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.

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.

[Formaldehyde in electronic cigarettes and in heat-not-burn products: let's make the point]. / La formaldeide nelle sigarette elettroniche e nei riscaldatori di tabacco (HnB): facciamo il punto.

The spread of electronic cigarettes (e-cigs) and of the so-called heat-not-burn (HnB), also known as heated tobacco products, presented as a less harmful alternative to traditional cigarettes, required further in-depth studies to demonstrate the real benefits or possible risks linked to this type of habit among smokers and possible new smokers. There are numerous harmful substances produced by these devices, such as metals, organic compounds, and aldehydes. The presence of formaldehyde is particularly worrying: its indoor concentration is 2.7, 1.2, and 40 µg/m3 for HnB, e-cigs, and traditional cigarettes, respectively. The evidence of this substance, which numerous epidemiological studies have already shown to be harmful to health (in particular, the International Agency for Research on Cancer classified it as a group 1 carcinogen), would lead to the need to modify the legislation with more restrictive rules on the use of these devices in public environment and in particular in the presence of more susceptible subjects, such as minors and pregnant women.

The Impact of Russia-Ukraine geopolitical conflict on the air quality and toxicological properties of ambient PM2.5 in Milan, Italy.

The geopolitical conflict between Russia and Ukraine has disrupted Europe's natural gas supplies, driving up gas prices and leading to a shift towards biomass for residential heating during colder months. This study assessed the consequent air quality and toxicological impacts in Milan, Italy, focusing on fine particulate matter (PM2.5, dp < 2.5 µm) emissions. PM2.5 samples were analyzed for their chemical composition and assessed for their oxidative potential using the dithiothreitol (DTT) assay across three periods reflecting residential heating deployment (RHD): pre-RHD, intra-RHD, and post-RHD periods. During the intra-RHD period, PM2.5 levels were significantly higher than those in other periods, with concentrations reaching 57.94 ± 7.57 µg/m3, indicating a deterioration in air quality. Moreover, levoglucosan was 9.2 times higher during the intra-RHD period compared to the pre-RHD period, correlating with elevated levels of elemental carbon (EC) and polycyclic aromatic hydrocarbons (PAHs). These findings were compared with previous local studies before the conflict, underscoring a significant rise in biomass-related emissions. DTT assay levels during the intra-RHD were 2.1 times higher than those observed during the same period in 2022, strongly correlating with biomass burning emissions. Our findings highlight the necessity for policies to mitigate the indirect health effects of increased biomass burning emissions due to the energy crisis triggered by the geopolitical conflict.

Exposure to secondhand aerosol from electronic cigarettes at homes: A real-life study in four European countries.

Electronic cigarette (e-cigarette) use emits potentially hazardous compounds and deteriorates indoor air quality. Home is a place where e-cigarettes may frequently be used amid its increasing prohibition in public places. This study assessed the real-life scenario of bystanders' exposure to secondhand e-cigarette aerosol (SHA) at home. A one-week observational study was conducted within the TackSHS project in four countries (Greece, Italy, Spain, and the United Kingdom) in 2019 including: 1) homes of e-cigarette users living together with a non-user/non-smoker; and 2) control homes with no smokers nor e-cigarette users. Indoor airborne nicotine, PM2.5, and PM1.0 concentrations were measured as environmental markers of SHA. Biomarkers, including nicotine and its metabolites, tobacco-specific nitrosamines, propanediol, glycerol, and metals were measured in participants' saliva and urine samples. E-cigarette use characteristics, such as e-cigarette refill liquid's nicotine concentration, e-cigarette type, place of e-cigarette use at home, and frequency of ventilation, were also collected. A total of 29 e-cigarette users' homes and 21 control homes were included. The results showed that the seven-day concentrations of airborne nicotine were quantifiable in 21 (72.4 %) out of 29 e-cigarette users' homes; overall, they were quite low (geometric mean: 0.01 µg/m3; 95 % CI: 0.01-0.02 µg/m3) and were all below the limit of quantification in control homes. Seven-day concentrations of PM2.5 and PM1.0 in e-cigarette and control homes were similar. Airborne nicotine and PM concentrations did not differ according to different e-cigarette use characteristics. Non-users residing with e-cigarette users had low but significantly higher levels of cotinine, 3'-OH-cotinine and 1,2-propanediol in saliva, and cobalt in urine than non-users living in control homes. In conclusion, e-cigarette use at home created bystanders' exposure to SHA regardless of the e-cigarette use characteristics. Further studies are warranted to assess the implications of SHA exposure for smoke-free policy.

