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Borgini A, Veronese C, De Marco C, Boffi R, Tittarelli A, Bertoldi M, Fern Ndez E, Tigova O, Gallus S, Lugo A, Gorini G, Carreras G, L Pez MJ, Continente X, Semple S, Dobson R, Clancy L, Keogan S, Tzortzi A, Vardavas C, Nicol S LP, Starchenko P, Soriano JB, Ruprecht AA. Particulate matter in aerosols produced by two last generation electronic cigarettes: a comparison in a real-world environment. Pulmonology 2024; 30:137-144. [PMID: 33879426 DOI: 10.1016/j.pulmoe.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 11/25/2022] Open
Abstract
The design of e-cigarettes (e-cigs) is constantly evolving and the latest models can aerosolize using high-power sub-ohm resistance and hence may produce specific particle concentrations. The aim of this study was to evaluate the aerosol characteristics generated by two different types of electronic cigarette in real-world conditions, such as a sitting room or a small office, in number of particles (particles/cm3). We compared the real time and time-integrated measurements of the aerosol generated by the e-cigarette types Just Fog and JUUL. Real time (10s average) number of particles (particles/cm3) in 8 different aerodynamic sizes was measured using an optical particle counter (OPC) model Profiler 212-2. Tests were conducted with and without a Heating, Ventilating Air Conditioning System (HVACS) in operation, in order to evaluate the efficiency of air filtration. During the vaping sessions the OPC recorded quite significant increases in number of particles/cm3. The JUUL e-cig produced significantly lower emissions than Just Fog with and without the HVACS in operation. The study demonstrates the rapid volatility or change from liquid or semi-liquid to gaseous status of the e-cig aerosols, with half-life in the order of a few seconds (min. 4.6, max 23.9), even without the HVACS in operation. The e-cig aerosol generated by the JUUL proved significantly lower than that generated by the Just Fog, but this reduction may not be sufficient to eliminate or consistently reduce the health risk for vulnerable non e-cig users exposed to it.
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Affiliation(s)
- A Borgini
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - C Veronese
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - C De Marco
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - R Boffi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Tittarelli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Bertoldi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - E Fern Ndez
- Tobacco Control Unit, Bellvitge Biomedical Research Institute (IDIBELL), L...Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Unit, Department of Cancer Epidemiology and Prevention, Catalan Institute of Oncology (ICO), L...Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, Campus of Bellvitge, University of Barcelona, Spain; Consortium for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Spain
| | - O Tigova
- Tobacco Control Unit, Bellvitge Biomedical Research Institute (IDIBELL), L...Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Unit, Department of Cancer Epidemiology and Prevention, Catalan Institute of Oncology (ICO), L...Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, Campus of Bellvitge, University of Barcelona, Spain; Consortium for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Spain
| | - S Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - A Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - G Gorini
- Oncologic network, prevention and research institute (ISPRO), Florence, Italy
| | - G Carreras
- Oncologic network, prevention and research institute (ISPRO), Florence, Italy
| | - M J L Pez
- Public Health Agency of Barcelona (ASPB), 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
| | - X Continente
- Public Health Agency of Barcelona (ASPB), 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
| | - S Semple
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, United Kingdom
| | - R Dobson
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, United Kingdom
| | - L Clancy
- Tobacco Free Research Institute Ireland (TFRI), Ireland
| | - S Keogan
- Tobacco Free Research Institute Ireland (TFRI), Ireland
| | - A Tzortzi
- Hellenic Cancer Society ... George D. Behrakis Research Lab (HCS), Greece
| | - C Vardavas
- Hellenic Cancer Society ... George D. Behrakis Research Lab (HCS), Greece
| | | | - P Starchenko
- European Network on Smoking and Tobacco Prevention (ENSP), Belgium
| | - J B Soriano
- Fundaci..n para la Investigaci..n Biom..dica del Hospital Universitario La Princesa (IISP), Spain
| | - A A Ruprecht
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Possenti I, Scala M, Lugo A, Clancy L, Keogan S, Gallus S. The effectiveness of Allen Carr's method for smoking cessation: A systematic review. Tob Prev Cessat 2023; 9:29. [PMID: 37780488 PMCID: PMC10540232 DOI: 10.18332/tpc/172314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Allen Carr's (AC) method is a pharmacotherapy-free approach to quit smoking that is delivered through seminars, online courses, or in the form of a book. It has gained popularity, but its effectiveness remains controversial due to a lack of scientific evidence. This systematic review aims to provide an updated overview of the current evidence on the effectiveness of the AC method. METHODS We conducted a systematic literature review of all epidemiological studies evaluating the effectiveness of the AC method for smoking cessation, published in PubMed/MEDLINE and Embase up to March 2023. RESULTS Among 34 original studies identified through the literature search, six met the inclusion criteria. These studies were published between 2006 and 2020, with sample sizes ranging from 92 to 620 participants. Of the six studies, two did not have a comparison group while four, including two randomized control led trials (RCT), had a comparison group. The included studies showed cessation rates for people who attended the seminars from 19% to 51%. An observational study found an odds ratio (OR) of abstinence for those attending AC single-session seminars of 6.52 (95% confidence interval, CI: 3.10-13.72) compared with controls with no treatment. One RCT found higher quit rates for AC single-session seminars compared with the online Irish National service (OR=2.26; 95% CI: 1.22-4.21). Another RCT reported no significant difference between AC single-session seminars and a specialist stopsmoking service. One single study on patients with head and neck disorders analyzed the effectiveness of reading the AC book, showing no significant results. CONCLUSIONS The AC seminar may be an effective intervention for smoking cessation. This approach deserves further RCTs with large sample sizes to strengthen the evidence. Scant data are available on the effectiveness of reading the AC book.
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Affiliation(s)
- Irene Possenti
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Marco Scala
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alessandra Lugo
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Luke Clancy
- Tobacco Free Research Institute Ireland, Focas Institute, Dublin, Ireland
| | - Sheila Keogan
- Tobacco Free Research Institute Ireland, Focas Institute, Dublin, Ireland
| | - Silvano Gallus
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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3
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Keogan S, Alonso T, Sunday S, Hanafin J, Tigova O, Fernandez E, Lopez MJ, Gallus S, Semple S, Tzortzi A, Boffi R, Gorini G, Lopez-Nicolas A, Arvind DK, Radu-Loghin C, Soriano JB, Clancy L. Particle Exposure Hazards of Visiting Outdoor Smoking Areas for Patients with Asthma or COPD Even in EU Countries with Comprehensive Smokefree Laws. Int J Environ Res Public Health 2023; 20:5978. [PMID: 37297582 PMCID: PMC10252725 DOI: 10.3390/ijerph20115978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/19/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
Smokefree laws are intended to protect against second-hand smoke (SHS) in outdoor areas. We examined if exposure to PM2.5 particles in outdoor smoking areas changed breathing rates in 60 patients with asthma (n = 30) or with COPD (n = 30), in an open, non-randomised, interventional study model in Czechia, Ireland and Spain. The patients wore a PM2.5 particle monitor (AirSpeck) and a breath monitor (RESpeck) for 24 h to determine changes in breathing rates (Br) at rest and during a visit to an outside smoking area. Spirometry and breath CO were measured before and the day after visiting an outdoor smoking area. The PM2.5 levels at the 60 venues were highly variable, ranging from ≥2000 µg/m3 (in 4 premises) to ≤10 µg/m3 (in 3 premises, which had only a single wall in the structure). At 39 venues, the mean PM 2.5 levels were ≥25 µg/m3. The breathing rate changed significantly in 57 of the 60 patients, resulting in an increase in some patients and a decrease in others. Comprehensive smokefree laws were ineffective in protecting asthma and COPD patients from exposure to high levels of SHS in outside areas of pubs and terraces, which should be avoided by these patients. These findings also support the extension of smokefree laws to outside areas.
