[PAPPS expert group: Lifestyle recommendations]. / Recomendaciones sobre el estilo de vida. Actualización PAPPS 2022.

We present the recommendations of the Preventive Activities and Health Promotion Programme (PAPPS) of the semFYC (Spanish Society of Family and Community Medicine) to promote healthy lifestyles using intervention methodology, and preventive actions against tobacco and alcohol use, healthy eating, physical activity in leisure time, prevention of traffic accidents, and child restraint systems. The recommendations have been updated, and new aspects highlighted, such as the definition of low-risk alcohol consumption, and the references have been updated. For the main recommendations, we include specific tables showing the quality of the evidence and the strength of the recommendation.

[Screening and brief intervention on alcohol consumption]. / Cribado e intervención breve en consumo de alcohol.

Morbidity associated with alcohol consumption includes digestive, psychiatric, neurological, infectious disease, cancers of various types, cardiovascular disease, intentional injuries, unintentional injuries, social pathology, and family problems. The most recent evidence does not indicate that "moderate" consumption is beneficial to health. The most recent evidence indicates that "moderate" consumption is not beneficial to health. Therefore, the emphasis should be placed on avoiding risky drinking and advising patients that it would be in their best health interest to avoid alcohol or to drink alcohol at low-risk doses. The AUDIT-C is the most appropriate screening instrument. Cognitive-behavioural and motivational strategies form the basis of brief intervention. Positive information about the benefits of moderation and information about the dangers of alcohol intake should be given. In early stages of dependence, pharmacological treatment for detoxification, withdrawal and follow-up is considered. More serious cases require coordination with addiction services. In Spain, BI has proven effective and to reduce alcohol consumption by 100g/week. Community strategies are the appropriate policy framework to achieve the best results from brief intervention. They should aim to reduce the supply and availability for consumption by adopting legislative measures to limit both economic and physical accessibility. Furthermore, measures should be implemented to reduce the demand for alcohol through health education for specific risk groups.

[Tobacco heated products: a new challenge in tobacco control]. / Los productos de tabaco calentado: nuevo reto en el control del tabaco.

As cigarette sales decline, the tobacco industry has turned to the sale of heated tobacco products (HTP), which are on the rise. We are concerned with reports erroneously indicating that heated tobacco is associated with a lower risk of cancer and other diseases than conventional cigarettes, citing as a source the Food and Drug Administration (FDA) of the United States. The FDA has indeed authorized the sale of an HTP, but denies that this approval is an endorsement of the product or that it is safe. Philip Morris asked the FDA to approve this product as a "modified risk" tobacco product. However, the Agency denied that the risk to users' health was less than conventional cigarettes, despite emitting less amount of some toxicants. Spain and the European Union should end the regulatory privileges that HTPs have until now. We identified at least five aspects to improve: 1) compliance with the prohibition of HTPs use where smoking is prohibited; 2) control of the prohibition of advertising, promotion, and sponsorship of HTPs; 3) that HTPs carry the same type of labeling as cigarettes; 4) limit that HTPs have characteristic aromas; and 5) treat HTPs fiscally at the same level as cigarettes.

[Fourteen years of tobacco control law in Spain. Current situation and proposals]. / Catorce años de ley de control del tabaco en España. Situación actual y propuestas.

Spain has made progress in tobacco control policies, highlighting the prohibition of tobacco consumption in closed public spaces. A continued decrease in the proportion of smokers is observed. Exposure to environmental tobacco smoke has decreased in entertainment venues, with a reduction of environmental nicotine and particulate levels over 90%, without negative impact at home. There are reductions in hospital admissions and in mortality from heart attack, decrease in hospitalizations for chronic lung disease and asthma, and decrease in the risk of prematurity and low birth weight. We must advance in: plain packaging, advertising campaigns to prevent consumption, equalize the price of different tobacco products, regulate electronic cigarettes in public places, consider new smoke-free spaces where minors and other vulnerable groups may be exposed, expand aid for cessation and promote health professionals training.

[PAPPS expert group. Lifestyle recommendations]. / Grupo de expertos del PAPPS. Recomendaciones sobre el estilo de vida.