The oxidative potential of particulate matter (PM) in different regions around the world and its relation to air pollution sources.

In this study, we investigated the impact of urban emission sources on the chemical composition of ambient particulate matter (PM) as well as the associated oxidative potential. We collected six sets of PM samples in five urban location sites around the world over long time periods varying from weeks to months, intentionally selected for their PM to be dominated by unique emission sources: (1) PM2.5 produced mainly by traffic emissions in central Los Angeles, United States (US); (2) PM2.5 dominated by biomass burning in Milan, Italy; (3) PM2.5 formed by secondary photochemical reactions thus dominated by secondary aerosols in Athens, Greece; (4) PM10 emitted by refinery and dust resuspension in Riyadh, Saudi Arabia (SA); (5) PM10 generated by dust storms in Riyadh, SA, and (6) PM2.5 produced mainly by industrial and traffic emissions in Beirut, Lebanon. The PM samples were chemically analyzed and their oxidative potential were quantified by employing the dithiothreitol (DTT) assay. Our results revealed that the Milan samples were rich in water soluble organic carbon (WSOC) and PAHs, even exceeding the levels measured on Los Angeles (LA) freeways. The PM in Athens was characterized by high concentrations of inorganic ions, specifically sulfate which was the highest of all PM samples. The ambient PM in LA was impacted by the traffic-emitted primary organic and elemental carbon. Furthermore, the contribution of metals and elements per mass of PM in Riyadh and Beirut samples were more pronounced relative to other sampling areas. The highest intrinsic PM redox activity was observed for PM with the highest WSOC fraction, including Milan (biomass burning) and Athens (secondary organic aerosols, SOA). PM in areas characterized by high metal emissions including dust events, refinery and industry, such as Riyadh and Beirut, had the lowest oxidative potential as assessed by the DTT assay. The results of this study illustrate the impact of major emission sources in urban areas on the redox activity and oxidative potential of ambient PM, providing useful information for developing efficient air pollution control and mitigation policies in polluted areas around the globe.

Chemical characterization and source apportionment of fine and coarse particulate matter inside the refectory of Santa Maria Delle Grazie Church, home of Leonardo Da Vinci's "Last Supper".

The association between exposure to indoor particulate matter (PM) and damage to cultural assets has been of primary relevance to museum conservators. PM-induced damage to the "Last Supper" painting, one of Leonardo da Vinci's most famous artworks, has been a major concern, given the location of this masterpiece inside a refectory in the city center of Milan, one of Europe's most polluted cities. To assess this risk, a one-year sampling campaign was conducted at indoor and outdoor sites of the painting's location, where time-integrated fine and coarse PM (PM(2.5) and PM(2.5-10)) samples were simultaneously collected. Findings showed that PM(2.5) and PM(2.5-10) concentrations were reduced indoors by 88 and 94% on a yearly average basis, respectively. This large reduction is mainly attributed to the efficacy of the deployed ventilation system in removing particles. Furthermore, PM(2.5) dominated indoor particle levels, with organic matter as the most abundant species. Next, the chemical mass balance model was applied to apportion primary and secondary sources to monthly indoor fine organic carbon (OC) and PM mass. Results revealed that gasoline vehicles, urban soil, and wood-smoke only contributed to an annual average of 11.2 ± 3.7% of OC mass. Tracers for these major sources had minimal infiltration factors. On the other hand, fatty acids and squalane had high indoor-to-outdoor concentration ratios with fatty acids showing a good correlation with indoor OC, implying a common indoor source.

The impact of stay-home policies during Coronavirus-19 pandemic on the chemical and toxicological characteristics of ambient PM2.5 in the metropolitan area of Milan, Italy.