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Affiliation(s)
- Sheila Keogan
- TobaccoFree Research Institute Ireland (TFRI), D02 HW71 Dublin, Ireland
| | - Tamara Alonso
- Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- CIBER Respiratory Diseases (CIBERES), 28029 Madrid, Spain
| | - Salome Sunday
- TobaccoFree Research Institute Ireland (TFRI), D02 HW71 Dublin, Ireland
| | - Joan Hanafin
- TobaccoFree Research Institute Ireland (TFRI), D02 HW71 Dublin, Ireland
| | - Olena Tigova
- CIBER Respiratory Diseases (CIBERES), 28029 Madrid, Spain
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), 08908 Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
- School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Esteve Fernandez
- CIBER Respiratory Diseases (CIBERES), 28029 Madrid, Spain
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), 08908 Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
- School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Maria Jose Lopez
- Public Health Agency of Barcelona (ASPB), 08023 Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB St. Pau), 08025 Barcelona, Spain
| | - Silvano Gallus
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), 20156 Milano, Italy
| | - Sean Semple
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling (UNISTIR), Stirling FK9 4LA, UK
| | - Anna Tzortzi
- Institute of Public Health, The American College of Greece, GR-153 42 Athens, Greece
| | - Roberto Boffi
- Fondazione IRCCS Istituto Nazionale dei Tumori (INT), 20133 Milan, Italy
| | - Giuseppe Gorini
- Istituto per lo Studio, la Prevenzione, e la Rete Oncologica (ISPRO), 50139 Firenze, Italy
| | - Angel Lopez-Nicolas
- Department of Economics, Polytechnic University of Cartagena (UPCT), 30202 Cartagena, Spain
| | - D. K. Arvind
- School of Informatics, University of Edinburgh, Edinburgh EH8 9YL, UK
| | - Cornel Radu-Loghin
- European Network on Smoking and Tobacco Prevention (ENSP), 1050 Brussels, Belgium
| | - Joan B. Soriano
- Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- CIBER Respiratory Diseases (CIBERES), 28029 Madrid, Spain
| | - Luke Clancy
- TobaccoFree Research Institute Ireland (TFRI), D02 HW71 Dublin, Ireland
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McDonnell BP, McCausland R, Keogan S, Clancy L, Regan C. Prevalence of illicit tobacco use and tobacco tax avoidance in pregnancy. Ir J Med Sci 2021; 190:1445-1449. [PMID: 33439415 PMCID: PMC7803878 DOI: 10.1007/s11845-020-02487-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/16/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Smoking during pregnancy is associated with adverse maternal and fetal outcomes. Tobacco tax avoidance and tax evasion undermine the effectiveness of tobacco tax policies, resulting in cheaper prices for smokers and increased tobacco usage. AIMS The purpose of this study was to explore the purchasing habits of pregnant smokers with regard to tobacco expenditure and use of illicit tobacco. METHODS Prospective cohort study. Face to face interviews were conducted with 90 attendees (age range 18-42 years; mean age 28 years) of a smoking cessation antenatal clinic in a large Irish tertiary level maternity hospital. Information regarding smoking habits, quantity of tobacco smoked, and location of purchase of tobacco was collected in addition to socioeconomic details. Tobacco products were examined to establish whether these were purchased from legitimate sources. RESULTS 76.6% of women smoked 10 or fewer cigarettes per day. The mean weekly spend on tobacco was €39. Seventeen women (18.8%) smoked roll-your-own tobacco. One woman (1.1%) currently possessed a pack of illicit tobacco, while another 5.5% of participants had purchased illicit tobacco in the past. Four women (4.4%) practiced tobacco tax avoidance by purchasing tobacco abroad or in Duty Free. CONCLUSIONS Use of illicit tobacco is low and only a minority of women engaged in tobacco tax avoidance. As the average price of tobacco in Ireland increases, weekly expenditure on tobacco products is a significant financial impact on low-income women. Smoking cessation would deliver significant financial gains in addition to health benefits.
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Affiliation(s)
- Brendan P McDonnell
- Coombe Women and Infants University Hospital, Cork Street, Dublin 8, Ireland.
- Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - Robert McCausland
- Coombe Women and Infants University Hospital, Cork Street, Dublin 8, Ireland
| | - Sheila Keogan
- TobaccoFree Research Institute, Focas Research Institute, DIT Kevin Street, Camden Row, Dublin 2, Ireland
| | - Luke Clancy
- TobaccoFree Research Institute, Focas Research Institute, DIT Kevin Street, Camden Row, Dublin 2, Ireland
| | - Carmen Regan
- Coombe Women and Infants University Hospital, Cork Street, Dublin 8, Ireland
- Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
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5
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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. Environ Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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6
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Carreras G, Lachi A, Cortini B, Gallus S, López MJ, López-Nicolás Á, Lugo A, Pastor MT, Soriano JB, Fernandez E, Gorini G, Castellano Y, Fu M, Ballbè M, Amalia B, Tigova O, López MJ, Continente X, Arechavala T, Henderson E, Gallus S, Lugo A, Liu X, Borroni E, Colombo P, Semple S, O’Donnell R, Dobson R, Clancy L, Keogan S, Byrne H, Behrakis P, Tzortzi A, Vardavas C, Vyzikidou VK, Bakelas G, Mattiampa G, Boffi R, Ruprecht A, De Marco C, Borgini A, Veronese C, Bertoldi M, Tittarelli A, Gorini G, Carreras G, Cortini B, Verdi S, Lachi A, Chellini E, López-Nicolás Á, Trapero-Bertran M, Guerrero DC, Radu-Loghin C, Nguyen D, Starchenko P, Soriano JB, Ancochea J, Alonso T, Pastor MT, Erro M, Roca A, Pérez P, García-Castillo E. Burden of disease from exposure to secondhand smoke in children in Europe. Pediatr Res 2021; 90:216-222. [PMID: 33149260 DOI: 10.1038/s41390-020-01223-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Secondhand smoke (SHS) exposure at home and fetal SHS exposure during pregnancy are a major cause of disease among children. The aim of this study is quantifying the burden of disease due to SHS exposure in children and in pregnancy in 2006-2017 for the 28 European Union (EU) countries. METHODS Exposure to SHS was estimated using a multiple imputation procedure based on the Eurobarometer surveys, and SHS exposure burden was estimated with the comparative risk assessment method using meta-analytical relative risks. Data on deaths and disability-adjusted life years (DALYs) were collected from National statistics and from the Global Burden of Disease Study. RESULTS Exposure to SHS and its attributable burden stalled in 2006-2017; in pregnant women, SHS exposure was 19.8% in 2006, 19.1% in 2010, and 21.0% in 2017; in children it was 10.1% in 2006, 9.6% in 2010, and 12.1% in 2017. In 2017, 35,633 DALYs among children were attributable to SHS exposure in the EU, mainly due to low birth weight. CONCLUSIONS Comprehensive smoking bans up to 2010 contributed to reduce SHS exposure and its burden in children immediately after their implementation; however, SHS exposure still occurs, and in 2017, its burden in children was still relevant. IMPACT Exposure to secondhand smoke at home and in pregnancy is a major cause of disease among children. Smoking legislation produced the adoption of voluntary smoking bans in homes; however, secondhand smoke exposure at home still occurs and its burden is substantial. In 2017, the number of deaths and disability-adjusted life years in children attributable to exposure to secondhand smoke in the European Union countries were, respectively, 335 and 35,633. Low birth weight caused by secondhand smoke exposure in pregnancy showed the largest burden. Eastern European Union countries showed the highest burden.
