Browsing by Author "Feliu, Ariadna"
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Publication 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(2023) Feliu, Ariadna; Quintero, Alex; Peruga, Armando; Carnicer, Dolors; Antón, Laura; Rey, Juan; Fernández, EsteveIntroduction: 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.Publication Determinants of tobacco use transitions in smoker nursing students in Catalonia: A prospective longitudinal study(2024) Laroussy, Kenza; Fernández, Esteve; Castellano, Yolanda; Fu, Marcela; Baena, Antoni; Feliu, Ariadna; Peruga, Armando; Margalef, Mercè; Tigova,Olena; Galimany, Jordi; Puig, Montserrat; Moreno, Carmen; Bueno, Albert; López, Antonio; Roca, Judith; Martínez, CristinaIntroduction: The use of emerging tobacco and nicotine products affects tobacco use behaviors among college students. Thus, we aimed to examine transitions in tobacco use patterns and identify their predictors among smokers in a cohort of nursing students in Catalonia (Spain). Methods: We conducted a prospective longitudinal study of Catalan nursing students between 2015-2016 and 2018-2019. We examined transitions in tobacco use patterns between baseline and follow-up among smokers from: 1) daily to non-daily smoking, 2) non-daily to daily smoking, 3) cigarette-only use to poly-tobacco use, 4) poly-tobacco use to cigarette-only use, 5) between products, 6) reducing consumption by ≥5 cigarettes per day (CPD); and 7) quitting smoking. We applied a Generalized Linear Model with a log link (Poisson regression) and robust variance to identify predictors of reducing cigarette consumption by ≥5 CPD and quitting smoking, obtaining both crude and adjusted (APR) prevalence ratios and their 95% confidence intervals (CIs). Results: Among daily smokers at baseline, 12.1% transitioned to non-daily smoking at follow-up, while 36.2% of non-daily smokers shifted to daily smoking. Among cigarette-only users, 14.2% transitioned to poly-tobacco use, while 48.4% of poly-tobacco users switched to exclusive cigarette use. Among all smokers (daily and non-daily smokers), 60.8% reduced their cigarette consumption by ≥5 CPD and 28.3% quit smoking. Being a non-daily smoker (APR=0.33; 95% CI 0.19-0.55) and having lower nicotine dependence (APR=0.78; 95% CI 0.64-0.96) were inversely associated with reducing cigarette consumption, while being a non-daily smoker (APR=1.19; 95% CI: 1.08-1.31) was directly associated with quitting smoking. Conclusions: Nursing students who smoked experienced diverse transitions in tobacco use patterns over time. Evidence-based tobacco use preventive and cessation interventions are needed to tackle tobacco use among future nurses.Publication Mapping indicators of tobacco and related product use: Unveiling challenges and variations in the Eurobarometer surveys over three decades(2025) Teshima, Ayaka; Martínez, Cristina; Filippidis, Filippos; Laverty, Anthony; Vardavas, Constantine; Feliu, Ariadna; Peruga, Armando; Fernandez, EsteveIntroduction: The European Commission's Special Eurobarometer surveys on tobacco are widely used as comparable and representative data across the European Union for monitoring consumption patterns. Despite their broad use, certain challenges persist, including inconsistencies in survey timelines and variations in the collected information across waves. This study aims to identify available tobacco and related product indicators, and assess their temporal comparability, to support researchers to better understand the potential uses of these data and their alignment with other sources. Methods: We explored questionnaires and reports in these surveys on tobacco from the Eurobarometer official website since its inception (1992, 2002, 2005, 2006, 2008, 2009, 2012, 2014, 2017, 2020 and 2023 waves). We extracted and compared questions and responses on use of tobacco and related products, as well as on sociodemographic variables. Finally, we compared all indicators, including frequency and wording, and further mapped the consistency of the indicators and type of product used across the different waves. Results: Current, daily, former and never use of conventional cigarettes has been consistently assessed across all waves, enabling temporal comparisons. From 2009, the surveys have expanded to include e-cigarette use; since 2012, the surveys include various combusted products such as cigars, pipes, cigarillos, and waterpipes, and from 2020, heated tobacco products. By contrast, detailed data on product-specific use intensity and initiation remain limited. While indicators for secondhand smoke exposure and smoking cessation were present in multiple waves, their comparability is hindered by variations in question-wording and responses. Conclusions: Some challenges exist in using Eurobarometer surveys for temporal estimation of tobacco-related burden. Nonetheless, these surveys remain a valuable and unique tool for monitoring tobacco and related product use across the European