The goal of this study was to characterize changes in components and toxicological properties of PM2.5 during the nationwide 2019-Coronavirus (COVID-19) lockdown restrictions in Milan, Italy. Time-integrated PM2.5 filters were collected at a residential site in Milan metropolitan area from April 11th to June 3rd at 2020, encompassing full-lockdown (FL), the followed partial-lockdown (PL2), and full-relaxation (FR) periods of COVID-19 restrictions. The collected filters were analyzed for elemental and organic carbon (EC/OC), water-soluble organic carbon (WSOC), individual organic species (e.g., polycyclic aromatic hydrocarbons (PAHs), and levoglucosan), and metals. According to online data, nitrogen dioxide (NO2) and benzene (C6H6) levels significantly decreased during the entire COVID-19 period compared to the same time span in 2019, mainly due to the government-backed shutdowns and curtailed road traffic. Similarly, with a few exceptions, surrogates of tailpipe emissions (e.g., traffic-associated PAHs) as well as re-suspended road dust (e.g., Fe, Mn, Cu, Cr, and Ti) were relatively lower during FL and PL2 periods in comparison with year 2019, whereas an increasing trend in mass concentration of mentioned species was observed from FL to PL2 and FR phases due to the gradual lifting of lockdown restrictions. In contrast, comparable concentrations of ambient PM2.5 and black carbon (BC) between lockdown period and the same time span in 2019 were attributed to the interplay between decreased road traffic and elevated domestic biomass burning as a result of adopted stay-home strategies. Finally, the curtailed road traffic during FL and PL2 periods led to ~25% drop in the PM2.5 oxidative potential (measured via 2',7'-dichlorodihydrofluorescein (DCFH) and dithiothreitol (DTT) assays) with respect to the FR period as well as the same time span in 2019. The results of this study provide insights into the changes in components and oxidative potential of PM2.5 in the absence of road traffic during COVID-19 restrictions.

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.

[Smoking in car: monitoring pollution of particulate matter, of organic volatile compounds and of carbon monoxide. The effect of opening the driver's window]. / Fumare in macchina: l'inquinamento da polveri, da composti organici volatili e da monossido di carbonio. L'effetto dell'apertura del finestrino.

OBJECTIVE: to identify the most suitable marker for monitoring ETS inside a moving car, and to verify the efficacy of window opening to reduce ETS pollution inside the car. DESIGN: experimental pilot study. SSETTING AND PARTICIPANTS: monitoring of ETS markers in a moving car. MAIN OUTCOMES MEASURES: we used real time analyzers to measure: n particulate matter as mass (mug/m3, PM1, PM2.5, PM10); n suspended particle number (total number of particles sized >0.3 e >0.4 mum; n the number of particles with aerodynamic size between 0.3-0.4 mum in diameter; n total volatile organic compounds (TVOC); n carbon monoxide (CO). The recordings were carried out inside a car moving on the road at the speed of 50 km/h, with controlled conditions of temperature and relative humidity. RESULTS: after lighting a cigarette, with driver's window closed, the levels of all the pollutants increased dramatically, with peaks of 700 mug/m3 for PM2.5 and PM10, and of over 600,000 particles/ liter, while TVOC reached values up to 6,000 mug/m3 and CO up to 6 ppm. When a cigarette was lit with the window 1/4 open, excess pollution was promptly recorded, although with less intensity. With the window completely open, PM, TVOC and CO concentrations were hardly measurable as compared to background levels. On the contrary, particle number increased dramatically up to over 300,000/liter, mostly due to the submicrometric particle fraction in the range 0.3-0.4 mum. CONCLUSION: smoking just a cigarette inside a car represents an extremely high exposure to ETS. Partially opening the window is useless to prevent the accumulation of pollutants. Complete window opening is helpful to remove coarse PM and volatile pollutants, but is ineffective against submicrometer particles. Measuring particle number seems to be the best way to assess ETS pollution inside a car.

[Observed smoking in car: results of a study of the Regional Health Prevention Service of Veneto, Northern Italy]. / La prevalenza dell'abitudine a fumare in automobile: i risultati dello studio osservazionale in Veneto.

OBJECTIVE: to estimate the prevalence of smokers inside cars or duty vehicles and the presence of children exposed to second hand smoke on board, in the NHS districts of Veneto Region. DESIGN: an observational study was carried out by the technicians of the Prevention department from October 1st to October 17th 2008. The observers had to record sex of the driver and of the passengers, their presumed ages, verify if drivers or passengers were smoking, and if there were any children on board. SETTING AND PARTICIPANTS: 19 Local Health Authorities (90,5%) out of 21 in the Veneto region. MAIN OUTCOMES MEASURES: percentage of crossings monitored out of the total scheduled. RESULTS: a total of 5,928 cars were examined at the crossings, males accounted for 61,4% of the drivers. Smoking overall by at least one person in the car was reported in 409 cases (6.9%, 12% among commercial vehicles), the driver alone was smoking in 87.3% of the cases, whereas only the passenger smoking represented 8.3% of the cases. Both the driver and passenger smoking were 4.4% of the observations. Children were present as passengers in 762 cars (12.9%); there were people smoking with children on board in 7 cars (0.9%). CONCLUSION: in spite of the efforts to limit the dangers of second hand smoke, smoking in car is still a common behaviour, and represents a serious risk both for both, adults and children. Focusing in research projects could help the Department of Prevention of the Local Health Authorities to increase their activities and involvement in the research field.

