RESUMEN
INTRODUCTION: The harmful effects of first and secondhand smoking are well-established. Smoke-free laws aim at protecting nonsmokers. This study aimed to assess the impact of the 2013 total ban on indoor smoking in Chile on hospitalizations and deaths of major cardiovascular events. AIMS AND METHODS: The logarithm of the monthly hospitalization and death rates, standardized by age for every 100 000 inhabitants, were estimated for ischemic heart disease, acute myocardial infarction, strokes, and a composite outcome of ischemic heart diseases (which includes acute myocardial infarction) and strokes. In addition, interrupted time series with synthetic control groups were used to assess changes in levels and trends after the intervention. RESULTS: The total ban on indoor smoking caused significant reductions in death rates for the three diseases studied for age groups above 20 years old. In addition, there were substantial decreases in the post-intervention hospitalization rates for ischemic heart disease: for the 20-44 age group, the decrease was 8.7% compared to the pre-intervention period (pâ <â .01). In comparison, such a reduction was 4% (pâ <â .01) for the ≥65 age group. For acute myocardial infarction, the decrease was 11.5% (pâ <â .01) for the 20-44 age group, while for stroke, it was a 1.2% (pâ <â .01) decrease for the total population. It is estimated that the smoking ban averted 15.6% of the deaths compared with the synthetic control groups. CONCLUSIONS: The implementation of total smoke-free environments in Chile contributed to the reduction of mortality for main cardiovascular diseases. This study provides additional evidence of causality linking the policy to health outcomes. IMPLICATIONS: The total indoor smoking ban significantly affected age-standardized hospitalization and deaths. The number of deaths averted by this policy is estimated at approximately 4758 and 5256 for IHD and stroke, respectively, during the 2013-2017 period (15.6% fewer deaths than predicted by the synthetic control groups). The study contributes to the body of evidence that supports total indoor smoking bans.
Asunto(s)
Enfermedades Cardiovasculares , Hospitalización , Contaminación por Humo de Tabaco , Humanos , Chile/epidemiología , Hospitalización/estadística & datos numéricos , Adulto , Persona de Mediana Edad , Contaminación por Humo de Tabaco/prevención & control , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Contaminación por Humo de Tabaco/efectos adversos , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/prevención & control , Anciano , Masculino , Femenino , Adulto Joven , Política para Fumadores/legislación & jurisprudencia , Infarto del Miocardio/mortalidad , Infarto del Miocardio/epidemiología , Infarto del Miocardio/prevención & control , Fumar/legislación & jurisprudencia , Fumar/epidemiología , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/prevención & controlRESUMEN
Smoking and exposure to secondhand smoke pose a significant risk to the health of populations. Although this evidence is not new, the commitment of countries to implement laws aimed at controlling consumption and eliminating exposure to secondhand smoke is uneven. Thus, in North America or in Europe, locations like California or Ireland, are pioneers in establishing policies aimed at protecting the population against smoking and secondhand smoke. Identifying measures that have worked would help control this important Public Health problem in other countries that are further behind in tobacco control policies. In Spain, there has been almost 15 years of little political action in legislation oriented to control the tobacco epidemic. If we want to achieve the tobacco endgame, new legislative measures must be implemented. In this paper, we have elucidated tobacco control policies that could be implemented and show how different countries have done so.
Asunto(s)
Política de Salud , Contaminación por Humo de Tabaco , Humanos , España/epidemiología , Contaminación por Humo de Tabaco/prevención & control , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Contaminación por Humo de Tabaco/efectos adversos , Política de Salud/legislación & jurisprudencia , Fumar/legislación & jurisprudencia , Fumar/epidemiología , Fumar/efectos adversos , Prevención del Hábito de Fumar/legislación & jurisprudencia , Cese del Hábito de Fumar/legislación & jurisprudencia , Política para Fumadores/legislación & jurisprudencia , Control del TabacoRESUMEN
OBJECTIVE: To examine the associations of partial and comprehensive smoke-free legislation with neonatal and infant mortality in Brazil using a quasi-experimental study design. DESIGN: Monthly longitudinal (panel) ecological study from January 2000 to December 2016. SETTING: All Brazilian municipalities (n=5565). PARTICIPANTS: Infant populations. INTERVENTION: Smoke-free legislation in effect in each municipality and month. Legislation was encoded as basic (allowing smoking areas), partial (segregated smoking rooms) or comprehensive (no smoking in public buildings). Associations were quantified by immediate step and longer term slope/trend changes in outcomes. STATISTICAL ANALYSES: Municipal-level linear fixed-effects regression models. MAIN OUTCOMES MEASURES: Infant and neonatal mortality. RESULTS: Implementation of partial smoke-free legislation was associated with a -3.3 % (95% CI -6.2% to -0.4%) step reduction in the municipal infant mortality rate, but no step change in neonatal mortality. Comprehensive smoke-free legislation implementation was associated with -5.2 % (95% CI -8.3% to -2.1%) and -3.4 % (95% CI -6.7% to -0.1%) step reductions in infant and neonatal mortality, respectively, and a -0.36 (95% CI -0.66 to-0.06) annual decline in the infant mortality rate. We estimated that had all smoke-free legislation introduced since 2004 been comprehensive, an additional 10 091 infant deaths (95% CI 1196 to 21 761) could have been averted. CONCLUSIONS: Strengthening smoke-free legislation in Brazil is associated with improvements in infant health outcomes-particularly under comprehensive legislation. Governments should accelerate implementation of comprehensive smoke-free legislation to protect infant health and achieve the United Nation's Sustainable Development Goal three.
