PUBLICACIONS

@article{pmid42633154,

title = {Trends in waterpipe and e-cigarette use among young people in the European Union, 2012-2023: a repeated cross-sectional study},

author = {Tan MS and Filippidis FT and Li CX and Laverty AA and Fernández E and Martínez C and Peruga A and Vardavas CI and Feliu A},

doi = {10.1016/j.lanepe.2026.101815},

issn = {2666-7762},

year  = {2026},

date = {2026-10-01},

journal = {Lancet Reg Health Eur},

volume = {69},

pages = {101815},

abstract = {BACKGROUND: Alternative tobacco and nicotine-containing products can challenge progress in tobacco control. Waterpipes and e-cigarettes gained popularity among youth at different times, driven by flavours, social influence, and perceived reduced harm. This study examined trends in waterpipe and e-cigarette use among youth in the European Union (EU) from 2012 to 2023.nnMETHODS: We analysed data from five waves (2012-2023) of the Special Eurobarometer surveys in 26 EU Member States (N = 20,466; ages 15-30). Multilevel Poisson models assessed trends by sociodemographic subgroups, adjusting for country-level factors. Adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs) are reported.nnFINDINGS: From 2012 to 2023, ever waterpipe use fell from 31.2% (95% CI: 29.1-33.3%) to 14.9% (13.2-16.8%), and current use (since 2017) from 2.5% (1.8-3.5%) to 1.8% (1.2-2.7%). Ever e-cigarette use rose from 12.2% (10.8-13.8%) to 25.8% (23.7-28.2%), and current use from 1.6% (1.1-2.3%) to 5.3% (4.0-6.8%), with cross-country variation. Compared with 2017, ever waterpipe use was lower in 2023 (aPR: 0.52, 95%CI: 0.42-0.66). Ever e-cigarette use was lower in 2012 (0.47; 0.40-0.54) and 2014 (0.75; 0.67-0.84). Current waterpipe use increased in 2020 (1.96; 1.16-3.28) then declined, while current e-cigarette use rose in 2020 (1.64; 1.15-2.34) and 2023 (4.27; 2.73-6.67). By 2023, ever waterpipe use was lower across all subgroups despite earlier heterogeneity, whereas ever e-cigarette use was higher among women (1.41; 1.18-1.69), urban residents (1.27; 1.11-1.46), and those without financial difficulties (1.38; 1.20-1.60). Current e-cigarette use was also higher across all groups.nnINTERPRETATION: Declining waterpipe use and rising e-cigarette use among young Europeans show divergent patterns and differences across sociodemographic groups, particularly among women and socioeconomically disadvantaged groups. Continued surveillance and targeted interventions are needed to address emerging vulnerabilities in high-risk populations.nnFUNDING: European Union's Horizon 2020.},

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}

@article{pmid42507051,

title = {Exploring factors that influence the implementation of presurgical smoking cessation interventions: a cross-sectional survey},

author = {Gavilan Castillo E and Fernández E and Panera JA and Ballbè M and Antón L and Mercader C and Ferré M and Serrano H and Martínez C},

doi = {10.1007/s12630-026-03158-8},

issn = {1496-8975},

year  = {2026},

date = {2026-07-01},

journal = {Can J Anaesth},

abstract = {PURPOSE: We aimed to evaluate the level of implementation of health care professionals in helping patients undergoing surgery quit smoking using the Ask, Advise, Assess, Assist, and Arrange Follow-Up (5As) brief intervention model, and to identify the main barriers and facilitators affecting the implementation during preoperative visits at hospitals in Catalonia, Spain.nnMETHODS: In a multicentre cross-sectional study, we administed an online survey to clinical health care professionals who perform preoperative visits (anesthesiologists, nurses, and psychologists). The main outcome variable was the implementation of 5As. We used the validated Knowledge, Attitudes, Behaviours, and Organization (KABO) questionnaire to assess barriers and facilitators. We performed univariate and bivariate analyses of the 5As and the KABO domains according to professional category and sociodemographic variables. We conducted multivariable analyses using generalized estimating equations controlling for covariates.nnRESULTS: The survey was completed by 216 professionals of 633 invited to participate (34.1%). Engagement was high in the categories Ask (median [interquartile range] 0-10 Likert scale score, 10.0 [9.0-10.0]) and Advise (7.5 [5.0-10.0]), but very low in Assist (1.0 [0.0-3.0]) and Arrange Follow-Up (0.0 [0.0-2.0]). "Individual skills" and "organizational support/resources" had significantly lower scores compared with other domains (Holm-adjusted P < 0.05), whereas "Individual commitment" and "Beliefs about patients' desire/readiness" had significantly higher scores.nnCONCLUSIONS: The level of implementation of smoking cessation in preoperative visits was poor. The main barriers detected were lack of knowledge and lack of resources and organizational support. Hospitals should promote strategies that address the main barriers identified and should apply interventions to help people quit smoking as a routine practice in preoperative visits.},

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tppubtype = {article}

}

@article{pmid42521419,

title = {Celebrating 20 years of the Tobacco Control Scale: Evolving to benchmark and advance policy implementation in a changing context},

author = {Feliu A and Joossens L and Martinez C},

doi = {10.1136/tc-2026-060471},

issn = {1468-3318},

year  = {2026},

date = {2026-07-01},

urldate = {2026-07-01},

journal = {Tob Control},

volume = {35},

number = {4},

pages = {423--424},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42533755,

title = {Evaluating the effect of cigarettes smoking on oesophageal cancer risk: a systematic review and meta-analysis with dose-response relationships},

author = {Teshima A and Possenti I and Bertacchi D and Bagnardi V and Specchia C and Martinez C and Fernández E and Gallus S and Lugo A},

doi = {10.1093/eurpub/ckag123},

issn = {1464-360X},

year  = {2026},

date = {2026-06-01},

journal = {Eur J Public Health},

volume = {36},

number = {4},

abstract = {Oesophageal cancer (OC) affects over 600 000 people annually, with tobacco smoking and alcohol consumption as primary risk factors. We aimed to synthesize existing evidence to quantify the dose-response relationship between smoking and OC risk. A systematic review and meta-analysis was conducted, examining case-control and cohort studies published up to April 2026. Pooled relative risks (RR) were estimated using random-effects models. Dose-response relationships by intensity, duration, and time since quitting of smoking were modelled using log-linear models, with linear or spline terms based on model fit. Of 221 eligible articles, 178 original studies were included. Compared with never smokers, the pooled RR of OC was 2.68 (95% confidence interval; CI: 2.37-3.03; n = 66) for current smokers, 1.71 (95% CI: 1.54-1.90; n = 61) for former smokers, and 2.15 (95% CI: 1.98-2.34; n = 144) for ever smokers. For current smokers compared with never smokers, the risk was 3.03 (95% CI: 2.42-3.79; n = 35) for squamous cell carcinoma (OSCC) and 2.25 (95% CI: 1.80-2.82; n = 14) for adenocarcinoma (OAC). OC risk increased non-linearly with smoking intensity, linearly with smoking duration, and decreased linearly with time since quitting. This meta-analysis reinforces the strong association between smoking and OC, with higher risk for OSCC than OAC. The observed non-linear dose-response relationship indicates that the risk of OC increases sharply even at low levels of smoking intensity, doubling below nine cigarettes and tripling below 17 cigarettes per day. These findings support complete smoking avoidance as the most effective prevention strategy of OC.},

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pubstate = {published},

tppubtype = {article}

}

@article{pmid42337627,

title = {The PIECES multi-site comparative case study protocol: mixed methods implementation evaluation of adapting, implementing and tailoring primary cancer prevention programmes in diverse contexts},

author = {Hensen N and Smit RA and Barrero A and Breunese J and Burazeri G and Caini S and Fernández E and Gorini G and Grams L and Mercader CG and Walters BH and Hinderaker HK and Janda M and Jiménez-Rueda A and Jaffery JI and Kahlhöfer J and Francisca Kenter RM and Lödding P and Macaulay L and Marushko K and Ramiro-Pareta M and O'Donnell R and Porthe V and Pontes C and Piera-Jiménez J and Qirjako G and Rocliffe P and Semple S and Troelstra SA and van der Ploeg HP and Willemsen MC and Woods C and Ylli A and Vis C and Martínez C and Nassau FV and PIECES consortium},

doi = {10.1186/s43058-026-01002-0},

issn = {2662-2211},

year  = {2026},

date = {2026-06-01},

journal = {Implement Sci Commun},

abstract = {BACKGROUND: Effective implementation of evidence-based programmes in real-world settings requires the capacity to adapt programmes and tailor implementation strategies to local contexts. Many primary cancer prevention (PCP) programmes that are effective in controlled settings struggle in routine practice. Although several frameworks outline principles of adaptation and tailoring, practical guidance on how to operationalise these processes remains limited. The PIECES project aims to help address this gap by developing, implementing, and evaluating structured support for tailored implementation of PCP programmes. Within the PIECES project, a toolkit was co-developed with practitioners and researchers to provide theory- and evidence-informed guidance for adapting, tailoring, implementing, and evaluating PCP programmes. The toolkit aims to strengthen implementation competencies through structured planning, collaborative learning, and evidence-informed decision-making. This paper presents the protocol for the PIECES study which evaluates the toolkit's usability, feasibility, and mechanisms of impact of PCP programmes across diverse healthcare and community settings.nnMETHODS: The PIECES study uses a multi-site pre-post comparative case study design with a mixed-methods implementation evaluation across 11 sites in Europe and Australia, reflecting variation in organisational structures, resources, and cultural contexts. The primary outcome is change in implementation competencies among toolkit users. Guided by the UK MRC Process Evaluation Framework and Proctor's implementation outcomes, the process evaluation examines toolkit usability, feasibility, user satisfaction, and perceived impact on implementation processes and outcomes. Quantitative and qualitative data, toolkit log data, and structured field notes will be collected at six-month intervals (2025-2027). In parallel, a realist evaluation will explore how, why, and under what conditions the toolkit supports tailored implementation. Together, these approaches provide complementary descriptive and explanatory insights into the mechanisms and contextual factors shaping tailored implementation of PCP programmes.nnDISCUSSION: This study is expected to contribute to implementation science by evaluating a structured, evidence-informed tool designed to strengthen capacity for tailored implementation of PCP programmes. Its multi-country design offers a natural field-laboratory to explore how implementation support tools function across varying contexts. By integrating process and realist evaluation approaches, the study is designed to generate practical and theoretical evidence to inform scalable, context-sensitive strategies and enhance the sustainability and impact of evidence-based prevention efforts.nnTRIAL REGISTRATION: ClinicalTrials.gov ID NCT06718322.},

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pubstate = {published},

tppubtype = {article}

}

@article{pmid41969175,

title = {Changes in concentrations of tobacco specific nitrosamines in saliva in the general population of Barcelona before and after implementation of tobacco control legislation},

author = {Pérez-Martín H and Lidón-Moyano C and González-Marrón A and Martín-Sánchez JC and Fu M and Ballbè M and Pérez-Ortuño R and Pascual JA and Fernández E and Martínez-Sánchez JM},

doi = {10.1080/1354750X.2026.2657869},

issn = {1366-5804},

year  = {2026},

date = {2026-06-01},

journal = {Biomarkers},

volume = {31},

number = {4},

pages = {249--257},

abstract = {CONTEXT: This study evaluated changes in salivary tobacco-specific nitrosamines (TSNAs) in smokers and non-smokers before and after Spain's smoke-free legislation.nnMETHODS: We conducted a longitudinal study of 272 adults in Barcelona, surveyed in 2004-2005 and 2013-2014, spanning the 2006 legislation and its 2011 extension. Saliva samples were analyzed for NNN, NNK, and NNAL, and geometric means with 95% confidence intervals were calculated. Data were stratified by sociodemographics, smoking status, smoking behavior, and anthropometrics. Linear mixed-effects models assessed adjusted percentage changes in TSNA concentrations.nnRESULTS: At baseline, overall TSNA concentrations were 1.5 [1.2-1.8] pg/mL for NNN, 1.4 [1.3-1.5] pg/mL for NNK, and 0.5 [0.5-0.6] pg/mL for NNAL. Among baseline smokers who quit, TSNAs decreased by -90.5% (NNN), -48.7% (NNK), and -86.2% (NNAL). Continuing smokers showed a 149.8% increase in NNN, while non-smokers showed no significant change.nnCONCLUSIONS: Concentrations of salivary TSNAs declined in those who quit smoking but increased for continuing smokers. Monitoring TSNAs in saliva is useful for assessing legislative impact.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41531671,

title = {Consumption patterns and withdrawal symptoms in dual cannabis-tobacco users in Spain: Cross-sectional study},