Tackling second-hand exposure to tobacco smoke and aerosols of electronic cigarettes: the TackSHS project protocol.

OBJECTIVE: The TackSHS project aims to comprehensively elucidate the impact that exposure to second-hand smoke (SHS) from cigarettes and second-hand aerosols (SHA) from electronic cigarettes have on the respiratory health of the European population according to socioeconomic characteristics and other determinants. METHOD: The TackSHS project involves a series of coordinated studies carried out by 11 academic and public health organisations from six European countries. The project will investigate: a) the determinants of SHS and SHA exposure assessed at the individual level (surveys on representative general population samples) and in common environments (environmental sampling in specific settings); b) the overall disease burden, mortality and morbidity attributable to such exposure; and c) its economic impact in terms of direct health care costs. The project will also examine specific acute respiratory health changes in healthy individuals and patients with respiratory diseases exposed to SHS and SHA. In addition, the project will examine the effectiveness of a novel intervention to reduce SHS exposure in households where smoking is permitted. All these studies are inter-related and involve collaborative coordination among the participant organisations. CONCLUSION: The comprehensive, integrated approach of the TackSHS project will enable a significant step forward from the current status quo in the understanding of the impact of SHS and SHA exposure on health and provide the basis for health policy recommendations to help European countries to further reduce the harm caused by SHS and SHA exposure.

Measuring for change: A multi-centre pre-post trial of an air quality feedback intervention to promote smoke-free homes.

INTRODUCTION: Second-hand smoke exposure in the home is a serious cause of ill-health for children. Behaviour change interventions have been developed to encourage parents to keep homes smoke-free. This study evaluates a novel air quality feedback intervention using remote air quality monitoring with SMS and email messaging to promote smoke-free homes among families from deprived areas. METHODS: This paper presents a pre-post study of this intervention. Using internet connected monitors developed with the Dylos DC1700, daily SMS and weekly email feedback provided for 16 days to participants recruited in four European countries. Participants were recruited based on their stage of change, in order to target those most able to achieve smoke-free homes. The primary outcome measure was median change in mean fine particulate matter (PM2.5) concentration between baseline and follow-up periods, while secondary outcome measures included change in time over the World Health Organisation (WHO) guideline limit for PM2.5 exposure over 24 h (25 µg/m3) in those periods and the number of homes where PM2.5 concentrations reduced. Telephone interviews were conducted with participants in Scotland post-intervention to explore intervention experience and perceived effectiveness. RESULTS: Of 86 homes that completed the intervention study, 57 (66%) experienced pre-post reductions in measured PM2.5. The median reduction experienced was 4.1 µg/m3 (a reduction of 19% from baseline, p = 0.008). Eight homes where concentrations were higher than the WHO guideline limit at baseline fell below that level at follow-up. In follow-up interviews, participants expressed positive views on the usefulness of air quality feedback. DISCUSSION: Household air quality monitoring with SMS and email feedback can lead to behaviour change and consequent reductions in SHS in homes, but within the context of our study few homes became totally smoke-free.

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.

Inhaled steroid/tobacco smoke particle interactions: a new light on steroid resistance.

