Evaluation of the impact of Spanish smoking legislation on tobacco consumption and passive exposure

In Spain, two smoke-free laws have been passed after the approval of the FCTC. In 2005, it came into effect a smoke-free legislation (Law 28/2005). This law was a great advance for public health in Spain; however, it was not complete in terms of health protection to secondhand smoke (SHS) exposure because it allowed smoking in hospitality sectors according to size of venues. The scientific evaluation of this law showed the need to promote a total ban and motivate the modification of the law in 2010 (Law 42/2010), extending the smoke-free regulation to all hospitality venues without exception and to some outdoors areas, including hospital premises, educational campuses, and playgrounds. The objectives of this doctoral thesis were: To assess the impact of the Spanish smoking legislations (Law 28/2005 and Law 42/2010) on tobacco epidemic (changes in consumption, dependence, motivation to quit and smoking cessation) among smokers of a general population cohort through self-reported information and biomarkers. To evaluate the impact of the Spanish tobacco control legislation on exposure to environmental tobacco smoke (self-reported and according to levels of cotinine in saliva) on non-smokers in a cohort population. To analyze the changes in the pattern of passive smoking of the non-smokers (displacement of exposure at workplace and leisure time to home) according to age, sex, and socioeconomic level. To analyze the correlation between the implementation of tobacco control policies and tobacco consumption, particularly rolling tobacco, electronic cigarettes (e-cigarettes) users and the intent to quit smoking in 27 countries of the European Union. To describe the acceptability of the recently implemented tobacco products regulations and to explore their relation with tobacco control legislation levels in Europe. The results of this doctoral thesis has been conducted through seven scientific articles, four of them published in journals indexed in Web of Science and three of them in peer review in journals indexed in Web of Science (please see the Section Scientific Articles of this thesis). Moreover, during my training in this doctoral thesis I got involved in other two articles one published and the other in peer review, both in journals indexed in Web of Science. In conclusion, the implementation of the two smoke-free legislations in Spain is related to a reduction in smoking prevalence and SHS exposure (either using salivary cotinine concentrations or information on self-reported exposure). However, the consumption of other tobacco products, particularly hand-rolled tobacco, has increased specially among young population. A significant increase was found in the salivary cotinine concentration among adult continuing smokers after both Spanish legislations. After the implementation of the two Spanish smoke-free bans, the main setting of SHS is in the leisure time and in work, where most of the exposed ones declared expending most of the time outdoor and not having specific areas for smokers. However, cotinine concentrations in non-smokers were significantly higher only among those declaring exposure to SHS at home after both legislations. The implementation of the two smoke-free legislations in Spain is related to an increasing of voluntary adoption of smoke-free homes (SFH) rules, in particular with an increase in complete SFH rules. In addition, we observed an association between complete indoor SFH adoption and the perceived risk of SHS exposure. In addition, great support for the studied tobacco products regulations was found which were positively related with European tobacco control levels of implementation at both ecological and individual levels

Correlation between tobacco control policies, consumption of rolled tobacco and e-cigarettes, and intention to quit conventional tobacco, in Europe

Peer ReviewedPostprint (author's final draft

Correlation between tobacco control policies, consumption of rolled tobacco and e-cigarettes, and intention to quit conventional tobacco, in Europe

Peer ReviewedPostprint (author's final draft

Smartphone and Tablet Usage during COVID-19 Pandemic Confinement in Children under 48 Months in Barcelona (Spain)

