Measurement of airborne nicotine, as a marker of secondhand smoke exposure, in homes with residents who smoke in 9 European countries.

OBJECTIVE: Smoke-free policies are effective in preventing secondhand smoke (SHS) exposure, but their adoption at home remains largely voluntary. This study aimed to quantify SHS exposure in homes with residents who smoke in Europe according to households' characteristics, tobacco consumption habits, and national contextual factors. METHODS: Cross-sectional study (March 2017-September 2018) based on measurements of air nicotine inside 162 homes with residents who smoke from nine European countries. We installed passive samplers for seven consecutive days to monitor nicotine concentrations. Through self-administered questionnaires, we collected sociodemographic information and the number of individuals who smoke, smoking rules, frequency, location, and quantity of tobacco use in households. Country-level factors included the overall score in the Tobacco Control Scale 2016, the smoking prevalence, and self-reported SHS exposure prevalence. Nicotine concentrations were analyzed as continuous and dichotomous variables, categorized based on the limit of quantification of 0.02 µg/m3. RESULTS: Overall, median nicotine concentration was 0.85 µg/m3 (interquartile range (IQR):0.15-4.42), and there was nicotine presence in 93% of homes. Participants reported that smoking was not permitted in approximately 20% of households, 40% had two or more residents who smoked, and in 79% residents had smoked inside during the week of sampling. We found higher nicotine concentrations in homes: with smell of tobacco smoke inside (1.45 µg/m3 IQR: 0.32-6.34), where smoking was allowed (1.60 µg/m3 IQR: 0.68-7.63), with two or more residents who smoked (2.42 µg/m3 IQR: 0.58-11.0), with more than 40 cigarettes smoked (2.92 µg/m3 IQR: 0.97-10.61), and where two or more residents smoked inside (4.02 µg/m3 IQR: 1.58-11.74). Household nicotine concentrations were significantly higher in countries with higher national smoking prevalence and self-reported SHS exposure prevalence (p < 0.05). CONCLUSIONS: SHS concentrations in homes with individuals who smoke were approximately twenty times higher in homes that allowed smoking compared to those reporting smoke-free household rules. Evidence-based interventions promoting smoke-free homes should be implemented in combination with strengthening other MPOWER measures.

Factors associated with changes in inpatients' smoking pattern during hospitalization and one month after discharge: A cohort study.

INTRODUCTION: Smokers are frequent users of healthcare services. Admissions to hospital can serve as a "teachable moment" for quitting smoking. Clinical guidelines recommend initiating smoking cessation services during hospitalization; however, in Southern European countries less than 5% of inpatients receive a brief intervention for smoking cessation. OBJECTIVES: The aims of this study were (i) to examine rates of smoking abstinence during and after hospitalization; (ii) to measure changes in smoking patterns among persons who continued smoking after discharge; and (iii) to identify predictors of abstinence during hospitalization and after discharge. METHODS: A cohort study of a representative sample of current adult smokers hospitalized in two Spanish and two Portuguese hospitals. We surveyed smokers during hospitalization and recontacted them one month after discharge. We used a 25-item ad hoc questionnaire regarding their smoking pattern, the smoking cessation intervention they have received during hospitalization, and hospital and sociodemographic characteristics. We performed a descriptive analysis using the chi-square test and a multivariate logistic regression to characterize the participant, hospital, and smoking cessation intervention (5As model) characteristics associated with smoking abstinence. RESULTS: Smoking patients from both countries presented high abstinence rates during hospitalization (Spain: 76.4%; Portugal: 70.2%); however, after discharge, their abstinence rates decreased to 55.3% and 46.8%, respectively. In Spain, smokers who tried to quit before hospital admission showed higher abstinence rates, and those who continued smoking reduced a mean of five cigarettes the number of cigarettes per day (p ≤ 0.001). In Portugal, abstinence rates were higher among women (p = 0.030), those not living with a smoker (p = 0.008), those admitted to medical-surgical wards (p = 0.035), who consumed their first cigarette within 60 min after waking (p = 0.006), and those who were trying to quit before hospitalization (p = 0.043). CONCLUSIONS: Half of the smokers admitted into the Spanish hospitals are abstinent one month after discharge or have reduced their cigarettes per day. Nevertheless, success rates could be increased by implementing evidence-based tobacco cessation programs at the organizational-level, including post-discharge active quitting smoking support. CLINICAL RELEVANCE: Three-quarters of the inpatients who smoke remain abstinent during hospitalization and over half achieve to maintain their abstinence or at least reduce their consumption one month after discharge, proving that admission to hospitals is an excellent teachable moment to quit smoking.