BACKGROUND: Inhaled steroid resistance is an obstacle to asthma control in asthmatic smokers. The reasons of this phenomenon are not yet entirely understood. Interaction of drug particles with environmental tobacco smoke (ETS) could change the aerodynamic profile of the drug through the particle coagulation phenomenon. Aim of the present study was to examine whether steroid particles interact with smoke when delivered in the presence of ETS. METHODS: Beclomethasone-hydrofluoralkane (BDP-HFA) pMDI particle profile was studied after a single actuation delivered in ambient air or in the presence of ETS in an experimental chamber using a light scattering Optical Particle Counter capable of measuring the concentrations of particle sized 0.3-1.0, 1.1-2.0, 2.1-3.0, 3.1-4.0, 4.1-5.0, and > 5.1 microm in diameter with a sampling time of one second. The number of drug particles delivered after a single actuation was measured as the difference between total particle number after drug delivery and background particle number. Two groups of experiments were carried out at different ambient background particle concentrations. Two-tail Student's t-test was used for statistical analysis. RESULTS: When delivered in ambient air, over 90% of BDP-HFA particles were found in the 0.3-1.0 microm size class, while particles sized 1.1-2.0 microm and 2.1-3.0 represented less than 6.6% and 2.8% of total particles, respectively. However, when delivered in the presence of ETS, drug particle profile was modified, with an impressive decrease of 0.3-1.0 microm particles, the most represented particles resulting those sized 1.1-2.0 microm (over 66.6% of total particles), and 2.1-3.0 microm particles accounting up to 31% of total particles. CONCLUSION: Our data suggest that particle interaction between inhaled BDP-HFA pMDI and ETS takes place in the first few seconds after drug delivery, with a decrease in smaller particles and a concurrent increase of larger particles. The resulting changes in aerosol particle profile might modify regional drug deposition with potential detriment to drug efficacy, and represent a new element of steroid resistance in smokers. Although the present study does not provide any functional or clinical assessment, it might be useful to advise smokers and non smokers with obstructive lung disease such as asthma or COPD, to avoid to act inhaled drugs in the presence of ETS in order to obtain the best therapeutic effect.

Efficacy of pins and diplomas as a reward for long-term smoking cessation.

AIMS AND BACKGROUND: Since 2004, the Antismoking Center of the National Cancer Institute of Milan has rewarded those who have been ex-smokers for longer than a year with a "former smoker" pin and a diploma. We investigated firstly whether these rewards contributed to maintain smoking withdrawal, secondly, which one of these was more appreciated and why, and thirdly, how they may have influenced the ex-smokers' perception of smoking and how this was reflected on those surrounding them (i.e., ex-smokers' personal and/or interpersonal areas). METHODS: A multiple-choice questionnaire was developed to investigate how much the rewards were appreciated and their effectiveness in maintaining smoking cessation. Moreover, smokers and non-smokers were asked about the impact of the pin. The questionnaire was completed on the phone by the last 100 ex-smokers who entered the pin and diploma program. RESULTS: All subjects appreciated the rewards, but only a few of them considered them as an aid to maintain long-term smoking cessation. Those who preferred the diploma stated that it represented a contribution to their self-esteem, an official recognition of being an ex-smoker, besides being something to show with pride to others. Those who preferred the pin principally stated it allowed them to be an example to other smokers. Most of the subjects reported that they wore the pin in several circumstances, raising interest and admiration. CONCLUSIONS: Rewarding ex-smokers one year after smoking cessation with a small prize may be a useful practice to improve the doctor-patient relationship, which is vital to maintain smoking cessation, and to boost the awareness of the availability of aids to reach this objective.

[The effects of the traffic restriction fee (Ecopass) in the center of Milan on urban pollution with particulate matter: the results of a pilot study]. / L'effetto del provvedimento di restrizione del traffico nel centro di Milano (Ecopass) sull'inquinamento urbano da polveri: i risultati di uno studio pilota.

BACKGROUND: the city of Milan introduced a traffic charging zone in city center in January 2008, named Ecopass. AIM OF THE STUDY: to compare PM1, PM2,5 and PM10 levels in and outside the restricted area before and after the enforcement of the charging scheme. METHODS: PM1, PM2,5 and PM10 exposures were measured by means of pre-calibrated portable laser-operated particle analyzers. PM10 data from the ARPA official monitoring stations were also evaluated. RESULTS: during a walking trip from Piazza Loreto (outside) to Piazza Duomo (inside Ecopass zone) and back, mean (SD) PM1, PM2,5 and PM10 were 31 (6), 68 (24) and 93 (37) microg/m3 inside the Ecopass zone, and 32 (6), 70 (37), 98 (48) microg/m3 in the outer area, respectively (not significant, ns). In another trip walking from Piazza Buonarroti to Piazza Duomo and back, PM1, PM2,5 and PM10 levels were 56 (2), 183 (14) and 245 (28) microg/m3 inside the Ecopass zone, and 58 (3), 197 (13) and 247 (24) microg/m3 in the outer area, respectively (ns). In the measurements taken from a car moving in three ring belts--one inside the restricted zone, and two outer radial orbitals--PM1, PM2,5 and PM10 levels were found 41 (1), 110 (8) and 148 (16) microg/m3 inside the Ecopass area, 42 (3), 116 (14) and 152 (28) microg/m3 along the middle belt, and 39 (4), 102 (15) and 127 (23) microg/m3 along the greater Milan orbital ("Tangenziale"), respectively (ns). Mean (SD) PM10 levels from ARPA in the two months before the enforcement were 71.2 (32.6) and 74.8 (38.4) microg/m3, in the Ecopass zone and outside, respectively while after the enforcement were 67.3 (36.4) and 70.9 (38.3) microg/m3 of PM10, respectively (ns). CONCLUSIONS: no signficant improvement in air quality was observed after the enforcement of the Ecopass charging zone in Milan. In spite of their limitations, the present data confirm that small scale reductions in particle emissions are not sufficient to reach the goal of an improvement in air quality. Large scale, coordinated interventions on an inter-regional basis are envisioned.

