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

Con las ventas de cigarrillos disminuyendo, la industria del tabaco se ha encomendado a la venta de los productos de tabaco calentado (PTC), cuyas ventas están aumentando. Hemos visto con preocupación informaciones que indican erróneamente que el tabaco calentado se asocia a un menor riesgo de cáncer y otras enfermedades que los cigarrillos convencionales, citando a la Food and Drug Administration (FDA) de los Estados Unidos como fuente. Es cierto que la FDA ha autorizado la venta de un PTC, pero niega que esta aprobación suponga un apoyo al producto o indique que este sea inocuo. Philip Morris pidió a la FDA que su PTC fuera aprobado como un producto de tabaco de «riesgo modificado», pero la Agencia negó que el riesgo para la salud de las personas usuarias fuese menor que el de los cigarrillos convencionales, a pesar de emitir menos cantidad de algunos tóxicos. España y la Unión Europea deberían acabar con los privilegios regulatorios de los que disfrutan los PTC. Identificamos por lo menos cinco aspectos que deben mejorarse: 1) el cumplimiento de la prohibición de su uso donde está prohibido fumar; 2) el control de la prohibición de publicidad, promoción y patrocinio de los PTC; 3) que los PTC lleven el mismo tipo de etiquetado que los cigarrillos; 4) limitar que los PTC tengan aromas característicos; y 5) tratar los PTC fiscalmente igual que los cigarrillos. (AU)

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. (AU)

[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.

Perceptions of plain cigarette packaging among smokers and non-smokers in Andalusia (Spain) / Percepciones del envase neutro del tabaco entre fumadores y no fumadores en Andalucía (España)

OBJECTIVES: Each year tobacco is responsible for 650,000 deaths in Europe and 55,000 in Spain. With tobacco advertising and promotion banned in Spain and most of Europe, the last bastion of marketing is the packaging. Plain tobacco packaging -which involves packs having a standardised appearance- has been proposed to counter this. The objective of this study is to research perceptions arising from the plain packaging of tobacco products. METHODS: We employed a qualitative research methodology -focus groups- with smokers and non-smokers in in two medium-sized Andalusian towns (Spain). RESULTS: Results show the importance of plain cigarette packaging as a form of promotion, particularly among women and young people, how pack colour influences product perceptions, and how removing full branding increases the salience of the warnings. CONCLUSIONS: Plain packaging, combined with pictorial health warnings, may reduce the capacity of packaging to be distinctive and a badge product. Altering pack design in such a way would make it more difficult for tobacco companies to create a favourable image of their brands and may help to reinforce the ability of the population to protect themselves from the dangers of smoking

OBJETIVOS: El tabaco es causa de aproximadamente 650.000 muertes en Europa, y de ellas, unas 55.000 en España. Debido a las prohibiciones de realizar actividades de publicidad y promoción, el envase está considerado como el último bastión de comunicación para la industria tabacalera. El envase neutro -un aspecto uniforme del envase para toda marca comercializada- ha sido propuesto como forma de combatirlo. El objetivo de este trabajo se centra en estudiar las percepciones que suscita el diseño neutro del envase. MÉTODOS: Se ha realizado una investigación cualitativa, a través de grupos focales en dos ciudades de tamaño medio con personas fumadoras y no fumadoras en dos ciudades de tamaño medio de Andalucía (España). RESULTADOS: Los resultados señalan la importancia que tendría el envase de tabaco neutro como estrategia de desnormalización del tabaco, en especial en las mujeres y las personas jóvenes, como el color del envase neutro influye en las percepciones que el consumidor tiene del producto, y como incrementa la visibilidad de las esquelas sanitarias insertadas en el envase. CONCLUSIONES: El envase neutro, unido a las advertencias sanitarias combinadas, podrían reducir la capacidad distintiva del envase. La desaparición de los rasgos estéticos del envase, de esta manera, añadiría una dificultad más a las compañías para presentar sus marcas de forma favorable, y ayudaría a proteger a la población de los peligros del tabaco

Perceptions of plain cigarette packaging among smokers and non-smokers in Andalusia (Spain).

