Secondhand smoke presence in outdoor areas in 12 European countries

Introduction: Secondhand smoke (SHS) causes morbidity and mortality among non-smokers. Objectives: To investigate SHS presence in outdoor areas from 12 European countries and its association with country-level characteristics. Methods: Cross-sectional study performed in 2017-2018 within the TackSHS project. We conducted a face-to-face survey on a representative sample of the population aged 15 years and older from 12 European countries: Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania, and Spain. Out of 11,902 participants, 8,562 were non-smokers. SHS presence was assessed in selected outdoor areas and defined as respondents viewing someone smoking the last time they visited each setting within the last 6 months. A ranking score for outdoor SHS presence was assigned to each country based on the SHS presence in each setting. We used Spearman's correlation (r) and the Chi-squared tests to assess the relationship between SHS presence and country-level characteristics. Results: Except for children's playgrounds (39.5%; 95% confidence interval, CI: 37.6%-41.3%), more than half of non-smokers reported SHS presence in outdoor areas: schools (52.0%; 95%CI: 50.2%-53.7%), stadia (57.4%; 95%CI: 55.4%-59.4%), parks (67.3%; 95%CI: 66.0%-68.5%), hospitals (67.3%; 95%CI: 65.8%-68.7%), public transport stops (69.9%; 95%CI: 68.6%-71.2%), bar/restaurant terraces (71.4%; 95%CI: 70.2%-72.6%), and beaches (72.8%; 95%CI: 71.4%-74.1%). Residents in Latvia showed the highest overall outdoor SHS presence rank, followed by Greece, and Portugal. Outdoor SHS presence was directly correlated to the country's smoking prevalence (r = 0.64), and inversely correlated to the Tobacco Control Scale 2016 overall score (r = -0.62), the socio-demographic index 2017 (r = -0.56), and Gross Domestic Product per capita 2018 (r = -0.47) (p < 0.001). Conclusions: SHS presence is high in most outdoor areas in Europe, especially in countries with higher smoking prevalence and lower tobacco control performance. To address outdoor SHS exposure, our findings require considering smoking bans along with other strategies to reduce smoking prevalence

Factors related to caregivers’ risk perception of secondhand smoke exposure on children’s health

Introduction: Home is one of the main places for children's secondhand smoke (SHS) exposure. The implementation of smoke-free rules at home might be influenced by caregivers' risk perception of SHS exposure. This study aimed to analyze factors related to caregivers' risk perception of SHS exposure in children. Methods: We conducted a cross-sectional telephone survey among a representative sample of 2411 parents or legal guardians of children aged <12 years in Spain in 2016. The main study variable was caregivers' healthrisk perception of SHS exposure on children. We investigated correlates of risk perception using multivariate Poisson regression models with robust variance. Results: Overall, 59.6% reported SHS exposure negatively affects children's health a lot, while 34.1% that it affects quite a bit, and 5.5% and 0.8% a little bit or not at all, respectively. The factors associated with a higher caregivers' risk perception were high education level (adjusted prevalence ratio, APR=1.11; 95% CI: 1.01-1.24), living in a non-smoking family unit (APR=1.17; 95% CI: 1.07-1.27), in a home with smoke-free rules (APR=1.34; 95% CI: 1.19-1.51), and with girls only (APR=1.14; 95% CI: 1.06-1.22). Conclusions: Caregivers' risk perception of SHS exposure is influenced by social determinants and smoking habits in family units. These findings support the need for interventions with a social equity perspective to reduce children's SHS exposure

Social inequalities in secondhand smoke exposure in children in Spain

Introduction: Children are particularly vulnerable to the health effects of secondhand smoke (SHS). The objectives of this study are to describe SHS exposure of children younger than 12 years in Spain and to identify potential social inequalities associated with SHS exposure. Material and Methods: A cross-sectional study was conducted in a representative sample of the population younger than 12 years in Spain. A computerassisted telephone interview was conducted with parents or legal guardians in 2016, to assess the children's SHS exposure at home, in the car, at school and at the nursery gates, in public transport, and during leisure time. The socio-demographic variables included were the child's age and sex, the highest educational attainment at home, and occupational social class. Prevalence and 95% confidence intervals were calculated for SHS exposure in each setting and for overall exposure. Results: In all, 71.8% of the children were exposed to SHS: 25.8% were exposed at home, 4.6% in the car, 8.2% in public transport, 31.9% at outdoor nursery or school gates, and 48% during leisure time. The higher the educational attainment at home, the lower the exposure (38.8% for primary school or lower, 28.7% for secondary school and 20.8% university level). The more deprived the social class, the higher the exposure (21.7% class I-II, 23.4% class III-IV and 31.1% class V-VII). SHS exposure in cars and overall exposure also decreased with higher educational achievement. Conclusions: In Spain, a large proportion of children are still exposed to SHS. Furthermore, there are clear social inequalities. To reduce SHS exposure, there is an urgent need for evidence-based interventions with an equity perspective

