Changes in tobacco imagery and smokers’ depiction in Spanish top-grossing films before and after the implementation of a comprehensive tobacco control policy in Spain

INTRODUCTION As more restrictions on tobacco marketing communication are implemented, tobacco marketing has persisted through smoking in films. Our aims were to assess changes in tobacco imagery exposure in Spanish top-grossing films before and after the banning of tobacco advertising in Spain, and to determine whether the depiction of smoking characters has changed over the years. METHODS A repeated cross-sectional study measured the tobacco content in the 10 Spanish top-grossing films in 2005, 2010 and 2015 (n=30) before and after a complete tobacco advertising ban. We conducted a descriptive and regression analysis of changes in tobacco impressions by year. RESULTS The 30 films contained 1378 tobacco occurrences (90.2% positive for tobacco) with a median length of eight seconds onscreen. Total tobacco occurrences deemed positive for tobacco interests significantly increased in 2010 and 2015 compared to 2005. However, we observed decreased odds of tobacco brands appearances (OR=0.25; p<0.001) in 2010 and of implied tobacco use (OR=0.44; p=0.002), and tobacco brands appearances (OR=0.36; p<0.001) in 2015 compared to 2005. There was a change of pattern in the type of role smokers played from a leading role to a supporting one (p<0.001). The population reach of positive for tobacco occurrence in Spanish top-grossing films decreased from 15.9 (95% CI: 15.86–15.86) per 1000 spectators in 2005 to 0.8 (95% CI: 0.82–0.82) in 2015. CONCLUSIONS The implementation of a ban on complete tobacco product advertising was followed by a decrease in tobacco incidents across top-grossing Spanish films. Yet, exposure to smoking in films is still unacceptably high.Ministry of Universities and Research from the Government of Catalonia 2021SGR0090

Luces y sombras para la salud pública: análisis crítico de la legislación sobre el tabaco en España

Tobacco smoking is a chronic disease that is the leading preventable cause of death in developed countries. In Spain, the prevalence of tobacco use has decreased driven by the implementation of tobacco control policies; however, current legislation does not establish a harmonized regulation for all tobacco products. The aim of this article is to review the current legislation and critically analyze its limitations in relation to the principles of good administration now defined in the Law 39/2015. Spanish in force tobacco control policies main limitations can be divided into four areas: the lack of specific regulation for new tobacco products; the differences in their regulation; the lack of information to the general population on their harmful effects and the new developments in the regulation of smoke-free spaces; and the lack of adaptation of the regulation to the most recent scientific evidence. All in all, the quality of tobacco control regulations in Spain, despite the successes achieved with the Law 28/2005, has been compromised by the State's laxity in the legislative, regulatory, and administrative spheres, which has led to a regulatory stagnation that runs counter to the principles of good regulation. This review should encourage scientific organizations and civil society associations to call for an actualization of the tobacco legislation, with determined and coordinated prevention and control policies to promote a tobacco-free Spain. (C) 2021 SESPAS. Published by Elsevier Espana, S.L.U

Intervenciones para la promoción de actividad física basadas en la teoría de la autodeterminación : una revisión narrativa (2011-2016)

El objetivo del presente estudio es revisar intervenciones recientes orientadas a la promoción de la actividad física mediante un enfoque basado en la Teoría de la Autodeterminación (SDT). Así, presentamos ideas apoyadas por la evidencia que los investigadores pueden utilizar para desarrollar sus futuros programas. Nuestro estudio incluye artículos publicados entre 2011 y 2016 que cumplen los siguientes criterios de inclusión: (a) SDT como principal marco teórico, (b) participantes sanos con edades ≥ 12 años, y (c) foco en la promoción de la actividad física y/o variables relacionadas. Presentamos los resultados en tres categorías: (a) estructura, enfoque teórico y aspectos generales, (b) desarrollo, y (c) evaluación. En relación con la estructura, encontramos dos tipos de intervención: aquellas desarrolladas en un contexto existente, donde los profesionales responsables reciben una formación específica que puede influir indirectamente en los estudiantes/pacientes, e intervenciones desarrolladas desde cero, dónde los participantes reciben la formación o información directamente. Los resultados muestran que el enfoque más habitual para desarrollar la intervención es el apoyo y la satisfacción de la autonomía. En cuanto al desarrollo de la intervención, es crucial entender las necesidades de la población diana y aplicar intervenciones hechas a medida que incluyan la SDT no solo como conceptos a explicar sino también como una manera de guiar el desarrollo de la intervención. Por último, para la evaluación de la intervención destacamos: (a) utilizar métodos mixtos, (b) evaluar medidas objetivas y autopercepciones, y (c) medir la satisfacción de los participantes con la intervención.The purpose of the present study is to review recent interventions aimed at promoting physical activity using selfdetermination theory (SDT) framework. We present evidence-based proposals that researchers could find useful to develop their own interventions. Our narrative review includes journal articles published between 2011 that meet the following inclusion criteria: (a) using SDT as reference framework, (b) targeting healthy participants with age ≥ 12 years old, and (c) pursuing a main goal of promoting physical activity or related variables. Results are presented in three categories: (a) structure, theoretical approach and general aspects of the intervention, (b) development, and (c) assessment. Regarding the structure, two types of interventions emerged: those conducted within an existing setting, where professionals in charge receive specific training that is expected to indirectly affect their students/patients; and interventions developed from zero, where participants receive direct training or information. Results showed that the most common background to develop SDT interventions is autonomy support and autonomy satisfaction. Concerning the development of the intervention, it appears essential to understand the needs of the target population and to develop tailored interventions that consider SDT not only as concepts to explain but also as a way of thinking that guides the development of the interventions. Regarding the assessment of the intervention, researchers could consider (a) using mixed-methods approach, (b) including objective and self-reported measures and (c) measuring participants' satisfaction with the intervention