OBJECTIVES: Each year tobacco is responsible for 650,000 deaths in Europe and 55,000 in Spain. With tobacco advertising and promotion banned in Spain and most of Europe, the last bastion of marketing is the packaging. Plain tobacco packaging -which involves packs having a standardised appearance- has been proposed to counter this. The objective of this study is to research perceptions arising from the plain packaging of tobacco products. METHODS: We employed a qualitative research methodology -focus groups- with smokers and non-smokers in in two medium-sized Andalusian towns (Spain). RESULTS: Results show the importance of plain cigarette packaging as a form of promotion, particularly among women and young people, how pack colour influences product perceptions, and how removing full branding increases the salience of the warnings. CONCLUSIONS: Plain packaging, combined with pictorial health warnings, may reduce the capacity of packaging to be distinctive and a badge product. Altering pack design in such a way would make it more difficult for tobacco companies to create a favourable image of their brands and may help to reinforce the ability of the population to protect themselves from the dangers of smoking.

Toxic compounds from tobacco in placenta samples analyzed by UPLC-QTOF-MS.

Polycyclic aromatic hydrocarbons (PAHs), tobacco-specific nitrosamines (TSNAs) and aromatic amines are carcinogens present in cigarette smoke. These compounds are distributed in the human body and they could be transferred to the foetus during the pregnancy. Placenta is the main barrier to these toxic compounds and its study is the objective of this work. A method based on solid-phase extraction (SPE) with ultra-performance liquid chromatography-tandem quadrupole-time-of-flight mass spectrometry (UPLC-QTOF-MS) has been examined and optimized for the analysis of 9 target analytes (4 tobacco-specific nitrosamines and some of their metabolites, 3 aromatic amines, nicotine and cotinine) in 26 placenta samples from smoking and non-smoking women. Limits of detection (LODs) were in the range of 3-27ng/g of placenta. Nicotine, cotinine, N-nitrosoanatabine (NAT) and 4-(methylnitrosamino)-1- (3-pyridyl)-1-butanone (NNK) metabolite, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) were detected in the placenta samples of smoking woman. Nicotine was detected in 3 out of 8 placentas from smoking women, always below the limit of quantification (88ng/g). This could be expected, as the half-life of nicotine in the body is limited to about 0.5-3h. Cotinine, the main metabolite from nicotine, was detected in all placentas from smoking women at concentrations between 17.2 and 61.8ng/g, reaching the highest values for those women that smoked the highest number of cigarettes. NAT and NNAL were detected in all placentas from smoking women, always below the limit of quantification (40ng/g and 33ng/g respectively).

El envase neutro de los productos de tabaco: una nueva estrategia para el control del tabaquismo / The plain packaging of tobacco products: a new strategy for tobacco control

Existe evidencia de que las políticas de control del tabaquismo integrales contribuyen a reducir la prevalencia del tabaquismo, por lo que es necesaria la implementación de las distintas medidas de manera conjunta. El empaquetado y etiquetado neutro del tabaco es una de las medidas recomendadas por el Convenio Marco de Control del Tabaco propuesto por la Organización Mundial de la Salud que contribuye a reducir la demanda de tabaco. En el momento actual, una serie de países están implementando esta medida de envasado neutro de los productos del tabaco, que implica desprender a los envases de los aspectos atractivos y promocionales, conservando el nombre de la marca, el cual debería aparecer en una fuente, tamaño, color y localización estándar en el envase. Australia fue el primer país que incorporó este envase en 2012 y recientemente otros países han aprobado la misma medida. En España, la legislación sobre tabaquismo (de 2005 y 2010) supuso un importante avance en las políticas de control del tabaquismo. La introducción de esta medida en España constituiría el siguiente paso en el desarrollo de una estrategia global para luchar contra este importante problema de salud. El objetivo de este trabajo es resumir y presentar de manera estructurada la información disponible sobre el papel que tiene el envase en los productos de tabaco dentro de las estrategias de marketing y comunicación, y describir los potenciales efectos que produce el envase neutro sobre diversos aspectos relacionados con la conducta de fumar (AU)