Primary and secondary health determinants explain a large part of the morbidity and mortality observed in primary care. The recommendations of the Program of Preventive Activities and Health Promotion (PAPPS) of the semFyC are presented, for the promotion of a healthy lifestyle through intervention methodology and preventive actions in tobacco consumption, alcohol consumption, healthy eating, physical activity in free time and prevention of traffic accidents and child restraint systems. The most common clinical prevention guidelines are outlined. The recommendations are updated, new aspects are pointed out, such as the definition of low-risk alcohol consumption, and the bibliography is updated. For the main recommendations, specific tables are included that show the quality of the evidence and the strength of the recommendation.

Attitudes towards anti-smoking legislation and prevalence of tobacco consumption in Spanish primary healthcare personnel.

INTRODUCTION: Our aim was to ascertain how the anti-smoking legislation of 2005/2010 has affected the behavior of primary healthcare center (PHC) personnel (medical and nonmedical) with respect to their attitudes towards tobacco, its consumption and the legislative changes. METHODS: We conducted a multi-center descriptive study of a randomized conglomerate sample of PHC personnel from each Autonomous Community in Spain. The questionnaire covered tobacco consumption, and knowledge/attitudes towards smoking and legislation. The statistical analysis used SPSS software. RESULTS: The sample consisted of 2040 PHC employees (1578 women, 77.4%). Never smokers, ex-smokers, and smokers represented 46.7%, 37.8%, and 15.5% of the sample, respectively. Tobacco prevalence amongst physicians and nurses was 12.3%. Following the introduction of the antismoking legislation, a decrease in consumption was observed. Most of the participants considered that tobacco consumption affected health, was an addictive illness, and passive smoking had an impact on the health of non-smokers. Whilst 91.6% agreed with the current legislation, only 25% felt that it encouraged cessation. CONCLUSIONS: Spanish primary healthcare professionals have a relatively low prevalence of smoking compared to the general population. It is necessary to implement more legislative measures to improve and maintain this outcome.

Health care costs and work absenteeism in smokers: study in an urban community.

INTRODUCTION: Higher morbidity caused by smoking-related diseases could increase health costs. We analyzed differences in the use of healthcare resources, healthcare costs and days of work absenteeism among smokers and non-smokers. METHODS: Cross-sectional study in smokers and non-smokers, aged between 45 and 74 years, from one urban health area. The variables studied were: age, sex, alcohol intake, physical activity, obesity, diseases, attendance at primary care clinics and hospital emergency rooms, days of hospitalization, prescription drug consumption and work absenteeism (in days). Annual cost according to the unit cost of each service (direct costs), and indirect costs according to the number of days missed from work was calculated. Crude and adjusted risks were calculated using logistic regression. RESULTS: Five hundred patients were included: 50% were smokers, 74% (372) men and 26% (128) women. Smokers used more healthcare resources, consumed more prescription drugs and had more days off work than non-smokers. Respective direct and indirect costs in smokers were 848.64 euros (IQ 25-75: 332.65-1517.10) and 2253.90 euros (IQ 25-75: 1024.50-13113.60), and in non-smokers were 474.71 euros (IQ 25-75: 172.88-979.59) and 1434.30 euros (IQ 25-75: 614.70-4712.70). The likelihood of generating high healthcare costs was more than double for smokers (OR=2.14; 95% CI: 1.44-3.19). CONCLUSION: More investment in programs for the prevention and treatment of smoking, as a health policy priority, could help to reduce the health and social costs of smoking.

[The challenge of electronic cigarettes]. / El desafío de los cigarrillos electrónicos.

The electronic cigarette (e-cig) is a device with a conventional cigarette shape that releases a determined dose of nicotine vapour through an electronic heating process. The nicotine cartridges vary significantly in the amount of nicotine released, even within the same brand. Not all brands admit that they contain nicotine, but this is detected in the majority of units analysed. The e-cig usually contains a propellant, such as propylene glycol, which is a lung irritant. The short-term respiratory effect of the vapour of an e-cig is similar to that caused by the smoke of a cigarette, and is a cause of broncho-restriction. The majority of brands contain glycerine and at least one case of lipoid pneumonia has been detected due to this substance. Many brands contain traces of N-nitrosamines, heavy metals, and other products that are found in conventional cigarette smoke, but in a much higher proportion. There is currently no scientific evidence available that shows it is an effective device for quitting smoking, thus it should not be pro-actively recommended for this purpose, and may interfere with the use of demonstrated scientific evidence-based treatments for quitting smoking. It may have an undesirable effect on promoting the starting of smoking in adolescents or keeping adult smokers consuming nicotine and on gestural dependency. The toxicity of the vapour is not well known, but it is known that they are not innocuous, thus they should not be used in closed public spaces.