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Affiliation(s)
- Giulia Carreras
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy.
| | - Alessio Lachi
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Barbara Cortini
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Silvano Gallus
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), Milan, Italy
| | - Maria José López
- Public Health Agency of Barcelona (ASPB), Barcelona, Spain.,CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain.,IIB Sant Pau, Barcelona, Spain
| | | | - Alessandra Lugo
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), Milan, Italy
| | | | - Joan B Soriano
- Hospital Universitario La Princesa (IISP), Madrid, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Esteve Fernandez
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain.,Catalan Institute of Oncology (ICO), L'Hopitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hopitalet de Llobregat, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Giuseppe Gorini
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
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Henderson E, Continente X, Fernández E, Tigova O, Cortés-Francisco N, Gallus S, Lugo A, Semple S, O'Donnell 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 in outdoor children's playgrounds in 11 European countries. Environ Int 2021; 149:105775. [PMID: 33228970 DOI: 10.1016/j.envint.2020.105775] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Tobacco presence in outdoor children's playgrounds is concerning not only because it leads to secondhand smoke (SHS) exposure, but also cigarette butt pollution and tobacco normalization. OBJECTIVES This study aimed to assess SHS exposure in children's playgrounds, according to area-level socioeconomic status (SES), smoke-free regulations, national smoking prevalence, and SHS exposure prevalence in playgrounds (2017-2018). METHODS We monitored vapor-phase nicotine concentration and tobacco-related variables in 20 different playgrounds in 11 European countries (n = 220 measurements) from March 2017 to April 2018. Playgrounds were selected according to area-level SES. Data on the number of people smoking, and cigarette butts inside the playground and on playground surroundings (<1 m away) were recorded. Playground smoking bans, the Tobacco Control Scale (TCS) score, national smoking prevalence and SHS exposure prevalence in playgrounds were used to group countries. To determine nicotine presence, we dichotomized concentrations using the limit of quantification as a cut-off point (0.06 μg/m3). Nicotine median concentrations were compared using non-parametric tests, and nicotine presence and tobacco-related observational variables using the Chi-squared test. RESULTS Airborne nicotine presence was found in 40.6% of the playgrounds. Median nicotine concentration was <0.06 μg/m3 (Interquartile range: <0.06-0.125) and higher median concentrations were found in more deprived neighborhoods, non-regulated playgrounds, in countries with lower overall TCS scores, higher national smoking prevalence and higher SHS exposure prevalence in playgrounds. Overall, people were smoking in 19.6% of the playgrounds. More than half of playgrounds had cigarette butts visible inside (56.6%) and in the immediate vicinity (74.4%). Presence of butts inside playgrounds was higher in sites from a low area-level SES, in countries with low TCS scores, and greater smoking prevalence and SHS exposure prevalence (p<0.05). CONCLUSIONS There is evidence of SHS exposure in children's playgrounds across Europe. These findings confirm the need for smoking bans in playgrounds and better enforcement in those countries with smoking bans in playgrounds.
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Affiliation(s)
- Elisabet Henderson
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Departament de Ciències Experimentals i de la Salut (DCEXS), Universitat Pompeu Fabra, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), 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
| | - Esteve Fernández
- Tobacco Control Unit, Institut Català d'Oncologia (ICO), Barcelona, Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain; School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Olena Tigova
- Tobacco Control Unit, Institut Català d'Oncologia (ICO), Barcelona, Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain; School of Medicine and Health Sciences, Universitat de Barcelona, 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
| | - Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Sean Semple
- Institute for Social Marketing and Health, University of Stirling, Stirling, United Kingdom
| | - Rachel O'Donnell
- Institute for Social Marketing and Health, University of Stirling, Stirling, United Kingdom
| | - Luke Clancy
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | - Sheila Keogan
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | - Ario Ruprecht
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Anna Tzortzi
- George D. Behrakis Research Lab-Hellenic Cancer Society, Athens, Greece
| | | | - Giuseppe Gorini
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Florence, Italy
| | | | - Joan B Soriano
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain; Hospital Universitario La Princesa, Madrid, Spain
| | | | - Joseph Osman
- OFT Conseil, Office Français de santé et bien-être au Travail, Paris, France
| | - Ute Mons
- Cancer Prevention Unit & WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Krzysztof Przewozniak
- The Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland; The Foundation Smart Health - Health in 3D, Warsaw, Poland
| | - José Precioso
- Instituto de Educação, Universidade do Minho, Braga, Portugal
| | - Ramona Brad
- Healthy Romania Generation 2035 Association, Bucharest, Romania
| | - Maria J López
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Departament de Ciències Experimentals i de la Salut (DCEXS), 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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8
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Gallus S, Lugo A, Liu X, Behrakis P, Boffi R, Bosetti C, Carreras G, Chatenoud L, Clancy L, Continente X, Dobson R, Effertz T, Filippidis FT, Fu M, Geshanova G, Gorini G, Keogan S, Ivanov H, Lopez MJ, Lopez-Nicolas A, Precioso J, Przewozniak K, Radu-Loghin C, Ruprecht A, Semple S, Soriano JB, Starchenko P, Trapero-Bertran M, Tigova O, Tzortzi AS, Vardavas C, Vyzikidou VK, Colombo P, Fernandez E. Who Smokes in Europe? Data From 12 European Countries in the TackSHS Survey (2017-2018). J Epidemiol 2021; 31:145-151. [PMID: 32249267 PMCID: PMC7813769 DOI: 10.2188/jea.je20190344] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 01/21/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Population data on tobacco use and its determinants require continuous monitoring and careful inter-country comparison. We aimed to provide the most up-to-date estimates on tobacco smoking from a large cross-sectional survey, conducted in selected European countries. METHODS Within the TackSHS Project, a face-to-face survey on smoking was conducted in 2017-2018 in 12 countries: Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania, and Spain, representing around 80% of the 432 million European Union (EU) adult population. In each country, a representative sample of around 1,000 subjects aged 15 years and older was interviewed, for a total of 11,902 participants. RESULTS Overall, 25.9% of participants were current smokers (31.0% of men and 21.2% of women, P < 0.001), while 16.5% were former smokers. Smoking prevalence ranged from 18.9% in Italy to 37.0% in Bulgaria. It decreased with increasing age (compared to <45, multivariable odds ratio [OR] for ≥65 year, 0.31; 95% confidence interval [CI], 0.27-0.36), level of education (OR for low vs high, 1.32; 95% CI, 1.17-1.48) and self-rated household economic level (OR for low vs high, 2.05; 95% CI, 1.74-2.42). The same patterns were found in both sexes. CONCLUSIONS These smoking prevalence estimates represent the most up-to-date evidence in Europe. From them, it can be derived that there are more than 112 million current smokers in the EU-28. Lower socio-economic status is a major determinant of smoking habit in both sexes.
