[Prescription of drugs for smoking cessation. Retrospective analysis of the health area of Zamora]. / Prescripción de fármacos para la deshabituación tabáquica. Análisis retrospectivo del área de salud de Zamora.

OBJECTIVE: To analyze the prescription of drugs to aid smoking cessation and to detect whether there are differences by age or sex. DESIGN: Retrospective cohort study. SITE: Zamora Health Area. PARTICIPANTS: Persons with smoking cessation attempts employing drugs funded in the period from 2020 to 2023. INTERVENTIONS: Request of pharmaceutical consumption of varenicline, bupropion and cytisine to the Pharmacy Information System of the Regional Health Management of Castilla y León. MAIN MEASUREMENTS: Number of quit attempts per person, treatment drug, number of medication containers per attempt, year, age and sex. Descriptive and statistical analysis using SPSS© v. 20. RESULTS: 2581 people tried to quit smoking with drugs, 2206 made one attempt and 375 made several attempts. Mean age was 50.7 years (95% CI: 50.2-51.1). No significant differences were found for age (P=.71) or sex (P=.74). There was a preference for prescribing varenicline over bupropion and low drug compliance, with only one container of medication being collected in about 50% of cases. A total of 1680 attempts were made to quit using cytisine in 2023, equivalent to 55.4% of the total number of treatment drugs used in the four years. The estimated cumulative incidence rate of drug withdrawal attempts in smokers between 18 and 65 years of age was 11.9%. CONCLUSIONS: The drug intervention had a low reach and poor compliance with the recommended treatment. It is essential to emphasize patient follow-up and drug adherence.

[Considerations for the design and implementation of interventions for the cessation of tobacco, alcohol and cannabis use in pregnancy: A qualitative study]. / Consideraciones para el diseño e implementación de las intervenciones para la cesación de consumo de tabaco, alcohol y cannabis en el embarazo. Un estudio cualitativo.

OBJECTIVE: To explore the opinion of different key stakeholders regarding the requirements that tobacco, alcohol and/or cannabis cessation interventions should meet to be implemented and to be acceptable and useful during pregnancy. DESIGN: A qualitative study with phenomenological approach. SITE: The study was conducted in Spain in 2022. PARTICIPANTS: Decision makers, health professionals, pregnant women using tobacco, alcohol and/or cannabis and their partners who are also users. METHODS: Data were collected through focus groups and in-depth interviews, until discourse saturation was reached and accurately transcribed. Exploratory analysis and inductive open coding were conducted, codes were merged into categories and subcategories were identified. RESULTS: Four categories and 18 subcategories were identified. The results suggest that interventions should be multicomponent. Among the interventions most accepted by pregnant women and their partners were specific cessation consultations, information, peer support (although they did not specify how) and financial incentives. Among other options to consider, co-oximetry, proposed by managers to obtain an objective register. CONCLUSIONS: The conclusion is that this intervention should be carried out at the level of prenatal care in primary care. There are doubts regarding the frequency, purpose, and follow-up of this multicomponent intervention, as well as the possibility of incorporating couples.

The contribution of positive affect and loneliness on readiness and self-efficacy to quit smoking among Spanish-speaking Mexican American smokers.

BACKGROUND: The existing research on affective and interpersonal determinants of smoking cessation largely under-represents minority smokers, such as Latinos. OBJECTIVE: The current study examined associations between affective and interpersonal factors with intermediary smoking cessation variables among Mexican-American smokers (N = 290; 60% male). METHODS: Measures of positive and negative affect, social support, and loneliness were each examined for associations with measures of motivational readiness to quit smoking, and smoking abstinence self-efficacy. Significant predictors were entered into models simultaneously to examine their unique associations. Covariates included gender, age, and educational attainment. RESULTS: Negative affect (b = .68, SE b = .14, p < .001) and loneliness (b = .20, SE b = .09, p < .05) were independently associated with motivation. Negative affect (b = .20, SE b = .06, p < .01) and positive affect (b = .34 SE b = .07, p < .001) were independently associated with self-efficacy. In the final models, only negative affect was associated with motivation (b = .68, SE b = .17, p < .001); whereas negative (b = .17, SE b = .06, p < .01) and positive (b = . 32, SE b = .07, p < .001) affect were associated with self-efficacy. CONCLUSION: Results highlight the importance of resilience factors (e.g., positive affect) among Mexican-American smokers. Cessation interventions regularly target negative affect among smokers; additional focus on positive affect in cessation interventions with this population may be warranted.

Future intentions and beliefs about roll-your-own cigarettes in adolescents.