[Impact of the smoke-free legislation on the prevalence and referred time exposure to the environmental tobacco smoke in Zaragoza]. / Impacto de la regulación de espacios sin humo en la exposición referida al humo ambiental de tabaco en Zaragoza.

OBJECTIVES: To assess the impact of the Law 42/2010, on the health measures on smoking, on the prevalence of the exposure to environmental tobacco smoke (ETS), the repercussions in frequently visited places, and support of the new legislation. DESIGN: A before-after evaluation by comparing two cross-sectional studies the comparison of two transverse surveys. PLACE: Primary Care, Delicias district (115,446 inhabitants) of Zaragoza city, including the Delicias Sur, Delicias Norte, Bombarda and Univérsitas basic health districts. PARTICIPANTS: A total of 387 users in 2009, and 400 in 2011 with ages between 20 and 79 years old assigned to the participating Primary Care Centres. MAIN MEASUREMENTS: Prevalences and mean exposure times, with their confidence intervals (CI). The differences were then calculated using the Chi-squared test and Analysis of Variance (ANOVA). RESULTS: The exposure prevalence to the ETS in 2011 was shown to be lower and statistically significant than that found before the implementation of the new legislative measure, falling from the 61.9% to the 40.5% (CI 95%=35.8-45.4%), with 61.5% of those polled being in favour of the new law (CI 95%=59.2-68.75), and 80.5% (79,08-86.44) mentioned still going to the same places with the same frequency. CONCLUSIONS: The impact has been favourable, decreasing the exposure by more than 20%, with this fall being more marked in the population that currently define themselves as non-smokers. There is population support for the new legislation. Finally, there has been no observed fall in the frequency of visits to the same places.

[Health, hospitality sector and tobacco industry]. / Salud, hostelería e industria del tabaco.

To present the strategies used by the tobacco industry to meet government regulatory measures of its products. To demonstrate the relationship between tobacco industry and the hospitality sector. Note that the arguments and strategies used routinely by the hospitality industry have been previously provided by the tobacco industry. Location of key documents by meta-search, links to declassified documents, specific websites of the tobacco and hospitality industry, news sources and published articles in health journals. This review reveals the close relationship between tobacco industry and hospitality sector. It highlights the strategies carried out by the tobacco industry, including strategic hoarding of information, public relations, lobbying, consultation program, smoker defence groups, building partnerships, intimidation and patronage. The arguments and strategies used by the hospitality industry to match point by point that used by the tobacco industry. These arguments are refutable from the point of view of public health as it is scientifically proven that totally smoke-free environments are the only way to protect non-smokers from tobacco smoke exposure and its harmful effects on health.

[Smoking-attributable deaths in Spain, 2006]. / Mortalidad atribuible al consumo de tabaco en España en 2006.

BACKGROUND AND OBJECTIVE: This study estimates smoking-attributable mortality in Spain in 2006. POPULATION AND METHOD: Source data included 1) smoking prevalence in Spain; 2) deaths occurred in Spain; and 3) relative risks of mortality by tobacco-caused diseases drawn from the Cancer Prevention Study II. All data corresponded to individuals aged 35 years and older. RESULTS: In 2006, 53,155 smoking-attributable deaths were estimated (14.7% of all deaths occurred in individuals≥35 years; 25.1% in men and 3.4% in women). Almost 90% (47,174) of these attributable deaths corresponded to men, and 11.3% (5,981) to women. The most frequent attributable deaths were: cancer (24,058), specially lung cancer (16,482), cardiovascular disease (17,560), specially ischemic heart disease (6,263) and stroke (4,283), and respiratory disease (11,537), specially chronic obstructive lung disease (9,886). Since 2001, a decrease in smoking-attributable mortality was observed in men and an increase in women. CONCLUSIONS: About one out of 7 deaths occurring annually in individuals≥35 years in Spain is attributable to smoking (one in 4 in men and one in 29 in women). Despite a decreasing trend in the number of smoking-attributable deaths over time (except in women, where they increase), the toll of estimated attributable deaths is still very high.