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Fu M, Castellano Y, Tigova O, Pérez-Ríos M, Driezen P, Kaai SC, Quah ACK, Vardavas CI, Fong GT, Fernández E. Support for regulating smoking in private and public places by adults who currently smoke and recently quit smoking in Spain. Tob Induc Dis 2024; 22:TID-22-149. [PMID: 39220715 PMCID: PMC11365038 DOI: 10.18332/tid/191797] [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: 06/10/2024] [Revised: 07/30/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION While indoor smoking restrictions are common, outdoor restrictions are still rare. We explored opinions and support for regulating smoking in different indoor and outdoor environments among adults who smoke and those who recently quit smoking, in Spain. METHODS The 2021 ITC EUREST-PLUS Spain Survey is a cross-sectional study conducted among a nationally representative sample of 1006 adults aged ≥18 years who smoked cigarettes (n=867) or had recently quit smoking (n=139). Using Poisson regression with robust variance, we estimated adjusted prevalence and prevalence ratios of favorable opinions on regulating smoking in different indoor and outdoor environments and support for regulation in unregulated outdoor environments, by sociodemographic and smoking-related characteristics. RESULTS There were highly favorable opinions for regulating smoking in places with minors (>95% in primary and secondary playgrounds, and cars with pre-school children and minors) and outdoor transportation (60-80%). There were less favorable opinions for regulating smoking in outdoor terraces of bars/pubs and restaurants (15-20%). Support for further total outdoor regulations on smoking was moderate for markets/shopping centers, public building entrances and swimming pools (40-60%), and low for restaurants/bars/pubs (29.2%). Having quit smoking, having no significant others who smoke and/or believing that cigarette smoke is harmful to others, were factors positively associated with favorable opinions and support for regulating smoking. CONCLUSIONS The settings in Spain with the most favorable opinions for regulation among adults who smoke and have recently quit smoking are places with minors, private cars with others and outdoor areas of public transportation, while the settings with the least favorable opinions were outdoor terraces of bars, pubs, and restaurants. Support for further total outdoor smoking bans is generally moderate, but low for restaurants, bars, and pubs. Overall, these findings suggest the feasibility of extending smoke-free policies to other public and private settings to protect others from tobacco smoke exposure.
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Affiliation(s)
- Marcela Fu
- Tobacco Control Unit, Catalan Institute of Oncology, WHO Collaborating Centre for Tobacco Control, L’Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Public Health, Mental Health, and Maternal and Child Health Nursing, Faculty of Nursing, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
| | - Yolanda Castellano
- Tobacco Control Unit, Catalan Institute of Oncology, WHO Collaborating Centre for Tobacco Control, L’Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
| | - Olena Tigova
- Tobacco Control Unit, Catalan Institute of Oncology, WHO Collaborating Centre for Tobacco Control, L’Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
- Department of Clinical Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Epidemiologií y Salud Pública, Instituto de Salud Carlos III, Madrid, España
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Susan C. Kaai
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Anne C. K. Quah
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Constantine I. Vardavas
- School of Medicine, University of Crete, Heraklion, Greece
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, United States
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology, WHO Collaborating Centre for Tobacco Control, L’Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
- Department of Clinical Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Bommelé J, Cremers H, Den Hollander W, Troelstra S, Geuke G, Dam W, Willemse E, Hopman P, Hipple Walters B, Willemsen M. Secondhand smoke exposure in public outdoor spaces in the Netherlands: The stronger the smell, the more exposure to nicotine. Tob Induc Dis 2024; 22:TID-22-81. [PMID: 38765694 PMCID: PMC11100306 DOI: 10.18332/tid/186952] [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: 02/14/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION While secondhand smoke exposure in outdoor spaces has been investigated before, no data on outdoor secondhand smoke exposure have been collected in the Netherlands. Such data could help policymakers gain support for smoke-free outdoor public spaces. METHODS Between May and November 2021, we visited 25 outdoor locations across the Netherlands. At each location, we conducted four measurements with smokers and one measurement without smokers. During each measurement, we counted the number of smokers present and we rated tobacco smell intensity on a five-point scale. Airborne nicotine and 3-ethenylpyridine (3-EP) data were collected through active sampling on thermal desorption tubes. The contents of these tubes were later analyzed using gas chromatography-mass spectrometry. Using linear mixed models, we investigated the association between levels of nicotine and the presence of smokers, the number of smokers, and the intensity of tobacco smell. We also investigated these association with levels of 3-EP. RESULTS Nicotine levels were higher when smokers were present (B=1.40; 95% CI: 0.69-2.11, p<0.001). For each additional smoker present, we measured higher levels of nicotine (B=0.23; 95% CI: 0.10-0.37, p=0.001). When the smell of tobacco smoke was noted to be stronger by the researchers, higher levels of nicotine were measured through sampling (B=0.85; 95% CI: 0.44-1.26, p<0.001). We found similar results for 3-EP levels. CONCLUSIONS This study showed that both nicotine and 3-EP are useful in quantifying levels of secondhand smoke in various outdoor locations. The level of nicotine exposure outdoors was positively associated with the number of smokers nearby. The intensity of the tobacco smell was also related to nicotine exposure: the stronger the smell of tobacco smoke, the more nicotine was measured in the air.