OBJECTIVE: To determine the predisposition to use roll-your-own (RYO) cigarettes and the beliefs about RYO cigarettes of all the students of 3°-4° of ESO during the years 2016-17 and 2018-19. A cross-sectional study. SETTING: Bisaura High School from Sant Quirze de Besora. Primary Health Care in the Catalan Health Institute, Catalunya, Spain. PARTICIPANTS: 111 3rd and 4th of ESO (14-16 years). MAIN MEASUREMENTS: Dependent variables used were future intentions of smoking and beliefs regarding RYO cigarettes. Independent variables were sex, course and ever smoked. The prevalence of the different dependent variables was described and compared according to the different independent variables with Pearson's Khi-square test. RESULTS: 26.6% of the adolescents intended to smoke in the future of which 17.4% intended to smoke RYO cigarettes and 13.8% manufactured cigarettes (MC). Around 30% of adolescents express at least one wrong belief regarding RYO cigarettes. For example, the 26.7% believed that smoking RYO cigarettes generated less addiction than MC and the 32.1% that was less harmful. Those who had smoked at some time in their life had a greater intention to smoke in the future (54.5%), to smoke MC (27.3%) and RYO cigarettes (40.9%) than those who had never smoked (7.7%, 4.6% and 1.5% respectively) (p<0.005). Some misconceptions differed depending on whether adolescents had ever smoked in life, sex and course. The boys believed that smoking RYO cigarettes was more natural than smoking MC (p<0.005). CONCLUSIONS: Educational activities to improve the information that young people have regarding RYO cigarettes are needed.

[Cost-benefit of medical advice for quitting smoking in the Region of Murcia]. / Coste-utilidad del consejo médico para dejar de fumar en la Región de Murcia.

OBJECTIVE: To perform a cost-benefit analysis of brief medical advice to quit smoking in the Region of Murcia. DESIGN: A cost-benefit analysis is performed on brief medical advice to quit smoking versus non-intervention. A Markov model is used to estimate the costs (€ in 2014), under the perspective of the National Health System, and health outcomes. These are measured in quality-adjusted life years (QALY). The time horizon of the analysis is 20years, and costs and health outcomes were discounted at 3%. A univariate and multivariate deterministic sensitivity analysis is performed. LOCATION: Region of Murcia. PARTICIPANTS: Smokers in the Region of Murcia. INTERVENTIONS: Brief advice to quit smoking. KEY MEASURES: Quality Adjusted Life Years (QALYs). RESULTS: With a time horizon of 5years (2018), the incremental cost-effectiveness ratio (ICER) would be €172,400 per QALY gained; at 10years (2023) the ICER was €30,300 per QALY gained; and, for the maximum horizon considered by the model, the ICER was €7,260 per QALY gained. CONCLUSIONS: Brief advice intervention is more efficient in the long-term than in the short-term and, depending on the Spanish cost-benefit threshold, public funding for this intervention would be recommended.

[Cardiovascular risk factors in the population at risk of poverty and social exclusión]. / Factores de riesgo cardiovascular en la población en situación de riesgo de pobreza y exclusión social.

GOALS: Detect if there are differences in prevalence, distribution of cardiovascular risk factors and risk according to REGICOR and SCORE's function; between people belonging to different occupational classes and population at risk of social exclusion. DESIGN: Cross-sectional. SITE: Occupational health unit of the City Hall of Córdoba. PARTICIPANTS: Sample availability of 628 people, excluding 59 by age or incomplete data. The group of municipal workers was obtained randomly while all contracted exclusion risk was taken. INTERVENTION: No preventive, diagnostic or therapeutic actions that modify the course of the previous situation of workers were applied. MAIN MEASUREMENTS: Smoke, glucose, lipids, blood pressure and BMI as main variables. T-student were used for comparison of means and percentages for Chi2. Statistical significance attached to an alpha error <5% and confidence interval with a 95% security. Receiver operator curves (ROC) were employed to find out what explanatory variables predict group membership of workers at risk of exclusion. RESULTS: Smoking (95% CI: -.224;-.443), hypercholesterolemia (95% CI: -.127;-.320), obesity (95% CI: -.005;-0.214), diabetes (95% CI: -.060;-.211) and cardiovascular risk were higher in men at risk of exclusion. In women there were differences in the same variables except smoking (P=.053). CONCLUSIONS: The existence of inequalities in prevalence of cardiovascular risk factors is checked. In a context of social crisis, health promotion and primary prevention programs directing to the most vulnerable, they are needed to mit.

ITC EUREST-PLUS Spain: protocol of a prospective longitudinal study of smokers in Spain.

