@article{pmid21964181,

title = {Secondhand smoke levels in public building main entrances: outdoor and indoor PM2.5 assessment},

author = {Sureda X and Martínez-Sánchez JM and López MJ and Fu M and Agüero F and Saltó E and Nebot M and Fernández E},

doi = {10.1136/tobaccocontrol-2011-050040},

issn = {1468-3318},

year  = {2012},

date = {2012-11-01},

journal = {Tob Control},

volume = {21},

number = {6},

pages = {543--548},

abstract = {BACKGROUND/OBJECTIVES: To describe secondhand smoke (SHS) levels in halls and main entrances (outdoors) in different buildings by measurement of PM(2.5) and airborne nicotine.nnMETHODS: Cross-sectional study in a sample of 47 public buildings. The authors studied SHS levels derived from PM(2.5) (micrograms per cubic metre) using TSI SidePak Personal Aerosol Monitors. The authors tested four locations within buildings: hall, main entrance (outdoor), control (indoor) and control (outdoor). The authors also measured airborne nicotine concentration (micrograms per cubic metre) in main entrances (outdoor). The authors computed medians and IQRs to describe the data. Spearman correlation coefficient (rsp) was used to explore the association between PM(2.5) concentrations simultaneously measured in halls and main entrances as well as between PM(2.5) and nicotine concentrations.nnRESULTS: The authors obtained an overall median PM(2.5) concentration of hall 18.20 μg/m(3) (IQR: 10.92-23.92 μg/m(3)), main entrance (outdoor) 17.16 μg/m(3) (IQR: 10.92-24.96 μg/m(3)), control (indoor) 10.40 μg/m(3) (IQR: 6.76-15.60 μg/m(3)) and control (outdoor) 13.00 μg/m(3) (IQR: 8.32-18.72 μg/m(3)). The PM(2.5) concentration in halls was more correlated with concentration in the main entrances (outdoors) (rsp=0.518, 95% CI 0.271 to 0.701) than with the control indoor (rsp=0.316, 95% CI 0.032 to 0.553). The Spearman correlation coefficient between nicotine and PM(2.5) concentration was 0.365 (95% CI -0.009 to 0.650).nnCONCLUSIONS: Indoor locations where smoking is banned are not completely free from SHS with levels similar to those obtained in the immediate entrances (outdoors) where smoking is allowed, indicating that SHS from outdoors settings drifts to adjacent indoors. These results warrant a revision of current smoke-free policies in particular outdoor settings.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid22117054,

title = {Exposure to secondhand smoke in Italian non-smokers 5 years after the Italian smoking ban},

author = {Martínez-Sánchez JM and Gallus S and Zuccaro P and Colombo P and Fernández E and Manzari M and La Vecchia C},

doi = {10.1093/eurpub/ckr156},

issn = {1464-360X},

year  = {2012},

date = {2012-10-01},

journal = {Eur J Public Health},

volume = {22},

number = {5},

pages = {707--712},

abstract = {BACKGROUND: No data on secondhand smoke (SHS) exposure are available on a national level in Italy. To assess the prevalence of exposure to SHS in indoor public places, home and cars in non-smoking Italian population, we conducted a survey 5 years after the national smoking ban.nnMETHODS: In 2010, we conducted a survey on a representative sample of the Italian population aged≥15 years. Analyses were conducted on 2365 non-smokers. Current (during the previous week) self-reported exposure to SHS was assessed in public places, at home and in private cars.nnRESULTS: The prevalence of SHS exposure in any setting (excluding workplaces) was 31.2%. SHS exposure was 10.2% in public places, 15.6% at home and 17.9% in cars. The corresponding estimates among the young (15-24 years) were 54.2% in any setting, 21.4% in public places, 27.1% at home and 32.9% in cars. By multivariate analysis, males, the young, subjects from southern Italy and former smokers were more frequently exposed in any setting.nnCONCLUSIONS: The Italian smoking ban substantially decreased SHS exposure. However, specific subpopulations, including the young, are still frequently exposed both in public and private places. We observed a relatively high SHS exposure in private vehicles. Thus, further control to improve compliance with the smoking ban and an extension of the smoke-free legislation to motor vehicles are needed.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid22341769,

title = {Smoke-free legislation: global reach, impact and remaining challenges},

author = {Gruer L and Tursan d'Espaignet E and Haw S and Fernández E and Mackay J},

doi = {10.1016/j.puhe.2011.12.005},

issn = {1476-5616},

year  = {2012},

date = {2012-03-01},

journal = {Public Health},

volume = {126},

number = {3},

pages = {227--229},

abstract = {Article 8 of the World Health Organization Framework Convention on Tobacco Control (2005) requires all signatory countries to adopt measures to protect people from tobacco smoke in indoor workplaces, indoor public places, public transport and other public places as appropriate. The aims of this symposium were to review progress across the world, to assess the evidence for the impact of legislation on health, and to identify the continuing challenges in making universal protection a reality. There was agreement that even in countries where strict legislation is enforced, many children continue to be dangerously exposed to parental second-hand smoke in the womb, the home and private cars. The importance of using accurate estimates of the burden of disease caused by second-hand smoke was agreed, in order to present an unassailable case for legislation and enforcement.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid22870289,