author = {Saura J and Enríquez M and Feliu A and Roca X and Mondón S and Barrio P and Andreu M and Segura L and Ballbè M and Fu M and Fernández E and Martínez C and DuCATA clinical group},

doi = {10.1016/j.abrep.2025.100656},

issn = {2352-8532},

year  = {2026},

date = {2026-06-01},

journal = {Addict Behav Rep},

volume = {23},

pages = {100656},

abstract = {BACKGROUND: Cannabis use has increased worldwide, with over 188 million users annually. In Spain, past-year prevalence among people aged 15-64 is 10.6%. Dual use of cannabis and tobacco is common, increasing health risks and complicating cessation. This study examines consumption patterns and cannabis withdrawal severity among dual users undergoing treatment for cannabis use disorder (CUD).nnMETHOD: A cross-sectional study was conducted in substance use treatment programs in Catalonia, Spain. Participants were cannabis users initiating CUD treatment. A questionnaire collected sociodemographic data, cannabis and tobacco use characteristics (e.g., number of spliffs, tobacco amount), nicotine dependence, motivation to quit, and cannabis withdrawal symptoms. Hierarchical cluster analysis using Gower's distance identified behavioral patterns among participants.nnRESULTS: Data from 94 participants seeking CUD treatment were included. Daily tobacco use was reported by 91.5%, with a mean Fagerström score of 4.2/10. Most participants (88.1%) co-used cannabis with tobacco, and 75.8% experienced cannabis withdrawal symptoms, with women reporting greater severity. Cluster analysis revealed two profiles: Cluster 1 (71.0%) included mostly older males with higher motivation to quit and fewer withdrawal symptoms; Cluster 2 (29.0%) was younger, more sex-balanced, and showed higher nicotine dependence, and more severe withdrawal symptoms.nnCONCLUSIONS: Co-use of cannabis and tobacco is highly prevalent among individuals entering CUD treatment. Higher nicotine dependence is associated with more severe withdrawal symptoms. Older males with higher motivation and fewer withdrawal symptoms may have better prognosis, highlighting motivation as cessation predictor. Findings underscore the need to enhance motivation to quit both substances and integrated treatment. The DuCATA project has been registered at Clinicaltrials.gov under the identifier [NCT05512091].},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42082364,

title = {From vision to action: a framework to assess readiness for the tobacco endgame},

author = {Feliu A and Martinez C and Vardavas C and Fernández E and Filippidis FT},

doi = {10.1136/tc-2025-059920},

issn = {1468-3318},

year  = {2026},

date = {2026-05-01},

journal = {Tob Control},

abstract = {BACKGROUND: Tobacco endgame strategies aim to reduce smoking prevalence to minimal levels (<5%) through measures that expand traditional tobacco control approaches. Although some countries have set endgame targets, most still report prevalence rates >15%, and practical guidance on how to assess readiness for endgame implementation remains limited. This study aims to synthetise the key determinants of jurisdictions' readiness for tobacco endgame and proposes a self-assessment tool to evaluate it.nnMETHODS: A narrative review of peer-reviewed and grey literature published between January 2010 and September 2025 was conducted. Publications were identified through targeted searches of academic databases and relevant organisational websites. A thematic synthesis of evidence on political, social and structural determinants of readiness was undertaken to identify recurring domains, which were later used to inform the development of a self-assessment tool.nnRESULTS: Nine readiness domains were identified: relatively low smoking prevalence; advanced implementation of WHO Framework Convention on Tobacco Control measures; robust enforcement infrastructure; social denormalisation of smoking; broad public understanding and support for ending tobacco use; a positive political climate and strong political will and leadership; a cohesive tobacco control community and civil society; minimal tobacco industry interference with strong protective mechanisms; and sufficient resources to implement tobacco endgame action plan. These domains guided the development of an evidence-informed self-assessment tool to help jurisdictions evaluate readiness, identify gaps and prioritise strategic actions.nnCONCLUSION: The Assessment of Readiness for Tobacco Endgame tool offers an evidence-informed framework to assess tobacco endgame readiness, helping jurisdictions assess capacities, identify gaps and guide strategic decision-making.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42502418,

title = {Effect of brief smoking cessation online training on knowledge, attitudes, behaviors, and organizational factors in European health professions students: A pre-post study},

author = {Martínez C and Pardavila-Belio MI and Laroussy K and Moreno C and Puig M and Agüeda Z and Sancho R and Lluch T and Canga-Armayor N and Pueyo-Garrigues M and Tricas-Sauras S and Lavilla-Gracia M and Duaso MJ and Vilaplana J and Roca J and Margalef M and Fernández E and Feliu A and INSTrUCT Research Group},

doi = {10.18332/tid/217007},

issn = {1617-9625},

year  = {2026},

date = {2026-01-01},

journal = {Tob Induc Dis},

volume = {24},

abstract = {INTRODUCTION: Health professionals play a critical role in tobacco prevention and cessation, but limited training during education often leaves their knowledge, attitudes, behaviors, and organizational support insufficient. Our aim was to assess the effect of an online brief smoking cessation training program on knowledge, attitudes, behaviors, and organizational factors among health professions students in Spain and the United Kingdom.nnMETHODS: A pre-post study was conducted among 756 undergraduate health professions students (652 from Spain and 104 from the UK) from four universities. Participants completed the validated Knowledge, Attitudes, Behaviors, and Organizational factors self-reported questionnaire for health professions Students (KABO_S) before and one month after the training. Generalized linear mixed models analyzed pre-post changes, adjusting for gender, age, and tobacco use.nnRESULTS: Significant increases were observed in the overall KABO_S score from 4.82 (SD=1.34) to 6.69 (SD=1.26) at one month (p<0.01). All dimensions increased in both countries (all p<0.01), with the greatest gains in individual knowledge/skills and attitudes/beliefs (median improvements ranging from 38.5% to 69.1%). Organizational resources showed the lowest gains (median improvement of 5.7% to 15.2%). Linear mixed models confirmed a significant increase in overall KABO_S scores (Spain: β=1.78; 95% CI: 1.67-1.90; UK: β=2.44; 95% CI: 2.13-2.74) and in each individual dimension (all p<0.001).nnCONCLUSIONS: Knowledge, attitudes, behaviors, and organizational factors improved significantly among health professions students in both countries. These findings suggest that this online training program may represent a promising addition to health professions curricula in Europe.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42220376,

title = {Psychometric validation of the Cannabis Withdrawal Checklist in a Spanish sample with cannabis use disorder},

author = {Saura J and Feliu A and Enríquez M and Roca X and Ballbè M and Fu M and Segura L and Fernández E and Martínez C},

doi = {10.3389/fpsyg.2026.1744004},

issn = {1664-1078},

year  = {2026},

date = {2026-01-01},

journal = {Front Psychol},

volume = {17},

pages = {1744004},

abstract = {INTRODUCTION: Cannabis is used globally. In Spain, it is often used in combination with tobacco, which may exacerbate withdrawal severity. Currently, no validated instrument exists to assess cannabis withdrawal symptoms in Spanish populations. This study aimed to validate the 15-item Cannabis (Marijuana) Withdrawal Checklist (CWC) for Spanish-speaking individuals who co-use cannabis and tobacco.nnMATERIALS AND METHODS: This psychometric validation study was nested within a multicenter longitudinal project conducted across 10 substance use treatment programs in Catalonia (Spain). The CWC was forward- and back-translated following COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) recommendations. Internal consistency, construct validity, and sensitivity to change over time were assessed using Cronbach's alpha, exploratory factor analysis (EFA), and mixed-effects analysis. Data from 82 participants were used to conduct the validation.nnRESULTS: The adapted CWC demonstrated high internal consistency (Cronbach's  = 0.918 at baseline; 0.885 at 2 weeks of treatment). EFA supported a unidimensional structure explaining approximately 60% of the variance. Although symptom severity did not significantly change over follow-up, withdrawal intensity was positively associated with the level of cannabis use. The scale effectively captured clinically relevant symptoms such as irritability, craving, and sleep difficulties.nnCONCLUSION: The Spanish CWC showed strong reliability and acceptable psychometric properties, supporting its use for assessing cannabis withdrawal symptoms in Spanish-speaking adults, particularly those who co-use tobacco products. The scale may be valuable in both research and clinical settings, particularly for monitoring withdrawal during treatment interventions. Further validation using larger, more diverse samples is warranted.nnCLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, identifier NCT0551209.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41603344,

title = {Public support for standardised packaging and policy implementation: an analysis of European survey data},

author = {Liang R and Laverty AA and Feliu A and Martinez C and Peruga A and Vardavas C and Filippidis FT},

doi = {10.1093/eurpub/ckag001},

issn = {1464-360X},

year  = {2026},

date = {2026-01-01},

journal = {Eur J Public Health},

abstract = {We conducted a secondary analysis of Eurobarometer survey data from 27 European countries, collected in 2017 (n = 28 300) and 2023 (n = 26 358), to assess changes in public support for standardised tobacco packaging. In the pooled analysis, support remained unchanged in the 19 MS without relevant legislation (adjusted Prevalence Ratio [aPR]=0.94, 95% Confidence Interval: 0.86-1.03), whereas the 8 MS that had implemented the policy by 2023 were significantly more likely to experience an increase in support (interaction term: aPR = 1.28, 1.17-1.41). The increase in support offers reassurance to policymakers advocating for tobacco packaging regulations and encourages MS to consider the adoption of similar policies.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41530058,

title = {Mapping loopholes in the current regulation of tobacco advertising, promotion, and sponsorship in Europe: a scoping review},

author = {Sæbø G and Carnicer-Pont D and Lopez AM and Koprivnikar H and Pénzes M and González-Marrón A and Arteta N and Fernández E},

doi = {10.1136/tc-2025-059329},

issn = {1468-3318},

year  = {2026},

date = {2026-01-01},

journal = {Tob Control},

abstract = {OBJECTIVE: To review and synthesise European evidence identifying loopholes in 'Tobacco Advertising, Promotion and Sponsorship' (TAPS) regulations and actions undertaken by European countries to curb TAPS.nnDATA SOURCES: We conducted a comprehensive search across seven databases (Medline/PubMed, Embase, Web of Science, Sociological abstracts, Global health, CINAHL and PsycInfo) along with grey literature from relevant tobacco control organisation websites. Searches were restricted by publication date (2005-2023), geographical setting (EU & European Free Trade Association countries) and language (English).nnSTUDY SELECTION: All reviewers independently screened titles and abstracts using a purpose-designed Excel spreadsheet to identify sources addressing loopholes in national or supranational settings, deciding on inclusion accordingly.nnDATA EXTRACTION: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist, we extracted data based on the 'Population, Concept and Context' framework, covering tobacco product type, media communication channel and findings indicating TAPS loopholes. Two reviewers used an Excel sheet to extract data.nnDATA SYNTHESIS: Of 1477 sources, 140 were included in the review. Analysis identified five key loopholes: (a) smoking depictions and tobacco advertising in traditional mass media (films and television), (b) cross-border branding and sponsorships, (c) point-of-sale marketing, (d) e-cigarette and tobacco advertising and promotion on the internet and (e) promotion and advertising of tobacco and novel nicotine products on social media.nnCONCLUSIONS: Curbing TAPS through comprehensive national bans and cross-border cooperation remains challenging because of the permeability of mass media, social media and other digital tools. Further research is necessary to develop strategies for effective implementation and enforcement to ensure compliance with TAPS regulations.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41216474,

title = {Impact of cigarette prices and age-of-sale policies on smoking prevalence among youth in 26 European Member States (2012-2023): a longitudinal ecological study using repeated cross-sectional data},

author = {Teshima A and Feliu A and Gallus S and Martinez C and Fernandez E},

doi = {10.1016/j.lanepe.2025.101511},

issn = {2666-7762},

year  = {2026},

date = {2026-01-01},

journal = {Lancet Reg Health Eur},

volume = {60},

pages = {101511},

abstract = {BACKGROUND: Reducing tobacco and nicotine use and preventing smoking initiation among youth are key public health priorities. We evaluated the impact of cigarette prices and age-of-sale laws on youth smoking prevalence in the European Union (EU).nnMETHODS: In this ecological study with 26 EU Member States as the unit of analysis, we estimated smoking prevalence among individuals aged 15-24, using five Eurobarometer waves (2012-2023, n = 12,087). We used fixed-effects panel regression models to assess the association between cigarette prices, the introduction of 18+ age-of-sale laws for tobacco products and changes in youth smoking prevalence, controlling for time and tobacco control policy implementation.nnFINDINGS: Weighted youth smoking prevalence decreased from 28.4% (841/2818) in 2012 to 22.2% (490/2222) in 2023, although the trend was not consistently downward. A €1 increase in inflation-adjusted cigarette prices per pack was associated with a 3.4 percentage point reduction in male youth prevalence (95% CI: -6.40 to -0.45), while there was no significant association for females or at the EU level. Regional variation was observed, with price increases associated with substantial reductions in youth smoking among both sexes in Southern Europe and among males in Northern Europe. In contrast, no such associations were found in Western or Eastern Europe. Age-of-sale laws were not significantly associated with youth smoking prevalence at the EU level.nnINTERPRETATION: Current taxation and age-of-sale policies remain insufficient, with impacts varying by sex and region. Achieving the tobacco endgame requires harmonised EU-level measures and stronger enforcement, particularly of these two policies, to prevent the ongoing influx of new youth smoking initiates. This study suggests that their potential impact has been constrained by inadequate enforcement to date rather than by policy ineffectiveness.nnFUNDING: None.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41344995,