Secondhand smoke exposure assessment in outdoor hospitality venues across 11 European countries.

OBJECTIVE: Due to partial or poorly enforced restrictions secondhand tobacco smoke (SHS) is still present in outdoor hospitality venues in many European countries. This study aimed to assess SHS concentrations in outdoor hospitality venues across Europe and identify contextual exposure determinants. METHODS: Cross-sectional study. We measured airborne nicotine and evidence of tobacco use in terraces of bars, cafeterias, and pubs from 11 European countries in 2017-2018. Sites were selected considering area-level socioeconomic indicators and half were visited during nighttime. We noted the smell of smoke, presence of smokers, cigarette butts, ashtrays, and number of physical covers. Contextual determinants included national smoke-free policies for the hospitality sector, the Tobacco Control Scale score (2016), and the national smoking prevalence (2017-2018). We computed medians and interquartile ranges (IQR) of nicotine concentrations and used multivariate analyses to characterize the exposure determinants. RESULTS: Nicotine was present in 93.6% of the 220 sites explored. Overall concentrations were 0.85 (IQR:0.30-3.74) µg/m3 and increased during nighttime (1.45 IQR:0.65-4.79 µg/m3), in enclosed venues (2.97 IQR:0.80-5.80 µg/m3), in venues with more than two smokers (2.79 IQR:1.03-6.30 µg/m3), in venues in countries with total indoor smoking bans (1.20 IQR:0.47-4.85 µg/m3), and in venues in countries with higher smoking prevalence (1.32 IQR:0.49-5.34 µg/m3). In multivariate analyses, nicotine concentrations were also positively associated with the observed number of cigarette butts. In venues with more than two smokers, SHS levels did not significantly vary with the venues' degree of enclosure. CONCLUSIONS: Our results suggest that current restrictions in outdoor hospitality venues across Europe have a limited protective effect and justify the adoption of total smoking bans in outdoor areas of hospitality venues.

Prevention of COVID-19 in retail food stores in Portugal: The importance of regulations in behavioural change / Prevención de COVID-19 en puntos de venta de alimentos en Portugal: la importancia de las regulaciones para el cambio de comportamiento

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Knowledge, attitudes and practice of self-medication among university students in Portugal: A cross-sectional study.

Aims: To describe the knowledge, attitudes and practices of self-medication in college students and to analyse the predicting factors for the engagement in that behaviour. Design: This is a cross-sectional study involving students (n = 840) from a Portuguese university, selected through stratified and proportional sampling. Data were collected using a self-administered questionnaire containing, in addition to sociodemographic issues, a scale measuring knowledge about self-medication (α = .488), a scale measuring attitudes towards self-medication (α = .708) and questions about the patterns of self-medication practices (α = .445). Differences between outcomes and sociodemographics were analysed through independent t-tests and ANOVA. A generalised linear model was calculated to determine the predictive variables of self-medication. Results: Over half of the respondents ( 54.3%, n = 434) had used some form of self-medication during the preceding year. Students revealed poor knowledge about the referred practice, correctly answering 1.60 (SD = 0.936) questions in a total of 3, and favourable attitudes towards self-medication (M = 2.17, SD = 0.950, range 1-5). Attending engineering sciences (ß = .718, 95% CI: 1.373-3.069, p < .001), being female (ß = .866, 95% CI: 1.700-3.327, p < .001) and having negative attitudes towards self-medication (ß = .367, 95% CI: 1.227-1.698, p < .001) predict the adoption of those practices. Conclusions: Self-medication is a common practice among university students, the level of self-medication knowledge is low and the low score of the level of attitudes revealed that students tended to have a correct positioning towards self-medication. Therefore, the recommendation to develop campaigns or educational programmes becomes obvious, in order to inform about the adverse effects of the use of non-prescribed medicine.

