Non-compliance with smoke-free law in public places: a systematic review and meta-analysis of global studies.

Introduction: Non-compliance with smoke-free law is one of the determinants of untimely mortality and morbidity globally. Various studies have been conducted on non-compliance with smoke-free law in public places in different parts of the world; however, the findings are inconclusive and significantly dispersed. Moreover, there is a lack of internationally representative data, which hinders the evaluation of ongoing international activities towards smoke-free law. Therefore, this meta-analysis aimed to assess the pooled prevalence of non-compliance with smoke-free law in public places. Methods: International electronic databases, such as PubMed/MEDLINE, Science Direct, Cochrane Library, CINAHL, African Journals Online, HINARI, Semantic Scholar, google and Google Scholar were used to retrieve the relevant articles. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA) guidelines. The Higgs I2 statistics were used to determine the heterogeneity of the reviewed articles. The random-effects model with a 95% confidence interval was carried out to estimate the pooled prevalence of non-compliance. Results: A total of 23 articles with 25,573,329 study participants were included in this meta-analysis. The overall pooled prevalence of non-compliance with smoke-free law was 48.02% (95% CI: 33.87-62.17). Extreme heterogeneity was observed among the included studies (I2 = 100%; p < 0.000). The highest non-compliance with smoke-free law was noted in hotels (59.4%; 95% CI: 10.5-108.3) followed by homes (56.8%; 95% CI: 33.2-80.4), with statistically significant heterogeneity. Conclusion: As the prevalence of non-compliance with smoke-free law is high in public places, it calls for urgent intervention. High non-compliance was found in food and drinking establishments and healthcare facilities. In light of these findings, follow-up of tobacco-free legislation and creating awareness that focused on active smokers particularly in food and drinking establishments is recommended.

Differential Impact of COVID-19 on Cancer Diagnostic Services Based on Body Regions: A Public Facility-Based Study in Hong Kong.

PURPOSE: A reduction in cancer services during the coronavirus disease of 2019 pandemic has affected cancer diagnoses. The purpose of this study is to quantitatively determine the impact on cancer diagnostic service in public facilities across Hong Kong. Quantifying the temporal changes in the number of cancer diagnoses before, during, and after the outbreak is useful to establish the scale of the problem and assess if there has been an adequate level of response. METHODS AND MATERIALS: This is a retrospective cohort study using a territory-wide database in Hong Kong from 2017 to 2020, and consecutive specimens received for pathologic diagnosis in public laboratories in 41 hospitals were retrieved. RESULTS: In 2020, a total of 455,453 pathologic specimens were received, which amounted to a 15.5% reduction compared with the prior 3-year average (P < .001). An analysis of confirmed malignant pathologic diagnoses revealed a statistically significant reduction in colorectal (-10.0%; P < .001) and prostate (-19.7%; P < .001), nonsignificant reduction in lung (-3.0%; P = .0526), and a marginal but nonsignificant increase for breast (0.7%; P = .7592) regions. Based on time series projection data, the estimated missed cancers for the 3 regions with reduced investigations were colorectal (10.0%), lung (3.0%), and prostate (19.7%). CONCLUSIONS: Variable impact on actual malignant pathologic diagnoses based on 4 body regions was observed, with a statistically significant reduction in colorectal, lung, and prostate regions, and marginal but insignificant increase in breast regions. The findings could help public health policy with future planning and intervention.

Support for smoke-free public places among adults in four countries in sub-Saharan Africa.

INTRODUCTION: There is no known safe level of secondhand smoke exposure; yet, less than 30% of the global population is covered by comprehensive smoke-free policies as of 2016 and there are few smoke-free policies in sub-Saharan Africa (SSA). This study examines the support for smoke-free public places in SSA and delineates their correlates. METHODS: Data collected through the Global Adult Tobacco Survey (2012-2017) were analyzed using SAS for descriptive and multivariable analyses, with a significance level set at p < .05. RESULTS: No SSA country had comprehensive smoke-free policies, defined as a prohibition of smoking in eight public places. In the four countries whose Global Adult Tobacco Survey data were analyzed (Nigeria, Cameroon, Kenya, and Uganda), support for the prohibition of smoking in public places was over 90% in all eight public places except bars. Support for smoking prohibition in bars was 65.8%, 81.1%, 81.4%, and 91.0% in Nigeria, Cameroon, Kenya, and Uganda, respectively. Factors associated with support for smoke-free bars differed across the four countries, but in all countries, current smokers had decreased odds of support for smoke-free bars. Knowledge of secondhand smoke harm and living in smoke-free homes were associated with increased odds of support for smoke-free bars in all countries except Kenya. CONCLUSION: The high support for smoke-free public places should inform the efforts of the public health community and policymakers in these four SSA countries toward meeting their obligations of Article 8 of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). IMPLICATIONS: Much of the population in SSA is not protected by comprehensive smoke-free policies. It was found that the overwhelming majority of adults in four large countries in SSA support the prohibition of smoking in public places and that knowledge of the health dangers of smoking and exposure to secondhand smoke and home smoking rules increased support for the prohibition. High support for the prohibition of smoking in these four SSA countries suggests tobacco control proponents should advocate for comprehensive smoke-free policies.

