INTRODUCTION:Exposure to tobacco content in media among youth is a well-established risk factor for smoking initiation and continued use. This study assessed the prevalence and nature of tobacco imagery on Spanish prime-time television (TV) programming and its associations with program characteristics: genre, production nationality, and broadcast timing. METHODS:A content analysis of 63959 minutes of TV programming in 2021, excluding advertisements and trailers, across 18 broadcast channels examined the presence of tobacco imagery: actual tobacco use, tobacco cultural cues, smoking ban violations, tobacco brand appearances, or any of these. RESULTS:The analysis revealed that 2.4% of the TV programming time contained at least one instance of tobacco imagery, resulting in 8.5 million impressions for viewers aged 4-24 years. Feature films had the highest prevalence of tobacco-related content (adjusted prevalence ratio, APR=11.9; 95% CI: 9.5-14.9). Tobacco-related content appeared more frequently outside designated children's protection hours (PR=0.7; 95% CI: 0.6-0.80). However, its presence within the designated children's protection schedule remains a significant concern, generating 15.6 million tobacco impressions for young viewers. CONCLUSIONS:The seemingly modest content level of tobacco imagery (2.4%) translates into a substantial number of impressions for young viewers aged 4-24 years, including during the designated children's protection schedule. Reducing tobacco imagery in films and TV series represents a promising strategy for curbing youth smoking. However, the current reliance on youth protection schedules is inadequate. To better protect children from tobacco imagery, policies should mandate strong anti-tobacco disclaimers preceding programs featuring tobacco and certificates of No Pay-off for tobacco portrayals.

Introduction People with mental health disorders have a disproportionately higher prevalence of tobacco consumption compared to the general population, resulting in an increased mortality caused by tobacco-related disorders. However, tobacco has usually been a neglected, non-priority topic in mental health services. Our aim was to describe tobacco control policies and strategies implemented so far in outpatient mental health services in Catalonia and identify unmet needs. Material and Methods Cross-sectional study conducted in 2022. An electronic questionnaire was sent to all the heads of outpatient mental health services in Catalonia (n=203). The questionnaire included 28 items covering four dimensions: intervention; staff training and commitment; control of smoke-free spaces; and tobacco policy communication. While data collection is still in progress, up to the present date 74.4% of responses have been obtained (n=151). Results Staff training and commitment dimensions showed that 67.8% of service heads promoted tobacco control policies, 77.6% supported tobacco cessation interventions and 71.5% claimed that their staff knew how to assist smokers to quit. However, only 48.6% of services included tobacco cessation in their healthcare portfolio, 65.5% registered tobacco consumption systematically in their records, and 54.2% offered help to quit smoking in their care plans. These percentages were lower in child and adolescent centers, where only 26.8% of these centres included tobacco cessation in their healthcare plans, 34.1% offered help to their young patients to quit smoking, and 28.2% provided interventions to prevent tobacco consumption initiation. Conclusions Interventions to systematically identify smokers and offer them effective help to quit are still far from being consistently implemented and are not aligned with mental health care plans. While specific effective interventions are available, a considerable gap remains in facing tobacco use among this population. Efforts and resources need to be directed especially towards the younger population with mental disorders, which is currently receiving even less support than adults.