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Affiliation(s)
- Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Xiaoqiu Liu
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Panagiotis Behrakis
- Institute of Public Health of the American College of Greece, Athens, Greece
| | - Roberto Boffi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Bosetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giulia Carreras
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Florence, Italy
| | - Liliane Chatenoud
- Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Luke Clancy
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | - Xavier Continente
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP) (Biomedical Research Centre Network for Epidemiology and Public Health), Madrid, Spain
- Institut d’investigació Biomèdica Sant Pau (IIB St. Pau), Barcelona, Spain
| | | | - Tobias Effertz
- University of Hamburg, Hamburg Business School, Institute for Law & Economics, Hamburg, Germany
| | | | - Marcela Fu
- Tobacco Control Unit, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Unit, Institut d’Investigació Biomèdica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
- Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | | | - Giuseppe Gorini
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Florence, Italy
| | - Sheila Keogan
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | | | - María J. Lopez
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP) (Biomedical Research Centre Network for Epidemiology and Public Health), Madrid, Spain
- Institut d’investigació Biomèdica Sant Pau (IIB St. Pau), Barcelona, Spain
| | | | - José Precioso
- Instituto de Educação, Universidade do Minho, Braga, Portugal
| | - Krzysztof Przewozniak
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Foundation “Smart Health - Health in 3D”, Warsaw, Poland
- Collegium Civitas, Warsaw, Poland
| | | | - Ario Ruprecht
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Joan B. Soriano
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
- Hospital Universitario La Princesa, Madrid, Spain
| | | | - Marta Trapero-Bertran
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Olena Tigova
- Tobacco Control Unit, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Unit, Institut d’Investigació Biomèdica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Anna S. Tzortzi
- Institute of Public Health of the American College of Greece, Athens, Greece
| | | | | | | | - Esteve Fernandez
- Tobacco Control Unit, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Unit, Institut d’Investigació Biomèdica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
- Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - the TackSHS Project Investigators
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
- Institute of Public Health of the American College of Greece, Athens, Greece
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Florence, Italy
- Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
- TobaccoFree Research Institute Ireland, Dublin, Ireland
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP) (Biomedical Research Centre Network for Epidemiology and Public Health), Madrid, Spain
- Institut d’investigació Biomèdica Sant Pau (IIB St. Pau), Barcelona, Spain
- University of Stirling, Stirling, Scotland
- University of Hamburg, Hamburg Business School, Institute for Law & Economics, Hamburg, Germany
- Department of Primary Care and Public Health, Imperial College, London, UK
- Tobacco Control Unit, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Unit, Institut d’Investigació Biomèdica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
- Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
- Smoke Free Life Coalition, Sofia, Bulgaria
- Universidad Politécnica de Cartagena, Cartagena, Spain
- Instituto de Educação, Universidade do Minho, Braga, Portugal
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Foundation “Smart Health - Health in 3D”, Warsaw, Poland
- Collegium Civitas, Warsaw, Poland
- European Network for Smoking Prevention, Bruxelles, Belgium
- Hospital Universitario La Princesa, Madrid, Spain
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya (UIC), Barcelona, Spain
- DOXA Institute, Milan, Italy
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9
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Henderson E, Continente X, Fernández E, Tigova O, Cortés-Francisco N, Gallus S, Lugo A, Semple S, O'Donnell 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 and other signs of tobacco consumption at outdoor entrances of primary schools in 11 European countries. Sci Total Environ 2020; 743:140743. [PMID: 32758838 DOI: 10.1016/j.scitotenv.2020.140743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Although smoking restrictions at child-related settings are progressively being adopted, school outdoor entrances are neglected in most smoke-free policies across Europe. OBJECTIVES To describe secondhand smoke (SHS) exposure and tobacco-related signs in outdoor entrances of primary schools in Europe according to area-level socioeconomic status (SES), smoke-free policy, national smoking prevalence, and geographical region. METHODS In this cross-sectional study we monitored vapor-phase nicotine concentrations at 220 school outdoor entrances in 11 European countries (March 2017-October 2018). To account for nicotine presence, we used the laboratory's limit of quantification of 0.06 μg/m3 as point threshold. We also recorded the presence of smell of smoke, people smoking, cigarette butts, and ashtrays. Half of the schools were in deprived areas. We grouped countries according to their Tobacco Control Scale (TCS) score, smoking prevalence (2017-2018), and United Nations M49 geographical region. RESULTS There were detectable levels of nicotine in 45.9% of the outdoor entrances, in 29.1% smell of smoke, in 43.2% people smoking, in 75.0% discarded butts, and in 14.6% ashtrays. Median nicotine concentration was below the laboratory's limit of quantification <0.06 μg/m3 (Interquartile range:<0.06-0.119). We found higher SHS levels in countries with lower TCS scores, higher national smoking prevalence, and in the Southern and Eastern European regions. People smoking were more common in schools from lower area-level SES and in countries with lower TCS scores (p<0.05). CONCLUSIONS Smoking at school outdoor entrances is a source of SHS exposure in Europe. These findings support the extension of smoking bans with a clear perimeter to the outdoor entrances of schools.
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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; Spanish Consortium for Research on 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; Spanish Consortium 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
- Tobacco Control Unit, Institut Català d'Oncologia, Av. Granvia de l'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge, Av. Granvia de l'Hospitalet 199, 08908 L'Hospitalet de Llobregat, Spain; School of Medicine and Health Sciences, 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
- Tobacco Control Unit, Institut Català d'Oncologia, Av. Granvia de l'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge, Av. Granvia de l'Hospitalet 199, 08908 L'Hospitalet de Llobregat, Spain; School of Medicine and Health Sciences, 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
| | - Rachel O'Donnell
- 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, 17 B Ipitou Street, 10557 Athens, Greece
| | - Vergina K Vyzikidou
- George D. Behrakis Research Lab-Hellenic Cancer Society, 17 B Ipitou Street, 10557 Athens, 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 1, 28006 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, 75011 Paris, France
| | - Ute Mons
- 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, 15B Wawelska Str., 02-034, Warsaw, Poland; The Foundation Smart Health - Health in 3D, 24 Makolagwy Str., 02-811 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; Spanish Consortium 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.