OBJECTIVE: The ITC EUREST-PLUS Spain Survey is a longitudinal study of a representative sample of Spanish adult (≥18 years old) smokers. This protocol describes the methods of the 2021 follow-up survey. METHOD: The ITC EUREST-PLUS Survey, a prospective cohort study of a representative sample of smokers in six European countries, was conducted in 2016 (baseline) and 2018 (waves 1 and 2). The 2021 ITC EUREST-PLUS Spain Survey is a continuation of the Spanish cohort with a new interview in 2021 (wave 3). Lost participants were replaced with new smokers recruited using the same multi-stage sampling design. This latest follow-up aims to examine current patterns and transitions of tobacco use and to evaluate the impact of new tobacco-related policies. COMMENTS: The ITC EUREST-PLUS Spain Survey will provide recent information about the impact of tobacco control policies on smoking behaviour.

Are levels of adipokines and micronutrients different in male adult smokers and non-smokers? A case-control study.

OBJECTIVE: Smoking is a common public problem leading to increases in oxidative stress and decreases in the levels of some micronutrients, finally affecting adipokine levels. The aim of this study was to compare the serum levels of omentin (intelectin-1), chemerin, TNF-α, and some micronutrient intakes in male smokers and non-smokers. METHODS: 40 male smokers and 40 male non-smokers with a mean age of 38.6±14.1 years were included in this study. Serum levels of omentin, chemerin, and TNF-α were measured. To calculate the daily intake of energy, carbohydrate, protein, fat, and some of the micronutrients, the 24-h recall and semi-quantitative food frequency questionnaire (FFQ) was used. RESULTS: Omentin, chemerin, and TNF-α levels in male smokers were lower than non-smokers, but these differences were not statistically significant. However, after adjustment for total and saturated fat intakes and age, omentin (ß=138.4, p=0.027) and TNF-α (ß=144.5, p=0.015) revealed significant differences. CONCLUSION: The serum levels of omentin, chemerin, TNF-α, and some micronutrient intakes were not significantly different between smokers and non-smokers. Further population studies are needed to clarify this subject.

[Current use of electronic cigarettes among never smoker high school students]. / Consumo actual de cigarrillos electrónicos entre estudiantes de secundaria que nunca han fumado.

OBJECTIVE: To test whether electronic cigarettes use among secondary school students in Spain is associated with initiating nicotine use. METHOD: Secondary analysis of the ESTUDES 2019 survey, a cross-sectional study conducted on a representative sample of students aged 14-18 years and selected students who had never smoked (n=16,705). We computed the prevalence and estimated the factors associated with current electronic cigarettes use (at least once in the month before the interview), with and without nicotine. RESULTS: The prevalence of current electronic cigarettes use among students who have never smoked is 2.5% (95% confidence interval [95%CI]: 2.2-2.9). 0.1% (95%CI: 0.08-0.2) declared using liquids with nicotine at least sometimes and 2.4% (95%CI: 2.1-2.8) using liquids always without nicotine. Being male and under 17 years of age, reporting binge drinking behavior, and having regular friends who use cannabis, increases the probability of current use of electronic cigarettes. The latter two variables seem to act as contextual variables associated with electronic cigarettes use. CONCLUSIONS: The percentage of Spanish never smoker students who currently use electronic cigarettes is lower than in neighboring countries, except for the United Kingdom. Only one in every 1000 Spanish students between 14 and 18 years old who have never smoked initiates the current use of nicotine with an electronic cigarette. However, we must monitor the evolution of this indicator.

Practice, barriers, and facilitators of healthcare providers in smoking cessation in Mexico.

OBJECTIVE: To assess the clinical practice, barriers, and facilitators in promoting smoking cessation in primary healthcare clinics in Mexico City. MATERIALS AND METHODS: A mixed method design was used. Surveys (n = 70) and semi-structured interviews (n = 9) were conducted with health personnel involved in smoking cessation clinics. RESULTS: Quantitative data revealed that physicians were more likely than nurses to 1) ask patients if they smoke (57.9% vs 34.5%, p = .057), 2) ask patients if they are interested in quitting smoking (65.7% vs 26.9%, p = .003), 3) provide advice to quit smoking (54.3% vs 29.2%, p = .056), and 4) assess whether pharmacotherapy is needed (21.9% vs 10%, p = .285). Qualitative data showed that nurses were more likely than physicians to report lack of resources to refer patients to smoking cessation services, lack of pharmacotherapy availability, and lack of provider training in smoking cessation. Reported barriers include lack of motivation among patients, lack of time for assessment, long appointment wait times, and lack of training. Reported facilitators include existence of smoking cessation programmes and pharmacotherapy at no cost to the patient, and having a multidisciplinary team. CONCLUSIONS: Due to numerous barriers, smoking cessation interventions are partially implemented in primary care clinics in Mexico City. A restructuring of services is necessary, and nurses should be given a more prominent role.