Who Smokes in Europe? Data From 12 European Countries in the TackSHS Survey (2017-2018).

BACKGROUND: Population data on tobacco use and its determinants require continuous monitoring and careful inter-country comparison. We aimed to provide the most up-to-date estimates on tobacco smoking from a large cross-sectional survey, conducted in selected European countries. METHODS: Within the TackSHS Project, a face-to-face survey on smoking was conducted in 2017-2018 in 12 countries: Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania, and Spain, representing around 80% of the 432 million European Union (EU) adult population. In each country, a representative sample of around 1,000 subjects aged 15 years and older was interviewed, for a total of 11,902 participants. RESULTS: Overall, 25.9% of participants were current smokers (31.0% of men and 21.2% of women, P < 0.001), while 16.5% were former smokers. Smoking prevalence ranged from 18.9% in Italy to 37.0% in Bulgaria. It decreased with increasing age (compared to <45, multivariable odds ratio [OR] for ≥65 year, 0.31; 95% confidence interval [CI], 0.27-0.36), level of education (OR for low vs high, 1.32; 95% CI, 1.17-1.48) and self-rated household economic level (OR for low vs high, 2.05; 95% CI, 1.74-2.42). The same patterns were found in both sexes. CONCLUSIONS: These smoking prevalence estimates represent the most up-to-date evidence in Europe. From them, it can be derived that there are more than 112 million current smokers in the EU-28. Lower socio-economic status is a major determinant of smoking habit in both sexes.

llicit Drug Use among College Students: The Importance of Knowledge about Drugs, Live at Home and Peer Influence.

The problem of consumption of illicit psychoactive substances by students in higher education is not new, since it is in this age group that the highest prevalence of consumption of these substances continues to occur. This study aimed to describe the prevalence of illicit drug use among university students and to analyze the predictive factors and patterns of illicit drug use among university students in Portugal. A cross-sectional design and a stratified random sampling method were used (n = 840). A validated self-administered questionnaire was used, consisting of socio-demographic characteristics, information about the patterns of illicit drugs consumption, and knowledge and attitudes toward illicit drugs use. The prevalence of illicit drugs consumption was 22.2%, while overall students had a low level of knowledge and moderate scores when it came to the attitudes toward drug use. Being male, having changed residence after entering higher education, having friends who use illicit drugs and possessing knowledge on drugs increased the likelihood of consuming illicit drugs. The results of the study could help develop strategies to reduce use of illicit drugs in academic settings, giving special attention to the influence of peers and students who changed their residence after entering higher education.

Secondhand smoke exposure in outdoor children's playgrounds in 11 European countries.