Asunto(s)
Muerte del Lactante/etiología , Mortalidad Infantil , Muerte Perinatal/etiología , Política para Fumadores/legislación & jurisprudencia , Prevención del Hábito de Fumar/métodos , Fumar/legislación & jurisprudencia , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Adolescente , Adulto , Anciano , Brasil/epidemiología , Femenino , Humanos , Lactante , Salud del Lactante , Recién Nacido , Modelos Lineales , Masculino , Persona de Mediana Edad , Embarazo , Humo/efectos adversos , Cese del Hábito de Fumar , Prevención del Hábito de Fumar/legislación & jurisprudencia , Productos de Tabaco/legislación & jurisprudencia , Contaminación por Humo de Tabaco/efectos adversosRESUMEN
Brazil was one of the first countries in the world to ban Electronic Smoking Devices (ESDs). This ban was motivated by the lack of evidence regarding the alleged therapeutic properties and harmlessness of these products. Anvisa was criticized for this move, especially by electronic cigarette's users groups. These groups argue that prohibition prevented people's access to a product that would aid smoking cessation and be less toxic than ordinary cigarettes. Thus, the question arises as to whether this decision was successful. Available data show that ESDs have diverse formulations and some toxic substances are released at significant levels during use. Studies in animals and humans have shown a potential toxic effect, also affecting the health of passive smokers. Studies are still inconclusive regarding its use as a cessation tool. A high level of use among adolescents was observed in countries whose use was authorized. Thus, Brazil's ban prevented the population from consuming a product that has not been proven effective toward smoking cessation, with indications of significant toxicity and highly attractive to young people.
O Brasil foi um dos primeiros países do mundo a proibir os Dispositivos Eletrônicos de Fumar (DEFs), tal proibição foi motivada pela inexistência de evidências relativas às alegadas propriedades terapêuticas e da inocuidade destes produtos. Por conta de tal proibição, A Anvisa foi criticada, especialmente de grupos de usuários. Estes grupos argumentam que tal ação proibiu um produto que auxiliaria a cessação ao tabagismo e seria menos tóxico que os cigarros comuns. Assim sendo, surge o questionamento se esta decisão foi acertada ou não. Os dados disponíveis mostram que os DEFs possuem formulações diversas e algumas substâncias tóxicas são liberadas durante sua utilização em níveis significativos. Estudos em animais e em humanos demonstraram potencial efeito tóxico. Os DEFs também demostraram que podem afetar a saúde de fumantes passivos. Quanto a seu uso como ferramenta de cessação, os estudos ainda não são conclusivos. Observou-se também um alto grau de uso entre adolescentes em países que seu uso foi autorizado. Desta forma o Brasil ao proibir estes produtos, impediu que a população consumisse um produto sem comprovação que auxiliasse no tratamento do tabagismo, com indícios de significativa toxidade e altamente atrativo aos jovens.
Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina , Política para Fumadores/legislación & jurisprudencia , Cese del Hábito de Fumar/métodos , Vapeo/legislación & jurisprudencia , Adolescente , Animales , Brasil , Humanos , Contaminación por Humo de Tabaco/efectos adversos , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Contaminación por Humo de Tabaco/prevención & control , Vapeo/efectos adversos , Vapeo/prevención & controlRESUMEN
OBJECTIVE: To review the implementation of the WHO Framework Convention onTobacco Control in theAmericas, describe two national case studies and analyze the evidence on electronic cigarettes from a public health perspective. MATERIALS AND METHODS: Revision of the tobacco control legislation and the scientific evidence regarding electronic cigarettes. RESULTS: Implementation of tobacco control policies is not homogeneous, with important advances in smoke-free environments, pictorial health warnings, and epidemiological surveillance, but challenges that remain for the implementation of a total ban of tobacco advertising, increases in tobacco taxes, and tobacco cessation programs. Tobacco industry interference is one of the main obstacles for advancing and novel products create uncertainty about their regulation. CONCLUSIONS: There is a need for political will for a comprehensive implementation of the Convention, with evidence-based decisions to confront challenges and to defend the achievements from tobacco industry interference.
OBJETIVO: Revisar la aplicación del Convenio Marco de la OMS para el Control del Tabaco en las Américas, describir dos estudios de caso nacionales y analizar la evidencia sobre los cigarrillos electrónicos desde la perspectiva de salud pública. MATERIAL Y MÉTODOS: Revisión de la legislación de control de tabaco y la evidencia científica sobre los cigarrillos electrónicos. RESULTADOS: La aplicación de políticas no es homogénea, con avances importantes en ambientes libres de humo, advertencias sanitarias gráficas y vigilancia epidemiológica, pero desafíos pendientes en la prohibición total de la publicidad, incremento de impuestos y cesación tabáquica.La interferencia de la industria tabacalera es uno de los principales obstáculos para avanzar y los nuevos productos crean incertidumbre sobre su regulación. CONCLUSIONES: Se necesita revitalizar la voluntad política para aplicar integralmente el Convenio, tomando decisiones basadas en evidencia ante los nuevos desafíos y defendiendo los logros de la interferencia de la industria.
Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina , Prevención del Hábito de Fumar/legislación & jurisprudencia , Productos de Tabaco/legislación & jurisprudencia , Publicidad , Práctica Clínica Basada en la Evidencia , Implementación de Plan de Salud , Promoción de la Salud/métodos , Humanos , Cooperación Internacional , Maniobras Políticas , México , Panamá , Política para Fumadores , Prevención del Hábito de Fumar/tendencias , Impuestos , Industria del Tabaco/economía , Industria del Tabaco/legislación & jurisprudencia , Productos de Tabaco/provisión & distribución , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Contaminación por Humo de Tabaco/prevención & control , Organización Mundial de la SaludRESUMEN
Resumo O Brasil foi um dos primeiros países do mundo a proibir os Dispositivos Eletrônicos de Fumar (DEFs), tal proibição foi motivada pela inexistência de evidências relativas às alegadas propriedades terapêuticas e da inocuidade destes produtos. Por conta de tal proibição, A Anvisa foi criticada, especialmente de grupos de usuários. Estes grupos argumentam que tal ação proibiu um produto que auxiliaria a cessação ao tabagismo e seria menos tóxico que os cigarros comuns. Assim sendo, surge o questionamento se esta decisão foi acertada ou não. Os dados disponíveis mostram que os DEFs possuem formulações diversas e algumas substâncias tóxicas são liberadas durante sua utilização em níveis significativos. Estudos em animais e em humanos demonstraram potencial efeito tóxico. Os DEFs também demostraram que podem afetar a saúde de fumantes passivos. Quanto a seu uso como ferramenta de cessação, os estudos ainda não são conclusivos. Observou-se também um alto grau de uso entre adolescentes em países que seu uso foi autorizado. Desta forma o Brasil ao proibir estes produtos, impediu que a população consumisse um produto sem comprovação que auxiliasse no tratamento do tabagismo, com indícios de significativa toxidade e altamente atrativo aos jovens.
Abstract Brazil was one of the first countries in the world to ban Electronic Smoking Devices (ESDs). This ban was motivated by the lack of evidence regarding the alleged therapeutic properties and harmlessness of these products. Anvisa was criticized for this move, especially by electronic cigarette's users groups. These groups argue that prohibition prevented people's access to a product that would aid smoking cessation and be less toxic than ordinary cigarettes. Thus, the question arises as to whether this decision was successful. Available data show that ESDs have diverse formulations and some toxic substances are released at significant levels during use. Studies in animals and humans have shown a potential toxic effect, also affecting the health of passive smokers. Studies are still inconclusive regarding its use as a cessation tool. A high level of use among adolescents was observed in countries whose use was authorized. Thus, Brazil's ban prevented the population from consuming a product that has not been proven effective toward smoking cessation, with indications of significant toxicity and highly attractive to young people.
Asunto(s)
Humanos , Animales , Adolescente , Cese del Hábito de Fumar/métodos , Política para Fumadores/legislación & jurisprudencia , Sistemas Electrónicos de Liberación de Nicotina , Vapeo/legislación & jurisprudencia , Contaminación por Humo de Tabaco/efectos adversos , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Contaminación por Humo de Tabaco/prevención & control , Brasil , Vapeo/efectos adversos , Vapeo/prevención & controlRESUMEN
OBJECTIVE: To evaluate the impact of a complete smoking ban in enclosed spaces on the incidence of acute myocardial infarction in Chile. METHODS: The population-based study involved residents of urban areas, where 80% of the Chilean population live, aged 20 years or older who had a myocardial infarction. Monthly myocardial infarction incidence and mortality rates at health-care facilities between January 2011 and December 2014 were derived from admission and mortality databases. Regression discontinuity methods were used to estimate the near-immediate impact on disease incidence of enforcing smoke-free legislation in March 2013. The same analysis was performed for ischaemic stroke, degenerative disc disease and colon cancer. Data on the concentration of fine respirable particulates were included in an additional analysis of myocardial infarction incidence in the Santiago metropolitan area. RESULTS: The enforcement of smoke-free legislation was associated with an abrupt, near-immediate decline of 0.639 cases of myocardial infarction per 100 000 adults per month (95% confidence interval, CI: 0.242 to 1.036; relative decline: 7.8%). Similar declines were observed in men and women and in people aged over and under 70 years. However, enforcement of the legislation was not associated with a significant change in the rate of ischaemic stroke, degenerative disc disease or colon cancer. The abrupt decline in myocardial infarction incidence was also observed when data on fine respirable particulates were included in an analysis for Santiago. CONCLUSION: The enforcement of extensive smoke-free legislation in Chile was associated with an abrupt, near-immediate decline in the incidence of myocardial infarction.