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Clancy L, Keogan S, Sunday S, Šípková M, Pastor Sanz M, Soriano J, partners T. Changes in breathing during exposure to SHS in outside areas of pubs in patients with asthma and COPD in three EU countries. Tob Prev Cessat 2020. [DOI: 10.18332/tpc/128074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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11
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Li S, Keogan S, Clancy L. Does smoke-free legislation work for teens too? A logistic regression analysis of smoking prevalence and gender among 16 years old in Ireland, using the 1995-2015 ESPAD school surveys. BMJ Open 2020; 10:e032630. [PMID: 32801188 PMCID: PMC7430408 DOI: 10.1136/bmjopen-2019-032630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To assess the role of tobacco control legislation (TCL) in youth smoking in Ireland. To examine the effects of smoke-free legislation in youth. To consider whether TCL contributed to the gender equalisation in prevalence in 16 years old seen between 2003 and 2015. SETTING Data are from the 4 yearly European School Survey Project on Alcohol and Other Drugs from 1995 to 2015. Total sample size was 12.394. A logistic regression model on grouped data was used. Dependent variable is whether a student was a smoker in last 30 days. Independent variables are time, gender and the policy indicators, workplace ban on smoking, point-of-sale (POS) display ban, the introduction of graphical images on packs and the average real price of cigarettes. RESULTS Smoking prevalence dropped from 41% in 1995 to 13% in 2015. The effects of policies differed between boys and girls. For girls, estimates for workplace bans, graphical images on packs and a unit real (Consumer Price Index adjusted) price increase reduced prevalence by 7.31% (95% CI 2.94% to 11.68%), 8.80% (95% CI 2.60% to 15.01%) and 5.87 (95% CI 2.96 to 8.79), respectively. The POS ban did not have a significant effect in girls. For boys, estimates for workplace bans and a unit real price increase, reduced prevalence by 8.41% (95% CI 5.16% to 11.66%) and 4.93% (95% CI 0.77% to 9.08%), respectively, POS gave an increase of 7.02% (95% CI 1.96% to 12.40%). The introduction of graphical images had an insignificant effect. CONCLUSIONS TC legislation helps to explain the out-of-trend reduction in youth smoking prevalence. The estimated differential effects of the workplace ban, POS displays, real price changes and graphical images on packs help to explain the sharper decline in girls than boys. These findings should remind policy-makers to give increased consideration to the possible effects on young people of any legislative changes aimed at adults in TCL.
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Affiliation(s)
- Shasha Li
- TU Dublin, TobaccoFree Research Institute Ireland, Kevin Street, Dublin 8, Dublin, Ireland
| | - Sheila Keogan
- TU Dublin, TobaccoFree Research Institute Ireland, Kevin Street, Dublin 8, Dublin, Ireland
| | - Luke Clancy
- TU Dublin, TobaccoFree Research Institute Ireland, Kevin Street, Dublin 8, Dublin, Ireland
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Keogan S, Alonso T, Sunday S, Tigova O, Fernández E, López MJ, Gallus S, Semple S, Tzortzi A, Boffi R, Gorini G, López-Nicolás Á, Radu-Loghin C, Soriano JB, Clancy L. Lung function changes in patients with chronic obstructive pulmonary disease (COPD) and asthma exposed to secondhand smoke in outdoor areas. J Asthma 2020; 58:1169-1175. [PMID: 32441557 DOI: 10.1080/02770903.2020.1766062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Further evidence is needed on the effects that short- and long-term exposure to secondhand smoke (SHS) have on the respiratory health of patients with lung disease. Within the TackSHS project we aimed to assess the acute respiratory effects in lung function that result from short-term SHS exposure among patients with asthma and chronic obstructive pulmonary disease (COPD). METHODS The study design was an intervention trial with measurements before/after exposure to SHS in legal outdoor smoking areas. We studied patients with asthma or COPD from Czechia, Ireland, and Spain. Forced spirometry, peak flow and carbon monoxide (CO) measurements were performed pre- and 24 h post- exposure. RESULTS Overall, 60 patients were studied, 30 with asthma, and 30 with COPD; 35 (58.3%) were female. There were no significant differences observed in exhaled CO between pre- and 24 h post-exposure neither in women (p = 0.210), nor in men (p = 0.169).A statistically significant decrease in forced vital capacity (FVC) was seen, overall, in asthma participants (p = 0.02) and in forced expiratory volume in the first second (FEV1), (p = 0.02), FVC (p = 0.04) and peak expiratory flow rate (PEFR) (p = 0.04) in female asthmatic participants. The observed decreases in respiratory measurements in COPD were not significant. There were no reported increases in symptoms, respiratory medication, or use of health services 24 h after the exposure. CONCLUSION We conclude that acute, short-term SHS exposure had a statistically significant effect on spirometry in female asthma patients but did not significantly modify spirometric indices 24 h later in COPD patients.
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Affiliation(s)
- Sheila Keogan
- TobaccoFree Research Institute Ireland, Focas Research Institute, DIT, Dublin, Ireland
| | - Tamara Alonso
- Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Salome Sunday
- TobaccoFree Research Institute Ireland, Focas Research Institute, DIT, Dublin, Ireland
| | - Olena Tigova
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Tobacco Control Unit, Catalan Institute of Oncology (ICO), 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, Bellvitge Campus, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Esteve Fernández
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Tobacco Control Unit, Catalan Institute of Oncology (ICO), 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, Bellvitge Campus, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - María José López
- Agència de Salut Pública de Barcelona, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica Sant Pau (IIB St. Pau), Barcelona, Spain
| | - Silvano Gallus
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Sean Semple
- Institute for Social Marketing, University of Stirling, Stirling, Scotland, UK
| | - Ana Tzortzi
- Institute of Public Health of the American College of Greece, Athens, Greece
| | - Roberto Boffi
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Giuseppe Gorini
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Florence, Italy
| | | | | | - Joan B Soriano
- Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Luke Clancy
- TobaccoFree Research Institute Ireland, Focas Research Institute, DIT, Dublin, Ireland
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McDonnell BP, Dicker P, Keogan S, Clancy L, Regan C. Smoking cessation Through Optimisation of clinical care in Pregnancy: the STOP randomised controlled trial. Trials 2019; 20:550. [PMID: 31481110 PMCID: PMC6724369 DOI: 10.1186/s13063-019-3653-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/13/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Cigarette smoking negatively impacts on maternal and fetal health. Smoking cessation is one of the few interventions capable of improving pregnancy outcomes. Despite the risks, the most effective antenatal model of care for smokers is still unclear, and specific recommendations for screening for fetal growth restriction are absent. METHODS This is a pragmatic randomised controlled trial of a dedicated smoking cessation clinic versus routine antenatal care as an intervention to reduce cigarette smoking behaviour. Smoking mothers randomised to the Smoking cessation Through Optimisation of clinical care in Pregnancy (STOP) clinic will have all antenatal care provided by a team comprising an obstetrician, a midwife, and a smoking cessation practitioner. This intervention includes ultrasound screening for fetal growth restriction. The control arm comprises two groups: one receiving standard care with ultrasound screening for fetal growth restriction, and one receiving standard care with ultrasound screening for growth restriction only if clinically indicated by their healthcare provider. Four hundred and fifty women will be recruited and randomised to either intervention or control arms stratifying for age, parity, and history of fetal growth restriction. RESULTS The primary outcome is self-reported, continuous abstinence from smoking between the quit date and end of pregnancy, validated by exhaled carbon monoxide or urinary cotinine. The quit date is targeted as being at or before 16 weeks' gestation and no further than 28 weeks' gestation. The secondary outcomes are a set of variables including maternal and fetal morbidity and mortality, neonatal complications and delivery outcomes, smoking and psychological outcomes, and qualitative measures. CONCLUSIONS Despite much research into cigarette smoking in pregnancy, the optimal model of care for these women is still unknown. This study has the potential to improve the model of antenatal care provided to pregnant women who smoke and to improve outcomes for both mother and infant. TRIAL REGISTRATION ISRCTN11214785 . Registered on 8 February 2018.