Burden of respiratory disease attributable to secondhand smoke exposure at home in children in Spain (2015)

This study aimed to estimate the number of incident cases and hospital admissions attributable to secondhand smoke (SHS) exposure at home for asthma, otitis media (OM), and lower respiratory infections (LRI) in children in Spain. The burden of respiratory disease caused by SHS exposure was estimated in terms of incident cases and hospitalized cases for asthma, OM, and LRI. Estimates were calculated using the population attributable fraction. The age-specific (0-1 year, 0-4 years, 5-11 years, and 0-11 years) prevalence of SHS exposure in children was estimated through a telephone survey performed in a representative sample of Spanish households with children in 2016. The risk estimates for all diseases were selected from international meta-analyses. The number of hospitalized cases was obtained for each disease from the Hospital Minimum Data Set provided by the Ministry of Health of Spain. Incident cases were obtained from the Global Health Data Exchange. In 2015, SHS exposure caused an estimated total of 136,403 incident cases of the following respiratory diseases: 9058 (8.5%) cases of asthma, 120,248 (8.5%) of OM, and 7097 (13.5%) of LRI in children aged 0-14 years old in Spain. Likewise, SHS exposure caused a total of 3028 hospitalized cases, with 379 (8.5%) for asthma and 167 (8.5%) for OM in children 0-11 years old, and 2482 (11.6%) for LRI in children <2 years old. The high burden of respiratory disease attributed to SHS exposure supports the need to improve protection of children against SHS exposure by extending smoke-free regulations to homes and cars

Secondhand smoke exposure in outdoor children’s playgrounds in 11 European countries

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

Who smokes in Europe? Data from 12 European countries in the TackSHS survey (2017-2018)

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

Morbidity attributable to secondhand smoke exposure in children under 5 years old in Spain, 2015

Background: Children are especially vulnerable to the detrimental health effects of secondhand smoke (SHS), which has been widely linked to asthma and otitis media (OM), among other diseases. This study aimed to estimate hospital admissions and disability-adjusted life years (DALY) attributable to SHS exposure in terms of asthma and OM among children under 5 years old in Spain during the year 2015. Methods The prevalence of SHS exposure in children under 5 was estimated through a telephone survey performed in 2016 in a representative sample of Spanish households with children. The Rate risks for asthma and otitis media were selected from different published international meta-analysis. The number of hospital admissions were obtained for each disease from the Minimum Basic Data Set provided by the Ministry of Health of Spain. Information about DALYs were obtained from estimations made by the World Health Organization. Both hospital admissions and DALYs attributable to SHS exposure were calculated using the population attributable fraction (PAF). Results 25.7% of children under 5 are exposed to SHS at home (any household member reported smoking either inside or on balconies or terraces). According to the literature, SHS exposure increases the risk of both asthma and OM by 1.32. The estimated percentage of children presenting each disease attributable to SHS exposure at home is 7.6%. In 2015, the number of children with at least one hospital admission for asthma (n=2,451) and OM (n=1,226) attributable to SHS exposure was 186 and 93, respectively. Likewise, attributable DALYs were 273 for asthma and 159 for OM. Conclusions 7.6% of burden disease for asthma and OM among young children is due to SHS exposure at home. This figure highlights the need of implementing smoke-free home interventions to reduce hospital admissions and DALYs for asthma and OM

Asociación entre el humo ambiental de tabaco y el estado de salud en la población infantil