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Affiliation(s)
- Jeroen Bommelé
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
| | - Hans Cremers
- National Institute for Public Health and the Environment, Bilthoven, Τhe Netherlands
| | - Wouter Den Hollander
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
| | - Sigrid Troelstra
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
| | - Gemma Geuke
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
| | - Wiebe Dam
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
| | - Eefje Willemse
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
| | - Petra Hopman
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
| | - Bethany Hipple Walters
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
| | - Marc Willemsen
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
- Department of Health Promotion, Maastricht University, Maastricht, Τhe Netherlands
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Fu M, Castellano Y, Laroussy K, Baena A, Margalef M, Feliu A, Galimany-Masclans J, Puig-Llobet M, Moreno-Arroyo C, Sancho R, Bueno A, López A, Guydish J, Fernández E, Martínez C. Passive exposure and perceptions of smoke-free policies in hospital and university campuses among nursing students: A cross-sectional multicenter study. Tob Induc Dis 2023; 21:93. [PMID: 37465255 PMCID: PMC10350793 DOI: 10.18332/tid/167390] [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: 04/04/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Outdoor smoke-free regulations reduce exposure to secondhand smoke (SHS) and help to denormalize tobacco use. As future key agents in health promotion, nursing students' attitudes should agree with tobacco-control policies. The objectives of this study were: 1) assess nursing students' exposure to SHS in nursing schools, 2) explore their perceptions of compliance with the existing smoke-free regulations in acute-care hospitals; and 3) describe their support for indoor and outdoor smoking bans on hospital and university campuses. METHODS This was a cross-sectional multicenter study conducted in 2015-2016 in all 15 university nursing schools in Catalonia, Spain. A questionnaire gathered information on SHS exposure, awareness of the smoke-free regulation in acutecare hospitals, and support for smoke-free policies in indoor and outdoor areas of hospitals and university campuses. Participants were nursing students attending classes on the day of the survey. We performed descriptive analyses and calculated adjusted prevalence ratios (APR) and 95% confidence interval (CI). RESULTS Of 4381 respondents, 99.1% had seen people smoking in outdoor areas of their university campus, and 75.2% had been exposed to SHS on the campus (6.0% indoors and 69.2% outdoors). Nearly 60% were aware of the smoking regulation in place in acute-care hospitals. There was widespread support for smoke-free indoor hospital regulation (98.7%), but less support (64.8%) for outdoor regulations. Approximately 33% supported the regulation to make outdoor healthcare campuses smoke-free, which was higher among third-year students compared to first-year students (APR=1.41; 95% CI: 1.24-1.62), among never smokers (41.4%; APR=2.84; 95% CI: 2.21-3.64) compared to smokers, and among those who were aware of the regulation (38.4%; 95% CI: 1.37-1.75). CONCLUSIONS Exposure to SHS on university campuses is high. Nursing students express low support for strengthening outdoor smoking bans on hospital and university campuses. Interventions aiming to increase their support should be implemented.