Multiple myeloma treatment patterns and clinical outcomes in the Latin America Haemato-Oncology (HOLA) Observational Study, 2008-2016.

Limited data are available regarding contemporary multiple myeloma (MM) treatment practices in Latin America. In this retrospective cohort study, medical records were reviewed for a multinational cohort of 1103 Latin American MM patients (median age, 61 years) diagnosed in 2008-2015 who initiated first-line therapy (LOT1). Of these patients, 33·9% underwent autologous stem cell transplantation (ASCT). During follow-up, 501 (45·4%) and 129 (11·7%) patients initiated second- (LOT2) and third-line therapy (LOT3), respectively. In the LOT1 setting, from 2008 to 2015, there was a decrease in the use of thalidomide-based therapy, from 66·7% to 42·6%, and chemotherapy from, 20·2% to 5·9%, whereas use of bortezomib-based therapy or bortezomib + thalidomide increased from 10·7% to 45·5%. Bortezomib-based therapy and bortezomib + thalidomide were more commonly used in ASCT patients and in private clinics. In non-ASCT and ASCT patients, median progression-free survival (PFS) was 15·0 and 31·1 months following LOT1 and 10·9 and 9·5 months following LOT2, respectively. PFS was generally longer in patients treated with bortezomib-based or thalidomide-based therapy versus chemotherapy. These data shed light on recent trends in the management of MM in Latin America. Slower uptake of newer therapies in public clinics and poor PFS among patients with relapsed MM point to areas of unmet therapeutic need in Latin America.

Certificación de establecimientos de atención médica en México: análisis de los incentivos para su continuidad / Certification of medical care facilities in Mexico: analysis of the incentives for its continuity

Resumen: Objetivo: Analizar el posible efecto de los modelos de certificación y de los incentivos implementados en la participación de establecimientos de atención médica (EAM) en la certificación del Consejo de Salubridad General entre 1999-2017. Material y métodos: Se colectaron documentos oficiales, impresos y en línea, sobre la certificación de EAM y se solicitó información a diversas instancias relacionadas mediante mecanismos de transparencia. Se analizó la participación de EAM en los períodos político-administrativos entre 1999-2017. Resultados: El promedio anual de participación entre 1999-2000 fue de 259.5 EAM; entre 2013-2016, de 72.5. La participación de EAM públicos es decreciente. En 2017, los EAM certificados eran <1%. Conclusiones: No se identificaron efectos positivos ni sostenidos de ajustes al modelo, ni de los incentivos implementados. Se observa disminución de la participación en los distintos periodos político-administrativos. Debe evaluarse profundamente el Sistema Nacional de Certificación de EAM y su posible efecto en la calidad clínica.

Abstract: Objective: To analyze the possible effect of certification models and healthcare organizations' (HOs) participation incentives in the General Health Council certification process in the 1999-2017 period. Materials and methods: Official printed and online documents about HOs' certification were collected. Information from instances related to the process was requested through transparency mechanisms. Health organizations' participation in political-administrative periods between 1997-2017 was analyzed. Results: The annual average participation in the certification process during the 1999-2000 period was 259.5 HOs; during the 2013-2016 period, the average was 72.5. Public units' participation in this process has been decreasing. In 2017, certified HO were <1%. Conclusions: No positive effects of adjustments to the certification model or the incentives applied were identified. Conversely, there is decreasing participation in the different political-administrative periods. The National HO Certification System and its possible effect on clinical quality must be thoroughly evaluated.

Utilization of the Ghana National Health Insurance Scheme and its association with patient perceptions on healthcare quality.