Objetivo: El objetivo principal del estudio es analizar la relación entre la exposición al humo ambientalde tabaco (HAT) en ni˜nos/as y el asma, las sibilancias y la salud percibida.Método: Estudio transversal mediante encuesta telefónica a una muestra representativa de 2411 menoresde 12 a˜nos de Espa˜na. Se describió la exposición al HAT en el ámbito privado y en el ámbito público, asícomo la prevalencia de asma, sibilancias y mala salud percibida autodeclaradas. La asociación entre losindicadores de salud y la exposición al HAT se analizó mediante modelos multivariados de regresión dePoisson con variancia robusta según edad y nivel de estudios.Resultados: La prevalencia de exposición al HAT en menores fue del 29,2% en el ámbito privado y del 42,5%en el ámbito público. No se observó asociación entre la exposición al HAT y el asma, las sibilancias y la malasalud percibida en menores de 5 a˜nos. En menores de 6-11 a˜nos con padres/madres con estudios primarioso secundarios, presentar asma (razón de prevalencia ajustada [RPa]: 2,1; intervalo de confianza del 95%[IC95%]: 1,2-3,8) y una peor salud percibida (RPa: 1,6; IC95%: 1,1-2,1) se asociaron positivamente con laexposición al HAT en el ámbito privado. En menores con progenitores o tutores con estudios universitariosse observó una asociación negativa entre presentar asma (RPa: 0,3; IC95%: 0,1-0,7) y sibilancias (RPa: 0,3;IC95%: 0,1-0,8) y la exposición al HAT.Conclusiones: Existen diferencias en la asociación entre la exposición al HAT y el asma, las sibilancias yuna peor salud percibida según el nivel de estudios. Se deberían planificar intervenciones con perspectivade equidad dirigidas a disminuir la exposición al HAT en la infancia

Social inequalities in secondhand smoke exposure in children in Spain

Introduction: Children are particularly vulnerable to the health effects of secondhand smoke (SHS). The objectives of this study are to describe SHS exposure of children younger than 12 years in Spain and to identify potential social inequalities associated with SHS exposure. Material and Methods: A cross-sectional study was conducted in a representative sample of the population younger than 12 years in Spain. A computerassisted telephone interview was conducted with parents or legal guardians in 2016, to assess the children's SHS exposure at home, in the car, at school and at the nursery gates, in public transport, and during leisure time. The socio-demographic variables included were the child's age and sex, the highest educational attainment at home, and occupational social class. Prevalence and 95% confidence intervals were calculated for SHS exposure in each setting and for overall exposure. Results: In all, 71.8% of the children were exposed to SHS: 25.8% were exposed at home, 4.6% in the car, 8.2% in public transport, 31.9% at outdoor nursery or school gates, and 48% during leisure time. The higher the educational attainment at home, the lower the exposure (38.8% for primary school or lower, 28.7% for secondary school and 20.8% university level). The more deprived the social class, the higher the exposure (21.7% class I-II, 23.4% class III-IV and 31.1% class V-VII). SHS exposure in cars and overall exposure also decreased with higher educational achievement. Conclusions: In Spain, a large proportion of children are still exposed to SHS. Furthermore, there are clear social inequalities. To reduce SHS exposure, there is an urgent need for evidence-based interventions with an equity perspective

Social inequalities in secondhand smoke exposure in children in Spain

Introduction: Children are particularly vulnerable to the health effects of secondhand smoke (SHS). The objectives of this study are to describe SHS exposure of children younger than 12 years in Spain and to identify potential social inequalities associated with SHS exposure. Material and Methods: A cross-sectional study was conducted in a representative sample of the population younger than 12 years in Spain. A computerassisted telephone interview was conducted with parents or legal guardians in 2016, to assess the children's SHS exposure at home, in the car, at school and at the nursery gates, in public transport, and during leisure time. The socio-demographic variables included were the child's age and sex, the highest educational attainment at home, and occupational social class. Prevalence and 95% confidence intervals were calculated for SHS exposure in each setting and for overall exposure. Results: In all, 71.8% of the children were exposed to SHS: 25.8% were exposed at home, 4.6% in the car, 8.2% in public transport, 31.9% at outdoor nursery or school gates, and 48% during leisure time. The higher the educational attainment at home, the lower the exposure (38.8% for primary school or lower, 28.7% for secondary school and 20.8% university level). The more deprived the social class, the higher the exposure (21.7% class I-II, 23.4% class III-IV and 31.1% class V-VII). SHS exposure in cars and overall exposure also decreased with higher educational achievement. Conclusions: In Spain, a large proportion of children are still exposed to SHS. Furthermore, there are clear social inequalities. To reduce SHS exposure, there is an urgent need for evidence-based interventions with an equity perspective