There is evidence that global tobacco smoking control policies contribute to decrease the prevalence of smoking among populations, so there is a need to effectively implement different measures in a coordinated way. The plain packaging and labelling of tobacco products is one of the measures proposed by the World Health Organisation Framework Convention on Tobacco Control. At the moment, leading countries are implementing this tobacco control measure, which involves a plain packaging for all tobacco products, i.e., the absence of any promotional or communication tool in the packaging, except the name of the brand, appearing with a standardised font, size, colour and placing in the pack. Australia was the first country to implement this measure in 2012 and recently other countries are legislating and approving it. In Spain, tobacco legislation (2005 and 2010), was an important advance in tobacco control policies. The introduction of plain packaging in Spain would mean the next step in the development of a global strategy for fighting this significant health problem. The aim of this article is to synthesise in a structured manner the role that the packaging of tobacco products has within marketing and communication strategies, as well as to describe the potential effects that the plain packaging has on some aspects of smoking behaviour, according to current literature (AU)

[The plain packaging of tobacco products: a new strategy for tobacco control]. / El envase neutro de los productos de tabaco: una nueva estrategia para el control del tabaquismo.

There is evidence that global tobacco smoking control policies contribute to decrease the prevalence of smoking among populations, so there is a need to effectively implement different measures in a coordinated way. The plain packaging and labelling of tobacco products is one of the measures proposed by the World Health Organisation Framework Convention on Tobacco Control. At the moment, leading countries are implementing this tobacco control measure, which involves a plain packaging for all tobacco products, i.e., the absence of any promotional or communication tool in the packaging, except the name of the brand, appearing with a standardised font, size, colour and placing in the pack. Australia was the first country to implement this measure in 2012 and recently other countries are legislating and approving it. In Spain, tobacco legislation (2005 and 2010), was an important advance in tobacco control policies. The introduction of plain packaging in Spain would mean the next step in the development of a global strategy for fighting this significant health problem. The aim of this article is to synthesise in a structured manner the role that the packaging of tobacco products has within marketing and communication strategies, as well as to describe the potential effects that the plain packaging has on some aspects of smoking behaviour, according to current literature.

Diferencias de género en el éxito al dejar de fumar: resultados a corto y largo plazo / Gender differences in success at quitting smoking: Short- and long-term outcomes

Los tratamientos para dejar de fumar son eficaces en hombres y mujeres. Sin embargo, las posibles diferencias encontradas en los resultados del tratamiento aún son objeto de controversia. Este estudio analiza si existen diferencias entre hombres y mujeres en el éxito al dejar de fumar a corto y largo plazo (> 1 año) con un programa de tratamiento que incluye la perspectiva de género. Se realizó una encuesta telefónica en fumadores atendidos en una unidad de tabaquismo. Los pacientes que completaron con éxito el tratamiento (3 meses), fueron encuestados telefónicamente para determinar su abstinencia a largo plazo; se validó la abstinencia mediante cooximetría (CO espirado ≤10 ppm) en los que se mantenían abstinentes. La probabilidad de permanecer abstinentes a largo plazo se calculó utilizando un análisis de supervivencia de Kaplan-Meier. La tasa de éxito del tratamiento fue de 41,3% (538/1302), sin diferencias por sexo. El 89% (479/538) fue localizado por teléfono y el 47,6% (256/479) se mantenía abstinente sin diferencias por sexo (p = ,519); la abstinencia fue validada en 191 de 256 (53,9% hombres y 46,1% mujeres). En el análisis de supervivencia, la probabilidad de que los hombres y las mujeres mantuvieran la abstinencia a largo plazo no fue significativa. No hay diferencias por sexo en el resultado del tratamiento para dejar de fumar, que incluyan aspectos de género, a corto y largo plazo (> 1 año)