Introduction Tobacco has usually been a neglected topic in the field of mental health, despite the high mortality it causes in this population. The aim of this study was to describe tobacco control strategies in hospital wards and mental health day centers in Catalonia, regardless its affiliation to the Catalan Network of Smoke-free Hospitals (XCHsF), to identify areas of improvement and to compare the results with those obtained a decade ago. Material and Methods Repeated cross-sectional study with the same methodology in 2009 and 2020. An electronic questionnaire of 24 items covering 4 dimensions (intervention; staff training and commitment; control of smoke-free spaces; tobacco policy communication) was sent to all heads of mental health units in Catalonia. We obtained 186 (96.9%) responses in 2009 and 208 (98.1%) responses in 2020. Results The number of mental health care centers that joined the XCHsF has increased (43% vs 76.4%; p<0.05) between 2009 and 2020, same as the mental health professionals that are members of the Smoke-free Project Committee (37.9% vs 86.6%; p<0.05). An improvement is observed in the dimensions "intervention" (always/often intervene in tobacco use from 34.7% to 72.6%; p<0.05) and "control of smoke-free spaces" (no indoor smoking spaces from 59.5% to 84.7%; p<0.05). The child/youth units have not increased their score in any dimension. 84.3% of heads agree that funding drugs to stop smoking would encourage patients to try quitting and the majority believe that the Tobacco Legislation (Law 42/2010) has helped to improve tobacco control and intervention in their unit. Conclusions Smoking control and interventions have increased in the last decade in mental health units in Catalonia after the Spanish Law 42/2010. Efforts must be done especially in the children/youth mental services. Continued monitoring areas for improvement, promoting interventions and training health professionals are warranted.

Background The Tobacco Control Scale (TCS) was first published in 2006 to monitor the implementation of tobacco control policies at country-level in Europe and, since then, every three years a new report (2007, 2010, 2013 and 2016) has been published. Our objective was to develop a website to gather and structure the information included in the TCS reports, to provide friendly dynamic graphics for professionals and the public, as well as, to compile other documents and publications derived from the scale. Methods The original TCS reports were used to bring together all the information and tables included in order to be able to access to all the information from one site. The researchers systematically reviewed all published articles that include the TCS, as main dependent or independent variable and other materials (seminars, photos, etc.) related to the scale. The researchers also generated dynamic graphics for visitors to explore how their countries' scores fluctuate across years and compare with other European countries. The website has been adapted to mobile devices. Results The website (www.tobaccocontrolscale.org) was launched at the 7 th ECTOH in March 2017 in Portugal. It has had 1,556 visits (July 2017): 55.9% direct, 21% referral, 12.9% social (55.7% via Twitter) and 10.2% others; the 73% have been new and 27% returning visitors. By country, 19.7% visitors were from Germany, 8.4% from Switzerland, 8.4% from Spain and 8.2% from the UK. The 17.5% have accessed to the website using either a mobile phone or a tablet. Conclusions The website has been well received by the tobacco control community with almost 1,600 visits from all over the world; however, more diffusion has to be made to stimulate its use and reach a larger audience in the future that could probably extend the use of the scale for tobacco control purposes.

Objective To assess the impact of two Spanish smoking legislations in the adoption of voluntary smoke-free-homes rules in Spain.Methods This is a longitudinal study, before and after the implementation of two national smoking bans (in 2005 and 2010), in a representative sample (n=1245) of non-institutionalised adults (>= 16 years) from Barcelona (Spain) surveyed in 2004-2005 and followed up in 2013-2014. The final sample analysed was 736 individuals (400 women and 336 men). We defined smoking rules in the houses as complete (when smoking was not allowed in the household), partial (when smoking was allowed in some places inside the house) or absent (when smoking was allowed everywhere). We calculated relative changes in the prevalence of smoking rules in homes before and after 2 national smoking legislations by means of prevalence ratios (PRs) and their 95% CIs.Results The households with voluntary smoke-free rules (complete or partial) relatively increased 31% after Spanish smoking bans (from 55.6% to 72.6%, p<0.001). The houses with complete rules relatively increased 57% (from 23.9% to 37.6%, p<0.001) whereas the houses with partial rules increased 11% (from 31.7% to 35.0%, p=0.148). The increase of any type of rules (complete and partial) was statistically significantly independent of sex (PR between 1.29 and 1.33), age (PR between 1.24 and 1.33), educational level (PR between 1.19 and 1.47) and minimum age in house (PR between 1.12 and 1.40). However, this increase was statistically and significantly higher only among never smokers (PR=1.46) at baseline.Conclusions The implementation of the smoke-free regulations in public and work places in Spain was associated with an increasing of voluntary adoption of smoke-free rules in homes. According to our data, the Spanish smoking bans did not shift the tobacco consumption from public and work places to private places (homes).