title = {People who smoke and formerly smoked do support a smoking ban in open spaces during and after the COVID-19 pandemic in Spain},

author = {Peruga A and Fu M and Castellano Y and Tigova O and Driezen P and Quah ACK and Fong GT and Fernández E},

doi = {10.1136/tc-2024-059228},

issn = {1468-3318},

year  = {2025},

date = {2025-12-01},

journal = {Tob Control},

abstract = {BACKGROUND: Spain implemented an extensive outdoor smoking ban during the COVID-19 pandemic in 2020. We examined support for this restriction during and beyond the pandemic among people who currently and formerly smoked.nnMETHODS: Cross-sectional study. The 2021 ITC EUREST-PLUS Spain Survey used a multistage sampling to obtain a representative sample of people who currently or formerly smoked (n=1006). We estimated prevalence ratios (PRs) to examine associations with ban support during and after the pandemic. Analyses accounted for the complex sampling design and were weighted to ensure representativeness.nnRESULTS: Most people who currently (79.2%) and formerly smoked (94.6%) supported the outdoor smoking ban when a safe interpersonal distance could not be maintained during the pandemic. Support for a permanent ban remained substantial (61.4% and 87.2%, respectively). Those who currently smoke were more likely to support bans during and after the pandemic if they had smoke-free homes (PR=1.11; PR=1.29, respectively), understood secondhand smoke harms to health (PR=1.40; PR=1.65), had tried to quit (PR=1.14; PR=1.30) and self-reported as healthy (PR=1.40; PR=1.47). Those who formerly smoked were more likely to support bans during the pandemic if they had smoke-free homes (PR=1.08) and did not self-report as healthy (PR=0.95); and after the pandemic if they had quit smoking for ≥6 months (PR=1.23) and used alternative tobacco products (PR=1.17).nnCONCLUSIONS: Most people who currently or formerly smoked in Spain supported the outdoor smoking ban during and after the COVID-19 pandemic. This high acceptance suggests that the pandemic may have created an opportunity to strengthen tobacco control.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41236782,

title = {Trends in initiation of regular cigarette smoking in 28 European countries, 1940-2019: retrospective reconstruction from repeated cross-sectional surveys},

author = {Teshima A and Bannon O and Filippidis FT and Feliu A and Gallus S and Peruga A and Martínez C and Fernández E},

doi = {10.1093/eurpub/ckaf184},

issn = {1464-360X},

year  = {2025},

date = {2025-11-01},

journal = {Eur J Public Health},

abstract = {In the European Union (EU), one in five youth currently smoke, with over half establishing regular smoking by age 18. Yet, evidence on the historical trends of smoking initiation remains scarce despite its importance for tobacco control. Using four waves of the Special Eurobarometer survey (2012-20; n = 110 753, aged ≥15), we retrospectively estimated trends in initiation rates (IRs) of regular cigarette smoking in the EU from 1940 to 2019 among individuals aged 10-24 by sex, region, and country for each calendar decade. EU-wide smoking IRs have decreased compared to the peak period, with narrowing disparities by sex and region. For males, the IRs have declined from 5.7% (95% CI = 5.6-5.9) in the 1970s to 3.2% (95% CI = 3.0-3.3) in the 2010s, and for females from 3.9% (95% CI = 3.7-4.0) in the 1990s to 2.4% (95% CI = 2.3-2.5) in the 2010s. The decline was more pronounced among young adults aged 18-24 than minors aged 10-17, with minors' IRs surpassing those of young adults during the 2010s. Marked declines occurred among young adults in all regions, while among minors, a clear decrease was observed only for males in Northern Europe. Concerningly, the IRs among minors have trended upward in Eastern Europe for both sexes. Despite declining youth smoking initiation, an unacceptably high number of European youth still begin smoking regularly before the legal age of 18. Stricter and comprehensive tobacco control policies targeting youth, along with smoke-free generation initiatives, could substantially reduce future tobacco use and smoking-related mortality.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41184106,

title = {Regulator's Trojan horse: the tobacco industry's advisory council institutionalised within the government in Spain},

author = {Peruga A and Fernandez R and Rodriguez-Lozano F and Nerin I and Cordoba R and Tigova O and Fernandez E},

doi = {10.1136/tc-2025-059495},

issn = {1468-3318},

year  = {2025},

date = {2025-11-01},

journal = {Tob Control},

abstract = {OBJECTIVE: To analyse the political strategies employed by tobacco industry representatives to exploit their statutory position on the Tobacco Market Commission's (TMC) Advisory Council (AC) to influence Spain's tobacco control policies between 2023 and 2024.nnMETHODS: A qualitative document analysis was conducted on all 22 official AC meeting minutes (January 2023-December 2024) obtained through a transparency request. From these records, 29 written statements by industry members were selected and systematically coded to identify political strategies of interference, guided by the Policy Dystopia Model.nnRESULTS: Of the 29 statements analysed, most originated from the tobacco manufacturers' association Asociación Empresarial del Tabaco. The most frequent strategy was obstructing or delaying policy implementation, particularly regarding plain packaging (14 statements). Other tactics included managing unfavourable information (seven statements), asserting a right to participate in policy discussions (five statements) and making veiled threats of legal action against proposed regulations (two statements).nnCONCLUSIONS: The tobacco industry exploited its institutionalised role on the AC as a 'Trojan horse' to actively subvert public health policies, contravening Spain's obligations under WHO Framework Convention on Tobacco Control Article 5.3. This legally sanctioned position creates a clear channel for policy interference. Urgent reforms are necessary to insulate public health policymaking from the vested commercial interests of the tobacco industry.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {Impact of cigarette prices and age-of-sale policies on smoking prevalence among youth in 26 European Member States (2012–2023): a longitudinal ecological study using repeated cross-sectional data},

author = {Ayaka Teshima and Ariadna Feliu and Silvano Gallus and Cristina Martínez and Esteve Fernández},

url = {https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(25)00303-5/fulltext},

year  = {2025},

date = {2025-10-28},

urldate = {2025-10-28},

journal = {The Lancet Regional Health - Europe},

abstract = {Tobacco use remains one of the leading preventable causes of death and disease in the European Union (EU), contributing substantially to lung cancer, cardiovascular disease, and other chronic conditions.1 Despite decades of tobacco control efforts in the EU, nearly a quarter of adults (24%) were estimated to smoke tobacco currently, 28% of males and 21% of females in 2023, and the associated health and economic burdens remain immense.2 The EU aims to reduce tobacco use to below 5% by 2040, in line with its Tobacco-Free Generation goal, which aligns with the tobacco endgame approach.3 This approach shifts the focus from controlling the tobacco epidemic to ending it by reducing use to minimal levels. A recent modelling study estimated that achieving a tobacco-free generation by eliminating smoking among individuals born between 2006 and 2010 could prevent approximately 148,600 (70.1%) of lung cancer deaths in males and 131,900 (72.2%) in females in Europe, among the highest avoidable burdens globally. The initiation and development of smoking occurs predominantly during a relatively narrow age window spanning adolescence and young adulthood (ages 15–24), and individuals who remain smoke-free through their mid-20s are unlikely to begin smoking thereafter.5 In the EU, recent estimates show that 93% of people who smoke establish regular smoking by the age of 25; thus, this period is considered a key intervention target for smoking prevention efforts.2 An earlier age of initiation increases vulnerability to nicotine addiction and elevates the burden of smoking-related diseases later in life, as health risks associated with smoking rise with cumulative exposure.6,7 Individuals who begin smoking at a younger age are more likely to develop nicotine dependence, progress to daily smoking, continue the consumption into adulthood, and ultimately become heavier tobacco users. Robust evidence supports the effectiveness of comprehensive tobacco control policies in reducing tobacco use, with increased taxation as one of the most cost-effective measures, especially for youth, who are more sensitive to price changes.10, 11, 12 Despite the Tobacco Taxation Directive 2011/64/EU, which sets harmonised minimum excise tax rates for manufactured cigarettes, large disparities in cigarette prices persist across EU countries.13 In addition, all EU countries have implemented a minimum legal tobacco purchase age of 18 years, as required by Article 16 of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) as of 2025; nonetheless, the timing and enforcement vary widely. Notably, Ireland has approved legislation to raise the minimum age further to 21, with implementation expected in 2028.14 These policies are internationally recommended as key tools to reduce youth smoking,10, 11, 12,15 but their long-term impact on youth smoking in the EU context remains underexplored. Existing evidence has primarily focused on adult populations, national-level assessments, or relied on composite indicators such as the score of the price component of the Tobacco Control Scale, rather than directly evaluating cigarette prices.16, 17, 18, 19 Therefore, this study examines patterns of youth smoking prevalence in the EU and assesses the impact of cigarette prices and 18+ age-of-sale laws on changes in youth smoking.

},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41072185,

title = {[The Tobacco Market Commission's reports: too opaque, too irrelevant]},

author = {Peruga A and Nerín I and Rodríguez Lozano F and Fernández R and Tigova O and Córdoba R and Martínez C and Fernández E},

doi = {10.1016/j.gaceta.2025.102529},

issn = {1578-1283},

year  = {2025},

date = {2025-10-01},

journal = {Gac Sanit},

volume = {39},

pages = {102529},

abstract = {The monthly reports from the Tobacco Market Commission in Spain (CMT, by its acronym in Spanish), while data-rich, have critical deficiencies that limit their usefulness for public health. A critical analysis reveals three fundamental problems: institutional ambiguity, methodological opacity, and relevant analytical omissions. The authorship of the reports is uncertain, as they are published under the name of an advisory committee with representation from the tobacco industry, which compromises their independence. Methodologically, they lack clear definitions for key variables and use excessively aggregated data categories, preventing rigorous analysis and the replicability of findings. The reports are based on data self-reported by the industry itself, with no evidence of independent audits, which constitutes a serious conflict of interest. Furthermore, they systematically omit crucial information that the CMT derives from its activities, such as breakdowns of tax revenue by product, price-elasticity analyses, estimates of illicit trade, and the sector's advertising and promotion expenditures. For these reports to become an effective tool for formulating evidence-based policies, a reform is essential to ensure transparency in authorship, methodological rigor, data verification, and the inclusion of relevant economic and fiscal analyses.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid40957677,

title = {Advertising exposure and the appeal of emerging nicotine-containing products among people who have never used nicotine: findings from the Eurobarometer 2023},

author = {Li CX and Wang PC and Feliu A and Laverty AA and Martinez C and Vardavas CI and Filippidis FT},

doi = {10.1136/tc-2025-059522},

issn = {1468-3318},

year  = {2025},

date = {2025-09-01},

journal = {Tob Control},

abstract = {INTRODUCTION: Emerging nicotine-containing products, including heated tobacco products (HTPs) and nicotine pouches, have been growing in popularity in the European Union (EU). Advertising exposure impacts perceived product appeal and may contribute to product initiation. However, the current EU's Tobacco Products Directive lacks a consistent framework for regulating these advertisements. This study examines how exposure to HTP and nicotine pouch advertisements influences their appeal among people who have never used nicotine.nnMETHODS: Data from the Special Eurobarometer 99.3 survey (May-June 2023) included 13 436 participants who have never used nicotine across 27 EU Member States. We estimated the weighted prevalence of HTP and nicotine pouch advertising exposure and perceived appeal and ran multilevel Poisson regression models adjusting for sociodemographic factors.nnRESULTS: 31.1% of participants reported HTP advertising exposure across the EU, with the highest levels reported in Romania (53.4%) and Slovakia (50.0%) and the lowest in Malta (13.6%). Nicotine pouch advertising exposure averaged 16.6%, peaking in Sweden (46.0%) and lowest in the Netherlands (5.0%) and Lithuania (7.7%). Product appeal remained low, with only 2.0% finding HTPs appealing and 1.3% finding nicotine pouches appealing. Exposed to HTP advertisements were 3.71 times more likely to find them appealing, while exposure to nicotine pouch advertisements increased perceived appeal of nicotine pouches by 5.78 times.nnCONCLUSION: Advertising exposure was associated with higher appeal of nicotine-containing products among people who have never used nicotine. Given the risk of initiation, EU-wide advertising restrictions could protect this group and limit the impact of these products on health.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid40976422,