Smoking cessation treatments are effective in men and women. However, possible sex-related differences in the outcome of these treatments remain a controversial topic. This study evaluated whether there were differences between men and women in the success of smoking cessation treatment, including gender-tailored components, in the short and long term (> 1 year). A telephone survey was carried out between September 2008 and June 2009 in smokers attended in a Smoking Cessation Clinic. All patients who have successfully completed treatment (3 months) were surveyed by telephone to determine their long-term abstinence. Those who remained abstinent were requested to attend the Smoking Cessation Clinic for biochemical validation (expired CO ≤10 ppm). The probability of remaining abstinent in the long-term was calculated using a Kaplan- Meier survival analysis. The treatment success rate at 3-months was 41.3% (538/1302) with no differences by sex 89% (479/538) among those located in the telephonic follow-up study and 47.6% (256/479) were abstinent without differences by sex (p = .519); abstinence was validated with CO less than 10 ppm in 191 of the 256 (53.9% men and 46.1% women). In the survival analysis, the probability of men and women remaining abstinent in the long-term was not significant. There are no differences by sex in the outcome of smoking cessation treatment that included gender-tailored components in the short and long term (> 1 year)

Gender differences in success at quitting smoking: Short- and long-term outcomes. / Diferencias de género en el éxito al dejar de fumar: resultados a corto y largo plazo.

Smoking cessation treatments are effective in men and women. However, possible sex-related differences in the outcome of these treatments remain a controversial topic. This study evaluated whether there were differences between men and women in the success of smoking cessation treatment, including gender-tailored components, in the short and long term (> 1 year). A telephone survey was carried out between September 2008 and June 2009 in smokers attended in a Smoking Cessation Clinic. All patients who have successfully completed treatment (3 months) were surveyed by telephone to determine their long-term abstinence. Those who remained abstinent were requested to attend the Smoking Cessation Clinic for biochemical validation (expired CO ≤10 ppm). The probability of remaining abstinent in the long-term was calculated using a Kaplan-Meier survival analysis. The treatment success rate at 3-months was 41.3% (538/1302) with no differences by sex 89% (479/538) among those located in the telephonic follow-up study and 47.6% (256/479) were abstinent without differences by sex (p = .519); abstinence was validated with CO less than 10 ppm in 191 of the 256 (53.9% men and 46.1% women). In the survival analysis, the probability of men and women remaining abstinent in the long-term was not significant. There are no differences by sex in the outcome of smoking cessation treatment that included gender-tailored components in the short and long term (> 1 year).

Los tratamientos para dejar de fumar son eficaces en hombres y mujeres. Sin embargo, las posibles diferencias encontradas en los resultados del tratamiento aún son objeto de controversia. Este estudio analiza si existen diferencias entre hombres y mujeres en el éxito al dejar de fumar a corto y largo plazo (> 1 año) con un programa de tratamiento que incluye la perspectiva de género. Se realizó una encuesta telefónica en fumadores atendidos en una unidad de tabaquismo. Los pacientes que completaron con éxito el tratamiento (3 meses), fueron encuestados telefónicamente para determinar su abstinencia a largo plazo; se validó la abstinencia mediante cooximetría (CO espirado ≤10 ppm) en los que se mantenían abstinentes. La probabilidad de permanecer abstinentes a largo plazo se calculó utilizando un análisis de supervivencia de Kaplan-Meier. La tasa de éxito del tratamiento fue de 41,3% (538/1302), sin diferencias por sexo. El 89% (479/538) fue localizado por teléfono y el 47,6% (256/479) se mantenía abstinente sin diferencias por sexo (p = ,519); la abstinencia fue validada en 191 de 256 (53,9% hombres y 46,1% mujeres). En el análisis de supervivencia, la probabilidad de que los hombres y las mujeres mantuvieran la abstinencia a largo plazo no fue significativa. No hay diferencias por sexo en el resultado del tratamiento para dejar de fumar, que incluyan aspectos de género, a corto y largo plazo (> 1 año).

Direct screening of tobacco indicators in urine and saliva by Atmospheric Pressure Solid Analysis Probe coupled to quadrupole-time of flight mass spectrometry (ASAP-MS-Q-TOF-).

A new screening method has been explored for direct analysis of tobacco smoke biomarkers in biological matrices (i.e., saliva and urine). Single run analysis using Atmospheric pressure Solid Analysis Probe (ASAP) and high resolution mass spectrometry with quadrupole and time of flight detector has been applied directly to some biological samples (i.e., urine and saliva), providing a fast, efficient and sensitive method of identification. The method has been applied to saliva and urine samples from heavy tobacco smokers for exposure studies. Nicotine itself, nicotine metabolites (i.e., cotinine, trans-3'-hydroxycotinine, nicotine-N-glucuronide) and other related tobacco smoke toxic compounds (i.e., NNK 4-[methyl(nitroso)amino]-1-(3-pyridinyl)-1-butanone, anatabine) were found in the analyzed samples. The identification of compounds was confirmed by ultrahigh performance liquid chromatography with MS-triple quadrupole detector after sample treatment. Different temporal trends and biomarkers behavior have been found in time series related samples. Both methods are compared for screening of these biological matrices.