Aims: The objectives of the present study were to describe smoking prevalence and compare the smoking attributes of adult smokers according to the type of tobacco product consumed.Methods: Repeated cross-sectional surveys (2004-2005 and 2011-2012) of a representative sample of the adult (>= 16 years) population in Barcelona, Spain, were used to assess self-reported tobacco consumption, smoking attributes, and salivary cotinine concentration. The survey conducted in 2004-2005 included information on 1245 subjects and the survey in 2011-2012 on 1307 individuals.Results: Smoking prevalence decreased over the study period (from 26.6% to 24.1% in self-reported daily smokers). The prevalence of daily smokers who reported the use of manufactured cigarettes declined from 23.7% in 2004-2005 to 17.3% in 2011-2012. The prevalence of roll-your-own cigarette users increased from 0.4% to 3.7%. According to data obtained in 2011-2012, the proportion of self-reported roll-your-own cigarette users was higher among men (19.8% vs. 9.5% of women), participants aged 16-44 years (22.9% vs. 5.8% of participants aged 45-65 years and 4.0% of participants aged >= 65 years), and participants with secondary and university education (17.7% and 18.5% vs. 7.9% of participants with less than primary and primary education). We did not observe differences in cotinine concentrations according to the type of tobacco product consumed.Conclusions: Systematic collection of data on smoking prevalence and smoker attributes from representative samples of the population is necessary for policymakers to develop efficient tobacco control interventions. Considering the increase of roll-your-own cigarette users and the unclear health consequences of their use, policymakers should aim to implement tax policies to equalize the prices of different types of tobacco products.

Life expectancy for people with severe mental disorders is up to 25 years less in comparison to the general population, mainly due to diseases caused or worsened by smoking. However, smoking is usually a neglected issue in mental healthcare settings. The aim of this article is to describe a strategy to improve tobacco control in the hospital mental healthcare services of Catalonia (Spain). To bridge this gap, the Catalan Network of Smoke-free Hospitals launched a nationwide bottom-up strategy in Catalonia in 2007. The strategy relied on the creation of a working group of key professionals from various hospitals —the early adopters— based on Rogers’ theory of the Diffusion of Innovations. In 2016, the working group is composed of professionals from 17 hospitals (70.8% of all hospitals in the region with mental health inpatient units). Since 2007, tobacco control has improved in different areas such as increasing mental health professionals’ awareness of smoking, training professionals on smoking cessation interventions and achieving good compliance with the national smoking ban. The working group has produced and disseminated various materials, including clinical practice and best practice guidelines, implemented smoking cessation programmes and organised seminars and training sessions on smoking cessation measures in patients with mental illnesses. The next challenge is to ensure effective follow-up for smoking cessation after discharge. While some areas of tobacco control within these services still require significant improvement, the aforementioned initiative promotes successful tobacco control in these settings.

Smoke-free legislation in indoor public places has concentrated smokers in the areas outside building entrances or other outdoor areas. This study assessed the drift of second-hand smoke between outdoor and indoor areas of cafés and restaurants in Barcelona, Spain, and characterized the exposure on outdoor terraces. Using a cross-sectional design, we monitored vapor-phase nicotine in indoor areas and outside entrances simultaneously (n=47), and on some outdoor terraces (n=51). We computed the median nicotine concentration and interquartile range (IQR) to describe the data and performed multivariate analysis to describe nicotine concentration and its determinants. The overall median nicotine concentration indoors was 0.65µg/m(3) (IQR: 0.29-1.17µg/m(3)), with significant differences based on the number of smokers at the entrance (p=0.039). At outside entrances, the overall median nicotine concentration was 0.41µg/m(3) (IQR: 0.21-1.17µg/m(3)). The nicotine concentrations indoors and at the corresponding outside entrances were not significantly different, and the multivariate analysis confirmed the relationship between these variables. On terraces, the overall median nicotine concentration was 0.54µg/m(3) (IQR: 0.25-1.14µg/m(3)), but it increased to 0.60µg/m(3) when a tobacco smell was perceived, 0.72µg/m(3) on closed terraces, 1.24µg/m(3) when there were >6 smokers, and 1.24µg/m(3) when someone smoked >20min. Multivariate analysis confirmed the outdoor terrace area, the season, the type of enclosure, and the number of smokers as the most relevant variables explaining nicotine concentration (R(2)=0.396). These findings show that second-hand smoke exposure exists in indoor areas due to smokers smoking at the outside entrances. In addition, exposure may occur on outdoor terraces when smokers are present and the terrace is enclosed to some extent. Thus, the current Spanish law does not fully protect non-smokers from second-hand smoke and supports extending regulation to some outdoor areas.