Asunto(s)
Infarto del Miocardio/epidemiología , Política Pública , Política para Fumadores/legislación & jurisprudencia , Fumar/legislación & jurisprudencia , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Adulto , Anciano , Chile/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud , Fumar/efectos adversos , Contaminación por Humo de Tabaco/efectos adversos , Adulto JovenRESUMEN
Passive smoking causes severe and lethal effects on health. Since 1996 Brazil has been moving forward in the implementation of anti-smoking legislation in enclosed public spaces. This article aims to evaluate the perceived enforcement of anti-smoking legislation in the cities of Porto Alegre (Rio Grande do Sul State), Rio de Janeiro and São Paulo, Brazil, based on the results of the ITC-Brazil Survey (International Tobacco Control Policy Evaluation Project). The results of the survey showed a significant reduction in the proportion of people who saw individuals smoking in restaurants and bars between 2009 and 2013 in the three cities surveyed. Concurrently there was an increase in the proportion of smokers who mentioned having smoked in the outer areas of these facilities. These results likely reflect a successful implementation of anti-smoking laws. Of note is the fact that by decreasing passive smoking we further enhance smoking denormalization among the general population, decreasing smoking initiation and increasing its cessation.
Asunto(s)
Aplicación de la Ley , Restaurantes/legislación & jurisprudencia , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Contaminación por Humo de Tabaco/prevención & control , Brasil , Política de Salud , Humanos , Entrevistas como Asunto , Percepción , Política Pública , Encuestas y Cuestionarios , Teléfono , Población UrbanaRESUMEN
OBJECTIVE:: To analyze successful national smokefree policy implementation in Colombia, a middle income country. MATERIALS AND METHODS:: Key informants at the national and local levels were interviewed and news sources and government ministry resolutions were reviewed. RESULTS:: Colombia's Ministry of Health coordinated local implementation practices, which were strongest in larger cities with supportive leadership. Nongovernmental organizations provided technical assistance and highlighted noncompliance. Organizations outside Colombia funded some of these efforts. The bar owners' association provided concerted education campaigns. Tobacco interests did not openly challenge implementation. CONCLUSIONS:: Health organization monitoring, external funding, and hospitality industry support contributed to effective implementation, and could be cultivated in other low and middle income countries.
Asunto(s)
Política para Fumadores , Colombia , Organización de la Financiación , Agencias Gubernamentales , Adhesión a Directriz , Promoción de la Salud , Humanos , Organizaciones , Política Pública , Restaurantes/legislación & jurisprudencia , Restaurantes/organización & administración , Política para Fumadores/legislación & jurisprudencia , Industria del Tabaco , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Contaminación por Humo de Tabaco/prevención & control , UniversidadesRESUMEN
Abstract: Objective: To analyze successful national smokefree policy implementation in Colombia, a middle income country. Materials and methods: Key informants at the national and local levels were interviewed and news sources and government ministry resolutions were reviewed. Results: Colombia’s Ministry of Health coordinated local implementation practices, which were strongest in larger cities with supportive leadership. Nongovernmental organizations provided technical assistance and highlighted noncompliance. Organizations outside Colombia funded some of these efforts. The bar owners’ association provided concerted education campaigns. Tobacco interests did not openly challenge implementation. Conclusions: Health organization monitoring, external funding, and hospitality industry support contributed to effective implementation, and could be cultivated in other low and middle income countries.
Resumen: Objetivo: Analizar la implementación exitosa de políticas nacionales de ambientes libres de humo en Colombia, un país de ingresos medios. Material y métodos: Entrevistas con informantes claves a nivel nacional y local, y revisión de artículos en las noticias y resoluciones ministeriales nacionales. Resultados: El Ministerio de Salud de Colombia coordinó las prácticas locales para la implementación, que fueron más fuertes en las ciudades grandes y en las ciudades con líderes políticos que la apoyaron. Organizaciones no gubernamentales proporcionaron asistencia técnica y destacaron el incumplimiento. Organizaciones fuera de Colombia financiaron algunos de estos esfuerzos. La asociación de propietarios de bares proporcionó campañas de educación concertadas. Intereses tabacaleros no desafiaron abiertamente la implementación. Conclusiones. La vigilancia de las organizaciones no gubernamentales, la financiación externa y el apoyo de la industria de la hospitalidad contribuyeron a una implementación eficaz. Tales factores pueden ser cultivados en países de ingresos bajos y medios.
Asunto(s)
Humanos , Política para Fumadores/legislación & jurisprudencia , Política Pública , Restaurantes/legislación & jurisprudencia , Restaurantes/organización & administración , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Contaminación por Humo de Tabaco/prevención & control , Universidades , Organizaciones , Colombia , Industria del Tabaco , Adhesión a Directriz , Organización de la Financiación , Agencias Gubernamentales , Promoción de la SaludRESUMEN
Resumo: O tabagismo passivo causa sérios e mortais efeitos à saúde. Desde 1996, o Brasil vem avançando na implementação da legislação antifumo em locais públicos fechados. Este artigo busca avaliar a percepção do cumprimento da legislação antifumo nas cidades de Porto Alegre (Rio Grande do Sul), Rio de Janeiro e São Paulo, com base nos resultados da pesquisa ITC-Brasil (International Tobacco Control Policy Evaluation Project). Os resultados desta pesquisa mostraram uma redução significativa da proporção de pessoas que notaram indivíduos fumando em restaurantes e bares entre 2009 e 2013 nas três cidades pesquisadas. Paralelamente, houve um aumento da proporção de fumantes que referiram ter fumado na área externa desses estabelecimentos. Tais resultados provavelmente refletem uma implementação exitosa das leis antifumo. Vale ressaltar que ao diminuir a exposição ao fumo passivo, aumentamos ainda mais a desnormalização do tabagismo na população em geral, podendo assim diminuir sua iniciação e aumentar a cessação de fumar.