Costes derivados del uso de servicios sanitarios y bajas laborales en pacientes fumadores: estudio en una comunidad urbana / Health care costs and work absenteeism in smokers: study in an urban community

Introducción: La mayor morbilidad ocasionada por el tabaquismo puede generar un incremento del coste sanitario. Analizamos la existencia de diferencias en el uso de recursos sanitarios, gasto sanitario y bajas laborales entre pacientes fumadores y no fumadores. Métodos: Estudio observacional transversal en pacientes fumadores y no fumadores de edad entre 45 y 74 años atendidos en una zona de salud urbana. Variables estudiadas: edad, sexo, consumo de alcohol, actividad física, obesidad, presencia de enfermedades, frecuentación a las consultas de atención primaria e interconsultas, asistencia a urgencias hospitalarias, días de hospitalización, consumo de fármacos y días de baja laboral. Se calculó el coste anual según el coste unitario de cada servicio (costes directos) y los costes indirectos según el número de días de baja. Se calcularon los riesgos crudos y ajustados mediante regresión logística. Resultados: Se analizaron 500 pacientes, el 50% fueron fumadores; 74% (372) hombres, 26% (128) mujeres. Los pacientes fumadores utilizaron más recursos sanitarios, consumieron más fármacos y tuvieron más días de baja laboral que los no fumadores. Los costes directos e indirectos en fumadores fueron respectivamente 848,64 euros (IQ 25-75: 332,65-1517,10) y 2.253,90 (IQ 25-75: 1.024,50-13.113,60); y en no fumadores 474,71 euros (IQ 25-75: 172,88-979,59) y 1.434,30 euros (IQ 25-75: 614,70-4.712,70); ser fumador incrementó más del doble la probabilidad de tener coste sanitario elevado (OR = 2,14; IC 95%: 1,44-3,19). Conclusión: Invertir más recursos en la prevención y el tratamiento del tabaquismo como una prioridad de política sanitaria contribuiría a la reducción en el medio plazo del sobrecoste que supone el consumo de tabaco

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

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.

Atmospheric pressure solid analysis probe coupled to quadrupole-time of flight mass spectrometry as a tool for screening and semi-quantitative approach of polycyclic aromatic hydrocarbons, nitro-polycyclic aromatic hydrocarbons and oxo-polycyclic aromatic hydrocarbons in complex matrices.

A new screening and semi-quantitative approach has been developed for direct analysis of polycyclic aromatic hydrocarbons (PAHs) and their nitro and oxo derivatives in environmental and biological matrices using atmospheric pressure solid analysis probe (ASAP) quadrupole-time of flight mass spectrometry (Q-TOF-MS). The instrumental parameters were optimized for the analysis of all these compounds, without previous sample treatment, in soil, motor oil, atmospheric particles (ashes) and biological samples such as urine and saliva of smokers and non-smokers. Ion source parameters in the MS were found to be the key parameters, with little variation within PAHs families. The optimized corona current was 4 µA, sample cone voltage 80 V for PAHs, nitro-PAHs and oxo-PAHs, while the desolvation temperatures varied from 300°C to 500°C. The analytical method performance was checked using a certified reference material. Two deuterated compounds were used as internal standards for semi-quantitative purposes together with the pure individual standard for each compound and the corresponding calibration plot. The compounds nitro PAH 9-nitroanthracene and oxo-PAH 1,4-naphthalenedione, were found in saliva and urine in a range below 1 µg/g while the range of PAHs in these samples was below 2 µg/g. Environmental samples provided higher concentration of all pollutants than urine and saliva.

Can we modify the enrollment in a postpartum smoking cessation intervention in Spain?