INTRODUCTION: Tobacco presence in outdoor children's playgrounds is concerning not only because it leads to secondhand smoke (SHS) exposure, but also cigarette butt pollution and tobacco normalization. OBJECTIVES: This study aimed to assess SHS exposure in children's playgrounds, according to area-level socioeconomic status (SES), smoke-free regulations, national smoking prevalence, and SHS exposure prevalence in playgrounds (2017-2018). METHODS: We monitored vapor-phase nicotine concentration and tobacco-related variables in 20 different playgrounds in 11 European countries (n = 220 measurements) from March 2017 to April 2018. Playgrounds were selected according to area-level SES. Data on the number of people smoking, and cigarette butts inside the playground and on playground surroundings (<1 m away) were recorded. Playground smoking bans, the Tobacco Control Scale (TCS) score, national smoking prevalence and SHS exposure prevalence in playgrounds were used to group countries. To determine nicotine presence, we dichotomized concentrations using the limit of quantification as a cut-off point (0.06 µg/m3). Nicotine median concentrations were compared using non-parametric tests, and nicotine presence and tobacco-related observational variables using the Chi-squared test. RESULTS: Airborne nicotine presence was found in 40.6% of the playgrounds. Median nicotine concentration was <0.06 µg/m3 (Interquartile range: <0.06-0.125) and higher median concentrations were found in more deprived neighborhoods, non-regulated playgrounds, in countries with lower overall TCS scores, higher national smoking prevalence and higher SHS exposure prevalence in playgrounds. Overall, people were smoking in 19.6% of the playgrounds. More than half of playgrounds had cigarette butts visible inside (56.6%) and in the immediate vicinity (74.4%). Presence of butts inside playgrounds was higher in sites from a low area-level SES, in countries with low TCS scores, and greater smoking prevalence and SHS exposure prevalence (p<0.05). CONCLUSIONS: There is evidence of SHS exposure in children's playgrounds across Europe. These findings confirm the need for smoking bans in playgrounds and better enforcement in those countries with smoking bans in playgrounds.

Secondhand smoke exposure and other signs of tobacco consumption at outdoor entrances of primary schools in 11 European countries.

INTRODUCTION: Although smoking restrictions at child-related settings are progressively being adopted, school outdoor entrances are neglected in most smoke-free policies across Europe. OBJECTIVES: To describe secondhand smoke (SHS) exposure and tobacco-related signs in outdoor entrances of primary schools in Europe according to area-level socioeconomic status (SES), smoke-free policy, national smoking prevalence, and geographical region. METHODS: In this cross-sectional study we monitored vapor-phase nicotine concentrations at 220 school outdoor entrances in 11 European countries (March 2017-October 2018). To account for nicotine presence, we used the laboratory's limit of quantification of 0.06 µg/m3 as point threshold. We also recorded the presence of smell of smoke, people smoking, cigarette butts, and ashtrays. Half of the schools were in deprived areas. We grouped countries according to their Tobacco Control Scale (TCS) score, smoking prevalence (2017-2018), and United Nations M49 geographical region. RESULTS: There were detectable levels of nicotine in 45.9% of the outdoor entrances, in 29.1% smell of smoke, in 43.2% people smoking, in 75.0% discarded butts, and in 14.6% ashtrays. Median nicotine concentration was below the laboratory's limit of quantification <0.06 µg/m3 (Interquartile range:<0.06-0.119). We found higher SHS levels in countries with lower TCS scores, higher national smoking prevalence, and in the Southern and Eastern European regions. People smoking were more common in schools from lower area-level SES and in countries with lower TCS scores (p<0.05). CONCLUSIONS: Smoking at school outdoor entrances is a source of SHS exposure in Europe. These findings support the extension of smoking bans with a clear perimeter to the outdoor entrances of schools.

Avaliação do programa "SmokeOut-i" na prevenção do tabagismo em contexto escolar / Evaluation of the "SmokeOut-i" program in the prevention of smoking in schools

Este estudo, aplicado em um distrito do Norte de Portugal, teve como objetivo avaliar a eficácia do programa de prevenção do tabagismo "SmokeOut-I" em alunos do 6º ano, por sexo. O programa "SmokeOut-I" foi elaborado no âmbito de um projeto financiado pela Fundação para a Ciência e a Tecnologia (FCT), sendo desenvolvido no Centro de Investigação em Estudos da Criança (CIEC) da Universidade do Minho, em Braga, Portugal, objetivando prevenir o consumo de tabaco em crianças e jovens. É um programa multidisciplinar focado na prevenção do tabagismo. Realizou-se um estudo quasi-experimental, tipo pré/pós-teste, com um grupo experimental (n=163), a quem foi aplicado o programa, e um grupo de controle (n=148), em 2014/2015. Ambos os grupos preencheram o mesmo questionário, no pré e pós-teste. Os resultados inter e intragrupos foram comparados usando estatística inferencial. A intervenção foi eficaz na melhoria dos conhecimentos/crenças sobre tabagismo, com resultados positivos na prevenção do comportamento face ao consumo de tabaco. Estudos longitudinais permitirão compreender a sua persistência no tempo.