Resumen: El tabaquismo pasivo causa serios y mortales efectos para la salud. Desde 1996, Brasil ha avanzado en la implementación de la legislación antitabaco en locales públicos cerrados. Este artículo busca evaluar la percepción del cumplimiento de la legislación antitabaco en las ciudades de Porto Alegre (Rio Grande do Sul), Río de Janeiro y São Paulo, Brasil, en base a los resultados de la investigación ITC-Brasil (International Tobacco Control Policy Evaluation Project). Los resultados de esta investigación mostraron una reducción significativa de la proporción de personas que notaron individuos fumando en restaurantes y bares entre 2009 y 2013 en las tres ciudades investigadas. Paralelamente, hubo un aumento de la proporción de fumadores que informaron haber fumado en el área externa de esos establecimientos. Tales resultados probablemente reflejan una implementación exitosa de las leyes antitabaco. Vale resaltar que al disminuir la exposición al humo pasivo, aumentamos incluso más la desnormalización del tabaquismo en la población en general, pudiendo así disminuir su iniciación y aumentar el abandono del tabaco.
Abstract: Passive smoking causes severe and lethal effects on health. Since 1996 Brazil has been moving forward in the implementation of anti-smoking legislation in enclosed public spaces. This article aims to evaluate the perceived enforcement of anti-smoking legislation in the cities of Porto Alegre (Rio Grande do Sul State), Rio de Janeiro and São Paulo, Brazil, based on the results of the ITC-Brazil Survey (International Tobacco Control Policy Evaluation Project). The results of the survey showed a significant reduction in the proportion of people who saw individuals smoking in restaurants and bars between 2009 and 2013 in the three cities surveyed. Concurrently there was an increase in the proportion of smokers who mentioned having smoked in the outer areas of these facilities. These results likely reflect a successful implementation of anti-smoking laws. Of note is the fact that by decreasing passive smoking we further enhance smoking denormalization among the general population, decreasing smoking initiation and increasing its cessation.
Asunto(s)
Humanos , Restaurantes/legislación & jurisprudencia , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Contaminación por Humo de Tabaco/prevención & control , Aplicación de la Ley , Percepción , Política Pública , Teléfono , Población Urbana , Brasil , Entrevistas como Asunto , Encuestas y Cuestionarios , Política de SaludRESUMEN
BACKGROUND: Smoke-free environments decrease smoking prevalence and consequently the incidence of heart disease and lung cancer. Due to issues related to poor enforcement, scant data is currently available from low/middle income countries on the long-term compliance to smoke-free laws. In 2006, high levels of secondhand smoke (SHS) were found in bars and restaurants in Guatemala City. Six months after a smoking ban was implemented in 2009, levels significantly decreased. However, in 2010, poor law compliance was observed. Therefore, we sought to assess long-term compliance to the ban using SHS measurements. METHODS: In 2014 we assessed SHS exposure using airborne nicotine monitors in bars (n = 9) and restaurants (n = 12) for 7 days using the same protocol as in 2006 and in 2009. Nicotine was measured using gas-chromatography (µg/m(3)) and compared to levels pre- (2006) and post-ban (2009). Employees responded to a survey about SHS exposure, perceived economic impact of the ban and customers' electronic cigarette use. In addition, we estimated the fines that could have been collected for each law infringement. RESULTS: Most (71 %) venues still have a smoking section, violating the law. The percentage of samples with detectable nicotine concentrations was 100, 85 and 43 % in 2006, 2009 and 2014, respectively. In bars, median (25(th) and 75(th) percentiles) nicotine concentrations were 4.58 µg/m(3) (1.71, 6.45) in 2006, 0.28 (0.17, 0.66) in 2009, and 0.59 (0.01, 1.45) in 2014. In restaurants, the corresponding medians were 0.58 µg/m(3) (0.44, 0.71), 0.04 (0.01, 0.11), and 0.01 (0.01, 0.09). Support for the law continues to be high (88 %) among bar and restaurant employees. Most employees report no economic impact of the law and that a high proportion of customers (78 %) use e-cigarettes. A total of US$50,012 could have been collected in fines. CONCLUSIONS: Long-term compliance to the smoking ban in Guatemala is decreasing. Additional research that evaluates the determinants of non-compliance is needed and could also contribute to improve enforcement and implementation of the smoke-free law in Guatemala.
Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina/estadística & datos numéricos , Exposición a Riesgos Ambientales/análisis , Política de Salud/legislación & jurisprudencia , Nicotina/análisis , Restaurantes/legislación & jurisprudencia , Fumar/legislación & jurisprudencia , Contaminación por Humo de Tabaco/análisis , Exposición a Riesgos Ambientales/legislación & jurisprudencia , Guatemala , Adhesión a Directriz , Humanos , Renta , Exposición Profesional , Humo/análisis , Encuestas y Cuestionarios , Contaminación por Humo de Tabaco/legislación & jurisprudenciaRESUMEN
OBJECTIVE: China issued a nationwide "Tobacco-Free Campus" Policy (TFCP) in January 2014, but it is unclear how well it was implemented across China's 2138 college campuses. We conducted an Internet survey of Beijing college students to evaluate the implementation of the TFCP in Beijing. METHODS: An Internet survey of 711 students from 37 colleges in Beijing was conducted in May 2015. Respondents reported on secondhand smoking (SHS) exposure on campus, knowledge on and actions taken against SHS, and tobacco marketing exposure on campus. RESULTS: Almost 90% of respondents were exposed to SHS on campus at least once in the past month. Approximately 37% of nonsmokers and 61% of smokers reported seeing a teacher smoking, and the majority of both smokers and nonsmokers reported seeing a classmate smoking in campus buildings. The likelihood and location of SHS exposure depend on the participant's demographics and own smoking behavior. Nonsmokers were more likely to be aware of the health risk of SHS than smokers. Although most participants were aware of the harms, only 13% and 9% tried to stop their last SHS exposure indoors and outdoors, respectively. Forty-seven students from 14 colleges noticed tobacco marketing activities on campus. CONCLUSIONS: The TFCP on Chinese college campuses was only partially enforced, particularly with regard to SHS. IMPLICATIONS: On January 29, 2014, the Chinese Ministry of Education issued the TFCP. A major barrier to effective tobacco control in China is the difficulty in implementing policies issued by the central government. At this point, it is unclear whether the TFCP was successfully implemented on China's college campuses. Major tobacco use monitoring efforts do not include college students. The present research describes the current tobacco control environment on Beijing's college campuses 15 months after the TFCP took effect. To our knowledge, this is the first paper in the English literature on tobacco environment and exposure (rather than a prevalence survey) of college students in China.
Asunto(s)
Política para Fumadores , Fumar/epidemiología , Adolescente , Adulto , Beijing/epidemiología , Femenino , Humanos , Internet , Masculino , Fumar/legislación & jurisprudencia , Cese del Hábito de Fumar , Prevención del Hábito de Fumar , Estudiantes , Encuestas y Cuestionarios , Nicotiana , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Contaminación por Humo de Tabaco/prevención & control , Universidades , Adulto JovenRESUMEN
OBJECTIVE: To analyze the passage of Costa Rica's 2012 tobacco control law. MATERIALS AND METHODS: Review of legislation, newspaper articles, and key informant interviews. RESULTS: Tobacco control advocates, in close collaboration with international health groups, recruited national, regional and international experts to testify in the Legislative Assembly, implemented grassroots advocacy campaigns, and generated media coverage to enact strong legislation in March 2012 consistent with the World Health Organization Framework Convention on Tobacco Control, despite tobacco industry lobbying efforts that for decades blocked effective tobacco control legislation. CONCLUSION: Costa Rica's experience illustrates how with resources, good strategic planning, aggressive tactics and perseverance tobacco control advocates can overcome tobacco industry opposition in the Legislative Assembly and Executive Branch. This determined approach has positioned Costa Rica to become a regional leader in tobacco control.
Asunto(s)
Política de Salud/legislación & jurisprudencia , Maniobras Políticas , Fumar/legislación & jurisprudencia , Industria del Tabaco/legislación & jurisprudencia , Costa Rica , Humanos , Salud Pública/legislación & jurisprudencia , Cese del Hábito de Fumar/legislación & jurisprudencia , Nicotiana , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Contaminación por Humo de Tabaco/prevención & control , Tabaquismo/prevención & controlRESUMEN
Objective. To analyze the passage of Costa Rica's 2012 tobacco control law. Materials and methods. Review of legislation, newspaper articles, and key informant interviews. Results. Tobacco control advocates, in close collaboration with international health groups, recruited national, regional and international experts to testify in the Legislative Assembly, implemented grassroots advocacy campaigns, and generated media coverage to enact strong legislation in March 2012 consistent with the World Health Organization Framework Convention on Tobacco Control, despite tobacco industry lobbying efforts that for decades blocked effective tobacco control legislation. Conclusion. Costa Rica's experience illustrates how with resources, good strategic planning, aggressive tactics and perseverance tobacco control advocates can overcome tobacco industry opposition in the Legislative Assembly and Executive Branch. This determined approach has positioned Costa Rica to become a regional leader in tobacco control.