OBJECTIVE: it is known that very few women who continue to smoke at the time of delivery stop smoking during the postpartum period. Discovering strategies that can be incorporated during pregnancy to help improve women's participation in postpartum interventions could increase the number of women non-smokers. The aim of this study is to identify the predictors of participation by pregnant women smokers in a postpartum smoking cessation intervention. DESIGN: a cross-sectional study was carried out amongst women smokers who had attended to give birth. SETTING: women attended the University Clinical Hospital 'Lozano Blesa' of Zaragoza (Spain) who were smokers before pregnancy and reported at delivery to have continued smoking during pregnancy were eligible and were invited to participate in the study. FINDINGS: 2044 women completed the questionnaire 24 hours after giving birth. The smoking prevalence during pregnancy was 18.2% (n=372) and 62.9% of them (n=234) participated. The logistic regression model provided five significant predictors for women who participated: intention to breast feed, having less of an urge to smoke the first cigarette of the day before pregnancy, having reduced consumption during pregnancy by 50% or more, having received advice and being willing to get help. CONCLUSIONS AND IMPLICATIONS FOR THE PRACTICE: the factors associated with participation show aspects that can be modified by maternal and child health professionals. Advice to stop smoking, received during pregnancy, encourages participation in a postpartum intervention. From the point of view of public health, the huge increase in the prevalence of smoking women poses the need to take advantage of the pregnancy as an opportunity for giving up smoking definitely. It would be necessary to identify what programmes of smoking cessation have better results in pregnant women and to know how to motivate health professionals to implement them.

A multicentre randomized trial of combined individual and telephone counselling for smoking cessation.

OBJECTIVE: The present study assessed the effectiveness of smoking cessation programs combining individual and telephone counselling, compared to individual or telephone counselling alone. METHOD: A randomized, multicentre, open-label trial was performed between January 2009 and July 2011 at six smoking cessation clinics in Spain. Of 772 smokers assessed for eligibility, 600 (77%) met inclusion criteria and were randomized. Smokers were randomized to receive individual counselling, combined telephone and individual counselling, or telephone counselling. The primary outcome was biochemically validated continuous abstinence at 52 weeks. RESULTS: The 52-week abstinence rate was significantly lower in the telephone group compared to the combined group (20.1% vs. 29.0%; OR, 1.32; 95% CI, 1.1-2.7) and to the individual counselling group (20.1% vs. 27.9%; OR, 1.37; 95% CI, 1.0-2.8). The 52-week abstinence rates were not significantly higher in the combined group than the individual group (OR, 0.97; 95% CI, 0.7-1.4). CONCLUSION: Individual counselling and combined individual and telephone counselling were associated with higher 52-week abstinence rates than telephone counselling alone. A combined approach may be highly useful in the clinical treatment of smokers, as it involves less clinic visits than individual counselling alone, thus reducing the program cost, and it increases patient compliance compared to telephone counselling alone.

Impacto de la nueva legislación sobre tabaquismo (Ley 42/2010) en los niveles de humo ambiental de tabaco en locales de hostelería / Impact of the new smoke-free legislation (law 42/2010) on levels of second-hand smoke in hospitality venues

Objetivo: Evaluar la contaminación por humo ambiental de tabaco en una muestra de locales de hostelería antes y después de la nueva legislación sobre tabaquismo. Métodos: Estudio evaluativo antes-después realizado en 2008 y 2011, tras la prohibición total. Medición de partículas respirables (PM2,5) mediante SidePack Aerosol Monitor en el interior de los locales y en el exterior. Se incluyeron 43 locales con mediciones antes y después de la legislación. Resultados: La concentración mediana de PM2,5 en el interior de los locales en 2008 fue 204,2Mig/m3, y en 2011 fue 18,62Mig/m3; en el exterior, en 2008 fue 47,04Mig/m3 y en 2011 fue 18,82Mig/m3. Las concentraciones más altas se encontraron en bares y cafeterías, seguidos de los locales de ocio nocturno. La contaminación en 2008 era 4,34 veces más alta en el interior de los locales que en el exterior; en 2011, la concentración de PM2,5disminuyó un 90,88% en el interior. Conclusiones: La prohibición total de fumar en los locales de hostelería protege a trabajadores y clientes de los riesgos para la salud de la exposición al humo ambiental de tabaco (AU)