OBJECTIVE: To determine the association between the utilization of the Ghana National Health Insurance Scheme (NHIS) and patient perceptions of quality of care. METHODS: Ghana Demographic and Health Survey (GDHS) 2014 had 19 questions on perceptions of quality of care received during the last reported health visit (n = 4332). These questions were summarized into an overall 100-point perception score using item response theory (IRT). Patients were divided into three utilization categories: those paying with their NHIS card fully, those paying with their card and out-of-pocket (OOP), and those paying fully OOP. A multiple linear regression model was used to measure the association between NHIS utilization and overall perception. RESULTS: In general, NHIS utilization was negatively associated with overall perception, and the difference across utilization categories was higher among private facility users than public facility users. Among private facilities, those who paid fully with NHIS reported five points lower than those who paid fully OOP (P = 0.005). Among public facilities, the difference is only 1.7 (P = 0.4342). CONCLUSION: NHIS utilization was a negative predictor for patient perceptions, but the differences are more nuanced according to type of facility. Future GDHS rounds should continue measuring perceptions in aid of policy to improve service delivery under the NHIS.

Formaldehyde Exposure in Indoor Air From Public Places and Its Associated Health Risks in Kunshan City, China.

This study assessed the noncarcinogenic and carcinogenic health risks associated with formaldehyde exposure for employees working in 4 categories of public places in Kunshan City in China. A total of 564 different public places, which can be divided into 4 categories (hotel and social interaction places, bathing and beauty places, cultural and entertainment places, and shopping places), and 2716 indoor air samples in those places were measured from January 1, 2010, to December 31, 2015. The average concentration of formaldehyde was 0.57 mg/m3, which is 5.7 times the acceptable concentration level (0.1 mg/m3). The noncarcinogenic risk assessment index for the 4 categories of places tested was above 1. The carcinogenic risk of formaldehyde for employees of the 4 categories of public places was 4.70 × 10-5 to 1.57 × 10-4, which was greater than the acceptable carcinogenic risk probability (1 × 10-6) from the US Environmental Protection Agency. The highest carcinogenic risk occurred in bathing and beauty places, and male employee carcinogenic risk was greater than that of females. Occupational formaldehyde exposure has serious noncarcinogenic and carcinogenic health risks for employees, and further research is needed to improve indoor air quality in the workplace environment.

Compliance with smoke-free legislation within public buildings: a cross-sectional study in Turkey.

OBJECTIVE: To investigate public compliance with legislation to prohibit smoking within public buildings and the extent of tobacco smoking in outdoor areas in Turkey. METHODS: Using a standardized observation protocol, we determined whether smoking occurred and whether ashtrays, cigarette butts and/or no-smoking signs were present in a random selection of 884 public venues in 12 cities in Turkey. We visited indoor and outdoor locations in bars/nightclubs, cafes, government buildings, hospitals, restaurants, schools, shopping malls, traditional coffee houses and universities. We used logistic regression models to determine the association between the presence of ashtrays or the absence of no-smoking signs and the presence of individuals smoking or cigarette butts. FINDINGS: Most venues had no-smoking signs (629/884). We observed at least one person smoking in 145 venues, most frequently observed in bars/nightclubs (63/79), hospital dining areas (18/79), traditional coffee houses (27/120) and government-building dining areas (5/23). For 538 venues, we observed outdoor smoking close to public buildings. The presence of ashtrays was positively associated with indoor smoking and cigarette butts, adjusted odds ratio, aOR: 315.9; 95% confidence interval, CI: 174.9-570.8 and aOR: 165.4; 95% CI: 98.0-279.1, respectively. No-smoking signs were negatively associated with the presence of cigarette butts, aOR: 0.5; 95% CI: 0.3-0.8. CONCLUSION: Additional efforts are needed to improve the implementation of legislation prohibiting smoking in indoor public areas in Turkey, especially in areas in which we frequently observed people smoking. Possible interventions include removing all ashtrays from public places and increasing the number of no-smoking signs.

Acceptability of provider-initiated HIV testing as an intervention for prevention of mother to child transmission of HIV and associated factors among pregnant women attending at Public Health Facilities in Assosa town, Northwest Ethiopia.