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Affiliation(s)
- Brendan P McDonnell
- Coombe Women & Infants University Hospital, Cork Street, Dublin 8, Ireland. .,Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - Patrick Dicker
- Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - Sheila Keogan
- TobaccoFree Research Institute, Focas Research Institute, DIT Kevin Street, Camden Row, Dublin 2, Ireland
| | - Luke Clancy
- TobaccoFree Research Institute, Focas Research Institute, DIT Kevin Street, Camden Row, Dublin 2, Ireland
| | - Carmen Regan
- Coombe Women & Infants University Hospital, Cork Street, Dublin 8, Ireland.,Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
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McDonnell BP, Keogan S, Clancy L, Regan C. Corrigendum to "Smoking cessation support and obstetric outcomes in an Irish maternity hospital" [Eur. J. Obstet. Gynecol. Reprod. Biol. 232 (2019) 1-4]. Eur J Obstet Gynecol Reprod Biol 2019; 236:266. [PMID: 30929969 DOI: 10.1016/j.ejogrb.2019.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Brendan P McDonnell
- Coombe Women and Infants University Hospital, Cork Street, Dublin 8, Ireland; Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - Sheila Keogan
- TobaccoFree Research Institute, Focas Research Institute, DIT Kevin Street, Camden Row, Dublin 2, Ireland
| | - Luke Clancy
- TobaccoFree Research Institute, Focas Research Institute, DIT Kevin Street, Camden Row, Dublin 2, Ireland
| | - Carmen Regan
- Coombe Women and Infants University Hospital, Cork Street, Dublin 8, Ireland; Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
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McDonnell BP, Keogan S, Clancy L, Regan C. Smoking cessation support and obstetric outcomes in an Irish maternity hospital. Eur J Obstet Gynecol Reprod Biol 2018; 232:1-4. [PMID: 30448746 DOI: 10.1016/j.ejogrb.2018.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/04/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Maternal cigarette smoking is a recognised risk factor for maternal and fetal morbidity and mortality and remains a significant problem in the Irish maternity system. Approximately 11% of Irish women will continue to smoke in pregnancy, despite awareness of the negative impact on their pregnancy. Although recommendations exist for the management of pregnant smokers, information on the antenatal care of Irish smokers in pregnancy has not been described. We reviewed the care given to smokers in a large urban maternity hospital. STUDY DESIGN This is a retrospective cohort study of 100 consecutive smokers and 110 contemporaneous non-smokers who delivered at a large urban maternity hospital of over 8200 births per year in Oct-Nov 2017. Data were obtained from both electronic patient records and chart review to ensure comprehensive capture of outcomes. RESULTS In general, mothers who smoked were younger (29yrs vs 33yrs p < 0.001) and of higher parity (1.4 vs. 1.0 p < 0.001) than non-smokers. They were less likely to have a planned pregnancy (44.4% vs 79.6%, p < 0.001) and less likely to have taken pre-conceptual folic acid (22.2% vs 58.3%, p < 0.001). These mothers also had a higher rate of history of illicit drug use, particularly cannabis (19.1% vs 0.9%, p < 0.001) and opiates (16.1% vs 0.9%, p < 0.001). Mental health issues were commoner in smokers with 36.3% describing depression, postnatal depression or bipolar disorder and 34.3% experiencing anxiety disorder or panic attacks. Smoking cessation advice was identified in only 36.5% of smokers and no smokers were referred for smoking cessation interventions. Two thirds of smokers were referred for an additional ultrasound, largely due to suspected fetal growth restriction. Infants of smoking mothers had lower mean birthweights (3.16 kg vs 3.47 kg p < 0.001) and mean birth centile (27th vs 47th p < 0.001) than non-smokers. Twenty eight percent of these infants were small for gestational age, an incidence significantly higher than non-smokers at 13% (p < 0.001). CONCLUSION Maternal cigarette smoking appears to be a largely tolerated risk factor in the population studied, despite being associated with poor obstetric outcomes. We identified an absence of smoking cessation services and a lack of intervention and structure around care pathways.
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Affiliation(s)
- Brendan P McDonnell
- Coombe Women and Infants University Hospital, Cork Street, Dublin 8, Ireland; Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - Sheila Keogan
- TobaccoFree Research Institute, Focas Research Institute, DIT Kevin Street, Camden Row, Dublin 2, Ireland
| | - Luke Clancy
- TobaccoFree Research Institute, Focas Research Institute, DIT Kevin Street, Camden Row, Dublin 2, Ireland
| | - Carmen Regan
- Coombe Women and Infants University Hospital, Cork Street, Dublin 8, Ireland; Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
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Keogan S, Li S, Clancy L. Allen Carr's Easyway to Stop Smoking - A randomised clinical trial. Tob Control 2018; 28:414-419. [PMID: 30361322 PMCID: PMC6589447 DOI: 10.1136/tobaccocontrol-2018-054243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 08/17/2018] [Accepted: 08/28/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To determine if Allen Carr's Easyway to Stop Smoking (AC) was superior to Quit.ie in a randomised clinical trial (RCT). SETTING Single centre, open RCT, general population based. PARTICIPANTS 300 adult smokers, 18 years plus, minimum 5 cigarettes daily, and English speaking. AC, 151 (females 44.4%) and Quit.ie, 149 (females 45.6%), mean age 44 years. outcomes for all 300 were analysed (intention-to-treat). Recruited through advertisement from July 2015 to February 2016. INTERVENTION Randomly assigned to AC (n=151) and Quit.ie (n=149), matched for age, sex and education. Block randomisation, enrolment and follow-up at 1, 3, 6 and 12 months. Primary aim was to determine if AC had higher quit rates than Quit.ie service at 3 months. Secondary aims: quit rates at 1, 6 and 12 months and analysis of associated factors including weight. AC consisted of a 5-hour seminar, in a group setting. Quit.ie is an online portal for smoking cessation. RESULTS AC had higher quit rates at 1, 3, 6 and 12 months. AC: 38%, (n=57), 27% (n=40), 23% (n=35), 22% (n=33) vs Quit.ie: 20% (n=30), 15% (n=22), 15% (n=23), 11% (n=17), respectively (all p values <0.05). Logistic regression AC vs Quit.ie, OR 2.26 (95% CI 1.22 to 4.21) p value=0.01. Weight gain 3.8 kg in AC vs 1.8 kg in Quit.ie (p value <0.05). CONCLUSIONS All AC quit rates were superior to Quit.ie, outcomes were comparable with established interventions. TRIAL REGISTRATION NUMBER ISRCTN12951013. Recruitment July 2015-February 2016.