Objetivo: Describir el conocimiento y la percepción de nocividad de los cigarrillos electrónicos (e-cigarrillos) en la población de Barcelona en 2013-2014. Métodos: Se utilizaron los datos del seguimiento (n = 736) de un estudio de cohortes de una muestra representativa de la población adulta de la ciudad de Barcelona. Resultados: El 79,2% de los participantes manifestó conocer el e-cigarrillo. El grado de conocimiento medio fue de 4,4 puntos sobre 10, con diferencias estadísticamente significativas según edad, nivel de estudios, consumo de tabaco y dependencia de la nicotina. La mayoría de los participantes conocieron los e-cigarrillos por los medios de comunicación clásicos (57,8%). El 47,2% de los participantes opinaba que los e-cigarrillos son menos nocivos que los cigarrillos convencionales. Conclusión: La publicidad de los e-cigarrillos en los medios de comunicación debería regularse debido a la escasa evidencia científica sobre su utilidad y sus potenciales efectos adversos.

El artículo presenta una reflexión sobre el estado del arte del empleo y el desempleo juvenil. Muestra una radiografía de la situación de los jóvenes en México frente al empleo y propone una lectura multifactorial y multidimensional para afrontar el desempleo juvenil.The article presents a reflection about youth unemployment and unemployment. Shows also a radiography of the situation of the youth employment in Mexico and proposes a reading multifactorial and multidimensional to confront the juvenile unemployment.L’article présente une réflexion sur l’état de l’art du chômage juvénile. Il montre aussi une radiographie de la situation des jeunes au Mexique face á l’emploi et propose une lecture multifactorial et multidimensionnelle pour affronter le chômage juvénile.

Objective: To estimate the prevalence of smoking in workers from hospitals within the Catalan Network for Smoke-free hospitals from 2009 to 2012 according to workers' sociodemographic characteristics and the type of hospital.Method: A meta-analysis was performed of prevalence surveys from representative samples of workers from 45 hospitals. The combined prevalence for all hospitals was calculated using a regression model with a random effects model weighted by sample size.Results: The overall prevalence of smoking was 28.1% (95%CI: 26.1 to 30.0%) with a maximum and minimum of 40.3% and 19.1%, respectively. The health professionals with the lowest prevalence of smoking were physicians (16.4%; 95%CI: 12.9 to 19.9) and nurses (25.4%; 95%CI 21.6 to 29.2).Conclusion: The prevalence of smoking in hospital health workers was lower than in the general population of working age. Physicians were the group with the lowest smoking prevalence. Smoking cessation should be promoted among other professional groups. (C) 2015 SESPAS. Published by Elsevier Espana, S.L.U.

The aim of this study is to review the literature on the composition of aerosols from electronic cigarettes (e-cigarettes) originated by human vaping and to describe the emission of particulate matter ≤2.5 μm in diameter (PM2.5) from conventional and e-cigarettes at home in real-use conditions.

