Compliance and enforcement of a partial smoking ban in Lisbon taxis: an exploratory cross-sectional study

BACKGROUND: Research evaluating enforcement and compliance with smoking partial bans is rather scarce, especially in countries with relative weak tobacco control policies, such as Portugal. There is also scarce evidence on specific high risk groups such as vehicle workers. In January 2008, Portugal implemented a partial ban, followed by poor enforcement. The purpose of this study was to explore the effectiveness of a partial smoking ban in a pro-smoking environment, specifically transportation by taxi in the city of Lisbon. Ban effectiveness was generally defined by ban awareness and support, compliance and enforcement. METHODS: Exploratory cross-sectional study; purposive sampling in selected Lisbon streets. Structured interviews were conducted by trained researchers while using taxi services (January 2009-December 2010). Participants: 250 taxi drivers (98.8% participation rate). Chi-square, McNemar, Man Whitney tests and multiple logistic regression were performed. RESULTS: Of the participants, 249 were male; median age was 53.0 years; 43.6% were current smokers. Most participants (82.8%) approved comprehensive bans; 84.8% reported that clients still asked to smoke in their taxis; 16.8% allowed clients to smoke. Prior to the ban this value was 76.9% (p < 0.001). The major reason for not allowing smoking was the legal ban and associated fines (71.2%). Of the smokers, 66.1% admitted smoking in their taxi. Stale smoke smells were detected in 37.6% of the cars. None of the taxi drivers did ever receive a fine for non-compliance. Heavy smoking, night-shift and allowing smoking prior the ban predicted non-compliance. CONCLUSIONS: Despite the strong ban support observed, high smoking prevalence and poor enforcement contribute to low compliance. The findings also suggest low compliance among night-shift and vehicle workers. This study clearly demonstrates that a partial and poorly-enforced ban is vulnerable to breaches, and highlights the need for clear and strong policies

Are physicians aware of their role in tobacco control? A conference-based survey in Portugal

Authors’ contributions: SBR conceived the study and gathered the information, completed data entry, data analysis and drafting of the manuscript. All authors participated in the design of the study, analysed and interpreted the data and critically reviewed the original draft. SBR and JMC coordinated the study design. PA coordinated the statistical analysis. All authors read and approved the final manuscript.Acknowledgements: The authors would like to thank the survey respondents for their participation and also the board and organising committee of the two conferences. In addition, the authors would like to thank Steve Dyson for the English text review.BACKGROUND: The crucial role of physicians in tobacco control (TC) is widely recognized. In 2008, Portugal implemented a non-comprehensive smoke-free policy (SFP). In 2009, a conference-survey was carried out to explore Portuguese physicians' engagement in tobacco control, by evaluating the following: 1) attendance at TC training and awareness of training needs; 2) participation in TC activities; 3) attitudes and beliefs regarding SFPs. METHODS: Questionnaire-based cross-sectional study conducted during two major national medical conferences targeting GPs, hospitalists, and students/recent graduates. Descriptive analysis and logistic regression were performed. RESULTS: Response rate was 63.7% (605/950). Of the 605 participants, 58.3% were GPs, 32.4% hospitalists, 9.3% others; 62.6% were female; mean age was 39.0 ± 12.9 years. Smoking prevalence was 29.2% (95% CI: 23.3-35.1) in males; 15.8% (95% CI: 12.1-19.5) in females, p < 0.001. While the overwhelming majority of physicians strongly agreed that second-hand smoke (SHS) endangers health, awareness of SFP benefits and TC law was limited, p < 0.001. A significant minority (35.5%) believed that SHS can be eliminated by ventilation systems. Most physicians lacked training; only a minority (9.0%) participated regularly in TC. Training was the most consistent predictor of participation in TC. General agreement with SFP was high; but significantly lower for indoor leisure settings, outdoors bans in healthcare/schools settings and smoking restrictions in the home/car, p < 0.001. Smoking behaviour strongly predicted support for smoking restrictions in restaurants and bars/discos, healthcare outdoors and private settings. CONCLUSIONS: The findings suggest that Portuguese physicians are not aware of their role in tobacco control. Poor engagement of physicians in TC may contribute to the current lack of comprehensive policies in Portugal and Europe and undermine social norm change. Medical and professional continuing education on tobacco control should be made top priorities

Smoking behaviour predicts tobacco control attitudes in a high smoking prevalence hospital: A cross-sectional study in a Portuguese teaching hospital prior to the national smoking ban