BACKGROUND: Despite more efforts for prevention of mother to child HIV transmission, still there are problems with provider-initiated HIV testing. This study was done to assess the acceptance rate of provider-initiated HIV testing among antenatal care attendants and its associated factors. METHODS: Institutions based cross sectional study with a sample size of 398 was conducted from February to March 2014 in two health facilities in Assosa town. Proportional allocation of the sample size of health facilities followed by systematic sampling method was done; data were collected using an interviewer administered questionnaire. Bivariate and multivariate regression analysis was employed using SPSS version 20. RESULTS: A total of 386 pregnant women participated with response rate 97 % and 312 (80.8 %) of them accepted provider-initiated HIV testing. The odds of acceptance of provider-initiated HIV testing was higher among rural residents (AOR 4.04; 95 % CI 1.24-13.11) than urban. It was also higher among students (AOR 6.00; 95 % CI 1.45-24.75), merchants (AOR 4.43; 95 % CI 1.18-16.68) and employed women (AOR 2.15; 95 % CI 1.08-4.30) than housewives. Pregnant women who had no stigmatized attitude towards people living with HIV/AIDS were more likely to accept testing (AOR 3.54; 95 % CI 1.23-10.16) than who had a strong stigmatized attitude. In addition, those who planned to disclose their test results from their husbands were higher odd of acceptance (AOR 14.85; 95 % CI 4.60-47.94) than who secreted. CONCLUSION: Acceptance of provider-initiated HIV testing among pregnant women attending for antenatal care services was relatively high. Mothers from urban residence, occupational satus being housewives, stigmatization and not having a plan to disclose the status of test results were negatively affect the acceptance of provider-initiated HIV testing. During counselling sessions, antenatal care providers should focus on barriers of provider-initiated HIV testing such as residence, occupational status, stigmatized attitudes and disclosure status of results of HIV tests.

Capacidade de manuseio da parada cardíaca em locais de alto fluxo de pessoas em Curitiba / Capacity of handling a heart arrest in places with a great flux of people in Curitiba

JUSTIFICATIVA: A parada cardiorrespiratória (PCR) é considerada uma situação preocupante, posto que o tempo até o início dos procedimentos de reversão interfere diretamente na sobrevida do paciente. Sabendo da importância desse atendimento pré-hospitalar o estado do Paraná promulgou uma lei, obrigando os estabelecimentos com grande concentração de pessoas a manterem um desfibrilador externo automático (DEA) disponível, bem como pessoal qualificado a ofertar suporte básico devida e a manusear o desfibrilador externo automático. OBJETIVO: Identificar a porcentagem de estabelecimentos com fluxo superior a 2000 pessoas/dia que possuem desfibrilador externo automático e avaliar o nível técnico do pessoal treinado para o atendimento de uma parada cardiorrespiratória. MÉTODOS: Considerou-se uma amostra de 40 estabelecimentos em Curitiba-PR. Nos locais onde consentiram a realização da pesquisa, avaliou-se a presença do desfibrilador externo automático, bem como seu funcionamento e acessibilidade. Em seguida apresentou-se um caso clínico para a identificação do desempenho do socorrista no atendimento de uma parada cardiorrespiratória. A identificação do desempenho foi realizada com base no protocolo Basic Life Suport (BLS) de avaliação seguindo os parâmetros da American Heart Association (AHA). RESULTADOS: Vinte e oito locais assentiram participar da pesquisa, e desses somente 13 (46,4%) possuíam o desfibrilador externo automático. Cinco desse locais concordaram em serem submetidos a um teste para avaliar o desempenho do socorrista, sendo que dois apresentaram nota 9, um nota 8 e dois inferior a 3. CONCLUSÃO: Poucos locais estão realmente adequados para fazer o atendimento necessário a uma parada cardiorrespiratória. É necessário maiores investimentos e uma maior fiscalização desses estabelecimentos.

BACKGROUND: Cardiorespiratory arrest (CRA) is considered an alarming situation, since time until onset of reversal procedures has a direct influence on patient survival. Given the importance of pre-hospital treatment, the state of Parana, Brazil passed a law obliging establishments with a large volume of people passing through them to have an automatic external defibrillator (AED) available, in addition to personnel qualified to provide basic life support and operate the automatic external defibrillator. OBJECTIVE: Identify the percentage of establishments with a daily flow of more than 2000 individuals that have an automatic external defibrillator and assess the technical level of trained personnel in treating cardiorespiratory arrest. METHODS: The sample was composed of 40 establishments in Curitiba, Parana state. The presence of automatic external defibrillator as well as its functionality and accessibility were assessed. Next, a clinical case was presented to evaluate the performance of emergency responders in treating cardiorespiratory arrest. Performance was based on the Basic Life Support (BLS) protocol, in accordance with American Heart Association (AHA) guidelines. RESULTS: Twenty-eight establishments agreed to take part in the study, 13 (46.4%) of which had an automatic external defibrillator on their premises. Five agreed to undergo a test to evaluatethe emergency responder's performance, 2 obtaining a score of 9, one 8 and two below 3. CONCLUSION: Few places are really adequate in order to treat a cardiorespiratory arrest. It is necessary further investments and a more efficient inspection of those establishments.