title = {Determinants of smoke-free homes adoption among Spanish adults who smoke: A prospective cohort study from the 2016-2021 International Tobacco Control (ITC) EUREST-PLUS Spain Surveys},

author = {Tigova O and Castellano Y and Fu M and Driezen P and Martínez C and Quah ACK and Fong GT and Fernández E},

doi = {10.1016/j.ypmed.2025.108415},

issn = {1096-0260},

year  = {2025},

date = {2025-09-01},

journal = {Prev Med},

volume = {200},

pages = {108415},

abstract = {OBJECTIVE: To assess the prevalence and associated factors of smoke-free homes (SFHs) among Spanish adults who smoke across three cohort waves, and to identify determinants of SFH adoption during follow-up (2016-2021).nnMETHODS: The International Tobacco Control EUREST-PLUS Spain Survey is a nationally representative cohort of ∼1000 adults (≥18 years) who smoke surveyed in 2016, 2018, and 2021. First, we conducted repeated cross-sectional analysis to estimate the prevalence of SFHs at each wave. Second, we estimated incidence and risk ratios (RR) with 95 % confidence intervals (CI) for SFH adoption during the follow-up using adjusted generalised linear models. Independent variables included sociodemographics, smoking characteristics, and beliefs about second-hand smoke harms.nnRESULTS: SFH prevalence was 13.1 % in 2016, 19.0 % in 2018, and 31.5 % in 2021 (p trend <0.001). Quitting smoking (RR = 2.66; 95 % CI: 2.10, 3.36), remaining in any stage other than precontemplation (RR = 1.76; 1.13, 2.73) and progressing beyond precontemplation stage (RR = 2.59; 1.99, 3.37) were determinants of SFH adoption. Maintaining moderate or high nicotine dependence (RR = 0.46; 0.30, 0.69) was inversely associated with SFH adoption.nnCONCLUSIONS: SFH prevalence among Spanish adults who smoke increased in 2016-2021. Initiatives promoting SFHs should encourage progression through the stages of change towards cessation and provide tailored support for individuals with high nicotine dependence.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid40971221,

title = {Predictors of Developing Positive Attitudes and Increasing Perceptions of Training in Tobacco Control Among Catalan Nursing Students: A Follow-Up Study},

author = {Laroussy K and Fernández E and Castellano Y and Fu M and Feliu A and Tigova O and Puig M and Galimany J and Moreno C and Martínez C},

doi = {10.1097/JAN.0000000000000664},

issn = {1548-7148},

year  = {2025},

date = {2025-09-01},

journal = {J Addict Nurs},

abstract = {BACKGROUND: The knowledge and attitudes toward tobacco control among nurses are important factors in ensuring appropriate management of the tobacco dependence.nnMETHODS: Observational prospective study of 1,097 Catalan nursing students. Participants completed a paper-and-pencil questionnaire at baseline (2015-2016) and an online survey at follow-up (2018-2019). We examined predictors of developing positive attitudes and increasing perceptions of training using Poisson regression models to compute the adjusted prevalence ratios (aPRs).nnRESULTS: Students in their last years of studies at baseline were less likely than those in the first years to develop a positive attitude towards the exemplary role of nursing students in tobacco control at follow-up (aPR = 0.74). Former smokers were more likely than current smokers to develop positive attitudes towards the exemplary role of health care professionals (aPR = 1.55) and, together with never smokers, to come to recognize the importance of nursing students setting a good example (aPR = 2.23 and aPR = 2.32, respectively). Last year's students were also less likely than those in the first years to increase their perceptions of tobacco-related training received (all aPR < 0.71). Never smokers were less likely than current smokers to increase their perception of training in pharmacological treatments other than nicotine replacement therapy (aPR = 0.81) and to consider themselves capable of helping smokers quit (aPR = 0.78).nnCONCLUSIONS: The year of school and smoking status were strong predictors of developing positive attitudes and increasing perceptions of training in tobacco control.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid40975944,

title = {Co-creating a gamified tool for cannabis and tobacco use monitoring: Participant-driven development},

author = {Martínez C and Saura J and Enríquez M and Feliu A and Fu M and Ballbè M and Roca X and Andreu M and Pla M and Maestre-González E and Mondon S and Barrio P and Raich A and Porthé V and Garcia-Pañella O and Colom J and Segura L and Fernández E and Rosa N},

doi = {10.1016/j.drugalcdep.2025.112880},

issn = {1879-0046},

year  = {2025},

date = {2025-09-01},

journal = {Drug Alcohol Depend},

volume = {276},

pages = {112880},

abstract = {INTRODUCTION: The growing use of cannabis, often alongside tobacco, presents challenges for substance use treatment programs (SUTPs), as it intensifies withdrawal symptoms. To address dual dependencies and improve engagement, we developed a gamified web app for individuals in SUTP who use cannabis to monitor their use. This paper describes the tool's co-creation process and and, findings that guided alignment with target needs.nnMETHODS: Seventeen adults with current or past cannabis use were recruited from SUTPs in Catalonia (2021-2023). Using a qualitative, participatory design, the study involved reflexive thematic analysis and co-creation with researchers, clinicians, and gamification experts. Development followed four phases: (1) Discovering, expectations and motivations through interviews; (2) Deepening in Co-design, exploring needs and profiles; (3) Narrative Development, basing stories on real experiences; and (4) Technical Development, adapting features to goals.nnRESULTS: In Phase 1, two archetypes were identified: "socializers" and "explorers", along with core values, such as acceptance, social connection, and life control. Phase 2 revealed expectations for content on autonomy, stigma reduction, empathy, self-confidence, tranquility, and curiosity as key motivators. Phase 3 created three stories. Phase 4 produced a customized tracking app, integrating questionnaires.nnCONCLUSION: This study highlights the value of co-creation in designing interventions for SUTPs and demonstrates usefulness of participatory approaches to create mHealth tools. These approaches informed the app's design to align with individuals' motivations and preferences, grounded in lived experiences. The resulting web app provides personalized support for substance use treatment. Future research should explore clinical and behavioral impacts.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid40795943,

title = {Perceptions of e-cigarettes and heated tobacco products among never users of nicotine in the European Union},

author = {Li CX and Wang PC and Feliu A and Laverty AA and Martinez C and Filippidis FT},

doi = {10.1093/ntr/ntaf168},

issn = {1469-994X},

year  = {2025},

date = {2025-08-01},

journal = {Nicotine Tob Res},

abstract = {INTRODUCTION: Emerging tobacco and nicotine products, such as e-cigarettes and heated tobacco products (HTPs), are gaining popularity, particularly among young people. This study examines the perceptions of e-cigarettes and HTPs among nicotine-naive individuals and their variations across sociodemographic subgroups.nnMETHODS: We conducted a cross-sectional analysis of the Special Eurobarometer 99.3 (May-June 2023) among never users of tobacco or nicotine products in the European Union (EU) (n = 13 436). We estimated the weighted prevalence of perceptions of e-cigarettes and HTPs: appeal, perceived effectiveness for smoking cessation, support for them being regulated like cigarettes, and support for keeping them out of sight in points-of-sale. Multi-level Poisson regression models examined associations of sociodemographic factors with these perceptions.nnRESULTS: Among never users in the EU, 2.6% found e-cigarettes appealing, while 2.0% found HTPs appealing. 50.8% and 58.8% of participants supported strict regulations and point-of-sale restrictions for these products, respectively. Younger age groups were more likely to find e-cigarettes (Prevalence Ratio [PR] = 1.70, for ages 15-39 vs. 55+) and HTPs (PR = 1.88, PR = 1.54 for ages 15-24 and 25-39) appealing and view them as effective for smoking cessation. Support for regulations similar to cigarettes was higher among women, individuals with higher education, those living with children, and those without financial difficulties.nnCONCLUSION: While the appeal of these products to never users remained low overall, the study found that young people were more likely to find them appealing, posing a risk for experimentation. Meanwhile, over 50% of respondents supported stricter regulations, which could influence policy changes in this area.nnIMPLICATIONS: Although appeal of e-cigarettes and Heated Tobacco Products (HTPs) was relatively low among people who have never used e-cigarettes, HTPs or smoking tobacco in the European Union, appeal was higher among younger age groups, which are often targeted by the industry. We also found substantial support for stricter regulatory policies for e-cigarettes and HTPs across the EU. These findings might encourage governments to increase restrictions around these emerging nicotine and tobacco products.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid40554131,

title = {Dimensions and domains to assess secondhand tobacco smoke exposure: insights from a Delphi study},

author = {Blanco-Ferreiro A and Rey-Brandariz J and Ahluwalia JS and Varela-Lema L and Galán I and Santiago-Pérez MI and Sureda X and Fu M and Schiaffino A and José López M and Continente X and Candal-Pedreira C and Mahabee-Gittens M and Pérez-Ríos M},

doi = {10.1016/j.gaceta.2025.102508},

issn = {1578-1283},

year  = {2025},

date = {2025-06-01},

journal = {Gac Sanit},

volume = {39},

pages = {102508},

abstract = {OBJECTIVE: To identify the dimensions and domains to be included in questionnaires when assessing self-reported secondhand tobacco smoke (SHS) exposure in etiological studies and in population health surveys.nnMETHOD: A qualitative study was conducted in two stages. In stage one, based on a Delphi methodology, 16 experts in tobacco epidemiology completed two questionnaires and attended a group session. In stage two, triangulation interviews were conducted with six experts from the Delphi study to provided in-depth reflection on the domains identified in stage one. The recorded transcriptions were analyzed using a thematic approach.nnRESULTS: The experts discussed the importance of assessing SHS exposure in specific scenarios, highlighting the home, workplace, leisure venues, and private transport. They discussed the importance of asking about cohabiting with smokers when assessing exposure at home. The experts stressed the importance of differentiating between leisure venues, by prioritizing closed over open spaces. In population-based health surveys, the experts recommended that the recall time should be recent, referring to the last seven days. In etiological studies, they suggested that lifetime exposures should be explored.nnCONCLUSIONS: This study marks the first step toward identifying the dimensions and domains for assessing self-reported SHS exposure. Question standardization when ascertaining SHS exposure is critical to permit cross study comparisons and to analyze trends in the evolution of SHS exposure.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid40135674,

title = {Patterns of Tobacco Use, Dependence, and Motivation to Quit Among Individuals Seeking Treatment for Alcohol and Cannabis Consumption in Catalonia (Spain)},

author = {Martinez C and Saura J and Enriquez M and Feliu A and Roca X and Castellano Y and Cabezas C and Suelves JM and Mondon S and Barrio P and Andreu M and Raich A and Fonseca F and Masferrer L and Bautista P and Fernandez E},

doi = {10.1080/02791072.2025.2479102},

issn = {2159-9777},

year  = {2025},

date = {2025-03-01},

journal = {J Psychoactive Drugs},

pages = {1--15},

abstract = {Understanding smoking behaviors in vulnerable groups is essential for effective cessation services. This study characterizes tobacco consumption and identifies factors associated with nicotine dependence and motivation to quit among individuals entering alcohol and cannabis treatment programs. A multi-center cross-sectional study was conducted in ten centers in Barcelona province. Participants' sociodemographics and tobacco use were assessed, including cigarette consumption and nicotine dependence (Fagerström test). Self-efficacy and motivation to quit were measured on a 0-10 Likert scale. A decision-tree analysis identified factors linked to moderate-to-high nicotine dependence (Fagerström ≥ 5) and high cessation motivation (≥7). Most participants (96.1%) use tobacco daily, with 57.0% using manufactured and 42.2% roll-your-own (RYO) cigarettes. Mean cigarette consumption was 15.2/day (SD = 8.7), with nicotine dependence (4.4, SD = 2.3). Cannabis users started smoking tobacco earlier than those who used alcohol. Over the past year, two-thirds attempted quitting and 60% had high cessation motivation. Self-efficacy for quitting was moderate (mean = 5.1; SD = 3.3). RYO use, age over 45, and alcohol use were associated with moderate-to-high nicotine dependence (probabilities = 0.52, 0.62, and 0.71, respectively). Having a non-tobacco social network was linked to a high motivation to quit (probability = 0.72). Participants had moderate nicotine dependence, low self-efficacy, and high motivation to quit tobacco. Dependence was higher among RYO users, ≥45 years/old, and people with alcohol use disorder. High motivation was more frequent among those with a non-tobacco social network. Integrating cessation support into substance treatment, focusing on RYO and young users, and promoting self-efficacy and tobacco-free socialization may enhance cessation success.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid40129551,

title = {Prevalence and determinants of smoke-free homes in 12 European countries: the TackSHS Survey},