Objective: To evaluate pollution by second-hand smoke in a sample of hospitality venues before and after the implementation of smoke-free legislation. Methods: A cross sectional, before-after study was conducted in 2008 and 2011 after the total ban. A SidePack Aerosol monitor was used both inside and outside the hospitality venues to measure fine breathable particles (PM2.5). A total of 43 places with pre- and post-legislation measurements were included. Results: The median indoor pollution in hospitality venues was 204.2Mig/m3 in 2008 and 18.82Mig/m3 in 2011; the average outdoor PM2.5 concentration was 47.04Mig/m3 in 2008 and 18.82Mig/m3 in 2011. Pollution was higher in bars and cafeterias, followed by pubs and discos. Before the law was implemented, pollution was 4.34 times higher indoors than outdoors; in 2011 the average indoor PM2.5 concentration decreased by 90.88%. Conclusions: Only a complete ban is able to protect workers and customers against the health risks of second-hand smoke exposure (AU)

Factores predictores de éxito según género en el tratamiento del tabaquismo / Predictors of outcome of a smoking cessation treatment by gender

Objetivo: Analizar los factores predictores de los resultados del tratamiento del tabaquismo según sexo,en personas fumadoras que solicitan tratamiento para dejar de fumar en una unidad de tabaquismo.Métodos: Estudio transversal en personas fumadoras que iniciaron tratamiento en una unidad de tabaquismo entre los anos 2002 y 2007. Se recogieron variables sociodemográficas, de patrón de consumo, ˜del entorno del paciente respecto al tabaco y la presencia de comorbilidad psiquiátrica. Se realizó tratamiento multicomponente: psicológico y farmacológico. Se consideró éxito del tratamiento la abstinenciacontinua validada con CO ≤10 ppm, y se realizó el análisis mediante el criterio de intención de tratar.Para analizar los factores predictores se llevó a cabo un análisis de regresión logística.Resultados: Se analizaron 1302 personas, 52,1% (678) hombres y 47,9% (624) mujeres, con una media deedad de 43,4 (10,2) anos. El consumo medio de cigarrillos era de 25,3 (10,4) y la dependencia física de ˜6,2 (2,2) puntos. El 41,3% (538) logró el éxito, sin encontrar diferencias. Los factores predictores del éxitoen los hombres fueron la menor dependencia física y una pareja no fumadora, y en las mujeres fueron lamayor edad, el menor consumo de cigarrillos, la minoría de amigos fumadores y no padecer ansiedad odepresión durante el tratamiento.Conclusiones: Hombres y mujeres tienen un porcentaje de éxito similar en los tratamientos para dejar defumar, aunque hay factores predictores del éxito diferentes según el sexo que condicionan la abstinencia.Es necesario incorporar la perspectiva del sexo en el consumo de tabaco, tanto en la prevención como enel tratamiento (AU)

Objective: To identify factors predictive of the outcome of a smoking cessation program by gender.Methods: A cross-sectional study of smokers starting treatment in a smoking cessation clinic from 2002to 2007 was conducted. The variables consisted of data on sociodemographic factors, smoking habits,the social context of smoking and psychiatric comorbidity prior to or during the smoking cessationprocess. All patients received multicomponent treatment consisting of psychological and pharmacological interventions. Success was defined as self-reported continuous abstinence confirmed by cooximetry(CO ≤10 ppm). Logistic regression was used to analyze the factors predictive of success.Results: A total of 1302 persons (52.1% men and 47.9% women), with a mean age of 43.4 (10.2) years,were included. The mean number of cigarettes smoked per day was 25.3 (10.4) and the mean Fagerströmtest score was 6.2 (2.2) points. The success rate was 41.3% (538) with no differences by gender. Positivepredictors were lower nicotine dependence and having a non-smoking partner in men and older age,smoking fewer cigarettes per day, having fewer smoking friends and not experiencing depression oranxiety during the treatment in women.Conclusions: Men and women have similar tobacco abstinence outcomes although gender factors play arole in determining abstinence. The gender perspective should be incorporated in smoking preventionand cessation programs (AU)

[Predictors of outcome of a smoking cessation treatment by gender]. / Factores predictores de éxito según género en el tratamiento del tabaquismo.