Union. To further enhance their utility, periodic re-evaluation by tobacco control experts is recommended to ensure that the surveys maintain comparability with past data while capturing effectively emerging products and trends.Item The Tobacco Control Scale as a research tool to measure country-level tobacco control policy implementation(2020) Feliu, Ariadna; Fernández, Esteve; Baena, Antoni; Joossens, Luk; Peruga, Armando; Fu, Marcela; Martínez, CristinaINTRODUCTION The Tobacco Control Scale (TCS) was designed for advocacy purposes but has also been used as a research tool. In the present study, we characterized TCS use, its limitations and strengths, and critically assessed its use as a research instrument. METHODS We conducted an extensive search of the biomedical databases PubMed and Web of Science for the keyword ‘tobacco control scale’ in all fields. The search was limited to studies published in the period March 2006 to December 2019. Out of 69 hits, 32 studies met the inclusion criteria. Two reviewers independently extracted information from each publication regarding their general characteristics, publication and research aspects, and the characteristics of the use of the TCS. RESULTS We found that researchers have used the TCS as a tool to monitor tobacco control policies mainly in cross-sectional observational studies with ecological and multilevel designs directed to advocacy and the promotion of further research. Different outcomes, such as smoking prevalence and quit ratios, have been associated with tobacco control policy scores. The main reported limitations of the TCS were a low variance across countries and a failure to express enforcement and to incorporate the most recent legislation. CONCLUSIONS The TCS has been commonly used to assess differences in outcomes according to tobacco control policies. However, there are still areas for improvement in its use in research regarding the lack of comparability of TCS scores across time. The lessons that have been learned should be used to adapt and expand the TCS overseas.Publication Tobacco imagery in prime-time television in Spain: A content analysis(2025) Peruga, Armando; Tigova, Olena; Feliu, Ariadna; Carnicer, Dolors; Anton, Laura; Bosch, Félix; Rey, Juan; Salto, Esteve; Fernández, Esteve; Martínez, CristinaIntroduction: 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.Publication Transitions in smoking status in nursing students: A prospective longitudinal study(2023) Laroussy, Kenza; Castellano, Yolanda; Fu, Marcela; Baena, Antoni; Feliu, Ariadna; Peruga, Armando; Margalef , Mercè; Aldazabal, Jon; Tigova, Olena; Galimany, Jordi; Puig, Montserrat; Moreno, Carmen; Bueno, Albert; López, Antonio; Roca, Judith; Saura, Judith; Fernández, Esteve; Martínez, CristinaAim: To describe transitions in smoking status and their determining factors among nursing students between baseline (2015-2016) and follow-up (2018-2019). Design: Observational prospective longitudinal study of 4381 nursing students in Catalonia (Spain). Methods: We examined transitions in smoking status from: (i) current smokers to recent quitters, (ii) never smokers to new smokers and (iii) former smokers to quitters who relapsed. We fitted logistic regression models to assess the predictors of quitting smoking. Results: The proportion of current smokers decreased from 29.7% at baseline to 23.6% at follow-up, with a cumulative incidence rate of quitting of 28.3% during follow-up. Nondaily smokers were more likely to quit than daily smokers. Of those who were never smokers at baseline, 4.6% were smokers at follow-up, and 23.2% of former smokers at baseline had relapsed at follow-up. Conclusions: Nondaily smokers were more likely to have quit smoking at follow-up among this cohort of nursing students. The early implementation of a comprehensive tobacco control program that includes tobacco-free campus policies, tobacco prevention interventions and cessation support during college years may decrease tobacco use among nursing students. Impact: Nursing students' tobacco use is concerning, as they are the future workforce of nurses who have a key role in tobacco product use prevention and cessation. During college years, nursing students have a greater likelihood of experimenting with several smoking status changes as well as to consolidate smoking behaviors. This is the first longitudinal study to highlight the factors associated with quitting smoking among a cohort of Spanish nursing students. Being a nondaily smoker at baseline predicted quitting at follow-up. Our findings support the early implementation of a comprehensive tobacco control program that includes tobacco-free campus policies, tobacco prevention interventions and tobacco cessation support during college years to decrease tobacco product use prevalence among nursing students. Reporting method: We have adhered to STROBE guidelines. No Patient or Public Contribution. This observational study has not been registered.