Pandèmies; Preescolar; Temps de pantallaPandemias; Preescolar; Tiempo de pantallaPandemics; Preschool; Screen timeBackground: Total lockdown due to COVID-19 pandemic might have potentially increased screen time in children. This study aims to describe the smartphone and tablets usage in children under 48 months living in Barcelona during the COVID-19 confinement. Methods: Cross-sectional study using a non-probabilistic sample of parents with children under 48 months living in Barcelona (Spain) during COVID-19 confinement (n = 313). We calculated percentages of exposure to smartphones and tablets. Moreover, for those children were exposed, we calculated unadjusted and adjusted Geometric Mean Ratios (GMR) of daily smartphones and tablets usage and their 95% confidence intervals (95% CI) trough Generalized Linear Models with Gamma family and link log. Associations were adjusted for potential confounders. Results: During COVID-19 confinement, 67.5% of children under 48 months were daily exposed to smartphones and tablets. Further, those children who were exposed during meals, as well as before going to bed, spend longer durations using them, aGMR = 2.38 (95% CI 1.73, 3.34) and aGMR = 1.95 (95% CI 1.34, 2.91) respectively. Conclusion: Two out of three children under 48 months living in Barcelona were daily exposed to smartphones and tablets during total lockdown due to COVID-19. Taking this findings into account cohort studies are needed to assess any change in the screen time patterns due to total confinement in order to allow the Government help families, particularly those more vulnerable, in a possible pandemic resurgence.The Group of Evaluation of Health Determinants and Health Policies (À.C.-H., C.L., A.D.-I., J.C.M.-S., and J.M.M.-S.) receives support from the Ministry of Universities and Research, Government of Catalonia (grant 2017SGR609) from the Government of Catalonia

Attitudes toward working conditions: are European Union workers satisfied with their working hours and work-life balance?

Objective: To describe the satisfaction with working hours and satisfaction with work-life balance and their association in the European Union (EU-28). Method: This is a cross-sectional study based on data from the Flash Eurobarometer 398 among workers of the EU-28 from 2014 (n = 13,683). We calculated percentages and their 95% confidence intervals (95%CI). We also applied a multi-level generalised linear model using the Poisson family, to calculate the adjusted prevalence ratios (aPR) of satisfaction with work-life balance based on working hours. All analyses were stratified by individual, employment and welfare regime country classification. Results: The satisfaction with working hours and work-life balance was 80.62% and 74.48%, respectively, and was significantly higher among women. The highest percentages of satisfaction were found in the Nordic welfare regime countries (90.2% and 85.3%, respectively). There was a statistically significant association between satisfaction with working hours and work-life balance (aPR: 2.63; 95%CI: 2.28-3.04), and the magnitude of the association differed in individual, employment and welfare regime country classifications. The main reasons declared for dissatisfaction were "excessive working hours" (48.7%), "shift work" (27.9%), and "inability to influence the work schedule" (28.3%). Differences were observed according to sex and type of welfare regime. Conclusion: The differences found in the association between satisfaction with work-life balance and working hours according to sociodemographic characteristics and welfare regime show that there are inequalities in the working conditions in the EU countries

Secondhand smoke risk perception and smoke-free rules in homes: a cross-sectional study in Barcelona (Spain)

Objective: to describe the voluntary adoption of smoke-free homes in Spain among general population and to identify variables associated with its voluntary adoption. Methods: cross-sectional study of a representative sample (n=731) of the adult population (>26 years) of Barcelona, Spain, in 2013-2014. We defined smoking rules inside the households as complete indoor rules (when smoking was not allowed inside the house), and partial or absent indoor rules (when smoking was allowed in some designated places inside the house or when smoking was allowed everywhere) and described them according to the perceived risk of the secondhand smoke (SHS) exposure. We calculated the prevalence and prevalence ratios (PR) according to sociodemographic variables. Results: 57.4% of households had complete indoor smoke-free rules. The prevalence of households with complete indoor rules was higher among women (PRa: 1.15; 95% CI 1.00 to 1.33), married (PRa: 1.18; 95% CI 1.01 to 1.38), never-smokers (PRa: 2.68; 95% CI 2.06 to 3.50) and in households where a minor lived (PRa: 1.40; 95% CI: 1.20-1.65). Believe that breathing tobacco smoke from smokers is dangerous for non-smokers (PRa: 1.77; 95% CI: 1.06-2.97) is associated with the voluntary adoption of complete indoor smoke-free home. Conclusions: risk perceptions of SHS exposure were associated with the voluntary adoption of indoor smoke-free homes

Attitudes toward working conditions: are European Union workers satisfied with their working hours and work-life balance?