Indoor Radon Exposure and COPD, Synergic Association? A Multicentric, Hospital-Based Case-Control Study in a Radon-Prone Area.

BACKGROUND: COPD is a multifactorial disease which causes considerable mortality and morbidity worldwide. Previous studies assessing the possible relationship between indoor radon exposure and COPD have shown inconclusive results. METHODS: A multicentric, hospital-based, case-control study was conducted in a Spanish radon-prone area. COPD cases were confirmed by spirometry and controls were selected due to trivial surgery or procedures not related to tobacco consumption. All participants had to have lived for at least 15 years in the same dwelling. Radon measurements were conducted individually in dwellings using alpha-track detectors. Results were obtained using multivariate logistic regression. RESULTS: 189 cases and 747 controls took part. There was no significant association between residential radon concentrations and COPD onset with a OR of 1.12 (95%CI 0.41-3.06) for individuals exposed to more than 200Bq/m3 compared to those exposed to less than 50Bq/m3. Heavy smokers seem to increase their COPD risk if exposed to higher radon concentrations vs those exposed to lower concentrations. There was a statistically significant synergy index between radon exposure and tobacco consumption, S-index 11.60 (95%CI 3.71-36.26). Indoor radon concentration was higher in never/light smokers with COPD compared to controls. CONCLUSIONS: No association between indoor radon and COPD has been observed. However, there might be some effect modification on the COPD risk in heavy smokers when high radon exposure is present. This is supported by the additive synergy observed. Also, a possible association between indoor radon and COPD onset in never and light smokers needs to be further studied.

Estimation of the Risk of Lung Cancer in Women Participating in a Population-Based Breast Cancer Screening Program. / Estimación del riesgo de cáncer de pulmón en mujeres que participan en un programa de cribado poblacional de cáncer de mama.

INTRODUCTION: Lung cancer mortality is increasing in women. In Spain, estimates suggest that lung cancer mortality may soon surpass breast cancer mortality, the main cause of cancer mortality among women. The aim of this study was to estimate the proportion of women at high risk of developing lung cancer in a group of participants in a population-based breast cancer screening program. METHODS: Cross-sectional study in a sample of women who participated in a population-based breast cancer screening program in 2016 in Hospitalet de Llobregat (n=1,601). High risk of lung cancer was defined according to the criteria of the National Lung Screening Trial (NLST) and the Dutch-Belgian randomized lung cancer screening trial (NELSON). RESULTS: Around 20% of smokers according to NLST criteria and 40% of smokers according to NELSON criteria, and around 20% of former smokers according to both criteria, are at high risk of developing lung cancer. A positive and statistically significant trend is observed between the proportion of women at high risk and nicotine dependence measured with the brief Fagerström test. CONCLUSIONS: A high proportion of participants in this breast cancer screening program have a high risk of developing lung cancer and would be eligible to participate in a lung cancer screening program. Population-based breast cancer screening programs may be useful to implement lung cancer primary prevention activities.

Indoor Radon Exposure and COPD, Synergic Association? A Multicentric, Hospital-Based Case-Control Study in a Radon-Prone Area.

BACKGROUND: COPD is a multifactorial disease which causes considerable mortality and morbidity worldwide. Previous studies assessing the possible relationship between indoor radon exposure and COPD have shown inconclusive results. METHODS: A multicentric, hospital-based, case-control study was conducted in a Spanish radon-prone area. COPD cases were confirmed by spirometry and controls were selected due to trivial surgery or procedures not related to tobacco consumption. All participants had to have lived for at least 15 years in the same dwelling. Radon measurements were conducted individually in dwellings using alpha-track detectors. Results were obtained using multivariate logistic regression. RESULTS: 189 cases and 747 controls took part. There was no significant association between residential radon concentrations and COPD onset with a OR of 1.12 (95%CI 0.41-3.06) for individuals exposed to more than 200Bq/m3 compared to those exposed to less than 50Bq/m3. Heavy smokers seem to increase their COPD risk if exposed to higher radon concentrations vs those exposed to lower concentrations. There was a statistically significant synergy index between radon exposure and tobacco consumption, S-index 11.60 (95%CI 3.71-36.26). Indoor radon concentration was higher in never/light smokers with COPD compared to controls. CONCLUSIONS: No association between indoor radon and COPD has been observed. However, there might be some effect modification on the COPD risk in heavy smokers when high radon exposure is present. This is supported by the additive synergy observed. Also, a possible association between indoor radon and COPD onset in never and light smokers needs to be further studied.

[Exposure to second-hand smoke in school adolescents from Tunja (Colombia), 2017]. / Exposición al humo de segunda mano en adolescentes escolarizados de Tunja, Colombia, 2017.