The impact of smoke-free legislation on educational differences in birth outcomes.

BACKGROUND: Smoke-free legislation may have positive effects on birth outcomes. Given that smoking and secondhand smoke during pregnancy vary with socioeconomic position, legislation may have greater effects in some socioeconomic groups. For this study, we evaluated the impact of a 2006 ban on smoking in public places in the Canadian province of Quebec on preterm birth, small-for-gestational-age birth and birth weight, and on educational differences in these birth outcomes. METHODS: We analysed data on singleton births in Quebec between 2003 and 2010. Logistic regression was used to model the association of smoke-free legislation with preterm birth (<37 weeks), very preterm birth (<34 weeks), small-for-gestational-age birth (<10th centile for gestational age and sex), low birth weight (<2500 g) and mean birth weight, adjusting for secular trends before and after legislation. Interaction terms were included to assess differential effects by level of maternal education. RESULTS: Smoke-free legislation was associated with average reductions of 3.1 preterm births (95% CI 0.1 to 6.0), 2.3 very preterm births (95% CI 0.9 to 3.7), 5.9 small-for-gestational-age births (95% CI 2.6 to 9.3) and 1.0 low birthweight infants (95% CI 0.4 to 1.6) per 1000 live births, as well as a 17.1 g increase in mean birth weight (95% CI 10.7 to 23.6). Legislation was associated with improved birth outcomes in all categories of maternal education. CONCLUSIONS: Smoke-free legislation in Quebec was associated with reductions in preterm and small-for-gestational-age births, and an increase in birth weight. There was no compelling evidence that legislation impacted educational gradients in birth outcomes.

Home and workplace built environment supports for physical activity.

BACKGROUND: Physical inactivity has been associated with obesity and related chronic diseases. Understanding built environment (BE) influences on specific domains of physical activity (PA) around homes and workplaces is important for public health interventions to increase population PA. PURPOSE: To examine the association of home and workplace BE features with PA occurring across specific life domains (work, leisure, and travel). METHODS: Between 2012 and 2013, telephone interviews were conducted with participants in four Missouri metropolitan areas. Questions included sociodemographic characteristics, home and workplace supports for PA, and dietary behaviors. Data analysis was conducted in 2013; logistic regression was used to examine associations between BE features and domain-specific PA. RESULTS: In home neighborhoods, seven of 12 BE features (availability of fruits and vegetables, presence of shops and stores, bike facilities, recreation facilities, crime rate, seeing others active, and interesting things) were associated with leisure PA. The global average score of home neighborhood BE features was associated with greater odds of travel PA (AOR=1.99, 95% CI=1.46, 2.72); leisure PA (AOR=1.84, 95% CI=1.44, 2.34); and total PA (AOR=1.41, 95% CI=1.04, 1.92). Associations between workplace neighborhoods' BE features and workplace PA were small but in the expected direction. CONCLUSIONS: This study offers empirical evidence on BE supports for domain-specific PA. Findings suggest that diverse, attractive, and walkable neighborhoods around workplaces support walking, bicycling, and use of public transit. Public health practitioners, researchers, and worksite leaders could benefit by utilizing worksite domains and measures from this study for future BE assessments.

Are park proximity and park features related to park use and park-based physical activity among adults? Variations by multiple socio-demographic characteristics.