title = {Exposure to secondhand smoke in terraces and other outdoor areas of hospitality venues in eight European countries},

author = {López MJ and Fernández E and Gorini G and Moshammer H and Polanska K and Clancy L and Dautzenberg B and Delrieu A and Invernizzi G and Muñoz G and Precioso J and Ruprecht A and Stansty P and Hanke W and Nebot M},

doi = {10.1371/journal.pone.0042130},

issn = {1932-6203},

year  = {2012},

date = {2012-01-01},

journal = {PLoS One},

volume = {7},

number = {8},

pages = {e42130},

abstract = {BACKGROUND: Outdoor secondhand smoke (SHS) concentrations are usually lower than indoor concentrations, yet some studies have shown that outdoor SHS levels could be comparable to indoor levels under specific conditions. The main objectives of this study were to assess levels of SHS exposure in terraces and other outdoor areas of hospitality venues and to evaluate their potential displacement to adjacent indoor areas.nnMETHODS: Nicotine and respirable particles (PM2.5) were measured in outdoor and indoor areas of hospitality venues of 8 European countries. Hospitality venues of the study included night bars, restaurants and bars. The fieldwork was carried out between March 2009 and March 2011.nnRESULTS: We gathered 170 nicotine and 142 PM2.5 measurements during the study. The median indoor SHS concentration was significantly higher in venues where smoking was allowed (nicotine 3.69 µg/m3, PM2.5: 120.51 µg/m3) than in those where smoking was banned (nicotine: 0.48 µg/m3, PM2.5: 36.90 µg/m3). The median outdoor nicotine concentration was higher in places where indoor smoking was banned (1.56 µg/m3) than in venues where smoking was allowed (0.31 µg/m3). Among the different types of outdoor areas, the highest median outdoor SHS levels (nicotine: 4.23 µg/m3, PM2.5: 43.64 µg/m3) were found in the semi-closed outdoor areas of venues where indoor smoking was banned.nnCONCLUSIONS: Banning indoor smoking seems to displace SHS exposure to adjacent outdoor areas. Furthermore, indoor settings where smoking is banned but which have a semi-closed outdoor area have higher levels of SHS than those with open outdoor areas, possibly indicating that SHS also drifts from outdoors to indoors. Current legislation restricting indoor SHS levels seems to be insufficient to protect hospitality workers--and patrons--from SHS exposure. Tobacco-free legislation should take these results into account and consider restrictions in the terraces of some hospitality venues to ensure effective protection.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid22590491,

title = {DYNAMO-HIA--a Dynamic Modeling tool for generic Health Impact Assessments},

author = {Lhachimi SK and Nusselder WJ and Smit HA and van Baal P and Baili P and Bennett K and Fernández E and Kulik MC and Lobstein T and Pomerleau J and Mackenbach JP and Boshuizen HC},

doi = {10.1371/journal.pone.0033317},

issn = {1932-6203},

year  = {2012},

date = {2012-01-01},

journal = {PLoS One},

volume = {7},

number = {5},

pages = {e33317},

abstract = {BACKGROUND: Currently, no standard tool is publicly available that allows researchers or policy-makers to quantify the impact of policies using epidemiological evidence within the causal framework of Health Impact Assessment (HIA). A standard tool should comply with three technical criteria (real-life population, dynamic projection, explicit risk-factor states) and three usability criteria (modest data requirements, rich model output, generally accessible) to be useful in the applied setting of HIA. With DYNAMO-HIA (Dynamic Modeling for Health Impact Assessment), we introduce such a generic software tool specifically designed to facilitate quantification in the assessment of the health impacts of policies.nnMETHODS AND RESULTS: DYNAMO-HIA quantifies the impact of user-specified risk-factor changes on multiple diseases and in turn on overall population health, comparing one reference scenario with one or more intervention scenarios. The Markov-based modeling approach allows for explicit risk-factor states and simulation of a real-life population. A built-in parameter estimation module ensures that only standard population-level epidemiological evidence is required, i.e. data on incidence, prevalence, relative risks, and mortality. DYNAMO-HIA provides a rich output of summary measures--e.g. life expectancy and disease-free life expectancy--and detailed data--e.g. prevalences and mortality/survival rates--by age, sex, and risk-factor status over time. DYNAMO-HIA is controlled via a graphical user interface and is publicly available from the internet, ensuring general accessibility. We illustrate the use of DYNAMO-HIA with two example applications: a policy causing an overall increase in alcohol consumption and quantifying the disease-burden of smoking.nnCONCLUSION: By combining modest data needs with general accessibility and user friendliness within the causal framework of HIA, DYNAMO-HIA is a potential standard tool for health impact assessment based on epidemiologic evidence.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid22384230,