<p>Abstract</p> <p>Background</p> <p>Several studies have investigated attitudes to and compliance with smoking bans, but few have been conducted in healthcare settings and none in such a setting in Portugal. Portugal is of particular interest because the current ban is not in line with World Health Organization recommendations for a "100% smoke-free" policy. In November 2007, a Portuguese teaching-hospital surveyed smoking behaviour and tobacco control (TC) attitudes before the national ban came into force in January 2008.</p> <p>Methods</p> <p>Questionnaire-based cross-sectional study, including all eligible staff. Sample: 52.9% of the 1, 112 staff; mean age 38.3 ± 9.9 years; 65.9% females. Smoking behaviour and TC attitudes and beliefs were the main outcomes. Bivariable analyses were conducted using chi-squared and MacNemar tests to compare categorical variables and Mann-Whitney tests to compare medians. Multilogistic regression (MLR) was performed to identify factors associated with smoking status and TC attitudes.</p> <p>Results</p> <p>Smoking prevalence was 40.5% (95% CI: 33.6-47.4) in males, 23.5% (95% CI: 19.2-27.8) in females (p < 0.001); 43.2% in auxiliaries, 26.1% in nurses, 18.9% among physicians, and 34.7% among other non-health professionals (p = 0.024). The findings showed a very high level of agreement with smoking bans, even among smokers, despite the fact that 70.3% of the smokers smoked on the premises and 76% of staff reported being frequently exposed to second-hand smoke (SHS). In addition 42.8% reported that SHS was unpleasant and 28.3% admitted complaining. MLR showed that smoking behaviour was the most important predictor of TC attitudes.</p> <p>Conclusions</p> <p>Smoking prevalence was high, especially among the lower socio-economic groups. The findings showed a very high level of support for smoking bans, despite the pro-smoking environment. Most staff reported passive behaviour, despite high SHS exposure. This and the high smoking prevalence may contribute to low compliance with the ban and low participation on smoking cessation activities. Smoking behaviour had greater influence in TC attitudes than health professionals' education. Our study is the first in Portugal to identify potential predictors of non-compliance with the partial smoking ban, further emphasising the need for a 100% smoke-free policy, effective enforcement and public health education to ensure compliance and promote social norm change.</p

Compliance and enforcement of a partial smoking ban in Lisbon taxis: an exploratory cross-sectional study

Abstract Background: Research evaluating enforcement and compliance with smoking partial bans is rather scarce, especially in countries with relative weak tobacco control policies, such as Portugal. There is also scarce evidence on specific high risk groups such as vehicle workers. In January 2008, Portugal implemented a partial ban, followed by poor enforcement. The purpose of this study was to explore the effectiveness of a partial smoking ban in a pro-smoking environment, specifically transportation by taxi in the city of Lisbon. Ban effectiveness was generally defined by ban awareness and support, compliance and enforcement. Methods: Exploratory cross-sectional study; purposive sampling in selected Lisbon streets. Structured interviews were conducted by trained researchers while using taxi services (January 2009-December 2010). Participants: 250 taxi drivers (98.8% participation rate). Chi-square, McNemar, Man Whitney tests and multiple logistic regression were performed

Analysis of knowledge, perceptions and self-confidence in tobacco control among graduating dental students in Portugal

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Exposiçao das crianças ao fumo ambiental do tabaco em casa e no carro

Introduction: Children's exposure to Environmental Tobacco Smoke (ETS) is associated with serious problems to their health, such as increased risk of acute lower airway infections, greater likelihood of recurrent respiratory infections, increased risk of ear infections induction and exacerbation of asthma and pulmonary emphysema. Exposure to ETS is especially serious for children with asthma. This exposure occurs in most cases when parents and / or other cohabitant smoke at home and / or in the car. Objectives: 1) to determine the prevalence of children exposed to ETS, at home and in the car; 2) to determine the prevalence of asthmatic children exposed to ETS at home; 3) to characterize the smoking behavior of parents and / or other cohabitant at home and in the car; 4) to identify socio-demographic factors associated with tobacco use at home. Methods: An observational cross-sectional study was developed: administration of a self-report questionnaire to 513 students from the 4th grade (8-11 years old) in the municipality of Braga during the academic year of 2010/2011. Results: Exposure to ETS at home was found in 27.5% of children; exposure to ETS in the car was found in 25.1% of children who use the car. Among the smoking parents, 69.8% of mothers and 56.8% of fathers smoke at home. Smoking at home is more common among parents with low socioeconomic status (p < 0,01). Conclusion: Exposure of children to the ETS is high. Fathers and mothers usually smoke at home and often in the car. These data justify an effective preventive intervention, which should constitute a priority for health education in schools and for health professionals.Introdução: A exposição das crianças ao Fumo Ambiental do Tabaco (FAT) está associada a graves problemas para a sua saúde, tais como maior risco de infeções agudas das vias aéreas inferiores, maior probabilidade de infeções respiratórias de repetição, risco acrescido de infeções nos ouvidos, indução e exacerbação de asma e enfisema pulmonar. A exposição ao FAT é especialmente grave para as crianças asmáticas. Esta exposição ocorre, na maioria dos casos, quando os pais e/ou outro convivente fumam no domicílio e/ou no carro. Objetivos: 1) Determinar a prevalência de crianças expostas ao FAT, em casa e no carro; 2) Determinar a prevalência de crianças asmáticas expostas ao FAT, em casa; 3) Caracterizar o comportamento tabágico dos pais e/ou outros conviventes em casa e no carro; 4) Identificar fatores sociodemográficos associados ao consumo de tabaco em casa. Metodologia: Estudo observacional descritivo transversal: aplicação de um questionário de auto-preenchimento a 513 alunos do 4.º ano de escolaridade (8-11 anos de idade) do Concelho de Braga no ano letivo de 2010/2011. Resultados: Estão expostas ao FAT: 27,5% das crianças em casa e 25,1% das crianças que usam o carro. Fumam em casa: 69,8% das mães e 56,8% dos pais fumadores. Fumar em casa é mais frequente nos pais com menor nível socioeconómico (p < 0,01). Conclusão: A exposição das crianças ao FAT é elevada. Os pais/mães fumam frequentemente em casa e no carro, o que justifica uma intervenção preventiva eficaz, que deverá ser uma prioridade de educação para a saúde, na escola e por parte dos profissionais de saúde