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Affiliation(s)
- Sheila Keogan
- TobaccoFree Research Institute Ireland, Focas Research Institute, DIT, Dublin 8, Dublin, Ireland
| | - Shasha Li
- TobaccoFree Research Institute Ireland, Focas Research Institute, DIT, Dublin 8, Dublin, Ireland
| | - Luke Clancy
- TobaccoFree Research Institute Ireland, Focas Research Institute, DIT, Dublin 8, Dublin, Ireland
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Li S, Keogan S, Taylor K, Clancy L. Decline of adolescent smoking in Ireland 1995-2015: trend analysis and associated factors. BMJ Open 2018; 8:e020708. [PMID: 29703856 PMCID: PMC5922513 DOI: 10.1136/bmjopen-2017-020708] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/23/2018] [Accepted: 03/01/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The study examines trends in smoking among Irish adolescents aged 15-16 years between 1995 and 2015 and the factors associated with their smoking behaviours between 2007 and 2015. METHODS Data were obtained from the European School Survey Project on Alcohol and Other Drugs Ireland between 1995 and 2015. To examine the gender gap, two-sample proportion tests were used. Multivariate logistic regression was performed to examine the factors associated with smoking behaviours. Dependent variable is whether a respondent is a smoker in last 30 days. Independent variables include gender, survey years, perceived ease of access to cigarettes, perceived risk of smoking, perceived relative wealth, parental monitoring, maternal relationship, family structure, truancy and peer smoking. RESULTS Smoking prevalence has dropped from 41% in 1995 to 13% in 2015. The prevalence was much higher among girls than boys in 1995. The gender gap was closed by 2015. Multivariate regression results show that peer smoking, perceived access to cigarettes, perceived risks of smoking, parental monitoring, truancy, maternal relationship, perceived relative wealth and family structure were all significantly associated with adolescent smoking, and some of the factors had different effects for female and male students. CONCLUSION Ireland has successfully achieved a considerable decrease of adolescent smoking from 1995 to 2015, during which various tobacco control policies have been implemented. In addition, the gender gap on adolescent smoking has been closed during the period. Adolescent smoking could be further improved through strengthening enforcement on adolescent access to cigarettes and maintaining a high-intensity tobacco control media campaign targeting adolescents. Parents could also contribute by enhancing monitoring.
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Affiliation(s)
- Shasha Li
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | - Sheila Keogan
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | | | - Luke Clancy
- TobaccoFree Research Institute Ireland, Dublin, Ireland
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Li S, Keogan S, Clancy L. Did the Irish 2004 smokefree legislation contribute to the sharp decline in youth smoking? Tob Induc Dis 2018. [DOI: 10.18332/tid/83959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Clancy L, Keogan S, Babineau K, Burns A. Irish Healthcare staff- Smoking, training and activity in treatment of tobacco dependence -an online survey. Tob Prev Cessat 2016. [DOI: 10.18332/tpc/64946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kabir Z, Keogan S, Clarke V, Clancy L. Second-hand smoke exposure levels and tobacco consumption patterns among a lesbian, gay, bisexual and transgender community in Ireland. Public Health 2013; 127:467-72. [PMID: 23615297 DOI: 10.1016/j.puhe.2013.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 12/20/2012] [Accepted: 01/22/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To estimate and identify characteristics of tobacco use, including use of roll-your-own (RYO) cigarettes and second-hand smoke (SHS) exposure, among a self-identified lesbian, gay, bisexual and transgender (LGBT) community in Ireland. STUDY DESIGN Web-based self-administered questionnaire survey using a cross-sectional study design. METHODS A convenience sample of 661 self-identified LGBT respondents was recruited through a well-advertised web-based survey tool method between March and May 2012. Prevalence rates were adjusted for age, sexual orientation, social class and nationality. Multivariable logistic regression was performed to characterize tobacco use profile and SHS exposure levels for estimating adjusted odds ratios (AOR) with 95% confidence intervals (CI). RESULTS Of the 661 respondents, 45.3% (95% CI 44.9-45.7) reported current use of tobacco and 15.6% reported current use of RYO cigarettes (results were significantly higher for lesbians in both categories). In addition, 40.3% (95% CI 39.9-40.6) of respondents reported SHS exposure at home (significantly higher in gays), and 50.1% (95% CI 49.3-50.8) reported SHS exposure in cars (significantly higher in lesbians); these two groups were not mutually exclusive. The oldest individuals and non-Irish nationals were more than twice as likely to report SHS exposure in cars compared with the youngest individuals and Irish nationals, and the least-educated individuals were more than twice as likely to report current use of RYO cigarettes compared with the most-educated individuals (AOR 2.26; 95% CI 1.06-4.79). Non-tobacco users were less likely to report SHS exposure at home compared with current tobacco users (AOR 0.31; 95% CI 0.21-0.46). DISCUSSION Despite inherent methodological limitations associated with identification of such a study sample, the adjusted rates indicate that tobacco use is very high among the LGBT community in Ireland compared with the general Irish population (smoking rate 29%). High levels of SHS exposure at home and in cars further underscore the significance of smoke-free private vehicle and 100% smoke-free home policies. A targeted tobacco control strategy should be explored for this vulnerable population.
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Affiliation(s)
- Z Kabir
- Department of Epidemiology and Public Health, Western Gateway Building, University College Cork, Western Road, Cork, Ireland.
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Abstract
Background Ireland introduced a comprehensive workplace smoke-free legislation in March, 2004. Smoking-related adverse birth outcomes have both health care and societal cost implications. The main aim of this study was to determine the impact of the Irish smoke-free legislation on small-for-gestationa- age (SGA) births. Methods and Findings We developed a population-based birthweight (BW) percentile curve based on a recent study to compute SGA (BW <5th percentile) and very SGA (vSGA - BW<3rd percentile) for each gestational week. Monthly births born between January 1999 and December 2008 were analyzed linking with monthly maternal smoking rates from a large referral maternity university hospital. We ran individual control and CUSUM charts, with bootstrap simulations, to pinpoint the breakpoint for the impact of ban implementation ( = April 2004). Monthly SGA rates (%) before and after April 2004 was considered pre and post ban period births, respectively. Autocorrelation was tested using Durbin Watson (DW) statistic. Mixed models using a random intercept and a fixed effect were employed using SAS (v 9.2). A total of 588,997 singleton live-births born between January 1999 and December 2008 were analyzed. vSGA and SGA monthly rates declined from an average of 4.7% to 4.3% and from 6.9% to 6.6% before and after April 2004, respectively. No auto-correlation was detected (DW = ∼2). Adjusted mixed models indicated a significant decline in both vSGA and SGA rates immediately after the ban [(−5.3%; 95% CI −5.43% to −5.17%, p<0.0001) and (−0.45%; 95% CI: −0.7% to −0.19%, p<0.0007)], respectively. Significant gradual effects continued post the ban periods for vSGA and SGA rates, namely, −0.6% (p<0.0001) and −0.02% (p<0.0001), respectively. Conclusions A significant reduction in small-for-gestational birth rates both immediately and sustained over the post-ban period, reinforces the mounting evidence of the positive health effect of a successful comprehensive smoke-free legislation in a vulnerable population group as pregnant women.
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Affiliation(s)
- Zubair Kabir
- TobaccoFree Research Institute Ireland, Dublin, Ireland.