A Case-Crossover Study to Investigate the Effects of Atmospheric Particulate Matter Concentrations, Season, and Air Temperature on Accident and Emergency Presentations for Cardiovascular Events in Northern Italy.

Atmospheric particulate matter (PM) has multiple adverse effects on human health, high temperatures are also associated with adverse health outcomes, and the frequency of cardiovascular events (CVEs) varies with season. We investigated a hypothesized increase in PM-related accident and emergency (A&E) presentations for CVE with high temperature, warm season, days of high influenza incidence, and in people with a cancer diagnosis, using a time-stratified case-crossover study design. Outcomes were associations of A&E presentation for CVE with atmospheric PM ≤ 10 µm (PM10), season, and air temperature. PM10 levels in the municipality of residence (exposure variable) were estimated by modeling data from local monitoring stations. Conditional logistic regression models estimated odds ratios (OR) with 95% confidence intervals (CI) for presentations in relation to supposed influencers, adjusting for confounders. Study participants were all who presented at the A&E of a large hospital near Milan, Italy, for a CVE (ICD-9: 390-459) from 1st January 2014 to 31st December 2015. There were 1349 A&E presentations for CVE in 2014-2015 and 5390 control days. Risk of A&E presentation was significantly increased on hot days with OR 1.34 (95%CI 1.05-1.71) per 10 µg/m3 PM10 increment (as mean PM10 on day of presentation, and 1 and 2 days before (lags 0-2)), and (for lag 0) in autumn (OR 1.23, 95%CI 1.09-1.37) and winter (OR 1.18, 95%CI 1.01-1.38). Risks were also significantly increased when PM10 was on lag 1, in people with a cancer diagnosis in the spring and summer months (1.88, 95%CI 1.05-3.37), and on days (lags 0-2) of high influenza incidence (OR 2.34, 95%CI 1.01-5.43). PM10 levels exceeded the 50 µg/m3 "safe" threshold recommended by the WHO and Italian legislation for only 3.8% of days during the warm periods of 2014-2015. Greater risk of A&E presentation for CVE in periods of high PM10 and high temperature suggests that "safe" thresholds for PM10 should be temperature-dependent and that the adverse effects of PM10 will increase as temperatures increase due to climate change.

Residual tobacco smoke: measurement of its washout time in the lung and of its contribution to environmental tobacco smoke.

BACKGROUND: Tobacco smoking entails inhaling millions of fine particles with each puff, and it is intuitive that after smoking a cigarette it will take a certain time to washout residual tobacco smoke (RTS) from the lungs with subsequent breaths. OBJECTIVES: To study the washout time of 0.3-1.0 microm particles after the last puff in 10 volunteer smokers by using equipment capable of measuring particle concentration in real time in the exhaled air. RESULT: Mean (standard deviation (SD)) lung RTS washout time was 58.6 (23.6) s, range 18-90 s, and corresponded to 8.7 (4.6) subsequent breathings. The contribution of individual and overall RTS to indoor pollution was calculated by subtracting incremental background particle concentration from room concentration after 10 consecutive re-entries of smokers after the last puff into a room of 33.2 m3, with an air exchange rate per hour in the range of 0.2-0.4. Mean (SD) individual RTS contribution consisted of 1402 (1490) million particles (range 51-3611 million), whereas RTS increased room 0.3-1.0 microm particle concentration from a baseline of 22,283 particles/l to a final room concentration of 341,956 particles/l, corresponding to a total increase in particulate matter (2.5) from a background of 0.56 up to 3.32 microg/m3. CONCLUSION: These data reveal a definite although marginal, role of RTS as a source of hidden indoor pollution. Further studies are needed to understand the relevance of this contribution in smoke-free premises in terms of risk exposure; however, waiting for about 2 min before re-entry after the last puff would be enough to avoid an unwanted additional exposure for non-smokers.