title = {Comparison of tobacco control scenarios: quantifying estimates of long-term health impact using the DYNAMO-HIA modeling tool},

author = {Kulik MC and Nusselder WJ and Boshuizen HC and Lhachimi SK and Fernández E and Baili P and Bennett K and Mackenbach JP and Smit HA},

doi = {10.1371/journal.pone.0032363},

issn = {1932-6203},

year  = {2012},

date = {2012-01-01},

journal = {PLoS One},

volume = {7},

number = {2},

pages = {e32363},

abstract = {BACKGROUND: There are several types of tobacco control interventions/policies which can change future smoking exposure. The most basic intervention types are 1) smoking cessation interventions 2) preventing smoking initiation and 3) implementation of a nationwide policy affecting quitters and starters simultaneously. The possibility for dynamic quantification of such different interventions is key for comparing the timing and size of their effects.nnMETHODS AND RESULTS: We developed a software tool, DYNAMO-HIA, which allows for a quantitative comparison of the health impact of different policy scenarios. We illustrate the outcomes of the tool for the three typical types of tobacco control interventions if these were applied in the Netherlands. The tool was used to model the effects of different types of smoking interventions on future smoking prevalence and on health outcomes, comparing these three scenarios with the business-as-usual scenario. The necessary data input was obtained from the DYNAMO-HIA database which was assembled as part of this project. All smoking interventions will be effective in the long run. The population-wide strategy will be most effective in both the short and long term. The smoking cessation scenario will be second-most effective in the short run, though in the long run the smoking initiation scenario will become almost as effective. Interventions aimed at preventing the initiation of smoking need a long time horizon to become manifest in terms of health effects. The outcomes strongly depend on the groups targeted by the intervention.nnCONCLUSION: We calculated how much more effective the population-wide strategy is, in both the short and long term, compared to quit smoking interventions and measures aimed at preventing the initiation of smoking. By allowing a great variety of user-specified choices, the DYNAMO-HIA tool is a powerful instrument by which the consequences of different tobacco control policies and interventions can be assessed.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid22129659,

title = {Nicotine depedence and salivary cotinine concentration in daily smokers},

author = {Fu M and Martínez-Sánchez JM and Agudo A and Pascual JA and Ariza C and Moncada A and Fernández E and DCOT Study Investigators},

doi = {10.1097/CEJ.0b013e32834a7e59},

issn = {1473-5709},

year  = {2012},

date = {2012-01-01},

journal = {Eur J Cancer Prev},

volume = {21},

number = {1},

pages = {96--102},

abstract = {There is scant information on nicotine dependence in smokers not seeking cessation treatment. This study analyses the relationship between nicotine dependence, measured by the Fagerström Test for Nicotine Dependence (FTND), and salivary cotinine concentration in a sample of smokers from the general population. We conducted a cross-sectional study (2004-2005) of a representative sample of the general population of Barcelona, Spain (n=1245). The analysis included 196 daily smokers aged more than 16 years. Information on smoking was obtained by questionnaire and cotinine concentration was determined in saliva. Geometric means of cotinine concentration by every single FTND item were computed, and multivariate linear regression was used to explore the relationship among these variables. Participants smoked a mean of 17.0 cigarettes per day, and the mean FTND score was 3.27 (95% confidence interval: 2.92-3.61). Around 17% of subjects (95% confidence interval: 12.0-22.5%) had high nicotine dependence. Cotinine concentration differed significantly by nicotine dependence levels. In a multiple linear regression model including the sum of the FTND items 2, 3, and 6, and the single FTND items 1, 4, and 5, adjusted for sex, the time to first cigarette after waking up (item 1), the number of cigarettes smoked daily (item 4), and smoking more in the first hours of the day (item 5) were significantly related to salivary cotinine concentration (R(2)=0.414). Salivary cotinine levels were associated with nicotine dependence as measured by the FTND, especially with the items on daily tobacco consumption, time to first cigarette after waking up, and smoking more in the first hours of the day.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid22035767,

title = {[Agreement between two observers in the measurement of smoking and use of safety belt and cell phones in vehicles]},

author = {Martínez-Sánchez JM and Curto A and Fernández E},

doi = {10.1016/j.gaceta.2011.07.011},

issn = {1578-1283},

year  = {2012},

date = {2012-01-01},

journal = {Gac Sanit},

volume = {26},

number = {1},

pages = {91--93},

abstract = {The aim of this study was to assess the feasibility of direct observations of smoking and use of seat belts and cell phones in drivers in the city of Barcelona, and to analyze the agreement between two observers. We performed 315 pairs of observations. The simple percentage inter-observer agreement between driver and passenger smoking was 100% with a Kappa coefficient=1.0. There was high inter-observer agreement in measurement of cell phone use and the number of passengers aged less than 14 years old. The variable with the lowest agreement was the driver's age. In conclusion, direct observation studies are a good resource for monitoring smoking and use of seat belts and cell phones in the drivers of motor vehicles.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}