Exposición de los niños y niñas portugueses al humo ambiental de tabaco en el coche familiar

Objectives: To assess the prevalence of children's exposure to second-hand smoke in the family car; to compare exposure among children with smoking and non-smoking parents. Methods: In 2011, a self-administered questionnaire was applied to a 4th grade Portuguese children national sample (N=3187, mean age 9.5±0.7, 51.1% boys). Prevalence rates and chi-square tests were computed. Results: Of the participants, 52.0% reported having, at least, one smoking parent. Overall exposure in the car was 28.9% (95% CI 27.3-30.5). Children's exposure among those reporting smoking parents was 46.9% (95% CI 44.4-49.4); and 8.6% (95% CI 7.1-10.1) among those reporting non-smoking parents (p<.001). Therefore, children with smoking parents were 5.44 times more likely to be exposed. Conclusions: Children's exposure to second-hand smoke in the family car is frequent, especially if one or both parents smoke. This highlights the need for effective tobacco control measures to prevent this severe health hazard.Objetivos: Describir la prevalencia de la exposición de niños y niñas al humo ambiental del tabaco en el coche familiar; comparar la exposición de niños y niñas con padres fumadores y no fumadores. Métodos: En 2011, se aplicó un cuestionario auto-administrado a una muestra de niños y niñas portugueses de 4 ◦ curso (N = 3187, edad promedio 9,5 ± 0,7, 51,1% varones). Se calcularon ratios de prevalencia y pruebas de chi-cuadrado. Resultados: El 52,0% informaron tener al menos un padre/madre fumador. En la muestra total, la exposición fue del 28,9% (CI95%: 27,3-30,5). Esta exposición fue del 46,9% (CI95%:44,4-49,4) entre los niños y niñas con padres fumadores y del 8,6% (CI95%:7,1-10,1) entre los con padres no fumadores (p < 0,001), por lo tanto, fue más de cinco veces mayor entre los niños y niñas con padres fumadores. Conclusiones: La exposición es alta, especialmente si uno o ambos padres fuman. Esto indica la necesidad de medidas de control efectivo del consumo de tabaco para prevenir este severo riesgo para la salud.This work was supported by the Portuguese Foundation for Science and Technology (FCT - Fundacao para a Ciencia e Tecnologia), grant number PTDC/CPE-CED/098281/2008

Receiving support to quit smoking and quit attempts among smokers with and without smoking related diseases : Findings from the EUREST-PLUS ITC Europe Surveys

INTRODUCTION Having a chronic disease either caused or worsened by tobacco smoking does not always translate into quitting smoking. Although smoking cessation is one of the most cost-effective medical interventions, it remains poorly implemented in healthcare settings. The aim was to examine whether smokers with chronic and respiratory diseases were more likely to receive support to quit smoking by a healthcare provider or make a quit attempt than smokers without these diseases. METHODS This population-based study included a sample of 6011 adult smokers in six European countries. The participants were interviewed face-to-face and asked questions on sociodemographic characteristics, current diagnoses for chronic diseases, healthcare visits in the last 12 months and, if so, whether they had received any support to quit smoking. Questions on smoking behavior included nicotine dependence, motivation to quit smoking and quit attempts in the last 12 months. The results are presented as weighted percentages with 95% confidence intervals (CI) and as adjusted odds ratios with 95% CI based on logistic regression analyses. RESULTS Smokers with chronic respiratory disease, those aged 55 years and older, as well as those with one or more chronic diseases were more likely to receive smoking cessation advice from a healthcare professional. Making a quit attempt in the last year was related to younger age, high educational level, higher motivation to quit, lower nicotine dependence and having received advice to quit from a healthcare professional but not with having chronic diseases. There were significant differences between countries with smokers in Romania consistently reporting more support to quit as well as quit attempts. CONCLUSIONS Although smokers with respiratory disease did indeed receive smoking cessation support more often than smokers without disease, many smokers did not receive any advice or support to quit during a healthcare visit.Supplement 2.</p