Objective: To describe the satisfaction with working hours and satisfaction with work-life balance and their association in the European Union (EU-28). Method: This is a cross-sectional study based on data from the Flash Eurobarometer 398 among workers of the EU-28 from 2014 (n = 13,683). We calculated percentages and their 95% confidence intervals (95%CI). We also applied a multi-level generalised linear model using the Poisson family, to calculate the adjusted prevalence ratios (aPR) of satisfaction with work-life balance based on working hours. All analyses were stratified by individual, employment and welfare regime country classification. Results: The satisfaction with working hours and work-life balance was 80.62% and 74.48%, respectively, and was significantly higher among women. The highest percentages of satisfaction were found in the Nordic welfare regime countries (90.2% and 85.3%, respectively). There was a statistically significant association between satisfaction with working hours and work-life balance (aPR: 2.63; 95%CI: 2.28-3.04), and the magnitude of the association differed in individual, employment and welfare regime country classifications. The main reasons declared for dissatisfaction were "excessive working hours" (48.7%), "shift work" (27.9%), and "inability to influence the work schedule" (28.3%). Differences were observed according to sex and type of welfare regime. Conclusion: The differences found in the association between satisfaction with work-life balance and working hours according to sociodemographic characteristics and welfare regime show that there are inequalities in the working conditions in the EU countries. (C) 2017 SESPAS. Published by Elsevier Espana, S.L.U

Compliance Surveillance of the Tobacco Control Legislation in a Spanish Region and Characterization of Passive Exposure to Tobacco Smoke and E-Cig in Children in Outdoor Spaces

Children; Smoking signage; Tobacco control legislationNiños; Señalización de fumar; Legislación de control del tabacoNens; Senyalització de fumar; Legislació de control del tabac(1) Background: Exposure to environmental tobacco smoke has decreased in recent years in Spain, due to the implementation of tobacco control policies. However, there is no regulation that protects against second-hand smoke (SHS) in outdoor environments. Our goal is to describe the smoking prohibition signage in public spaces and to characterize tobacco consumption in outdoor environments describing the SHS exposure in children. (2) Methods: A cross-sectional study using direct observation was carried out with a convenience sample (n = 179) that included hospitality venues with terraces, schools and healthcare facilities in the municipality of Sant Cugat del Vallès (Barcelona, Spain). The observations were made without notifying the owners by one single field researcher between April and June 2018. The variables were evaluated by signage and signs of tobacco consumption (ashtrays, cigarette butts and presence of smokers). (3) Results: Smoke-free zone signage outside public spaces was present in 30.7% of all venues, with only 50.9% correctness. When analysing terraces of hospitality venues, in 35.8% of them there were children present with 66.7% of tobacco consumption. (4) Conclusions: Our results show a low prevalence of antismoking signage, without an impact on tobacco consumption regardless of the presence of children

Motivation and main flavour of use, use with nicotine and dual use of electronic cigarettes in Barcelona, Spain: a cross-sectional study

Objective This study seeks to describe current e-cigarette users' patterns of use including primary motivation for use, dual use, use with nicotine and principal flavour used, according to individuals' sociodemographic characteristics and conventional tobacco consumption in Barcelona, Spain. Design, setting and participants This is a cross sectional study of adult (≥18) current e-cigarette users of Barcelona (n=600), recruited in 2015. Researchers calculated percentages and ORs with their 95% CIs of users' e-cigarette use with nicotine, primary motivation for use and preferred flavour. The analyses were stratified by sociodemographic variables including sex, age and level of education and by patterns of e-cigarette use and past and current conventional tobacco use. Results The most prevalent motivation for using e-cigarettes was to reduce tobacco smoking (48%, n=288), followed by quitting smoking (39.2%, n=235), and to use e-cigarettes in places where tobacco smoking was prohibited (10.2%, n=61). The most prevalent primary flavour used was tobacco (49%, n=294), followed by fruit (19.5%, n=117). People younger than 25 years old (OR=4.36, 95%CI 1.99 to 9.57) were more likely than older people to use them where smoking cigarettes was prohibited. A greater proportion of those in the youngest age group preferred fruit flavour compared with older individuals (29.3%, n=41). Conclusions Younger users of e-cigarettes and non smokers are more likely to use flavours other than tobacco and to use e-cigarettes mainly for recreational purposes