INTRODUCTION: Adolescents exposed to second-hand smoke have a higher risk of morbidity. This is one of the main preventable public health problems in Latin America. OBJECTIVE: To determine the prevalence and sociodemographic factors associated with exposure to second-hand tobacco smoke at home and out-of-home, in school adolescents from Tunja-Colombia. METHODOLOGY: This cross-sectional study included 1100 school students, aged between 11 and 19 years. The information was obtained using a self-administered and totally anonymous questionnaire. For the analysis, the proportions of everyday exposure and the mean number of days of exposure to second-hand smoke during a regular week were estimated. For the associations, ordinal logistic regression and negative binomial regression models were performed. RESULTS: The average age of the participants was 14.5 years, with the majority (59%) being female. As regards second-hand tobacco smoke exposure at home, an everyday prevalence of 4.9% was found, from 1 to 6 days of 14.7%, with a mean exposure of 0.7 days (SD 1.7). Additionally, there was a higher prevalence of exposure to second-hand smoke out-of-home: every day 8%, from 1 to 6 days of 34.1%, with a mean exposure of 1.5 days (SD 2.2). CONCLUSION: The prevalence of exposure to second-hand smoke in adolescents of Tunja was high. Interventions at school and family level are recommended to counteract this problem.

Smoking-Attributable mortality in Spain in 2016.

INTRODUCTION: Smoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence. METHODS: A smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases. RESULTS: In 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65. CONCLUSIONS: One in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.

Trends in tracheal, bronchial and lung cancer attributed to smoking in South America: Global Burden of Disease analysis 1990-2019 / Tendencias del cáncer de tráquea, bronquios y pulmón atribuido al tabaquismo en Sudamérica: análisis de la carga mundial de morbilidad 1990-2019 / Tendências em câncer de traqueia, brônquios e pulmão atribuídas ao tabagismo na América do Sul: análise da carga global de doença de 1990 a 2019

ABSTRACT Objective. To investigate the burden of tracheal, bronchus, and lung (TBL) cancer due to tobacco exposure in the last 30 years in 12 South American countries. Methods. We used the Global Burden of Disease (GBD) 2019 exposure-response function to analyze the total tobacco, smoking, and secondhand smoke exposure-related TBL cancer deaths and disability-adjusted life years (DALYs), for 12 South American countries, between 1990 and 2019. Metrics were described as absolute numbers or rates per 100 000 individuals. The relative change in burden was assessed by comparing the 1990-1994 to 2015-2019 periods. Results. In 2019, the all-ages number of TBL cancer deaths and DALYs associated with tobacco exposure in South America was 29 348 and 658 204 in males and 14 106 and 318 277 in females, respectively. Age-adjusted death and DALYs rates for the region in 2019 were 182.8 and 4035 in males and 50.8 and 1162 in females, respectively. In males, 10/12 countries observed relative declines in TBL death rates attributed to tobacco exposure while only 4 countries reduced their mortality in females. Conclusion. While significant efforts on tobacco control are under place in South America, substantial burden of TBL cancer persists in the region with significant sex-specific disparities. Increased country-specific primary data on TBL cancer and tobacco exposure is needed to optimize healthcare strategies and improve comprehension of regional trends.

RESUMEN Objetivo. Investigar la carga del cáncer de tráquea, bronquios y pulmón por exposición al tabaco en los últimos 30 años en 12 países de Sudamérica. Métodos. Se utilizó la función de relación entre exposición y respuesta de la carga mundial de morbilidad del 2019 para analizar las muertes por cáncer de tráquea, bronquios y pulmón asociadas a la exposición total al tabaco, al tabaquismo activo y al tabaquismo pasivo, así como los años de vida ajustados en función de la discapacidad (AVAD), en 12 países de Sudamérica, entre 1990 y el 2019. Los resultados se presentaron en forma de número absoluto o de tasa por 100 000 personas. Se evaluó el cambio relativo de la carga mediante la comparación de los períodos 1990-1994 y 2015-2019. Resultados. En el 2019, el número de muertes por cáncer de tráquea, bronquios y pulmón y los AVAD asociados a la exposición al tabaco para todas las edades en Sudamérica fueron de 29 348 y 658 204 en los hombres y de 14 106 y 318 277 en las mujeres, respectivamente. La tasa de mortalidad y los AVAD ajustados por la edad correspondientes al 2019 en la región fueron de 182,8 y 4035 en los hombres y de 50,8 y 1162 en las mujeres, respectivamente. En el caso de los hombres, en 10 de los 12 países se observaron disminuciones relativas de la tasa de mortalidad por cáncer de tráquea, bronquios y pulmón atribuido a la exposición al tabaco, mientras que en el caso de las mujeres solo en 4 países hubo una reducción de la mortalidad. Conclusión. Aunque en Sudamérica se están llevando a cabo iniciativas importantes para el control del tabaco, en esta región persiste una carga considerable de cáncer de tráquea, bronquios y pulmón, con diferencias significativas en función del sexo. Es preciso contar con más datos primarios específicos de cada país sobre el cáncer de tráquea, bronquios y pulmón, así como sobre la exposición al tabaco, para optimizar las estrategias de atención de salud y mejorar la comprensión de las tendencias regionales.