BACKGROUND: Parks are valuable resources for physical activity (PA) given their widespread availability and low cost to maintain and use. Both proximity to parks and the availability of particular features are important correlates of PA. However, few studies have explored multiple measures of proximity simultaneously or the specific facilities associated with park use and park-based PA among adults, let alone differences across socio-demographic characteristics. The purpose of this study was to examine associations between park proximity and park facilities and adults' park use and park-based PA, while also exploring differences by gender, age, race, and income. METHODS: Data on monthly park use and weekly amount of PA undertaken in parks were collected via a mail survey of adults from randomly-selected households (n = 893) in Kansas City, Missouri (KCMO) in 2010-2011. Three measures of park proximity were calculated within 1 mile of participating households: distance to the closest park, number of parks, and total park area. All parks in KCMO were audited using the Community Park Audit Tool to determine the availability of 14 park facilities within 1 mile of each participant (e.g., trail, playground, tennis court). Multilevel logistic regression was used to examine the relationship between each of park use and park-based PA and 1) three measures of park proximity, and 2) the availability of 14 park facilities within 1 mile of participants. Separate analyses were conducted by gender, age, race, and income, while controlling for all socio-demographic characteristics and BMI. RESULTS: Across all sub-samples, distance to the closest park was not significantly related to either park use or park-based PA. However, numerous significant associations were found for the relationship of number of parks and amount of park space within 1 mile with both outcomes. As well, diverse facilities were associated with park use and park-based PA. For both park proximity and facilities, the significant relationships varied widely across gender, age, race, and income groups. CONCLUSIONS: Both park proximity and park facilities are related to park use and park-based PA. Understanding how such associations vary across demographic groups is important in planning for activity-friendly parks that are responsive to the needs of neighborhood residents.

Tobacco control policies in outdoor areas of high volume American transit systems.

Very little is known about how smoking and other tobacco use is regulated in outdoor and semi-enclosed spaces across transit systems. The purpose of this study was to understand how American transit systems are regulating cigarettes and other tobacco products, including smokeless tobacco and e-cigarettes, in outdoor or quasi-outdoor spaces. Within four regions of the United States, a purposive convenience sample was taken of the top five volume American transit systems (n = 20) based on annual ridership. Each transit authority website was systematically reviewed to produce a cross-sectional study of the published policies regarding tobacco product use for indoor, outdoor, and quasi-outdoor spaces of transit property; rules regarding cigarettes, smokeless tobacco and electronic cigarettes were identified. Policies regulating tobacco use were enacted by transit systems and/or the cities and states in which transit systems are located. The majority (80%) of transit systems banned smoking in outdoor areas; few prohibited smokeless tobacco use (15%, n = 3) and some disallowed e-cigarettes (30%, n = 6). Violation consequences ranged widely from none to verbal warnings, ejection from transit property, fines, and imprisonment. Regulating smoking in outdoor or quasi-outdoor environments is common in American transit environments. These policies can help protect vulnerable populations from exposure to secondhand smoke and communicate a tobacco-free norm.

Measuring visual exposure to smoking behaviours: a viewshed analysis of smoking at outdoor bars and cafés across a capital city's downtown area.

BACKGROUND: The influence of visual exposure to health-related behaviours, such as smoking, is increasingly acknowledged in the public health literature. Social contagion or normalisation is thought to operate through the visibility of those behaviours. There has been a lack of systematic and comprehensive approaches to quantifying visual exposure to these behaviours over a relatively large geographic area. We describe the novel application of a geographic tool, viewshed analysis, to estimate visual exposure to smoking outside bars/cafés across a downtown area. METHODS: Smoking was observed for different times and days of the week at 14 outdoor areas of bars/cafés throughout downtown Wellington, New Zealand. We used these data to extrapolate to other bars/cafés with outdoor seating. We then conducted viewshed analyses to estimate visual exposure to smoking at bars/cafés for all public outdoor spaces. RESULTS: We observed a smoking point prevalence of 16%. Visibility analyses indicated that estimated visible smoking was highest in the evenings (7-8 pm), where the average values across Wednesday and Friday ranged from zero up to 92 visible smokers (mean=1.44). Estimated visible smoking at midday ranged from zero to 13 (mean=0.27). Values were also higher at the end of the week compared with midweek in the evening. Maps indicate that streets with high levels of retail shops and hospitality areas had high values of estimated visible smokers, particularly in the evening where numbers were consistently above 50. CONCLUSIONS: This paper highlights a useful method for measuring the extent of visual exposure to smoking behaviours across relatively large areas using a geospatial approach. Applying this method in other locations would require consideration of place-specific characteristics which impact on visibility and could be improved through more sophisticated extrapolation of observational data across the study area. The findings of this and similar research could ultimately support the expansion of smokefree public spaces.