OBJECTIVE: To identify factors predictive of the outcome of a smoking cessation program by gender. METHODS: A cross-sectional study of smokers starting treatment in a smoking cessation clinic from 2002 to 2007 was conducted. The variables consisted of data on sociodemographic factors, smoking habits, the social context of smoking and psychiatric comorbidity prior to or during the smoking cessation process. All patients received multicomponent treatment consisting of psychological and pharmacological interventions. Success was defined as self-reported continuous abstinence confirmed by cooximetry (CO ≤10 ppm). Logistic regression was used to analyze the factors predictive of success. RESULTS: A total of 1302 persons (52.1% men and 47.9% women), with a mean age of 43.4 (10.2) years, were included. The mean number of cigarettes smoked per day was 25.3 (10.4) and the mean Fagerström test score was 6.2 (2.2) points. The success rate was 41.3% (538) with no differences by gender. Positive predictors were lower nicotine dependence and having a non-smoking partner in men and older age, smoking fewer cigarettes per day, having fewer smoking friends and not experiencing depression or anxiety during the treatment in women. CONCLUSIONS: Men and women have similar tobacco abstinence outcomes although gender factors play a role in determining abstinence. The gender perspective should be incorporated in smoking prevention and cessation programs.

[Impact of the new smoke-free legislation (law 42/2010) on levels of second-hand smoke in hospitality venues]. / Impacto de la nueva legislación sobre tabaquismo (Ley 42/2010) en los niveles de humo ambiental de tabaco en locales de hostelería.

OBJECTIVE: To evaluate pollution by second-hand smoke in a sample of hospitality venues before and after the implementation of smoke-free legislation. METHODS: A cross sectional, before-after study was conducted in 2008 and 2011 after the total ban. A SidePack Aerosol monitor was used both inside and outside the hospitality venues to measure fine breathable particles (PM2.5). A total of 43 places with pre- and post-legislation measurements were included. RESULTS: The median indoor pollution in hospitality venues was 204.2µg/m(3) in 2008 and 18.82µg/m(3) in 2011; the average outdoor PM2.5 concentration was 47.04µg/m(3) in 2008 and 18.82µg/m(3) in 2011. Pollution was higher in bars and cafeterias, followed by pubs and discos. Before the law was implemented, pollution was 4.34 times higher indoors than outdoors; in 2011 the average indoor PM2.5 concentration decreased by 90.88%. CONCLUSIONS: Only a complete ban is able to protect workers and customers against the health risks of second-hand smoke exposure.

A proactive smoking cessation intervention in postpartum women.

OBJECTIVE: to analyse the efficacy of a proactive intervention during the postpartum period to prevent a relapse in recent quitters and to promote progress in the behavioural process of change in smokers. DESIGN: randomised controlled trial designed for women at the end of the pregnancy using a proactive intervention. Motivational Interviewing (MI) and relapse prevention served as principles for the programme. In the intervention group, four telephone supporting sessions were performed in weeks 3, 6, 9 and 12. For the control group only two check calls in weeks 3 and 12. SETTING: women who attended the University Clinical Hospital 'Lozano Blesa' of Zaragoza (Spain) to give birth between January 2009 and March 2010. The intervention began after delivery, lasted for 3 months, and finished with a visit to validate abstinence biochemically. FINDINGS: a total of 2,044 women were studied, 30.6% (n=626) smoked before pregnancy; 65.8% (n=412) of them agreed to participate. The results for recent quitters by self-report showed that the probability of remaining abstinent after 12 weeks was 74% for the intervention group and 37% for the control group. Only the half of the sample attended the visit at 3 months to confirm the abstinence biochemically. For smokers, 90.7% of the intervention group said that they would be ready to try to quit in the following 6 months, vs. 18.3% for the control group. CONCLUSIONS AND IMPLICATIONS FOR THE PRACTICE: a proactive intervention in the postpartum period may reduce the probability of relapse in recent quitters and helps female smokers to make progress in the behavioural process of change. Such interventions should be included systematically in mother-child health services.