This study, applied in a district in the North of Portugal, aimed to evaluate the effectiveness of the "SmokeOut-I" smoking prevention program in 6th grade students, by sex. The "SmokeOut-I" program was developed as part of a project financed by the Foundation for Science and Technology (FCT), being developed at the Research Center for Child Studies (CIEC) at the University of Minho, in Braga, Portugal, aiming to prevent tobacco consumption in children and young people. It is a multidisciplinary program focused on the prevention of smoking. A quasi-experimental study, pre / post-test type, was carried out with an experimental group (n = 163), to whom the program was applied, and a control group (n = 148), in 2014/2015. Both groups completed the same questionnaire, in the pre and post-test. Inter- and intragroup results were compared using inferential statistics. The intervention was effective in improving knowledge / beliefs about smoking, with positive results in preventing behavior in the face of tobacco consumption. Longitudinal studies will help to understand its persistence over time.

Prevalence of Portuguese Children Exposed to Secondhand Smoke at Home and in the Car.

INTRODUCTION: Children's exposure to secondhand smoke is a cause of serious health problems and infant morbidity. This is the first nationally representative study conducted in Portugal to describe the prevalence of children exposed to secondhand smoke at home and in the car. MATERIAL AND METHODS: This is a descriptive cross-sectional study with a representative sample of 2396 Portuguese children aged 0 to 9 years old, stratified by age and administrative region NUTS II. Questionnaires were administered between January and September 2016. RESULTS: Results showed that 6.1% of mothers and 11.2% of fathers reported smoking at home. It was found that 4.5% of mothers and 8.3% of fathers reported smoking in the car. Results also showed that 5.4% of children were double exposed to secondhand smoke at home and in the car. Children whose parents were smokers and had a lower level of education were more exposed to secondhand smoke at home. DISCUSSION: Children's exposure to secondhand smoke has been decreasing in Portugal. Parental smoking and a low educational level were risk factors for children's exposure to secondhand smoke at home. CONCLUSION: The main source of children's exposure to secondhand smoke is parental smoking. As such, it is crucial to implement effective measures to control parental smoking. It is necessary to promote smoking cessation among parents and to ban smoking inside the car.

Introdução: A exposição das crianças ao fumo ambiental do tabaco é uma importante causa de graves problemas de saúde e morbilidade infantil. Este é o primeiro estudo com representatividade nacional realizado em Portugal a descrever a prevalência de crianças expostas ao fumo ambiental do tabaco em casa e no carro. Material e Métodos: Trata-se de um estudo transversal descritivo que inclui uma amostra representativa de 2396 crianças portuguesas dos 0 aos 9 anos de idade, estratificada por idade e por região administrativa NUTS II. A aplicação de questionários decorreu entre janeiro e setembro de 2016. Resultados: Verifica-se que 6,1% das mães e 11,2% dos pais fumam no domicílio. Constata-se que 4,5% das mães e 8,3% dos pais fumam no carro. Verifica-se também que 5,4% das crianças estão duplamente expostas ao fumo ambiental do tabaco em casa e no carro. As crianças cujos pais são fumadores e com menor nível de escolaridade, estão mais expostas ao fumo ambiental do tabaco em casa. Discussão: A exposição das crianças ao fumo ambiental do tabaco tem diminuído em Portugal. Ainda assim, o consumo de tabaco dos pais e um baixo nível de escolaridade são fatores de risco para a exposição das crianças em casa. Conclusão: Uma vez que a principal fonte de exposição das crianças ao fumo ambiental do tabaco é o tabagismo dos pais, é necessário promover a cessação tabágica junto dos mesmos, assim como implementar a proibição de fumar no carro.

