Browsing by Author "Fernández, Esteve"
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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 Consumo actual de cigarrillos electrónicos entre estudiantes de secundaria que nunca han fumado(2022) Peruga, Armando; Martínez, Cristina; Fu, Marcela; Ballbè, Montse; Tigova, Olena; Carnicer-Pont, Dolors; Fernández, EsteveObjetivo: Examinar si en España el uso de los cigarrillos electrónicos está asociado a la iniciación del consumo de nicotina entre los estudiantes de secundaria. Método: Análisis secundario de datos de la encuesta ESTUDES 2019, estudio transversal realizado a una muestra representativa de estudiantes entre 14 y 18 años. Seleccionamos los alumnos que nunca habían fumado (n=16.705). Calculamos la prevalencia y estimamos los factores asociados al consumo de cigarrillos electrónicos al menos una vez en el mes anterior a la entrevista, con y sin nicotina. Resultados: La prevalencia de consumo actual de cigarrillos electrónicos entre estudiantes que nunca han fumado es del 2,5% (intervalo de confianza del 95% [IC 95%]: 2,2-2,9). El 0,1% (IC 95%: 0,08-0,2) reportó haber utilizado alguna vez líquidos con nicotina y el 2,4% (IC 95%: 2,1-2,8) siempre sin nicotina. Ser varón, menor de 17 años, hacer botellón y tener amigos habituales que consumen cannabis aumenta la probabilidad de consumo actual de cigarrillos electrónicos. Estas dos últimas variables parecen actuar como variables contextuales asociadas al consumo de cigarrillos electrónicos. Conclusiones: El porcentaje de estudiantes españoles que nunca han fumado, pero que consumen cigarrillos electrónicos actualmente, es menor que en los países de nuestro entorno, a excepción del Reino Unido. Solo uno de cada 1000 estudiantes españoles de secundaria que nunca han fumado se inicia en el consumo actual de nicotina con un cigarrillo electrónico. No obstante, debemos vigilar cómo evoluciona este indicador.Publication Control del tabaquismo en el siglo XXI: una perspectiva global y local(2022) Fernández, Esteve; Peruga, ArmandoPublication 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.Item Night entertainment venues comply poorly with the smoke-free law in Chile(2021) Peruga, Armando; Fu, Marcela; Molina, Xaviera; Fernández, EsteveThe initial high level of compliance with the Chilean comprehensive national smoke-free law in 2013 is fading, particularly in the hospitality sector. This paper draws attention to how using a simple and low-cost surveillance inquiry may help focus on the use of scarce inspection resources to improve compliance with the law in the hospitality sector. We conducted a cross-sectional assessment of second-hand smoke exposure in night entertainment venues in Santiago, Chile, by measuring particulate matter of less than 2.5 m (PM2.5). Smoking where prohibited by law was observed in 36% of the venues visited. Venues where smoking was spotted at the time of the observation had a median PM2.5 concentration 13 times higher than background concentration on the street. The study shows that a targeted approach for inspection to find pockets of venues with suboptimal compliance is feasible and affordablePublication People who smoke and formerly smoked do support a smoking ban in open spaces during and after the COVID-19 pandemic in Spain(2025) Peruga, Armando; Fu, Marcela; Castellano, Yolanda; Tigova, Olena; Driezen, Pete; Quah, Anne; Fong, Geoffrey; Fernández, EsteveBackground: Spain implemented an extensive outdoor smoking ban during the COVID-19 pandemic in 2020. We examined support for this restriction during and beyond the pandemic among people who currently and formerly smoked. Methods: Cross-sectional study. The 2021 ITC EUREST-PLUS Spain Survey used a multistage sampling to obtain a representative sample of people who currently or formerly smoked (n=1006). We estimated prevalence ratios (PRs) to examine associations with ban support during and after the pandemic. Analyses accounted for the complex sampling design and were weighted to ensure representativeness. Results: Most people who currently (79.2%) and formerly smoked (94.6%) supported the outdoor smoking ban when a safe interpersonal distance could not be maintained during the pandemic. Support for a permanent ban remained substantial (61.4% and 87.2%, respectively). Those who currently smoke were more likely to support bans during and after the pandemic if they had smoke-free homes (PR=1.11; PR=1.29, respectively), understood secondhand smoke harms to health (PR=1.40; PR=1.65), had tried to quit (PR=1.14; PR=1.30) and self-reported as healthy (PR=1.40; PR=1.47). Those who formerly smoked were more likely to support bans during the pandemic if they had smoke-free homes (PR=1.08) and did not self-report as healthy (PR=0.95); and after the pandemic if they had quit smoking for ≥6 months (PR=1.23) and used alternative tobacco products (PR=1.17). Conclusions: Most people who currently or formerly smoked in Spain supported the outdoor smoking ban during and after the COVID-19 pandemic. This high acceptance suggests that the pandemic may have created an opportunity to strengthen tobacco control.Item Los productos de tabaco calentado: nuevo reto en el control del tabaco(2021) Peruga, Armando; Rodríguez Lozano, Francisco; López, María José; Córdoba