Distância percebida até as instalações de lazer e sua associação com a prática de atividade física e de exercícios em adolescentes de Curitiba, Paraná, Brasil / Perceived distance to recreational facilities and the association with physical activity and exercise among adolescents in Curitiba, Paraná State, Brazil / La percepción de la distancia a las instalaciones de ocio y su relación con la actividad física y el ejercicio en los adolescentes de Curitiba, Paraná, Brasil

O objetivo deste estudo foi verificar a associação entre a distância percebida até instalações de lazer (parques, praças, academias, ginásios e ciclovias) com a prática de atividade física e de exercícios em adolescentes de Curitiba, Paraná, Brasil. Estudo transversal realizado com amostra representativa de 1.474 adolescentes (14-18 anos), alunos da rede pública de ensino. Foi verificada associação inversa entre a distância > 31 minutos até academias e ginásios com a prática de atividade física nos meninos (RP = 0,78; IC95%: 0,69-0,88 e RP = 0,79; IC95%: 0,66-0,95, respectivamente). O número de instalações próximas da residência associou-se positivamente com a prática de atividade física nos meninos (RP = 1,18; IC95%: 1,04-1,34). Para as meninas, a distância > 31 minutos até um ginásio apresentou associação inversa com a prática de exercícios de força (RP = 0,93; IC95%: 0,87-0,99). Esses achados sugerem que a distância e a quantidade de instalações de lazer no bairro podem afetar o padrão de atividade física de adolescentes, sendo essa relação diferente entre os sexos.

The aim of this study was to verify the association between perceived distance to recreational facilities (parks, gyms, sports courts, and bike lanes) for physical activity and exercise among adolescents in Curitiba, Paraná State, Brazil. A cross-sectional study was conducted with a representative sample of 1,474 adolescents (14-18 years) enrolled in public schools. There was an inverse association between distance (> 31 minutes) to gyms and sports courts and physical activity among boys (PR = 0.78; 95%CI: 0.69-0.88 and PR = 0.79; 95%CI: 0.66-0.95, respectively). The number of facilities near home was positively associated with physical activity in boys (PR = 1.18; 95%CI: 1.04-1.34). Among girls, distance (> 31 minutes) to sports courts was inversely associated with strength training (PR = 0.93; 95%CI: 0.87-0.99). The findings suggest that distance from home and number of recreational facilities in the neighborhood may affect patterns of physical activity among adolescents and that the association differs between boys and girls.

El objetivo de este estudio fue investigar la asociación entre la distancia percibida a instalaciones recreativas (parques, gimnasios, gimnasios y carriles-bici) para la práctica de actividad física y el ejercicio en los adolescentes de Curitiba, Paraná, Brasil. Es un estudio transversal con una muestra representativa de 1.474 adolescentes (14-18 años), estudiantes de escuelas públicas. Se observó una asociación inversa entre la distancia > 31 minutos hasta los gimnasios y centros de acondicionamiento físico con la práctica de la actividad física de los niños (RP = 0,78; IC95%: 0,69-0,88 y RP = 0,79; IC95%: 0,66-0,95, respectivamente). El número de lugares cerca de la residencia se asoció positivamente con la práctica de la actividad física de los niños (RP = 1,18; IC95%: 1,04-1,34). Para las niñas, la distancia > 31 minutos a un gimnasio se asoció inversamente con el ejercicio del poder (RP = 0,93; IC95%: 0,87-0,99). Estos hallazgos sugieren que la distancia y la cantidad de instalaciones de ocio en la zona puede afectar el patrón de actividad física de los adolescentes, diferenciándose esta relación entre sexos.

Alcohol-selling outlets and mortality in Switzerland--the Swiss National Cohort.

AIM: To examine the association of alcohol-related mortality and other causes of death with neighbourhood density of alcohol-selling outlets for on-site consumption. DESIGN, SETTING AND PARTICIPANTS: Longitudinal study of the adult Swiss population (n = 4 376 873) based on census records linked to mortality data from 2001 to 2008. MEASUREMENTS: Sex-specific hazard ratios (HR) for death and 95% confidence intervals (95%CI) were calculated using Cox models adjusting for age, educational level, occupational attainment, marital status and other potential confounders. The density of alcohol-selling outlets within 1000 m of the residence was calculated using geocodes of outlets and residences. FINDINGS: Compared with >17 outlets within 1000 m the HR for alcohol-related mortality in men was 0.95 (95%CI: 0.89-1.02) for 8-17 outlets, 0.84 (95%CI: 0.77-0.90) for 3-7 outlets, 0.76 (95%CI: 0.68-0.83) for 1-2 outlets and 0.60 (95%CI: 0.51-0.72) for 0 outlets. The gradient in women was somewhat steeper, with a HR comparing 0 with >17 outlets of 0.39 (95%CI: 0.26-0.60). Mortality from mental and behavioural causes and lung cancer were also associated with density of alcohol-selling outlets: HRs comparing 0 outlets with >17 outlets were 0.64 (95%CI: 0.52-0.79) and 0.79 (95%CI: 0.72-0.88), respectively, in men and 0.46 (95%CI: 0.27-0.78) and 0.63 (95%CI: 0.52-0.77), respectively, in women. There were weak associations in the same direction with all-cause mortality in men but not in women. CONCLUSIONS: In Switzerland, alcohol-related mortality is associated with the density of outlets around the place of residence. Community-level interventions to reduce alcohol outlet density may usefully complement existing interventions.