Are smokers 'hardening' or rather 'softening'? An ecological and multilevel analysis across 28 European Union countries

Background: tobacco control policies can reduce smoking prevalence. These measures may be less effective where smoking prevalence has significantly declined, as the remaining smokers have 'hardened'. Our aim was to empirically evaluate the 'hardening hypothesis' at the population level in the European Union (EU) and explore factors associated with hardcore smoking. Methods: we conducted two separate analyses in the EU using data on smoking from the Eurobarometer surveys (2009-2017, n=112 745). 1) A panel-data fixed-effects linear regression to investigate changes over time in the percentage of hardcore smokers in relation to standardised smoking prevalence at the country level. 2) A multilevel logistic regression analysis with hardcore (daily smokers, ≥15 cigarettes per day who have not attempted to quit in the last 12 months) or light (<5 cigarettes per day) smoking as the dependent variable and time as the main independent variable, controlling for individual and ecological variables. Results: we studied 29 010 current smokers (43.8% hardcore smokers and 14.7% light smokers). The prevalence of hardcore smoking among adult smokers increased by 0.55 (95% CI 0.14-0.96) percentage points per each additional percentage point in the overall smoking prevalence. The odds of being a hardcore smoker increased over time and were higher in middle-aged males and people with financial difficulties, while the odds of being a light smoker significantly declined among females. Conclusion: this study does not support the 'hardening hypothesis' in the EU between 2009 and 2017, but suggests a softening of the smoking population. Existing tobacco control policies are likely to be suitable to further decrease smoking prevalence in Europe

Novel tobacco and nicotine products and youth in the European Union

In recent years, there has been a rapid proliferation of novel tobacco and nicotine products in the market, which have gained in popularity among adolescents. The prevalence of ever users of electronic cigarettes (e-cigs) in Europe among those aged 10–24 ranges from 5.5% to 56.6%, with significant variations across countries. Adolescents have reported several reasons for e-cig use initiation, including low harm perception, social acceptability, novelty, and peer influence. Despite being marketed as safe alternatives, e-cigs are not risk-free and have already been associated with respiratory diseases. A major concern is their potential to renormalize smoking among non-smokers and to foster nicotine dependence, leading to the initiation of conventional cigarette smoking, which would reverse actual declining trends in tobacco consumption. Hence, to prevent a setback on the progress made in tobacco control, there is a pressing need for more comprehensive regulation, with a particular focus on adolescents, given that the teenage years are pivotal in determining future smoking behavior

Novel tobacco and nicotine products and youth in the European Union

In recent years, there has been a rapid proliferation of novel tobacco and nicotine products in the market, which have gained in popularity among adolescents. The prevalence of ever user of electronic cigarettes (e-cigs) in Europe among those aged 10–24 ranges from 5.5% to 56.6%, with significant variations across countries. Adolescents have reported several reasons for e-cigs use initiation, including low harm perception, social acceptability, novelty, and peer influence. Despite being marketed as safe alternatives, e-cigs are not risk-free and have already been associated with respiratory diseases. A major concern is their potential to renormalize smoking among non-smokers and to foster nicotine dependence, leading to initiation of conventional cigarette smoking, which would revert actual declining trends in tobacco consumption. Hence, to prevent a setback in the progress made in tobacco control, there is a pressing need for more comprehensive regulation, with a particular focus on adolescents, given that teenage years are key in determining future smoking behaviors