García, Rodrigo; Nerín, Isabel; Sureda, Xisca; Fernández, EsteveCon las ventas de cigarrillos disminuyendo, la industria del tabaco se ha encomendado a la venta de los productos de tabaco calentado (PTC), cuyas ventas están aumentando. Hemos visto con preocupación informaciones que indican erróneamente que el tabaco calentado se asocia a un menor riesgo de cáncer y otras enfermedades que los cigarrillos convencionales, citando a la Food and Drug Administration (FDA) de los Estados Unidos como fuente. Es cierto que la FDA ha autorizado la venta de un PTC, pero niega que esta aprobación suponga un apoyo al producto o indique que este sea inocuo. Philip Morris pidió a la FDA que su PTC fuera aprobado como un producto de tabaco de «riesgo modificado», pero la Agencia negó que el riesgo para la salud de las personas usuarias fuese menor que el de los cigarrillos convencionales, a pesar de emitir menos cantidad de algunos tóxicos. Espana˜ y la Unión Europea deberían acabar con los privilegios regulatorios de los que disfrutan los PTC. Identificamos por lo menos cinco aspectos que deben mejorarse: 1) el cumplimiento de la prohibición de su uso donde está prohibido fumar; 2) el control de la prohibición de publicidad, promoción y patrocinio de los PTC; 3) que los PTC lleven el mismo tipo de etiquetado que los cigarrillos; 4) limitar que los PTC tengan aromas característicos; y 5) tratar los PTC fiscalmente igual que los cigarrillos.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.Item Tobacco control policies in the 21st century: achievements and open challenges(2021) Peruga, Armando; López, María José; Martinez, Cristina; Fernández, EsteveNoncommunicable diseases (NCDs), including cancer, are responsible for almost 70% of all deaths worldwide. Tobacco use is a risk factor common to most NCDs. This article discusses tobacco control policies and highlights major achievements and open challenges to reduce smoking prevalence and attributable morbidity and mortality in the 21st century. The introduction of the WHO Framework Convention on Tobacco Control in 2005 has been a key achievement in the field and has already facilitated a drop in both smoking prevalence and exposure to secondhand smoke. Indicatively, the size of the worldwide population benefiting from at least one cost-effective tobacco control policy has quadrupled since 2007. In addition, plain cigarette packaging has been successfully introduced as a tobacco control policy, surmounting efforts of the tobacco industry to challenge this based on trade and investment law. Nevertheless, tobacco control still faces major challenges. Smoking prevalence needs to be further reduced in a rather expedited manner. Smoke-free environments should be extended, and the use of plain tobacco packaging with large pictorial health warnings for all tobacco products should be further promoted in some parts of the world. Some of these measures will require prompt determination and diligence. For example, bold political decisions are needed to significantly increase real prices of tobacco products through excise taxes, ban added ingredients that are currently used to increase the attractiveness of tobacco products and ban the tobacco industry’s corporate social responsibility initiatives. Finally, the debate on harm reduction strategies for tobacco control still needs to be resolved.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.Publication Trends in initiation of regular cigarette smoking in 28 European countries, 1940-2019: retrospective reconstruction from repeated cross-sectional surveys(2025) Teshima, Ayaka; Bannon, Olivia; Filippidis, Filippos; Feliu, Ariadna; Gallus, Silvano; Peruga, Armando; Martínez, Cristina; Fernández, EsteveIn the European Union (EU), one in five youth currently smoke, with over half establishing regular smoking by age 18. Yet, evidence on the historical trends of smoking initiation remains scarce despite its importance for tobacco control. Using four waves of the Special Eurobarometer survey (2012-20; n = 110 753, aged ≥15), we retrospectively estimated trends in initiation rates (IRs) of regular cigarette smoking in the EU from 1940 to 2019 among individuals aged 10-24 by sex, region, and country for each calendar decade. EU-wide smoking IRs have decreased compared to the peak period, with narrowing disparities by sex and region. For males, the IRs have declined from 5.7% (95% CI = 5.6-5.9) in the 1970s to 3.2% (95% CI = 3.0-3.3) in the 2010s, and for females from 3.9% (95% CI = 3.7-4.0) in the 1990s to 2.4% (95% CI = 2.3-2.5) in the 2010s. The decline was more pronounced among young adults aged 18-24 than minors aged 10-17, with minors' IRs surpassing those of young adults during the 2010s. Marked declines occurred among young adults in all regions, while among minors, a clear decrease was observed only for males in Northern Europe. Concerningly, the IRs among minors have trended upward in Eastern Europe for both sexes. Despite declining youth smoking initiation, an unacceptably high number of European youth still begin smoking regularly before the legal age of 18. Stricter and comprehensive tobacco control policies targeting youth, along with smoke-free generation initiatives, could substantially reduce future tobacco use and smoking-related mortality.