RESUMO Objetivo. Investigar a carga de câncer de traqueia, brônquios e pulmão (TBP) decorrente da exposição ao tabaco nos últimos 30 anos em 12 países da América do Sul. Métodos. A função de exposição-resposta do estudo Carga Global de Doença (GBD, na sigla em inglês) 2019 foi usada para analisar o número de mortes e de anos de vida ajustados por incapacidade (AVAI) por câncer de TBP relacionado à exposição total ao tabaco e ao tabagismo e ao fumo passivo em 12 países da América do Sul entre 1990 e 2019. Os índices foram descritos em números absolutos ou taxas por 100 mil pessoas. A variação relativa da carga foi avaliada comparando-se os períodos de 1990 a 1994 e de 2015 a 2019. Resultados. Em 2019, os números de mortes e de AVAI por câncer de TBP associado à exposição ao tabaco na América do Sul, em todas as idades, foram, respectivamente, 29.348 e 658.204 em homens e 14.106 e 318.277 em mulheres. As taxas de mortalidade e os AVAI ajustados por idade na região foram, respectivamente, 182,8 e 4.035 em homens e 50,8 e 1.162 em mulheres em 2019. Em homens, 10 dos 12 países registraram uma diminuição relativa das taxas de mortalidade por câncer de TBP atribuído à exposição ao tabaco, mas somente 4 países obtiveram uma redução da mortalidade em mulheres. Conclusão. Apesar dos consideráveis esforços atuais para o controle do tabaco na América do Sul, ainda há uma expressiva carga de câncer de TBP na região, com disparidades significativas entre os sexos. É necessário dispor de mais dados primários sobre câncer de TBP e exposição ao tabaco específicos para cada país para aprimorar as estratégias de atenção à saúde e melhorar a compreensão das tendências regionais.

Adolescent smoking and the social capital of local communities in three counties in Romania.

OBJECTIVE: To identify the effect of social capital on adolescent smoking. METHOD: A stratified random sample of 1313 7th and 8th grade students from three counties in Transylvania, Romania, completed a self-administered questionnaire on smoking-related knowledge, attitudes and behaviours. The impact of social capital was measured (personal and community activities, school achievements and smoking-related knowledge). Multivariate multinomial logistic regression models were used to measure the association between social participation and smoking. RESULTS: Experimenting with smoking was mostly related to knowledge about smoking, academic performance and second-hand tobacco smoke exposure at home. The strongest risk factor of adolescent smoking was the smoking behaviour of classmates: those who reported a significant proportion of smokers among their classmates were nine times more likely to smoke themselves than in other cases (adjusted odds ratio [aOR]: 9.05). Those who considered smoking to be harmless were 4 times more likely to be smokers than those who considered this behaviour to be dangerous (aOR: 4.28). Poor academic results increased adolescents' smoking (aOR: 3.22 and 2.66). The odds were significantly higher for smoking, if they had an active social life (aOR: 2.54). Regular church attendance proved to be a protective factor (aOR: 0.45). CONCLUSIONS: Several social capital factors can play a role in adolescent smoking. The organization and the development of community activities aimed at prevention must strengthen the factors related to the community's social capital to reduce the likelihood of teenage smoking.

Leucoplasia homogénea bucal en pacientes fumadores de tabaco / Homogeneous Buccal Leukoplakia in Tobacco-smoking Patients