author = {Tigova O and Stival C and Castellano Y and Lugo A and Fu M and Mar López A and Martínez C and Soriano JB and O'Donnell R and Semple S and López MJ and Fernández E and Gallus S},

doi = {10.1183/23120541.00950-2024},

issn = {2312-0541},

year  = {2025},

date = {2025-03-01},

journal = {ERJ Open Res},

volume = {11},

number = {2},

abstract = {BACKGROUND: Homes are one of the primary locations where people are exposed to second-hand smoke (SHS) in Europe. We describe the prevalence and identify the main determinants of having home-smoking restrictions in 12 European countries.nnMETHODS: Cross-sectional survey in 12 European countries conducted in 2017-2018 (TackSHS project). Approximately 1000 participants representing the general population aged ≥15 years of each country were interviewed face to face. Individual- and country-level characteristics were explored through adjusted prevalence ratios (PRs) obtained from multilevel Poisson models with random effects.nnRESULTS: Among 11 734 participants, 70.2% (95% confidence interval (CI) 69.4-71.0%) had smoke-free homes and 17.5% (95% CI 16.8-18.2%) had partial home-smoking restrictions in place. Prevalence of smoke-free homes ranged from 44.4% in Greece to 84.5% in England. Having a smoke-free home was significantly inversely associated with current (PR=0.60) or former (PR=0.95) smoking and living in a household with one (PR=0.70) or two or more (PR=0.58) people who smoke. It was also significantly associated with being ≥65 years old (PR=1.05), being female (PR=1.07), having a high educational level (PR=1.09) and living with children (PR=1.09). Having a smoke-free home was associated with living in northern Europe, while partial home-smoking restrictions were more likely among respondents from eastern Europe and countries with lower  gross domestic product.nnCONCLUSIONS: The prevalence of smoke-free homes in Europe is relatively high, but with large variability across countries. European countries with a lower prevalence of smoke-free homes should implement tailored interventions targeting identified determinants and incorporate the success of other countries.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid40756166,

title = {Exposure to secondhand smoke from cigarettes and secondhand aerosol from tobacco and nicotine products in indoor and outdoor public spaces in the European Union: a cross-sectional study},

author = {Li CX and Wang PC and Feliu A and Laverty AA and Martinez C and Peruga A and Girvalaki C and Radu Loghin C and Vardavas CI and Filippidis FT},

doi = {10.1136/bmjph-2025-002903},

issn = {2753-4294},

year  = {2025},

date = {2025-01-01},

journal = {BMJ Public Health},

volume = {3},

number = {2},

pages = {e002903},

abstract = {INTRODUCTION: In December 2024, the Council of the European Union (EU) adopted a recommendation to expand regulations on the use of nicotine-containing products both in indoor settings and specific outdoor areas. This study aimed to examine sociodemographic factors associated with exposure to conventional tobacco smoke and aerosols across the EU and support for relevant regulations.nnMETHODS: We performed a secondary analysis of cross-sectional data from the Special Eurobarometer 99.3 (n=26 358, May-June 2023) across 27 EU Member States (MS). We estimated the weighted prevalence of secondhand exposure to tobacco smoke and aerosols and support for bans on smoking, e-cigarettes and heated tobacco products in public settings. Multilevel Poisson regression models explored associations between sociodemographic factors and these outcomes.nnRESULTS: Exposure to secondhand smoke and aerosols varied across EU MS. Younger individuals, those with higher education, living with children, and current and former tobacco and nicotine users (prevalence ratio (PR) 1.16, 1.01-1.33; and PR 1.22, 1.05-1.41, respectively) were more likely to report exposure to both tobacco smoke and aerosol from emerging products. Women (PR 1.05, 1.02-1.08; and PR 1.03, 1.02-1.05, respectively), those living with children (PR 1.05, 1.02-1.07; and PR 1.04, 1.02-1.07, respectively) and those with higher education levels (PR 1.10, 1.04-1.15; and PR 1.10, 1.06-1.14) were more likely to support bans, whereas those with financial difficulties (PR 0.94, 0.89-0.99 and PR: 0.95, 0.91-0.99, respectively), as well as current and former smokers (PR 0.61, 0.55-0.67; and PR 0.78, 0.73-0.84, respectively) and emerging product users (PR 0.84, 0.76-0.92; and PR 0.69, 0.62-0.76, respectively), were less supportive.nnCONCLUSION: Our analysis found that both exposure to secondhand smoke and aerosol and support for bans in public spaces vary substantially between population subgroups and across countries. Our findings can support EU MS in implementing targeted interventions to increase population support for and implement the recent EU Council recommendations.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid40791264,

title = {Impact of tobacco control policies on socioeconomic inequalities in smoking prevalence and quit ratios: an ecological study in the European Union (2009-2020)},

author = {Feliu A and Fernandez E and Tamí-Maury I and Martinez C},

doi = {10.1136/bmjph-2024-002418},

issn = {2753-4294},

year  = {2025},

date = {2025-01-01},

journal = {BMJ Public Health},

volume = {3},

number = {2},

pages = {e002418},

abstract = {BACKGROUND: Tobacco control efforts have succeeded in reducing smoking prevalence and increasing smoking cessation rates in the European Union Member States (EU27). However, the impact of these policies has been unequal across different income groups.nnMETHODS: Ecological study with the country as unit of analysis. We used the Tobacco Control Scale (TCS) in EU27 in 2010 and the prevalence of smoking and quit ratios from the Eurobarometer surveys (2009, n=27 788; and 2020, n=28 288). We analysed the relationship between the TCS scores (2010) and smoking indicators and their relative changes (between 2009 and 2020) using scatter plots and multiple linear regression models.nnFINDINGS: In the EU27, high inequalities exist among different income groups. High-income residents had lower smoking prevalence (19 vs 40%) and higher quit ratios (55 vs 32%) compared with the low-income group. Positive changes in smoking indicators from 2009 to 2020 were stronger in the high-income group. There was a stronger negative correlation between TCS scores and smoking prevalence in high-income groups (r=-0.615, p<0.01; r=-0.498; p=0.01) and between its relative changes but only in the high-income group (r=-0.478; p=0.01). A positive correlation was observed between TCS scores and quit ratios (r=0.580, r=0.548, both p<0.01) in high- and moderate-income populations.nnCONCLUSIONS: Declines in smoking prevalence and increases in quit ratios were considerably lower in moderate- and low-income groups. Tailoring tobacco control policies to address financial, social and structural barriers, such as ensuring free access to cessation services, implementing targeted outreach programmes, adopting culturally and linguistically appropriate interventions, among others, is essential for making these measures more equitable, which is key for the EU27 to achieve its tobacco-free goal by 2040.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid39838401,

title = {Clinician's perceptions and experiences with tobacco treatment in people who use cannabis: a qualitative study},

author = {Martínez C and Pla M and Feliu A and Enríquez M and Saura J and Cabezas C and Colom J and Suelves JM and Mondon S and Barrio P and Andreu M and Raich A and Bernabeu J and Roca X and Narváez M and Fernández E and Group of clinicians of the ACT_ATAC study},

doi = {10.1186/s13011-024-00632-8},

issn = {1747-597X},

year  = {2025},

date = {2025-01-01},

journal = {Subst Abuse Treat Prev Policy},

volume = {20},

number = {1},

pages = {3},

abstract = {INTRODUCTION: Global demand for the treatment of cannabis use disorder has increased significantly, prompting a need to understand effective strategies for addressing concurrent cannabis and tobacco use. This study focuses on clinicians' experiences and perceptions in delivering tobacco cessation services to people who use cannabis.nnMETHODS: Fifteen participants (12 females, 3 males) participated in three homogenous focus groups, including two groups with extensive experience in providing tobacco cessation among the substance use population in Catalonia, Spain, and one group of clinicians without such experience. Thematic analysis was conducted to identify key patterns and insights in their discourse, focusing on shared themes and divergences across groups.nnRESULTS: Five main themes and 17 subthemes emerged: Individual characteristics, Clinician characteristics, Models of intervention, Organizational healthcare models, and Health policies. Clinicians stressed the importance of intervention models and the active role of professionals in addressing tobacco use within routine care, as tobacco cessation could mitigate social and chronic stigma among people who use cannabis, especially those engaged in polydrug use.nnDISCUSSION AND CONCLUSIONS: Recommendations included integrating tobacco cessation into all services, reducing healthcare service fragmentation, improving resource accessibility, enhancing clinical documentation, and advocating for stronger population-level tobacco control policies.nnTRIAL REGISTRATION: The ACT-ATAC project has been successfully registered at Clinicaltrials.gov [NCT04841655].},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid40495994,

title = {Tobacco imagery in prime-time television in Spain: A content analysis},

author = {Peruga A and Tigova O and Feliu A and Carnicer-Pont D and Anton L and Bosch F and Rey-Pino JM and Salto E and Fernández E and Martínez C},

doi = {10.18332/tid/204750},

issn = {1617-9625},

year  = {2025},

date = {2025-01-01},

journal = {Tob Induc Dis},

volume = {23},

abstract = {INTRODUCTION: Exposure to tobacco content in media among youth is a well-established risk factor for smoking initiation and continued use. This study assessed the prevalence and nature of tobacco imagery on Spanish prime-time television (TV) programming and its associations with program characteristics: genre, production nationality, and broadcast timing.nnMETHODS: A content analysis of 63959 minutes of TV programming in 2021, excluding advertisements and trailers, across 18 broadcast channels examined the presence of tobacco imagery: actual tobacco use, tobacco cultural cues, smoking ban violations, tobacco brand appearances, or any of these.nnRESULTS: The analysis revealed that 2.4% of the TV programming time contained at least one instance of tobacco imagery, resulting in 8.5 million impressions for viewers aged 4-24 years. Feature films had the highest prevalence of tobacco-related content (adjusted prevalence ratio, APR=11.9; 95% CI: 9.5-14.9). Tobacco-related content appeared more frequently outside designated children's protection hours (PR=0.7; 95% CI: 0.6-0.80). However, its presence within the designated children's protection schedule remains a significant concern, generating 15.6 million tobacco impressions for young viewers.nnCONCLUSIONS: The seemingly modest content level of tobacco imagery (2.4%) translates into a substantial number of impressions for young viewers aged 4-24 years, including during the designated children's protection schedule. Reducing tobacco imagery in films and TV series represents a promising strategy for curbing youth smoking. However, the current reliance on youth protection schedules is inadequate. To better protect children from tobacco imagery, policies should mandate strong anti-tobacco disclaimers preceding programs featuring tobacco and certificates of No Pay-off for tobacco portrayals.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid40443706,

title = {Recommendations for updating regulations on advertising, promotion and sponsorship of tobacco and nicotine products in the European Union},

author = {Koprivnikar H and Carnicer-Pont D and López AM and González-Marrón A and Sæbø G and Gallus S and Possenti I and Lambrou A and Papachristou E and Pénzes M and Schoretsaniti S and Arteta N and Fernández E},

doi = {10.18332/tpc/204275},

issn = {2459-3087},

year  = {2025},

date = {2025-01-01},

journal = {Tob Prev Cessat},

volume = {11},

abstract = {INTRODUCTION: Comprehensive bans on advertising, promotion and sponsorship of tobacco and nicotine products (TAPS) have proven effective in reducing their use. The Joint Action on Tobacco Control 2 (JATC2) aims to identify TAPS gaps in the current European Union (EU) regulations and to provide comprehensive recommendations for updating them.nnMETHODS: An online consultation with European TAPS national experts was conducted in 2023. Seventy-seven experts from 27 European countries were contacted and 38 experts from 21 countries participated in the consultation.nnRESULTS: Significant gaps in current TAPS regulations were identified, particularly in entertainment, online media and points of sale. Citizens are not adequately protected from TAPS, the tobacco industry extensively uses loopholes to circumvent regulations. TAPS-related issues currently affect tobacco and particularly non-therapeutic nicotine products, devices, accessories, products imitations and all marketing channels, entertainment, online media and especially, social networks. To address these challenges, regulations should include bans on internet sales and TAPS at points of sale, licensing, decreased retail availability, plain packaging and ban on corporate social responsibility actions, corporate promotion and 'brand stretching'. These measures should be accompanied by effective monitoring and enforcement, dissuasive sanctions, formalized collaboration among countries and international collaboration, civil society involvement, strong public education, and community awareness programs.nnCONCLUSIONS: There is an urgent need to address the current gaps in the EU TAPS regulations through comprehensive and harmonized TAPS bans across all EU countries. Updated regulations must anticipate emerging industry strategies and new products, ensuring continuous adaptation to counteract them effectively.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid40241742,

title = {Mapping indicators of tobacco and related product use: Unveiling challenges and variations in the Eurobarometer surveys over three decades},

author = {Teshima A and Martínez C and Filippidis FT and Laverty AA and Vardavas CI and Feliu A and Peruga A and Fernandez E},