Second-hand smoke and indoor air quality in public places in Gaza City.

Second-hand smoke is a major cause of preventable disease and death in the Eastern Mediterranean Region. To assess how second-hand smoke impacts air quality, respirable suspended particles (PM2.5) which are emitted during cigarette and waterpipe smoking, were measured inside and outside of 18 smoking and 5 nonsmoking public venues in Gaza city. Median PM2.5 level inside the smoking venues was 117 microg/m3, which exceeds the WHO guidelines for daily PM2.5 exposure (25 microg/m3) by more than 4-fold. The median level inside the smoking venues (117 microg/m3) was significantly higher than outside the venues (43 microg/m3), and significantly higher than the median level inside non-smoking venues (40 microg/m3). By contrast particulate levels outside non-smoking venues (35 microg/m3) did not differ from the corresponding levels inside (40 microg/m3). To protect employees and the public from second-hand smoke exposure, policies prohibiting sinoking in public niaces are needed in Gaza city.

Evaluating New York City's smoke-free parks and beaches law: a critical multiplist approach to assessing behavioral impact.

This article describes the evaluation of the law banning smoking in New York City's parks and beaches that went into effect in 2011. We discuss the practical and methodological challenges that emerged in evaluating this law, and describe how we applied the principles of critical multiplism to address these issues. The evaluation uses data from three complementary studies, each with a unique set of strengths and weaknesses that can provide converging evidence for the effectiveness of the law. Results from a litter audit and an observational study suggest the ban reduced smoking in parks and beaches. The purpose, methodology and baseline results from an ongoing survey that measures how frequently adults in NYC and across New York State notice people smoking in parks and on beaches are presented and discussed. Limitations are considered and suggestions are offered for future evaluations of similar policies.

Frequência de estruturas parasitárias em praças e parques públicos da cidade de Porto Alegre-RS / Frequency parasitic structures in public squares and parks of the city of Porto Alegre-RS

O solo é um dos principais reservatórios de estruturas parasitárias e importante vetor na disseminação de parasitos entre a população, pois nele alguns helmintos e protozoários desenvolvem uma etapa do seu ciclo biológico. No período de julho de 2001 a junho de 2004, foram coletadas 3.120 amostras de solo em 18 áreas públicas de Porto Alegre-RS. Das amostras processadas pelo método de centrífugo-flutuação, 40,8 por cento revelaram a presença de estruturas parasitárias e 100 por cento das praças públicas estavam contaminadas. As estruturas encontradas foram: ovos de Ascaris spp. (10,2 por cento), ovos de Trichuris spp. (4,4 por cento), ovos de Toxocara spp. (4,2 por cento), ovos da superfamília Strongyloidea(3,4 por cento), oocistos de protozoários (16,0 por cento) e larvas de helmintos (18,0 por cento). Esses dados evidenciam a necessidade de implementação de medidas de controle que reduzam o risco de contaminação desses lugares públicos...

Soil is a major reservoir of parasite structures and is an important vehicle for the spread of parasites in the population because some helminths and protozoa spend a stage of their life cycle there. From July 2001 to June 2004 3,120 soil samples were collected in 18 areas of Porto Alegre, RS. The samples were processed by the flotation method and 40.8 percent had parasite structures, while 100 percent of the public squares were contaminated. The structures were: Ascaris spp. (10.2 percent ), eggs of Trichuris spp. (4.4 percent ), Toxocara spp. (4.2 percent ), eggs of the Strongyloidea superfamily (3.4 percent ), protozoan oocysts (16.0 percent ) and larvae of helminths (18.0 percent ). Based on these data, there is a need to implement control measures that reduce the risk of contamination of public places...