Introducción: La leucoplasia es la lesión potencialmente maligna más común de la mucosa bucal; el consumo de tabaco es el principal factor etiológico; se presentan distintos grados de displasia epitelial. Su estudio permite conocer mejor las manifestaciones clínicas e histopatológicas de esta enfermedad. Objetivo: Caracterizar clínica e histopatológicamente la leucoplasia homogénea bucal en pacientes fumadores de tabaco. Métodos: Se realizó un estudio descriptivo y transversal. El universo estuvo compuesto por 75 pacientes fumadores de tabaco y cigarros, atendidos en la consulta estomatológica del Policlínico de Especialidades del Hospital Clínico-Quirúrgico Saturnino Lora Torres de Santiago de Cuba. Mediante el examen clínico e histopatológico se diagnosticó leucoplasia homogénea bucal. Para la recolección del dato primario se confeccionó un modelo con las siguientes variables: grupo de edad, sexo, diagnóstico clínico, tiempo en el hábito de fumar, localización anatómica y estudio histopatológico de la enfermedad. Resultados: En la casuística prevaleció el sexo masculino (58,6 por ciento) y el grupo etario de 60 años y más (41,3 por ciento); la hiperparaqueratosis (64,0 por ciento), el infiltrado inflamatorio crónico ligero (60,0 por ciento) y la displasia epitelial leve (73,3 por ciento) fueron las alteraciones hísticas más comunes en fumadores con 21 y más años. La hipercromasia del núcleo (100,0 por ciento) y el pleomorfismo nuclear (96,80 por ciento) resultaron los cambios celulares más prominentes. Las alteraciones de los clavos interpapilares (92,0 por ciento), la hiperplasia del estrato basal (88,9 por ciento) y la pérdida de la polaridad (87,3 por ciento) resultaron los signos displásicos tisulares más significativos en la leucoplasia bucal y la mucosa de carrillo (40,0 por ciento) el sitio anatómico de mayor ocurrencia de lesiones. Conclusiones: Todos los pacientes fumadores de tabaco y cigarro presentaron, clínicamente, lesiones leucoplásicas bucales, confirmadas por el estudio histopatológico; el sexo masculino y el grupo de 60 y más años son los de mayor afectación. La hiperparaqueratosis, el infiltrado inflamatorio crónico ligero y la displasia epitelial leve fueron los de mayor predominio; la hipercromasia del núcleo y el pleomorfismo nuclear fueron los cambios celulares más prominentes. En el tejido displásico epitelial prevalecieron las alteraciones de los clavos interpapilares, la hiperplasia del estrato basal y la pérdida de la polaridad y el sitio más afectado, la mucosa de carrillo(AU)

Introduction: Leukoplakia is the most common potentially malignant lesion of the buccal mucosa; tobacco use is the main etiological factor; different degrees of epithelial dysplasia are present. Its study allows a better understanding of the clinical and histopathological manifestations of this disease. Objective: To clinically and histopathologically characterize homogeneous buccal leukoplakia in patients who smoke tobacco. Methods: A descriptive and cross-sectional study was performed. The universe was composed of 75 patients who smoked tobacco and cigars, attended in the stomatological consultation of the Specialties Polyclinic of the Clinical-Surgical Hospital Saturnino Lora Torres of Santiago de Cuba. By means of clinical and histopathological examination, homogeneous buccal leukoplakia was diagnosed. For the collection of the primary data, a model was made with the following variables: age group, sex, clinical diagnosis, time in smoking habit, anatomical location and histopathological study of the disease. Results: Male sex (58.6 percent)) and age group 60 years and older (41.3 percent) prevailed in the casuistry; hyperkeratosis (64.0 percent)), mild chronic inflammatory infiltrate (60.0 percent)) and mild epithelial dysplasia (73.3 percent)) were the most common histopathological alterations in smokers aged 21 years and older. Hyperchromasia of the nucleus (100.0 percent)) and nuclear pleomorphism (96.80 percent)) were the most prominent cellular changes. Interpapillary nail alterations (92.0 percent)), stratum basale hyperplasia (88.9 percent)) and loss of polarity (87.3 percent)) resulted the most significant tissue dysplastic signs in buccal leukoplakia and cheek mucosa (40.0 percent)) the anatomical site of highest occurrence of lesions. Conclusions: All tobacco and cigarette smoking patients presented, clinically, buccal leukoplastic lesions, confirmed by histopathological study; male sex and the 60 and older age group are the most affected. Hyperparapokeratosis, mild chronic inflammatory infiltrate and mild epithelial dysplasia were the most predominant; hyperchromasia of the nucleus and nuclear pleomorphism were the most prominent cellular changes. In the epithelial dysplastic tissue, interpapillary nail alterations, hyperplasia of the stratum basale and loss of polarity prevailed and the most affected site, the cheek mucosa(AU)

Asociación bidireccional entre uso de tabaco y riesgo de depresión en el estudio de cohorte SUN / Bidirectional association between tobacco use and depression risk in the SUN cohort study