The European Code Against Cancer – new evidence and recommendations

Cancer is a major public health concern in the European Union (EU). There were 2.7 million new cancer cases and 1.3 million deaths in 2020 in the EU; of them, around 40% could have been prevented. Primary prevention is the most cost-effective long-term strategy for cancer control. The European Code Against Cancer (ECAC, 4th edition) is a health education tool aimed at raising awareness about evidence-based cancer prevention actions among EU citizens. The ECAC describes 12 ways individuals can reduce their cancer risk. Awareness of the ECAC (4th ed.) has been low (2–21%) and, therefore, efforts are needed to improve cancer prevention awareness throughout the region. Civil society and other stakeholders’ engagement is key to improving cancer prevention in the region. Our aim is to propose recommendations to improve future ECAC editions to ensure an increase in cancer prevention literacy in the EU

The European Code Against Cancer – new evidence and recommendations

Cancer is a major public health concern in the European Union (EU). There were 2.7 million new cancer cases and 1.3 million deaths in 2020 in the EU; of them, around 40% could have been prevented. Primary prevention is the most cost-effective long-term strategy for cancer control. The European Code Against Cancer (ECAC, 4th edition) is a health education tool aimed at raising awareness about evidence-based cancer prevention actions among EU citizens. The ECAC describes 12 ways individuals can reduce their cancer risk. Awareness of the ECAC (4th ed.) has been low (2–21%) and, therefore, efforts are needed to improve cancer prevention awareness throughout the region. Civil society and other stakeholders’ engagement is key to improving cancer prevention in the region. Our aim is to propose recommendations to improve future ECAC editions to ensure an increase in cancer prevention literacy in the EU

Regulation of Electronic Cigarette Use in Public and Private Areas in 48 Countries Within the WHO European Region: A Survey to In-country Informants

Background: The objective of this study is to describe the legislation regulating the use of electronic cigarettes (e-cigarettes) in various places in European countries. Methods: A survey among experts from all countries of the World Health Organization (WHO) European Region was conducted in 2018. We collected and described data on legislation regulating e-cigarette use indoors and outdoors in public and private places, the level of difficulties in adopting the legislation, and the public support and compliance. Factors associated with the legislation adoption were identified with Poisson and linear regression analyses. Results: Out of 48 countries, 58.3% had legislation on e-cigarette use at the national level. Education facilities were the most regulated place (58.3% of countries), while private areas (eg, homes, cars) were the least regulated ones (39.6%). A third of countries regulated e-cigarette use indoors. Difficulty and support in adopting the national legislation and its compliance were all at a moderate level. Countries' smoking prevalence and income levels were linked to legislation adoption. Conclusions: Although most WHO European Region countries had introduced e-cigarette use legislation at the national level, only a few of the legislation protect bystanders in indoor settings

Effectiveness of a telephone-based intervention for smoking cessation in patients with severe mental disorders: study protocol for a randomized controlled trial

Mental disorders; Smoking cessation; TelephoneMalalties mentals; Deixar de fumar; TelèfonEnfermedades mentales; Dejar de fumar; TeléfonoBACKGROUND: Up to 75% of inpatients with mental disorders smoke, and their life expectancy is decreased by up to 25 years compared to the general population. Hospitalized patients without monitoring after discharge quickly return to prehospitalization levels of tobacco use. The aim of the 061 QuitMental study is to assess the effectiveness of a multicomponent and motivational telephone-based intervention to stop smoking through a quitline addressed to smokers discharged from mental health hospital wards. METHODS: A pragmatic randomized controlled trial, single blinded, will include 2:1 allocation to the intervention group (IG) and the control group (CG). The IG will receive telephone assistance to quit smoking (including psychological and psychoeducational support, and pharmacological treatment advice if required) proactively for 12 months, and the CG will receive only brief advice after discharge. The sample size, calculated with an expected difference of 15 points on smoking abstinence between groups (IG, 20% and CG, 5%), α = 0.05, β = 0.10, and 20% loss, will be 334 participants (IG) and 176 participants (CG). Participants are adult smokers discharged from psychiatric units of five acute hospitals. Measurements include dependent variables (self-reported 7-day point prevalence smoking abstinence (carbon monoxide verified), duration of abstinence, number of quit attempts, motivation, and self-efficacy to quit) and independent variables (age, sex, and psychiatric diagnoses). In data analysis, IG and CG data will be compared at 48 h and 1, 6, and 12 months post discharge. Multivariate logistic regression (odds ratio; 95% confidence interval) of dependent variables adjusted for potential confounding variables will be performed. The number needed to treat to achieve one abstinence outcome will be calculated. We will compare the abstinence rate of enrolled patients between groups. DISCUSSION: This trial evaluates an innovative format of a quitline for smokers with severe mental disorders regardless of their motivation to quit. If effective, the pragmatic nature of the study will permit transfer to routine clinical practice in the National Health System