACETA SANITARIA 2018; 33:401-407. [PMID: 30033093 DOI: 10.1016/j.gaceta.2018.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 04/19/2018] [Accepted: 04/24/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To explore the perception of professionals and patients with regard to ethical issues involved in addressing the habit of smoking in primary care consultations. METHOD A qualitative study was designed, consisting of 12 semi-structured interviews with professionals, 7 interviews with patients and 2 focus groups with 6 professionals and 7 primary care patients (a total of 32 participants). An intentional sampling was conducted, including profiles of professionals and patients of both sexes, different ages and experience in relation to smoking. A content analysis was performed with an inductive analytical approach from data to the creation of theoretical categories. RESULTS Four main categories were identified: 1) ethical issues related to the responsibility of the professional when treating patients who smoke; 2) issues related to attitude to patients who smoke; 3) issues related to fair and equitable distribution of resources and to the role of the different levels of government in relation to the control of smoking; and 4) issues related to smokers' autonomy regarding their habit and smoking cessation. CONCLUSIONS An alliance is needed between the ethics that support the autonomy of patients who smoke and the regulation of tobacco consumption. This approach should be included in clinical training programmes dealing with tobacco use, dependence and cessation.
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Affiliation(s)
- Pablo Muñoz-Cifuentes
- Grupo de investigación en Bioética, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España.
| | - Rodrigo Córdoba
- Centro de Salud Delicias Sur, IIS Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Rogelio Altisent
- Centro de Salud Actur Sur, IIS Aragón, Cátedra de Profesionalismo y Ética Clínica, Universidad de Zaragoza, Zaragoza, España
| | - María Teresa Delgado-Marroquín
- Centro de Salud Delicias Norte, IIS Aragón, Cátedra de Profesionalismo y Ética Clínica, Universidad de Zaragoza, Zaragoza, España
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