doi = {10.18332/tid/202651},

issn = {1617-9625},

year  = {2025},

date = {2025-01-01},

journal = {Tob Induc Dis},

volume = {23},

abstract = {INTRODUCTION: The European Commission's Special Eurobarometer surveys on tobacco are widely used as comparable and representative data across the European Union for monitoring consumption patterns. Despite their broad use, certain challenges persist, including inconsistencies in survey timelines and variations in the collected information across waves. This study aims to identify available tobacco and related product indicators, and assess their temporal comparability, to support researchers to better understand the potential uses of these data and their alignment with other sources.nnMETHODS: We explored questionnaires and reports in these surveys on tobacco from the Eurobarometer official website since its inception (1992, 2002, 2005, 2006, 2008, 2009, 2012, 2014, 2017, 2020 and 2023 waves). We extracted and compared questions and responses on use of tobacco and related products, as well as on sociodemographic variables. Finally, we compared all indicators, including frequency and wording, and further mapped the consistency of the indicators and type of product used across the different waves.nnRESULTS: Current, daily, former and never use of conventional cigarettes has been consistently assessed across all waves, enabling temporal comparisons. From 2009, the surveys have expanded to include e-cigarette use; since 2012, the surveys include various combusted products such as cigars, pipes, cigarillos, and waterpipes, and from 2020, heated tobacco products. By contrast, detailed data on product-specific use intensity and initiation remain limited. While indicators for secondhand smoke exposure and smoking cessation were present in multiple waves, their comparability is hindered by variations in question-wording and responses.nnCONCLUSIONS: Some challenges exist in using Eurobarometer surveys for temporal estimation of tobacco-related burden. Nonetheless, these surveys remain a valuable and unique tool for monitoring tobacco and related product use across the European Union. To further enhance their utility, periodic re-evaluation by tobacco control experts is recommended to ensure that the surveys maintain comparability with past data while capturing effectively emerging products and trends.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid39265319,

title = {[From evidence to practice: The Disemination and Implementation Science in primary care]},

author = {Martínez C and Camarelles Guillem F and González-Viana A and Sánchez Á and Tigova O and Fernández E},

doi = {10.1016/j.aprim.2024.103077},

issn = {1578-1275},

year  = {2025},

date = {2025-01-01},

journal = {Aten Primaria},

volume = {57},

number = {1},

pages = {103077},

abstract = {Dissemination and Implementation Science focuses on bridging the gap between scientific research and its practical application in the real world. By identifying and promoting effective strategies, the Science of Dissemination and Implementation disseminates and implements evidence-based interventions in healthcare settings, taking into account the needs, barriers, context, resources, and end users. This special article introduces and debates the most recent advances in this field, highlighting key approaches, theoretical frameworks, as well as specific challenges and opportunities applied to primary and community care. Additionally, concrete examples tailored to the Spanish context are presented. Given the nascent state of the use of the Dissemination and Implementation Science in Spain, the authors recommend strategically adopting this approach and its principles in primary and community care to expedite the adoption of effective interventions that promote health.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid39846443,

title = {Trends and Association between Smoking and the Socio-Demographic Index Among 11 South American Countries, 1990-2019},

author = {Afolayan OK and Velazquez J and Tundealao S and Fernández E and Martínez C and Leon-Novelo L and Retamales J and Tamí-Maury I},

doi = {10.1080/10826084.2024.2440384},

issn = {1532-2491},

year  = {2025},

date = {2025-01-01},

journal = {Subst Use Misuse},

volume = {60},

number = {4},

pages = {566--576},

abstract = {OBJECTIVES: To examine prevalence trends in the use of smoked tobacco products in 11 South American (SA) countries (i.e., Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Paraguay, Peru, Suriname, Uruguay, and Venezuela) and their association with country-specific socio-demographic index (SDI) over 30 years.nnDATA AND METHODS: The estimates of SDI and smoked tobacco prevalence stratified by age, sex, and country were extracted from the Global Burden of Disease Study (1990-2019) on individuals aged 15+. The annual percentage changes (APCs) of trends in country-specific prevalence of smoked tobacco were evaluated using Joinpoint regression. Correlation analysis was also used to explore the association between country-specific prevalence of smoked tobacco and their SDIs, a measure of developmental status considering income per capita, educational attainment, and total fertility rate.nnRESULTS: While all SA countries showed an overall decline in smoked tobacco use prevalence between 1990 and 2019 (APCs between -0.52%-and -4.73%;  < 0.05), Bolivia and Ecuador showed a significant increasing trend (APCs of 0.34% and 0.20%). Country-specific SDI was strongly and significantly correlated (rs = -0.99 to -0.85) with smoking prevalence in SA countries, except for Ecuador and Bolivia (rs = 0.16 and 0.36, respectively).nnCONCLUSION: In recent decades, most SA countries have experienced a significant reduction in the prevalence of smoked tobacco use, except Ecuador and Bolivia, where smoking rates have risen, showing a direct correlation with SDI. These findings can contribute to the design and implementation of strategies and policies for tobacco prevention and control in the SA region especially within the two affected countries - Ecuador and Bolivia.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38944617,

title = {Incidence and Determinants of COVID-19 Among People Who Smoke (2018-2021): Findings From the ITC EUREST-PLUS Spain Surveys},

author = {Carnicer-Pont D and Fu M and Castellano Y and Tigova O and Driezen P and Quah ACK and Kaai SC and Soriano JB and Vardavas CI and Fong GT and Fernández E},

doi = {10.1016/j.arbres.2024.05.037},

issn = {1579-2129},

year  = {2024},

date = {2024-11-01},

journal = {Arch Bronconeumol},

volume = {60},

number = {11},

pages = {690--697},

abstract = {OBJECTIVE: To estimate the cumulative incidence of COVID-19 and its determinants among a nationally representative sample of adults from Spain who smoke.nnMETHODS: This is a prospective cohort study that uses data from two waves (Wave 2 in 2018 and Wave 3 in 2021) of the ITC EUREST-PLUS Spain Survey. At baseline (Wave 1 in 2016), all respondents were adults (aged ≥18) who smoked. In total, 1008 respondents participated in Wave 2, and 570 out of 888 eligible participants were followed up in Wave 3 (64.2%). We estimated the cumulative incidence and the relative risk of COVID-19 (RR) and 95% confidence intervals (CI) during follow-up using self-reported information on sociodemographic, smoking-related and health-related characteristics and identified associated factors using multivariable Poisson models with robust variance adjusted for the independent variables.nnRESULTS: The overall cumulative incidence of self-reported COVID-19 was 5.9% (95% CI: 3.9-8.0%), with no significant differences between males (6.3%; 95% CI: 3.6-9.0%) and females (5.6%; 95% CI: 3.2-8.0%). After adjusting for age, sex, and educational level, COVID-19 incidence was positively associated with moderate nicotine dependence (RR: 2.37; 95% CI: 1.04-5.40) and negatively associated with having a partner who smoked (RR: 0.12; 95% CI: 0.03-0.42), and having friends but not a partner who smoked (RR: 0.28; 95% CI: 0.14-0.56).nnCONCLUSION: The correlates of having had COVID-19 among people who smoke should be considered when tailoring information and targeted non-pharmacological preventive measures.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid39308778,

title = {More or less "modest" versus significant excess mortality due to COVID-19 deaths in Europe},

author = {Soriano JB and Peláez A and Lumbreras S and Fernández E and Ancochea J},

doi = {10.1016/j.lanepe.2024.101060},

issn = {2666-7762},

year  = {2024},

date = {2024-10-01},

journal = {Lancet Reg Health Eur},

volume = {45},

pages = {101060},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38288784,

title = {Quitline nurses' experiences in providing telephone-based smoking cessation help to mental health patients: A mixed methods study},

author = {Rosa N and Feliu A and Ballbè M and Alaustre L and Vilalta E and Torres N and Nieva G and Pla M and Pinet C and Raich A and Mondon S and Barrio P and Andreu M and Suelves JM and Vilaplana J and Enríquez M and Castellano Y and Guydish J and Fernández E and Martínez C},

doi = {10.1111/jpm.13012},

issn = {1365-2850},

year  = {2024},

date = {2024-10-01},

journal = {J Psychiatr Ment Health Nurs},

volume = {31},

number = {5},

pages = {755--766},

abstract = {WHAT IS KNOWN ON THE SUBJECT?: Quitlines are known to be effective in helping people quit smoking, including those with mental health conditions. It is particularly important to address smoking in this population as the prevalence of smoking ranges from 40% to 75%. However, professionals working in quitlines often face barriers due to their limited training and resources to effectively support these smokers quit, especially if they are not mental health professionals. Therefore, training programmes should be developed to enhance their knowledge and skills in providing smoking cessation support to this vulnerable population. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The '061 QUIT-MENTAL study' evaluated the efficacy of a proactive telephone-based intervention for smoking cessation among smokers with severe mental health disorders. Conducted through a quitline service in Catalonia, Spain, the study focused on training non-mental health specialized nurses and other health professionals to provide evidence-based interventions for promoting smoking cessation among individuals with mental health disorders. The objective of this study is to assess the changes in nurses' knowledge and readiness to treat smokers with mental health conditions, while also capturing their insights and perceptions regarding the facilitators and barriers to providing smoking cessation interventions. The training and insights of the nurses were integral to conducting this research and providing valuable information for the future sustainability of such interventions. This is particularly important as quitlines hold the potential to offer cessation support to these patients at the community level. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: While the training programme was successful in improving non-mental health specialized nurses' knowledge and motivation skills to help patients with mental health disorders quit smoking, they encountered obstacles in delivering this intervention over the phone. These difficulties were mainly due to challenges in reaching participants and delivering the intervention as detailed in the protocol. The study highlights the need of reducing barriers for providers in attending to these patients, particularly if they are non-mental health specialized professionals. By minimizing the stigmatization associated with caring for mentally ill individuals and promoting coordination with specialists, innovative approaches may be introduced to alleviate the burden of tobacco-related diseases among this population. ABSTRACT: Introduction The viewpoint of those who implement a programme for the first time is crucial for understanding its impact and ensuring its long-term viability. The 061 QUIT-MENTAL study was a pragmatic randomized controlled trial evaluating a proactive telephone-based intervention addressed to mental health patients conducted by non-psychiatric specialized nurses. Aim We assessed nurses' knowledge of smoking cessation interventions addressed to this population before and after receiving training and their insights after delivering the intervention. Method Mixed methods study: (1) Pre-post evaluation to assess self-reported knowledge, self-efficacy and opinions about smoking cessation. (2) In-depth interviews with key nurses to ascertain their perceptions regarding the impact of the training received in delivering the study intervention. Results The training enhanced nurses' knowledge of psychological and pharmacological resources to aid these patients, as well as their ability to increase their motivation to quit. However, nurses reported difficulties in delivering population-based interventions to individuals with mental health disorders. These challenges primarily arose from participants being hard to reach, exhibiting low motivation to quit, struggling to comprehend instructions or follow recommendations, and nurses feeling unsure about their capacity to assist individuals with mental illnesses in quitting, despite the training they received. Discussion Despite the training and protocol designed to facilitate the delivery of the intervention, nurses faced difficulties in providing population-based interventions to individuals with mental health disorders. Implications for Practice Future quitline programmes aimed at the population with mental health disorders should strive to reduce barriers for providers in attending to these patients, particularly if they are non-mental health specialized professionals. By minimizing the stigmatization associated with caring for mentally ill individuals and promoting coordination with specialists, innovative approaches may be introduced to alleviate the burden of tobacco-related diseases among this population.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36975072c,

title = {Training mental health residents in tobacco and alcohol: Relationship with their clinical intervention},

author = {Mondon S and Raich A and Martí C and Fernández E and Ballbè M and La Red Catalana de Hospitales Sin Humo GTTYSM},

doi = {10.20882/adicciones.1837},

issn = {0214-4840},

year  = {2024},

date = {2024-09-01},

journal = {Adicciones},

volume = {36},

number = {3},

pages = {277--286},

abstract = {The objective of this study is to describe how mental health professionals in training (residents) apply the brief intervention (5As) on the tobacco and alcohol consumption to their patients, and if this is related to the training received and/or their own consumption. This is a cross-sectional study in which a self-reported questionnaire was administered to first-year residents of mental health professionals in Catalonia (2016-2019) (psychiatrists, psychologists and nurses). We performed a descriptive analysis of the variables and we applied a chi-square test for the comparison of proportions. 154 professionals completed the questionnaire. Half of them had not received any university training on intervention in smoking (46.8%) or in alcohol consumption (53.2%). Those who had received it, advised, assessed and helped their patients to quit smoking more frequently (p = 0.008, p = 0.037 and p = 0.039; respectively). Those who had received training in alcohol intervention gave advice, performed assessments and offered help to quit/reduce alcohol among their patients more frequently (p < 0,001; p = 0,001; y p < 0,001; respectively). Residents usually helped more to quit or reduce alcohol than to quit tobacco (p < 0,001). 60.1% of them never or rarely helped their patients to stop smoking and 34.6% rarely helped in the case of alcohol. In general, nurses did more intervention for tobacco than alcohol use, regardless of the training received. The lack of training of professionals in tobacco and alcohol intervention at university is related to a lack of intervention on patients in their professional practice, regardless of their own consumption.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36975072b,