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Currie L, Keogan S, Campbell P, Gunning M, Kabir Z, Clancy L. An evaluation of the range and availability of intensive smoking-cessation services in Ireland. Ir J Med Sci 2010; 179:225-31. [DOI: 10.1007/s11845-009-0356-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Accepted: 04/23/2009] [Indexed: 10/20/2022]
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Kabir Z, Keogan S, Clarke V, Currie LM, Clancy L. Smoking profile among the gay and lesbian community in Ireland. Ir J Med Sci 2009; 179:423-6. [PMID: 19618234 DOI: 10.1007/s11845-009-0391-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Accepted: 06/22/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We hypothesized that smoking rates among the Gay and Lesbian Community (GLC) in Ireland are not significantly different from the general Irish population. METHODS A convenience sampling of self-identified GLC was recruited using electronic (n = 700) and print (n = 500) media procedures in response to survey call advertisements (December 2006-March 2007). In all, 1,113 had complete smoking data and were analyzed. Data on a random sample of 4,000 individuals, using the Irish Office of Tobacco Control monthly telephone survey, were analyzed for the same period. RESULTS Adjusted smoking rates in GLC were 26 and 24.6% in the general Irish population (P = 0.99), while "heavy" (> or =20 cigarettes/day) smoking prevalence was 44.1 and 36.6%, respectively (P = 0.02). Upper SES GLCs are "heavy" smokers compared with general population of similar SES group (P = 0.01). CONCLUSION When considering two different sampling methodologies, this study suggests that smoking rates among the GLC in Ireland are not significantly different from the general Irish population.
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Affiliation(s)
- Z Kabir
- The Digital Depot, Research Institute for a Tobacco Free Society, Thomas Street, Dublin 8, Ireland
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Kabir Z, Manning PJ, Holohan J, Keogan S, Goodman PG, Clancy L. Second-hand smoke exposure in cars and respiratory health effects in children. Eur Respir J 2009; 34:629-33. [PMID: 19357146 DOI: 10.1183/09031936.00167608] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We examined potential associations of ever asthma, and symptoms of wheeze (past 12 months), hay fever, eczema and bronchitis (cough with phlegm) among school children exposed to second-hand smoke (SHS) in cars, using a modified Irish International Study of Asthma and Allergies in Childhood (ISAAC) protocol. 2,809 children of 13-14 yrs old and who selected randomly from post-primary schools throughout Ireland completed the 2007 ISAAC self-administered questionnaire. Adjusted OR (adjusted for sex, active smoking status of children interviewed and their SHS exposure at home) were estimated for the associations studied, using multivariable logistic regression techniques. Overall, 14.8% (13.9% in young males, 15.4% in young females) of Irish children aged 13-14 yrs old were exposed to SHS in cars. Although there was a tendency towards increased likelihood of both respiratory and allergic symptoms with SHS exposure in cars, wheeze and hay fever symptoms were significantly higher (adjusted OR 1.35 (95% CI 1.08-1.70) and 1.30 (1.01-1.67), respectively), while bronchitis symptoms and asthma were not significant (1.33 (0.92-1.95) and 1.07 (0.81-1.42), respectively). Approximately one in seven Irish schoolchildren are exposed to SHS in cars and could have adverse respiratory health effects. Further studies are imperative to explore such associations across different population settings.
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Affiliation(s)
- Z Kabir
- Tobacco Free Research Institute, Dublin, Ireland
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Kabir Z, Clarke V, Keogan S, Currie LM, Zatonski W, Clancy L. Smoking characteristics of Polish immigrants in Dublin. BMC Public Health 2008; 8:428. [PMID: 19117510 PMCID: PMC2630949 DOI: 10.1186/1471-2458-8-428] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Accepted: 12/31/2008] [Indexed: 11/21/2022] Open
Abstract
Background This study examined two main hypotheses: a) Polish immigrants' smoking estimates are greater than their Irish counterparts (b) Polish immigrants purchasing cigarettes from Poland smoke "heavier" (≥ 20 cigarettes a day) when compared to those purchasing cigarettes from Ireland. The study also set out to identify significant predictors of 'current' smoking (some days and everyday) among the Polish immigrants. Methods Dublin residents of Polish origin (n = 1,545) completed a previously validated Polish questionnaire in response to an advertisement in a local Polish lifestyle magazine over 5 weekends (July–August, 2007). The Office of Tobacco Control telephone-based monthly survey data were analyzed for the Irish population in Dublin for the same period (n = 484). Results Age-sex adjusted smoking estimates were: 47.6% (95% Confidence Interval [CI]: 47.3%; 48.0%) among the Poles and 27.8% (95% CI: 27.2%; 28.4%) among the general Irish population (p < 0.001). Of the57% of smokers (n = 345/606) who purchased cigarettes solely from Poland and the 33% (n = 198/606) who purchased only from Ireland, 42.6% (n = 147/345) and 41.4% (n = 82/198) were "heavy" smokers, respectively (p = 0.79). Employment (Odds Ratio [OR]: 2.89; 95% CI: 1.25–6.69), lower education (OR: 3.76; 95%CI: 2.46–5.74), and a longer stay in Ireland (>24 months) were significant predictors of current smoking among the Poles. An objective validation of the self-reported smoking history of a randomly selected sub-sample immigrant group, using expired carbon monoxide (CO) measurements, showed a highly significant correlation coefficient (r = 0.64) of expired CO levels with the reported number of cigarettes consumed (p < 0.0001). Conclusion Polish immigrants' smoking estimates are higher than their Irish counterparts, and particularly if employed, with only primary-level education, and are overseas >2 years.
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Affiliation(s)
- Zubair Kabir
- Research Institute for a Tobacco Free Society (RIFTFS), The Digital Depot, Thomas Street, Dublin, Ireland
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Abstract
BACKGROUND The association of nocturnal asthma symptoms with a diurnal increase in inflammatory activity suggests a role for anti-inflammatory therapy in nocturnal asthma. METHODS Fifty patients with asthma with nocturnal symptoms entered a randomised, double blind, placebo controlled, crossover study. After a two week baseline period patients received nedocromil sodium (4 mg) or placebo four times daily. After eight weeks of treatment patients crossed to the alternative treatment for a further eight weeks. Symptom severity was recorded on a scale of 0-4 and inhaled bronchodilator use and peak flow (PEFR) were also recorded daily by the patients. Asthma severity, pulmonary function (FEV1, PEFR, FVC), and adverse events were recorded at clinic visits (baseline and after four and eight weeks of treatment). Global effectiveness was rated by clinician and patient, and treatment preference was recorded. RESULTS Efficacy was assessed from data from 28 patients. Night-time asthma (mean (SE) difference between nedocromil sodium and placebo: -0.52 (0.13)), total nocturnal symptom severity defined as night-time asthma plus morning tightness (-0.72 (0.20)), and night-time bronchodilator use (-0.62 (0.23)) were reduced with nedocromil sodium compared with placebo treatment during the primary efficacy period (weeks 5-8) and during weeks 1-4 (-0.36 (0.12), -0.63 (0.20), and -0.55 (0.28), respectively). Morning and evening PEFR values improved slightly--but not significantly--compared with placebo. Patient and clinician opinions favoured nedocromil sodium treatment. Daytime asthma, daytime cough, and clinic assessment of asthma severity (secondary efficacy variables) were improved with nedocromil sodium treatment; day-time bronchodilator use and clinic pulmonary function were not. CONCLUSIONS Nedocromil sodium was more effective than placebo in reducing nocturnal symptoms of asthma and bronchodilator use in this group of patients.
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Affiliation(s)
- L Clancy
- St James's Hospital, Dublin, Ireland
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