Objetivo. Analizar la adopción de la ley de control del tabaco de 2012 en Costa Rica. Material y métodos. Revisión de la legislación, artículos de periódicos y entrevistas con informantes clave. Resultados. Los defensores del control del tabaco, en estrecha colaboración con grupos internacionales de salud pública y expertos nacionales, regionales e internacionales, reclutados para testificar en la Asamblea Legislativa, implementaron campañas de comunicación e incidencia política que resultaron en la aprobación en marzo de 2012 de una legislación fuerte y en consonancia con el Convenio Marco para el Control del Tabaco de la Organización Mundial de la Salud. Todo esto a pesar de los esfuerzos de la industria tabacalera que, por décadas, había logrado bloquear la aprobación de una legislación eficaz de control del tabaco en Costa Rica. Conclusión. La experiencia de Costa Rica ilustra cómo con recursos, una buena planificación estratégica, tácticas agresivas y perseverancia, los defensores del control del tabaco pudieron superar la oposición de la industria tabacalera en la Asamblea Legislativa y el Poder Ejecutivo. La adopción de una ley efectiva de control de tabaco ha posicionado a Costa Rica como un líder regional en el control de tabaco.
Asunto(s)
Humanos , Fumar/legislación & jurisprudencia , Industria del Tabaco/legislación & jurisprudencia , Política de Salud/legislación & jurisprudencia , Maniobras Políticas , Nicotiana , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Contaminación por Humo de Tabaco/prevención & control , Tabaquismo/prevención & control , Salud Pública/legislación & jurisprudencia , Cese del Hábito de Fumar/legislación & jurisprudencia , Costa RicaRESUMEN
INTRODUCTION: Many low- and middle-income countries (LMICs) have enacted legislation banning smoking in public places, yet enforcement remains challenging. The aim of this study was to assess the feasibility of using a validated low-cost methodology (the Dylos DC1700) to provide objective evidence of smoke-free (SF) law compliance in hospitality venues in urban LMIC settings, where outdoor air pollution levels are generally high. METHODS: Teams measured indoor fine particulate matter (PM2.5) concentrations and systematically observed smoking behavior and SF signage in a convenience sample of hospitality venues (bars, restaurants, cafes, and hotels) covered by existing SF legislation in Mexico, Pakistan, Indonesia, Chad, Bangladesh, and India. Outdoor air PM2.5 was also measured on each sampling day. RESULTS: Data were collected from 626 venues. Smoking was observed during almost one-third of visits with substantial differences between countries-from 5% in India to 72% in Chad. After excluding venues where other combustion sources were observed, secondhand smoke (SHS) derived PM2.5 was calculated by subtracting outdoor ambient PM2.5 concentrations from indoor measurements and was, on average, 34 µg/m(3) in venues with observed smoking-compared to an average value of 0 µg/m(3) in venues where smoking was not observed (P < .001). In over one-quarter of venues where smoking was observed the difference between indoor and outdoor PM2.5 concentrations exceeded 64 µg/m(3). CONCLUSIONS: This study suggests that low-cost air quality monitoring is a viable method for improving knowledge about environmental SHS and can provide indicative data on compliance with local and national SF legislation in hospitality venues in LMICs. IMPLICATIONS: Air quality monitoring can provide objective scientific data on SHS and air quality levels in venues to assess the effectiveness of SF laws and identify required improvements. Equipment costs and high outdoor air pollution levels have hitherto limited application in LMICs. This study tested the feasibility of using a validated low-cost methodology in hospitality venues in six LMIC urban settings and suggests this is a viable method for improving knowledge about SHS exposure and can provide indicative data on compliance with SF legislation.
Asunto(s)
Monitoreo del Ambiente/economía , Pobreza/economía , Política para Fumadores/economía , Fumar/economía , Contaminación por Humo de Tabaco/análisis , Contaminación por Humo de Tabaco/economía , Contaminación del Aire Interior/análisis , Contaminación del Aire Interior/economía , Contaminación del Aire Interior/legislación & jurisprudencia , Bangladesh , Monitoreo del Ambiente/legislación & jurisprudencia , Monitoreo del Ambiente/métodos , Humanos , Renta , India , México , Pakistán , Material Particulado/análisis , Pobreza/legislación & jurisprudencia , Restaurantes , Política para Fumadores/legislación & jurisprudencia , Fumar/legislación & jurisprudencia , Prevención del Hábito de Fumar , Encuestas y Cuestionarios , Contaminación por Humo de Tabaco/legislación & jurisprudenciaRESUMEN
Very recently ASH -Global Action for everyone's health 2014 published two lesson on the progress of smoke free regulations in two countries France and Uruguay with all the explanations and comments referring to the results, limits and benefits of different strategies. I am trying to see in comparison with this two examples what we have done and what is necessary to learn in the future for also having in Romania a strong free regulation for smoke free environment.