title = {Training mental health residents in tobacco and alcohol: Relationship with their clinical intervention},

author = {Mondon S and Raich A and Martí C and Fernández E and Ballbè M and La Red Catalana de Hospitales Sin Humo GTTYSM},

doi = {10.20882/adicciones.1837},

issn = {0214-4840},

year  = {2024},

date = {2024-09-01},

journal = {Adicciones},

volume = {36},

number = {3},

pages = {277--286},

abstract = {The objective of this study is to describe how mental health professionals in training (residents) apply the brief intervention (5As) on the tobacco and alcohol consumption to their patients, and if this is related to the training received and/or their own consumption. This is a cross-sectional study in which a self-reported questionnaire was administered to first-year residents of mental health professionals in Catalonia (2016-2019) (psychiatrists, psychologists and nurses). We performed a descriptive analysis of the variables and we applied a chi-square test for the comparison of proportions. 154 professionals completed the questionnaire. Half of them had not received any university training on intervention in smoking (46.8%) or in alcohol consumption (53.2%). Those who had received it, advised, assessed and helped their patients to quit smoking more frequently (p = 0.008, p = 0.037 and p = 0.039; respectively). Those who had received training in alcohol intervention gave advice, performed assessments and offered help to quit/reduce alcohol among their patients more frequently (p < 0,001; p = 0,001; y p < 0,001; respectively). Residents usually helped more to quit or reduce alcohol than to quit tobacco (p < 0,001). 60.1% of them never or rarely helped their patients to stop smoking and 34.6% rarely helped in the case of alcohol. In general, nurses did more intervention for tobacco than alcohol use, regardless of the training received. The lack of training of professionals in tobacco and alcohol intervention at university is related to a lack of intervention on patients in their professional practice, regardless of their own consumption.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38916135,

title = {Improving tobacco cessation interventions in hospitals: Pre-post evaluation of an innovative health systems intervention in Catalonia (Spain)},

author = {Martínez C and Feliu A and Enriquez M and Antón L and Castellano Y and Company A and Romero O and Ripoll R and Ruz A and Papadakis S and Fernández E},

doi = {10.1093/tbm/ibae016},

issn = {1613-9860},

year  = {2024},

date = {2024-09-01},

journal = {Transl Behav Med},

volume = {14},

number = {9},

pages = {549--560},

abstract = {This study measured changes in healthcare professionals' (HCPs) performance in tobacco cessation intervention before and 6 months after a health system intervention. The intervention involved exposure to online training for staff and the implementation of a structured organizational change-level practice model that included some strategies, comprising establishing tobacco cessation steering groups with champions in each hospital, developing tailored protocols and guidelines within each organization, conducting on-site workshops for clinicians, and creating posters and pocket materials summarizing the intervention. Pre-post evaluation in four hospitals in Barcelona province (Catalonia, Spain). We assessed the knowledge, attitudes, behaviors, and organizational factors (KABO) and the performance of each of the components of the 5As Model for Treating Tobacco Use according to a scale from 0 ("Never") to 10 ("Always") among HCPs. We performed Wilcoxon signed-rank tests for paired samples and assessed changes in performance by performing linear regression. A total of 255 HCPs completed the pre-post evaluation. All components of the 5As Model increased, with "Assist" and "Arrange a follow-up" showing the greatest improvement. Several KABO dimensions significantly increased, including individual skills (mean score: 3.3-5.7, P < .001), attitudes and beliefs (4.8-5.4, P < .001), individual commitment (5.9-6.6, P < .001), and perception of having positive organizational support (4.3-4.7, P < .001). An increase in each point in individual skills and support of the organization was associated with increased rates of 5As delivery, with the greatest associations found for "Assist" (0.60 and 0.17, respectively) and "Arrange a follow-up" (0.71 and 0.18, respectively). The intervention was successful in increasing HCPs individual skills, attitudes and beliefs, individual commitment, and perception of having positive organizational support and the performance of all components of the 5As. Future research should focus on strategies that promote organizational support, a dimension that is essential to increasing Assist and Arrange, which were less implemented at baseline.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36975072,

title = {Training mental health residents in tobacco and alcohol: Relationship with their clinical intervention},

author = {Mondon S and Raich A and Martí C and Fernández E and Ballbè M and La Red Catalana de Hospitales Sin Humo GTTYSM},

doi = {10.20882/adicciones.1837},

issn = {0214-4840},

year  = {2024},

date = {2024-09-01},

journal = {Adicciones},

volume = {36},

number = {3},

pages = {277--286},

abstract = {The objective of this study is to describe how mental health professionals in training (residents) apply the brief intervention (5As) on the tobacco and alcohol consumption to their patients, and if this is related to the training received and/or their own consumption. This is a cross-sectional study in which a self-reported questionnaire was administered to first-year residents of mental health professionals in Catalonia (2016-2019) (psychiatrists, psychologists and nurses). We performed a descriptive analysis of the variables and we applied a chi-square test for the comparison of proportions. 154 professionals completed the questionnaire. Half of them had not received any university training on intervention in smoking (46.8%) or in alcohol consumption (53.2%). Those who had received it, advised, assessed and helped their patients to quit smoking more frequently (p = 0.008, p = 0.037 and p = 0.039; respectively). Those who had received training in alcohol intervention gave advice, performed assessments and offered help to quit/reduce alcohol among their patients more frequently (p < 0,001; p = 0,001; y p < 0,001; respectively). Residents usually helped more to quit or reduce alcohol than to quit tobacco (p < 0,001). 60.1% of them never or rarely helped their patients to stop smoking and 34.6% rarely helped in the case of alcohol. In general, nurses did more intervention for tobacco than alcohol use, regardless of the training received. The lack of training of professionals in tobacco and alcohol intervention at university is related to a lack of intervention on patients in their professional practice, regardless of their own consumption.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid39298750,

title = {Patterns of Use and Withdrawal Syndrome in Dual Cannabis and Tobacco Users (DuCATA_GAM-CAT): Protocol for a Mixed Methods Study},

author = {Saura J and Feliu A and Enríquez-Mestre M and Fu M and Ballbè M and Castellano Y and Pla M and Rosa N and Radeva P and Maestre-González E and Cabezas C and Colom J and Suelves JM and Mondon S and Barrio P and Andreu M and Raich A and Bernabeu J and Vilaplana J and Roca Tutusaus X and Guydish J and Fernández E and Martínez C},

doi = {10.2196/58335},

issn = {1929-0748},

year  = {2024},

date = {2024-09-01},

journal = {JMIR Res Protoc},

volume = {13},

pages = {e58335},

abstract = {BACKGROUND: Approximately 1 in 6 cannabis users develop a cannabis use disorder (CUD) and the odds increase to 1 in 2 for daily users.nnOBJECTIVE: The Dual use of Cannabis and Tobacco Monitoreing through a Gamified Web app (DuCATA_GAM-CaT) project aims to identify cannabis-tobacco patterns of use and withdrawal symptoms among individuals with CUD who are attending substance abuse programs.nnMETHODS: The project uses a mixed methods approach consisting of 3 studies. First, a participatory qualitative study involves focus groups comprising individuals with CUD, clinicians, project researchers, and an expert gamification company to co-design a gamified web app. Second, a longitudinal prospective study to follow up individuals over 6 weeks with CUD attending substance abuse programs . Participants report their cannabis-tobacco usage patterns, type and frequency of tobacco use, nicotine dependence, withdrawal symptoms, psychoemotional factors, and motivation to quit both substances. Predictive analysis techniques are used to analyze clinical, demographic, psychological, and environmental data to predict the probability of achieving abstinence. Third, homogeneous focus groups to explore participants' experiences during their CUD treatment.nnRESULTS: By June 2024, the project had completed the first study, defining eligible cannabis user profiles, developed the initial web app prototype, and initiated recruitment across 10 centers, with 74 participants enrolled, aiming to reach 150 participants in total.nnCONCLUSIONS: All participants are required to provide informed consent, and their information is kept confidential and anonymized following confidentiality rules. The research team is committed to disseminating the results obtained to professional and patient groups, as well as informing public health agents, to positively influence political and social decision makers and design programmers. Additionally, we aim to prioritize the publication of the results in high-impact journals specialized in drug abuse, public health, and health care services research.nnTRIAL REGISTRATION: ClinicalTrials.gov NCT05512091; https://clinicaltrials.gov/study/NCT05512091.nnINTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/58335.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38886051,

title = {Tobacco endgame goals and measures in Europe: current status and future directions},

author = {Ollila H and Ruokolainen O and Laatikainen T and Koprivnikar H and and JATC-2 WP9 co-authors},

doi = {10.1136/tc-2024-058606},

issn = {1468-3318},

year  = {2024},

date = {2024-06-01},

urldate = {2024-06-01},

journal = {Tob Control},

abstract = {The European Union (EU) aims for a tobacco use prevalence of less than 5% by 2040 with its Tobacco-Free Generation goal, aligning with the tobacco endgame approach. In the Joint Action on Tobacco Control 2 (JATC-2) -project, we examined adopted and planned endgame goals and measures as well as preparedness to counter tobacco industry interference in the process. We surveyed key informants in 24 out of 50 countries in the WHO European Region (19 of the 27 EU Member States, MS). Altogether, eight countries (7 EU MS) had official governmental endgame goals, and an additional six EU MS had similar proposals from government, civil society or research entities. Movement towards tobacco endgame was most evident in retail-oriented and consumer-oriented policies. These include restricting the sales of tobacco and related products and raising the age limit above 18 years. Product standards were used especially to regulate flavours but no measures to substantially reduce addictiveness were reported. Market-oriented measures that tap into industry profits were predominantly missing, and countries often lacked concrete tools to prevent industry interference. Respondents' concerns around tobacco endgame were related to high smoking prevalence in some population groups, non-combustible and new nicotine products, cross-border marketing, political will, challenges with the existing regulations and industry interference. Results indicate both momentum and challenges in adopting and disseminating measures that facilitate achieving tobacco endgame goals. The EU goal can be used to advocate for national endgame goals and measures, and for the strengthened implementation of the WHO Framework Convention on Tobacco Control.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38804329,

title = {[What does Harm Reduction in Tobacco Use means to Public Health]},

author = {Ayesta J and Peruga A and Rebollar A and Rey N and Zamorano A and Verdejo S and Panero J and Doncel JC and Martín A and Pérez-Sacristán EM},

url = {https://pmc.ncbi.nlm.nih.gov/articles/PMC11575274/},

issn = {2173-9110},

year  = {2024},

date = {2024-05-01},

urldate = {2024-05-01},

journal = {Rev Esp Salud Publica},

volume = {98},

abstract = {Harm reduction is a classic Public Health concept to refer to the reduction of the negative effect of drug use/abuse with a focus on justice and human rights, but the tobacco industry has been perverting this concept for years and using it as a tool for its own marketing. This publication details what real harm reduction action on tobacco use would be, when it should be implemented, and what pillars it should be based on. Different methods of reducing the harmful effects of tobacco and nicotine have been tried and tested over time, but the results have been poor; therefore, smoking cessation by the various officially recognised methods is recommended as a priority objective, using the tools that are truly supported by science. In contrast, it also explains the strategies developed by the industry to manipulate consumers and make them dependent on products that can eventually kill them: from the development of filtered cigarettes to light cigarettes, and from menthol to flavoured vapes. In all cases, they have falsely led people to believe that they were developing less toxic products when they were not. Nowadays, both light and menthol cigarettes are banned in Spain, filters have not reduced risk but increased the use, and vapes try to replace cigarettes with their attractive flavours and their false legend of healthier products when what they are really doing is maintaining the same addiction by changing the object, encouraging dual use, and attracting younger and younger non-smokers. At the same time, a strategy of dividing the opinion of health professionals has been developed, using medical doctors and researchers with recognised conflicts of interest but who manage to confuse consumers. In conclusion, we consider that, although nicotine releasing devices may be useful elements in some particular cases, they are not recommended at the population level as they can promote onset, prevent cessation, as well as maintaining the addictive capacity. The only nicotine products that are recommended are those of pharmacological use approved for the case and provided they are used as a transitional tool to complete cessation.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid40936741,