Objective: To analyse the trend in ambulatory surgery procedures in Catalonia (Spain) hospitals with regard to the activity in inpatient care units and structural resources in surgery.Methods: A descriptive study was performed using data from the Statistics of Health Facilities with Inpatient Care of the Health Department of the Catalan Government from 2001 to 2011. Data from acute care hospitals were analysed and were classified in public and private hospitals.Discussion: The percentage of ambulatory surgical procedures increased by 63.2% and the percentage of inpatient surgery decreased by 23.5% (this trend was more pronounced in public hospitals). This result coincided with a decrease of structural resources in surgery (beds and operating rooms) and with an improvement in inpatient surgical activity (a decrease in the mean length of stay and bed occupancy rate in all hospitals). Structural surgery resources were optimized and efficiency was improved in surgery inpatient care units (C) 2015 SESPAS. Published by Elsevier Espana, S.L.U. All rights reserved.

Objective: To describe knowledge of electronic cigarettes (e-cigarettes) and their perceived harmfulness in the population of Barcelona in 2013-2014.Methods: We used participants from a longitudinal study of a representative sample of the adult population in the city of Barcelona (n = 736). The field work was conducted between May 2013 and February 2014.Results: Awareness of e-cigarette was 79.2%. The average level of knowledge was 4.4 points out of 10; there were statistically significant differences according to age, educational level, tobacco consumption, and nicotine dependence. Most participants had learned about e-cigarettes through traditional media (57.8%). Nearly half (47.2%) of the participants believed that e-cigarettes are less harmful than conventional cigarettes.Conclusion: Advertising of e-cigarettes in the media should be regulated because there is still scarce scientific evidence about the usefulness and harmful effects of these devices. (C) 2014 SESPAS. Published by Elsevier Espana, S.L.U. All rights reserved.

Objective To describe where smokers smoke outdoors, where non-smokers are exposed outdoors to secondhand smoke (SHS), and attitudes towards smoke-free outdoor areas after the implementation of national smoke-free legislation. Design This cross-sectional study was conducted between June 2011 and March 2012 (n=1307 participants). Setting Barcelona, Spain. Participants Representative, random sample of the adult (≥16 years) population. Primary and secondary outcomes Proportion of smoking and prevalence of exposure to SHS in the various settings according to type of enclosure. Percentages of support for outdoor smoke-free policies according to smoking status. Results Smokers reported smoking outdoors most in bars and restaurants (54.8%), followed by outdoor places at work (46.8%). According to non-smokers, outdoor SHS exposure was highest at home (42.5%) and in bars and restaurants (33.5%). Among non-smoking adult students, 90% claimed exposure to SHS on university campuses. There was great support for banning smoking in the majority of outdoor areas, which was stronger among non-smokers than smokers. Over 70% of participants supported smoke-free playgrounds, school and high school courtyards, and the grounds of healthcare centres. Conclusions Extending smoking bans to selected outdoor settings should be considered in further tobacco control interventions to protect non-smokers from SHS exposure and to establish a positive model for youth. The majority of public support for some outdoor smoke-free areas suggests that it is feasible to extend smoking bans to additional outdoor settings.

OBJECTIVE:To describe and compare the perceptions of the general population about the harmful effects of electronic cigarettes (e-cigarettes) on users and on those passively exposed to e-cigarettes and the perceptions about e-cigarette usefulness for reducing or eliminating tobacco smoking.DESIGN, SETTING, AND PARTICIPANTS:We analysed cross-sectional data from a longitudinal study of a representative sample of the general adult (≥16 years) population of Barcelona, Spain (336 men and 400 women). The fieldwork was conducted between May 2013 and February 2014. We computed the percentages, adjusted OR and their corresponding 95% CI among participants with some awareness of e-cigarettes (79.2% of the sample).PRIMARY AND SECONDARY OUTCOME MEASURES:We assessed the perception about harmfulness for e-cigarette users and for passively exposed non-e-cigarette users, as well as the perception of usefulness for smokers of cigarette cessation and reduction.RESULTS:In this sample, 40.1% thought that e-cigarettes had a harmful effect on users, and 27.1% thought that e-cigarettes had a harmful effect on passively exposed bystanders (p<0.001). Particularly, more never-smokers perceived that e-cigarettes had harmful effects on passively exposed bystanders than current smokers (34.4% vs 20.6%; OR=1.93, 95% CI 1.02 to 3.63). More people perceived e-cigarettes as being useful for reducing smoking than for quitting (50.6% vs 29.9%, p<0.001), as well as for reducing smoking than as being harmful to users (50.6% vs 40.1%, p=0.044).DISCUSSION:The perception that e-cigarettes are useful for reducing tobacco consumption was more prevalent than the perception that e-cigarettes are harmful to users and to those passively exposed to e-cigarettes. Advertisements and messages about the use of e-cigarettes and their harmful effects should be regulated and based on scientific evidence to avoid creating erroneous ideas about their use.