Asunto(s)
Agencias Gubernamentales/legislación & jurisprudencia , Política de Salud/legislación & jurisprudencia , Fumar/legislación & jurisprudencia , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Francia/epidemiología , Humanos , Educación del Paciente como Asunto/tendencias , Rumanía/epidemiología , Fumar/epidemiología , Fumar/tendencias , Prevención del Hábito de Fumar , Contaminación por Humo de Tabaco/prevención & control , Contaminación por Humo de Tabaco/estadística & datos numéricos , Uruguay/epidemiología , Organización Mundial de la SaludRESUMEN
The smoke-free legislation implemented in Spain in 2006 imposed a partial ban on smoking in public and work places, but the result did not meet expectations. Therefore, a more restrictive anti-smoking law was passed five years later in 2011 prohibiting smoking in all public places, on public transport, and the workplace. With the objective of assessing the impact of the latter anti-smoking legislation on children's exposure to second-hand smoke (SHS), we assessed parent's smoking habits and children's urine cotinine (UC) concentrations in 118 boys before (2005-2006) and after (2011-2012) the introduction of this law. Repeated cross-sectional follow-ups of the "Environment and Childhood Research Network" (INMA-Granada), a Spanish population-based birth cohort study, at 4-5 years old (2005-2006) and 10-11 years old (2011-2012), were designed. Data were gathered by ad-hoc questionnaire, and median UC levels recorded as an objective indicator of overall SHS exposure. Multivariable logistic regression was used to examine the association between parent's smoking habits at home and SHS exposure, among other potential predictors. An increase was observed in the prevalence of families with at least one smoker (39.0% vs. 50.8%) and in the prevalence of smoking mothers (20.3% vs. 29.7%) and fathers (33.9% vs. 39.0%). Median UC concentration was 8.0ng/mL (interquartile range [IQR]: 2.0-21.8) before legislation onset and 8.7ng/mL (IQR: 2.0-24.3) afterwards. In the multivariable analysis, the smoking status of parents and smoking habits at home were statistically associated with the risk of SHS exposure and with UC concentrations in children. These findings indicate that the recent prohibition of smoking in enclosed public and workplaces in Spain has not been accompanied by a decline in the exposure to SHS among children, who continue to be adversely affected. There is a need to target smoking at home in order to avoid future adverse health effects in a population that has no choice in the acceptance or not of SHS exposure-derived risk.
Asunto(s)
Contaminación del Aire Interior/análisis , Exposición por Inhalación , Fumar/legislación & jurisprudencia , Contaminación por Humo de Tabaco/análisis , Contaminación del Aire Interior/legislación & jurisprudencia , Niño , Preescolar , Cotinina/orina , Estudios Transversales , Estudios de Seguimiento , Humanos , Exposición por Inhalación/legislación & jurisprudencia , Masculino , Prevalencia , Fumar/epidemiología , España/epidemiología , Encuestas y Cuestionarios , Factores de Tiempo , Contaminación por Humo de Tabaco/legislación & jurisprudenciaRESUMEN
BACKGROUND: Comprehensive smoke-free laws have been followed by drops in hospitalisations for acute myocardial infarction (AMI), including in a study with 2â years follow-up for such a law in Uruguay. METHODS: Multiple linear and negative binomial regressions for AMI admissions (ICD-10 code 121) from 37 hospitals for 2â years before and 4â years after Uruguay implemented a 100% nationwide smoke-free law. RESULTS: Based on 11â 135 cases, there was a significant drop of -30.9 AMI admissions/month (95% CI -49.8 to -11.8, p=0.002) following implementation of the smoke-free law. The effect of the law did not increase or decrease over time following implementation (p=0.234). This drop represented a 17% drop in AMI admissions following the law (IRR=0.829, 95% CI 0.743 to 0.925, p=0.001). CONCLUSIONS: Adding two more years of follow-up data confirmed that Uruguay's smoke-free law was followed by a substantial and sustained reduction in AMI hospitalisations.
Asunto(s)
Hospitalización , Infarto del Miocardio , Salud Pública/legislación & jurisprudencia , Política para Fumadores , Cese del Hábito de Fumar/legislación & jurisprudencia , Fumar/legislación & jurisprudencia , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Adulto , Femenino , Humanos , Masculino , Infarto del Miocardio/terapia , Prevención del Hábito de Fumar , Uruguay , Lugar de TrabajoRESUMEN
INTRODUCTION: The California antitobacco culture may have influenced home smoking bans in Mexico. Based on the Behavioral Ecological Model, exposure to socially reinforcing contingencies or criticism may explain adoption of home smoking bans in Tijuana, Mexico, approximating rates relative to San Diego, California, and higher than those in Guadalajara, Mexico. METHODS: A representative cross-sectional population survey of Latinos (N = 1,901) was conducted in San Diego, Tijuana, and Guadalajara between June 2003 and September 2004. Cities were selected to represent high-, medium-, and low-level exposure to antitobacco social contingencies of reinforcement in a quasiexperimental analysis of possible cultural influences across borders. RESULTS: Complete home smoking ban prevalence was 91% in San Diego, 66% in Tijuana, and 38% in Guadalajara (p < .001). Sample cluster-adjusted logistic regression showed significantly lower odds of complete home smoking bans in Guadalajara (odds ratio [OR] = .048) and in Tijuana (OR = .138) compared to San Diego after control for demographics. Odds of complete home smoking bans in both Guadalajara and Tijuana in comparison with San Diego were weakened when mediators for bans were controlled in predictive models. Direction of association was consistent with theory. When theoretical mediators were explored as possible moderators, weak and nonsignificant associations were obtained for all interaction terms. Bootstrap analyses demonstrated that our multivariable logistic regression results were reliable. CONCLUSIONS: Results suggest that California antismoking social contingencies mediate complete home smoking bans in all 3 cities and may account for the greater effects in Tijuana contrasted with Guadalajara.