title = {EFFECTIVENESS OF A POST-DISCHARGE PHONE-BASED SMOKING CESSATION INTERVENTION FOR PATIENTS WITH SEVERE MENTAL HEALTH DISORDERS: THE 061 QUITMENTAL RANDOMIZED CONTROLLED CLINICAL TRIAL},

author = {Martínez C and Feliu A and Saura J and Nieva G and Pinet C and Raich A and Mondon S and Barrio P and Andreu M and Hernández-Ribas R and Costa S and Suelves JM and Vilaplana J and Enríquez M and Alaustre L and Vilalta E and Alvarez JB and Guydish J and 061 Quitmental Group and Fernández E and Ballbè M},

doi = {10.1007/s11469-024-01254-8},

issn = {1557-1874},

year  = {2024},

date = {2024-02-01},

journal = {Int J Ment Health Addict},

abstract = {A pragmatic double-blind randomized controlled trial was conducted in Barcelona to assess a telephone-based smoking cessation intervention's effectiveness for individuals with mental health disorders post-discharge. Participants were divided into an Intervention Group (IG) and Control Group (CG) with a 2:1 allocation ratio. The IG received proactive motivational assistance, while the CG received brief advice. Biochemically validated past 7-day abstinence was the main outcome measure. Of 530 screened individuals, 294 were enrolled (200 IG, 94 CG). During follow-up, participants reported 97 episodes of ≥7-day abstinence (IG: 51, CG: 26). Overall abstinence probability was 30-35%, with no difference between groups at one-year follow-up. However, intervention participants were more likely to report abstinence if they quit during hospitalization or were considering quitting. The intervention effectively supported smoking abstinence in motivated individuals. Combining this with clinical and community-based interventions holds promise for aiding smoking cessation in those with mental disorders.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37683574b,

title = {Effectiveness of smoking cessation interventions among pregnant women: An updated systematic review and meta-analysis},

author = {Vila-Farinas A and Pérez-Rios M and Montes-Martinez A and Ruano-Ravina A and Forray A and Rey-Brandariz J and Candal-Pedreira C and Fernández E and Casal-Acción B and Varela-Lema L},

doi = {10.1016/j.addbeh.2023.107854},

issn = {1873-6327},

year  = {2024},

date = {2024-01-01},

journal = {Addict Behav},

volume = {148},

pages = {107854},

abstract = {OBJECTIVE: To carry out a systematic review of systematic reviews with an update of the existing evidence relating to a broad range of smoking cessation interventions, including psycho-social, digital and pharmacologic interventions, for pregnant women.nnDATA-SOURCES: Search was conducted in March 2022 in PubMed, EMBASE, and Cochrane in two stages: 1) a search of systematic reviews and meta-analyses, published from January 2012 through January 2022; 2) an update of those that fulfilled eligibility criteria reproducing the primary search strategy.nnSTUDY ELIGIBILITY CRITERIA: We selected randomized clinical trials (RCTs) that evaluated the effectiveness of pharmacological, digital, and psychosocial interventions in aged 18 years and over who were daily smokers, and compared these with routine care, less intense interventions or placebo.nnSTUDY APPRAISAL AND SYNTHESIS METHODS: Data from eligible studies were manually extracted by two authors and reviewed by a third. The quality of the reviews was evaluated using the AMSTAR scale, and risk of bias was measured with the Rob-2 tool and GRADE level of evidence.nnRESULTS: The meta-analysis included 63 RCTs (n = 19849 women). The interventions found to be effective were: financial incentives (RR:1.77; 95%CI:1.21-2.58), counseling (RR:1.27; 95%CI:1.13-1.43) and long-term nicotine replacement therapy (NRT) (RR:1.53; 95%CI:1.16-2.01). Short-term NRT, bupropion, digital interventions, feedback, social support, and exercise showed no effectiveness. The GRADE level of evidence was moderate-to-high for all interventions, with the exception of long-term NRT.nnCONCLUSIONS: Non-pharmacological interventions for smoking cessation are the most effective for pregnant women. The moderator analysis suggests that pregnant women of low socioeconomic status might benefit less from smoking cessation interventions than women of a high socioeconomic status. These women are usually heavier smokers that live in pro-smoking environments and could require more intensive and targeted interventions.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37683574,

title = {Effectiveness of smoking cessation interventions among pregnant women: An updated systematic review and meta-analysis},

author = {Vila-Farinas A and Pérez-Rios M and Montes-Martinez A and Ruano-Ravina A and Forray A and Rey-Brandariz J and Candal-Pedreira C and Fernández E and Casal-Acción B and Varela-Lema L},

doi = {10.1016/j.addbeh.2023.107854},

issn = {1873-6327},

year  = {2024},

date = {2024-01-01},

journal = {Addict Behav},

volume = {148},

pages = {107854},

abstract = {OBJECTIVE: To carry out a systematic review of systematic reviews with an update of the existing evidence relating to a broad range of smoking cessation interventions, including psycho-social, digital and pharmacologic interventions, for pregnant women.nnDATA-SOURCES: Search was conducted in March 2022 in PubMed, EMBASE, and Cochrane in two stages: 1) a search of systematic reviews and meta-analyses, published from January 2012 through January 2022; 2) an update of those that fulfilled eligibility criteria reproducing the primary search strategy.nnSTUDY ELIGIBILITY CRITERIA: We selected randomized clinical trials (RCTs) that evaluated the effectiveness of pharmacological, digital, and psychosocial interventions in aged 18 years and over who were daily smokers, and compared these with routine care, less intense interventions or placebo.nnSTUDY APPRAISAL AND SYNTHESIS METHODS: Data from eligible studies were manually extracted by two authors and reviewed by a third. The quality of the reviews was evaluated using the AMSTAR scale, and risk of bias was measured with the Rob-2 tool and GRADE level of evidence.nnRESULTS: The meta-analysis included 63 RCTs (n = 19849 women). The interventions found to be effective were: financial incentives (RR:1.77; 95%CI:1.21-2.58), counseling (RR:1.27; 95%CI:1.13-1.43) and long-term nicotine replacement therapy (NRT) (RR:1.53; 95%CI:1.16-2.01). Short-term NRT, bupropion, digital interventions, feedback, social support, and exercise showed no effectiveness. The GRADE level of evidence was moderate-to-high for all interventions, with the exception of long-term NRT.nnCONCLUSIONS: Non-pharmacological interventions for smoking cessation are the most effective for pregnant women. The moderator analysis suggests that pregnant women of low socioeconomic status might benefit less from smoking cessation interventions than women of a high socioeconomic status. These women are usually heavier smokers that live in pro-smoking environments and could require more intensive and targeted interventions.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid39398343,

title = {Assessment of exposure to secondhand tobacco smoke in Spain: A scoping review},

author = {Blanco-Ferreiro A and Teijeiro A and Varela-Lema L and Rey-Brandariz J and Candal-Pedreira C and Martin-Gisbert L and García G and Galán I and Fernández E and Mourino N and Pérez-Ríos M},

doi = {10.18332/tid/192118},

issn = {1617-9625},

year  = {2024},

date = {2024-01-01},

journal = {Tob Induc Dis},

volume = {22},

abstract = {INTRODUCTION: There is no consensus on the questions that should be included in questionnaires to properly ascertain exposure to secondhand tobacco smoke (SHS). The objective of this study is to analyze the questions included in studies which have assessed SHS exposure in Spain.nnMETHODS: A scoping review was performed, using PubMed, Embase and Web of Science databases, selecting original articles published in English and Spanish, across the period 2012-2021. We extracted data from each study regarding its design, target population, sample size or geographical scope; we also collected data regarding how studies dealt with exposure to SHS including assessment and intensity of SHS, exposure setting, geographical scope, and the verbatim questions used.nnRESULTS: Finally, 75 studies were identified. In the 23 studies carried out in children, verbatim questions were included in 8 studies, and the setting most studied was the home. SHS exposure was assessed during pregnancy and postnatally by 8 studies, the verbatim questions used were described in 2 studies, being exposure ascertained at home and workplace. In the adult population, 14 of 44 studies described the verbatim questions; the setting most studied was the home. Verbatim questions varied among studies.nnCONCLUSIONS: Questionnaire-based assessment of SHS exposure is highly heterogeneous, hindering comparability between studies. Therefore, it is necessary to set a standard questionnaire to assess exposure to SHS.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38910916,

title = {Changes in prevalence and socioeconomic inequalities in secondhand smoke exposure in Spanish children, 2016-2019},

author = {Sanz-Mas M and Continente X and Henderson E and Fernández E and Schiaffino A and Pérez-Ríos M and Espelt A and Guxens M and López MJ},

doi = {10.18332/tid/189392},

issn = {1617-9625},

year  = {2024},

date = {2024-01-01},

journal = {Tob Induc Dis},

volume = {22},

abstract = {INTRODUCTION: Children are vulnerable to secondhand smoke (SHS) exposure, especially those with lower socioeconomic status. This study assesses the changes in prevalence and socioeconomic inequalities in SHS exposure in children younger than 12 years old in Spain between 2016 and 2019.nnMETHODS: We conducted two cross-sectional studies among representative samples of households with children aged <12 years in Spain, in 2016 (n=2411) and 2019 (n=2412). Families were interviewed to assess children's SHS exposure in private settings and outdoor public venues and their adoption of home and car smoke-free rules. We used the education level of the home main earner as a proxy for socioeconomic position. Changes over time in the prevalence and socioeconomic inequalities of SHS exposure and smoke-free rules were estimated through adjusted Poisson regression models with robust variance according to sociodemographic covariates (adjusted prevalence ratios, APRs).nnRESULTS: In 2019, 70.5% of children were exposed to SHS in Spain. No changes between 2016 and 2019 were found for overall SHS exposure, exposure at home, and at school entrances. SHS exposure increased at public transport stations (APR=1.24; 95% CI: 1.03-1.49) and outdoor hospitality venues (APR=1.17; 95% CI: 1.07-1.29) while it decreased in cars (APR=0.74; 95% CI: 0.56-0.98) and parks (APR=0.87; 95% CI: 0.77-0.98). Households with lower education level had higher prevalence of SHS exposure at home in 2019 compared with those with university studies (primary: APR=1.30; 95% CI: 1.11-1.51; secondary: APR=1.12; 95% CI: 1.00-1.25) and were less likely to adopt home indoor smoke-free rules (primary: APR=0.88; 95% CI: 0.79-0.99; secondary: APR=0.95; 95% CI: 0.89-1.02). Socioeconomic inequalities in SHS exposure at home persisted between 2016 and 2019 (p>0.05), while decreased in smoke-free rules in cars (p=0.039).nnCONCLUSIONS: Reported SHS exposure among children in Spain remained high between 2016 and 2019. Inequalities persisted at home, highlighting the need for measures to reduce such exposure with an equity perspective.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33879426,

title = {Particulate matter in aerosols produced by two last generation electronic cigarettes: a comparison in a real-world environment},

author = {Borgini A and Veronese C and De Marco C and Boffi R and Tittarelli A and Bertoldi M and Fern Ndez E and Tigova O and Gallus S and Lugo A and Gorini G and Carreras G and L Pez MJ and Continente X and Semple S and Dobson R and Clancy L and Keogan S and Tzortzi A and Vardavas C and Nicol S LP and Starchenko P and Soriano JB and Ruprecht AA and TackSHS Project Investigators},

doi = {10.1016/j.pulmoe.2021.03.005},

issn = {2531-0437},

year  = {2024},

date = {2024-01-01},

journal = {Pulmonology},

volume = {30},

number = {2},

pages = {137--144},

abstract = {The design of e-cigarettes (e-cigs) is constantly evolving and the latest models can aerosolize using high-power sub-ohm resistance and hence may produce specific particle concentrations. The aim of this study was to evaluate the aerosol characteristics generated by two different types of electronic cigarette in real-world conditions, such as a sitting room or a small office, in number of particles (particles/cm). We compared the real time and time-integrated measurements of the aerosol generated by the e-cigarette types Just Fog and JUUL. Real time (10s average) number of particles (particles/cm) in 8 different aerodynamic sizes was measured using an optical particle counter (OPC) model Profiler 212-2. Tests were conducted with and without a Heating, Ventilating Air Conditioning System (HVACS) in operation, in order to evaluate the efficiency of air filtration. During the vaping sessions the OPC recorded quite significant increases in number of particles/cm. The JUUL e-cig produced significantly lower emissions than Just Fog with and without the HVACS in operation. The study demonstrates the rapid volatility or change from liquid or semi-liquid to gaseous status of the e-cig aerosols, with half-life in the order of a few seconds (min. 4.6, max 23.9), even without the HVACS in operation. The e-cig aerosol generated by the JUUL proved significantly lower than that generated by the Just Fog, but this reduction may not be sufficient to eliminate or consistently reduce the health risk for vulnerable non e-cig users exposed to it.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}