Evaluamos la asociación del consumo de tabaco o su abandono con el riesgo de depresión y determinamos si presentar depresión se asoció al inicio de fumar. Diseño: estudio de cohortes prospectivo de 16.519 graduados universitarios españoles sin depresión al inicio del estudio. El consumo de tabaco se determinó al inicio y tras cuatro años de seguimiento. Los casos incidentes de depresión fueron autoinformados en los cuestionarios de seguimiento. Usamos modelos de regresión de Cox para estimar los Hazard Ratios (HR) de depresión según el nivel de tabaquismo inicial y sus cambios. Se estimaron los Odds Ratios (OR) para la asociación entre prevalencia de tabaquismo a lo largo de la vida y comienzo del hábito con modelos de regresión logística. Se observó un HR (IC 95%) para fumadores de 1,24 (1,05-1,46) en comparación con los que nunca habían fumado. Los participantes con la exposición más alta al tabaco (≥ 20 paquetes-año) tuvieron un incremento relativo del riesgo de depresión de 38%. Dejar de fumar durante los primeros cuatro años de seguimiento se asoció inversamente con la depresión (HR = 0,63; IC 95% = 0,40-0,99). Observamos un incremento significativo del riesgo de aparición de tabaquismo en los participantes con prevalencia de depresión a lo largo de la vida (OR multivariable = 1,44; IC 95% = 1,13-1,83). Encontramos una asociación bidireccional entre el consumo de tabaco y la depresión en la cohorte SUN. El control del tabaco y las campañas sanitarias de abstinencia deberían considerarse estrategias efectivas de salud pública para prevenir y manejar los trastornos depresivos. (AU)

We assessed the association of tobacco use or smoking cessation with depression risk and determined if the presence of a depressive disorder was associated with smoking onset. We conducted a prospective cohort study (SUN Project) based on 16,519 Spanish university graduates without depression at baseline. Tobacco use was determined at baseline and after four years of follow-up. Incident cases of depression were ascertained according to a previously validated report of a clinical diagnosis of depression during follow-up. Multivariable Cox regression models were used to estimate hazard ratios (HR) of depression according to previous smoking status. We used logistic regression models as a secondary analysis to estimate Odds Ratios (OR) of smoking onset during the first four years of follow-up according to lifetime depression prevalence at baseline. The multivariable HR (95% CI) for current smokers was 1.24 (1.05-1.46) as compared to participants who had never smoked. Participants with the highest exposure to tobacco (≥ 20 packsyears) had a significant 38% relative increment in depression risk. Smoking cessation during the first four years of follow-up was inversely associated with depression (HR = 0.63; 95% CI = 0.40-0.99). Finally, a significant increment in the risk of smoking onset for participants with lifetime depression prevalence was observed (multivariable OR = 1.44; 95% CI = 1.13-1.83). A bidirectional association between tobacco use and depression in the SUN cohort was found. Therefore, tobacco control and health promotion campaigns for smoking cessation could be considered as effective strategies of public health for the prevention and management of depressive disorders. (AU)

¿Cómo afecta el tabaquismo en la elección de pareja estable? / How does smoking tobacco affect choosing a stable partner?

El objetivo de este estudio fue analizar el rechazo hacia los fumadores decara al establecimiento de una relación de pareja estable. La muestra constó de 445 participantes que fueron reclutados mediante el método de bola denieve. Se utilizó un cuestionario elaborado ad hoc que fue aplicado en líneade forma individual. Se evaluó la influencia del tabaquismo en la elecciónde pareja estable, estable con convivencia en el mismo hogar y estable conconvivencia en el hogar e hijos en común. Los resultados mostraron unimportante rechazo hacia personas fumadoras para los distintos tipos derelación. Se hallaron diferencias estadísticamente significativas en funcióndel nivel de estudios, el tabaquismo de los participantes y el tabaquismo desus parejas. Se encontró mayor nivel de rechazo hacia personas fumadorasen los participantes con estudios universitarios, en los no fumadores y enaquellos con pareja no fumadora. Los principales motivos de rechazohicieron referencia a higiene, salud y gasto económico. En conclusión, eltabaquismo puede obstaculizar el establecimiento de una relación de parejaestable. Este argumento podría ser incorporado al listado de inconvenientesasociados al tabaquismo de cara a la prevención y el tratamiento. (AU)

This study aimed to analyze the rejection towards smokers when considering a stable relationship. The sample included 445 participants who were recruited using the snowball method. A questionnaire created adhoc was answered online by each participant. The effect of tobacco usewas evaluated in choosing a stable partner, a stable partner to live with,and a stable partner to live with and have children. The results showed asignificant rejection towards smokers for the different types of relationships.Statistically significant differences were found depending on the participants’educational background and tobacco use, and their partner’s tobacco use.A higher level of rejection towards smokers was found in participants withuniversity studies, in non-smokers, and those with a non-smoker partner. Themain reasons for rejection were related to hygiene, health, and householdeconomy. In conclusion, tobacco use can interfere with the establishment ofa stable relationship. This argument could be added to the list of drawbacksassociated with tobacco use for prevention and treatment. (AU)