BACKGROUND:Mental health units have usually been exempted from complete smoke-free policies. The aim of this study was to compare the self-reported level of exposure to secondhand smoke (SHS) of patients and staff in psychiatric units to objective measures, and examine preference for different types of smoking bans.METHODS:Cross-sectional survey about ban preferences and self-reported exposure to SHS by means of a self-administered questionnaire administered to patients and staff from 65 inpatient psychiatric units in Catalonia (95.5% of all units). We measured air concentrations of particulate matter ≤ 2.5 μm (PM2.5 in µg/m(3)) as a marker of SHS in these units.RESULTS:600 patients and 575 professionals completed the questionnaire. 78.7% of them were objectively exposed to SHS (PM2.5>10 μm/m(3)) but 56.9% of patients and 33.6% of staff believed they were not exposed at all and 41.6% of patients and 28.4% of staff believed the environment was not at all unhealthy. Nurses had a higher smoking prevalence than psychiatrists (35.8% vs 17.2%; p<0.001), and nurses had a higher perception of being moderately highly exposed to SHS (40.3% vs 26.2%; p<0.001). PM2.5 levels were significantly different depending on the type of smoking ban implemented but unrelated to the perception of SHS levels by both patients and staff. Only 29.3% of staff and 14.1% of patients strongly supported total smoking bans.CONCLUSIONS:Patients and staff have substantial misperceptions about the extent of their exposure to SHS and low awareness about the harmful environment in which they stay/work. This might have an influence on the preference for less restrictive smoke-free bans. It is particularly noteworthy that less that one-third of mental health staff supported smoke-free units, suggesting an urgent need for further education about the harmful health effects of SHS.

BACKGROUND:In 2006, Spain implemented a national smoke-free legislation that prohibited smoking in enclosed public places and workplaces (except in hospitality venues). In 2011, it was extended to all hospitality venues and selected outdoor areas (hospital campuses, educational centers, and playgrounds). The objective of the study is to evaluate changes in exposure to secondhand smoke among the adult non-smoking population before the first law (2004-05) and after the second law (2011-12).METHODS:Repeated cross-sectional survey (2004-2005 and 2011-2012) of a representative sample of the adult (≥ 16 years) non-smoking population in Barcelona, Spain. We assess self-reported exposure to secondhand smoke (at home, the workplace, during leisure time, and in public/private transportation vehicles) and salivary cotinine concentration.RESULTS:Overall, the self-reported exposure to secondhand smoke fell from 75.7% (95%CI: 72.6 to 78.8) in 2004-05 to 56.7% (95%CI: 53.4 to 60.0) in 2011-12. Self-reported exposure decreased from 32.5% to 27.6% (-15.1%, p<0.05) in the home, from 42.9% to 37.5% (-12.6%, p=0.11) at work/education venues, from 61.3% to 38.9% (-36.5%, p<0.001) during leisure time, and from 12.3% to 3.7% (-69.9%, p<0.001) in public transportation vehicles. Overall, the geometric mean of the salivary cotinine concentration in adult non-smokers fell by 87.2%, from 0.93 ng/mL at baseline to 0.12 ng/mL after legislation (p<0.001).CONCLUSIONS:Secondhand smoke exposure among non-smokers, assessed both by self-reported exposure and salivary cotinine concentration, decreased after the implementation of a stepwise, comprehensive smoke-free legislation. There was a high reduction in secondhand smoke exposure during leisure time and no displacement of secondhand smoke exposure at home.