Traffic risk behaviour: an observational study of drivers' behaviour in Braga (Portugal) / Comportamiento de riesgo vial: un estudio observacional del comportamiento de los conductores en Braga (Portugal)

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Evolución de la epidemia tabáquica en adolescentes escolarizados portugueses y europeos, por sexo, entre 1998 y 2014 / Evolution of smoking epidemic in Portuguese and European school adolescents by gender between 1998 and 2014

Objetivos: Analizar el estado actual y la evolución de la epidemia de tabaquismo en los adolescentes escolarizados portugueses y europeos, por sexo. Pacientes y método: El consumo de tabaco y su evoución se obtuvieron de la base de datos de los informes del Health Behavior in School-Aged Children (HBSC) entre 1997/1998 y 2013/2014. Resultados: En Portugal, según el último informe de HBSC, el 12% de los chicos y el 10% de las chicas de 15 años fumaban al menos un cigarrillo a la semana, que es similar a la media de prevalencia europea. En cuanto a la evolución del consumo de tabaco en Portugal entre 1997/1998 y 2013/2014, la prevalencia a los 15 años se redujo del 19 al 12% en chicos y del 14 al 10% en las chicas; a los 13 años, disminuyó del 5% en chicos y el 4% en chicas al 3% en chicos y chicas; a los 11 años, la prevalencia disminuyó del 2 al 1% en los chicos y del 1 al 0% en las chicas. Conclusiones: La evolución del consumo de tabaco en Portugal y Europa muestra un descenso en los adolescentes, con diferencias por género. Las diferencias existentes entre los sexos apuntan a la necesidad de intensificar y adecuar las intervenciones para la prevención de la experimentación del tabaco en adolescentes por género

Objectives: To analyze the current status and evolution of the smoking epidemic in Portuguese and European school adolescents by gender. Patients and methods: Tobacco use and its evolution were obtained from the data base of the reports of the Health Behavior in School-Aged Children (HBSC) between 1997/1998 and 2013/2014. Results: In Portugal, according to the last report of the HBSC, 12% of 15-year old boys and 10% of girls smoked at least one cigarette a week, which is similar to the mean European prevalence. Regarding the evolution of tobacco use in Portugal between 1997/1998 and 2013/2014, prevalence at 15 years of age decreased from 19 to 12% in boys and from 14 to 10% in girls; at 13 years, it decreases from 5% in boys and from 4% in girls to 3% in boys and girls; at 11 years, the prevalence decreased from 2 to 1% in boys and from 1 to 0% in girls. Conclusions: The evolution of tobacco use in Portugal and Europe demonstrates a decrease in adolescents, with differences by gender. The existing differences between genders indicate the need to intensify and adapt the interventions for the prevention of experimenting with tobacco in adolescents by gender

Parents' educational level and second-hand tobacco smoke exposure at home in a sample of Portuguese children.

Second-hand tobacco smoke (SHS) exposure is a major and entirely avoidable health risk for children's health, well-being and development. The main objective of the current study was to investigate the association between parents' educational level and children's SHS home exposure. A self-administered questionnaire was conducted within a sample of 949 students in 4th grade (mean age 9.56±0.75, 53.4% male). The sample was randomly selected from all schools located at Lisbon District, Portugal. The current study confirmed that Portuguese children are exposed to unacceptable high levels of SHS at home, mainly by their parents' smoke. Prevalence of smokers was higher amongst parents with low educational level. Children of parents with low educational level were more likely to suffer SHS exposure at home. These results confirmed the social inequalities associated with smoking, support the relevance of more research on this subject and stress the need for more interventions to control this problem. Some interventions should be specifically aimed at less educated parents, particularly at less educated mothers.

Opinions on a car smoking ban: a needed guide for public health decision-makers / Opiniones sobre la prohibición de fumar en el coche: la guía necesaria para la toma de decisiones de salud pública

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