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Affiliation(s)
- Marcela Fu
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia, l'Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d'Investigació Biomèdica de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
- Department of Public Health, Mental Health, and Maternal and Child Health Nursing, School of Nursing, Universitat de Barcelona, Barcelona, Spain
- Center for Biomedical Research in Respiratory, Madrid, Spain
| | - Yolanda Castellano
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia, l'Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d'Investigació Biomèdica de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
- Center for Biomedical Research in Respiratory, Madrid, Spain
- Department of Odonto-Stomatology, School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Kenza Laroussy
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia, l'Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d'Investigació Biomèdica de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
- Department of Public Health, Mental Health, and Maternal and Child Health Nursing, School of Nursing, Universitat de Barcelona, Barcelona, Spain
| | - Antoni Baena
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia, l'Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d'Investigació Biomèdica de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
- eHealth Center, School of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Mercè Margalef
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia, l'Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d'Investigació Biomèdica de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
- Center for Biomedical Research in Respiratory, Madrid, Spain
| | - Ariadna Feliu
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia, l'Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d'Investigació Biomèdica de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
- Center for Biomedical Research in Respiratory, Madrid, Spain
| | - Jordi Galimany-Masclans
- Department of Public Health, Mental Health, and Maternal and Child Health Nursing, School of Nursing, Universitat de Barcelona, Barcelona, Spain
| | - Montse Puig-Llobet
- Department of Public Health, Mental Health, and Maternal and Child Health Nursing, School of Nursing, Universitat de Barcelona, Barcelona, Spain
| | - Carmen Moreno-Arroyo
- Department of Fundamental and Medical-Surgical Nursing, School of Nursing, Universitat de Barcelona, Barcelona, Spain
- Nursing Research Group, Digestive System, Diagnostics, Pharmacogenetics, Care Support and Clinical Prevention Program, Institut d'Investigació Biomèdica de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
| | - Raül Sancho
- Department of Public Health, Mental Health, and Maternal and Child Health Nursing, School of Nursing, Universitat de Barcelona, Barcelona, Spain
- Nursing Research Group, Digestive System, Diagnostics, Pharmacogenetics, Care Support and Clinical Prevention Program, Institut d'Investigació Biomèdica de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Bueno
- Nursing Care Management, Equip d'Atenció Primària Roses, Institut Català de la Salut, Girona, Spain
| | - Antonio López
- Nursing Care Management, Equip d'Atenció Primària Valls Urbà, Institut Català de la Salut, Tarragona, Spain
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, United States
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia, l'Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d'Investigació Biomèdica de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
- Center for Biomedical Research in Respiratory, Madrid, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, Universitat de Barcelona, l'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Martínez
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia, l'Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d'Investigació Biomèdica de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
- Department of Public Health, Mental Health, and Maternal and Child Health Nursing, School of Nursing, Universitat de Barcelona, Barcelona, Spain
- Center for Biomedical Research in Respiratory, Madrid, Spain
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, United States
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Bommelé J, Walters BH, van Dorsselaer S, Willemsen MC. Outdoor smoking as a nuisance to non-smokers: The case for smoke-free outdoor public spaces in dense urban areas. Tob Prev Cessat 2022; 8:08. [PMID: 35280520 PMCID: PMC8859987 DOI: 10.18332/tpc/145502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/23/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Despite the growing number of smoke-free spaces, many non-smokers continue to be involuntarily exposed to secondhand smoke outdoors and on public streets. Both theory and research suggest that people living in densely populated urban areas are more likely to smoke than those living in less densely populated areas. Consequently, non-smokers in densely populated urban areas might be more likely to be exposed and feel annoyed by secondhand smoke outdoors. We investigated whether the extent to which non-smokers feel annoyed by secondhand smoke exposure in outdoor public spaces is related to urban population density. METHODS We used cross-sectional survey data from the Netherlands 'Module Substance Use' survey (2020 data, n=9375). This is a nationally representative sample of the adult population in the Netherlands. Using logistic regression models, we investigated whether urban population density predicts both smoking and non-smokers' annoyance to secondhand smoke exposure outdoors. RESULTS We found that smoking rates were associated with urban population density. In the Netherlands, people living in extremely population-dense urban areas were more likely to smoke than those living in non-urban areas (AOR=1.59; 95% CI: 1.25-2.02, p<0.001). Feeling annoyed by secondhand smoke outdoors was also associated with urban population density: non-smokers living in extremely population-dense urban areas were more likely to be annoyed than respondents living in non-urban areas (AOR=1.65; 95% CI: 1.34-2.02, p<0.001). CONCLUSIONS These cross-sectional data highlight the importance of comprehensive local tobacco control policy programs that include creating smoke-free outdoor public spaces. This need for such smoke-free outdoor public spaces might be particularly strong in densely populated areas.
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Affiliation(s)
- Jeroen Bommelé
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
| | - Bethany Hipple Walters
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
- Massachusetts General Hospital, Boston, United States
| | - Saskia van Dorsselaer
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
| | - Marc C. Willemsen
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
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