Person: Peruga, Armando
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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 Tobacco endgame in the WHO European Region: Feasibility in light of current tobacco control status(2023) González, Adrián; Koprivnikar, Helena; Tisza, Judit; Cselkó, Zsuzsa; Lambrou, Angeliki; Peruga, Armando; Kilibarda, Biljana; Lidón, Cristina; Carnicer, Dolors; Papachristou, Efstathios; Nunes, Emilia; Carreras, Giulia; Gorini, Giuseppe; Pérez, Hipólito; Martínez, Jose; Spizzichino, Lorenzo; Karekla, Maria; Maurice Mulcahy; Vasic, Milena; Ruokolainen, Otto; Guignard, Romain; Schoretsaniti, Sotiria; Laatikainen, Tiina; Nguyen-Thanh, Viêt; Ollila, HannaIntroduction: To assess the feasibility of developing World Health Organization (WHO) European Region countries' goals and measures in line with tobacco endgame objectives, information on the current tobacco control context and capacity is needed. The aim of this study was to assess the implementation of the Framework Convention on Tobacco Control (WHO FCTC) and MPOWER measures in the region. Methods: In this cross-sectional study we used data from the WHO FCTC implementation reports and MPOWER from 2020 in 53 WHO European Region countries. Six domains (i.e. capacity, taxation and price policies, other national key regulations, public awareness raising and communication, tobacco use cessation, and monitoring) were formed. Subsequently, available indicators under these domains were scored and the level of implementation was computed for each country. Mann-Whitney tests were carried out to compare the scores between the group of countries with and without official endgame goals. Results: Overall, implementation of the WHO FCTC with the selected indicators at the country level ranged from 28% to 86%, and of MPOWER from 31% to 96%. Full implementation was achieved by 28% of WHO FCTC Parties in the region in taxation and price policies, 12% in public awareness raising and communication, and 42% in monitoring. In capacity, tobacco use cessation and other national key regulations, none of the Parties in the region reached full implementation. Overall median WHO FCTC scores were significantly higher in countries with official endgame goals than in those without (p<0.001). Conclusions: There is unequal implementation of both WHO FCTC and MPOWER measures among WHO European Region countries. MPOWER and WHO FCTC provide all the measures for the necessary first steps, followed by innovative measures, to accomplish tobacco endgame goals.Publication Exposure of 4- year to 24- year olds to tobacco imagery on prime- time Chilean television(2023) Peruga, Armando; Oscar Urrejola; Delgado, Iris; Matute, María Isabel; Castillo-Laborde, Carla; Molina, Xaviera; Hirmas Adauy, Macarena; Olea, Andrea; González, Claudia; Aguilera, Ximena; Sargent, JamesIntroduction: The extent of the population's exposure to tobacco imagery across all genres of regular TV programming and the contribution of each of these genres is unknown, except for UK broadcast channels. The objective of this study is to estimate the exposure of young people to tobacco imagery on Chilean prime-time television and the programme source contributing to such exposure. Methods: Programmes aired during 3 weeks in 2019 from the 15 highest audience channels in Chile were content-analysed for the occurrence of tobacco categorised as actual use, implied use, tobacco paraphernalia, tobacco brand appearances and whether they violated Chilean smoke-free law for each 1 min interval (92 639). The exposure of young people to tobacco content was estimated using media viewership figures. Results: Young people received 29, 11 and 4 million tobacco impressions of any type, explicit use and smoke-free violation, respectively, at a rate of 21.8, 8.0 and 2.1 thousand impressions per hour of TV viewing. The main sources of exposure to tobacco impressions were feature films and animated productions, which were almost entirely non-Chilean. Finally, young people were exposed to tobacco brand impressions primarily through films, effectively circumventing the advertising ban in Chile. Discussion: Television programming is a source of significant youth exposure to tobacco imagery, including branding impressions. To conform to the WHO FCTC, Chile should prohibit tobacco branding in any TV programme and require strong anti-tobacco advertisements prior to any TV programme portraying tobacco.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 Exposure to tobacco impressions during prime-time TV among Chilean minors by sex and socioeconomic status(2022) Peruga, Armando; Castillo-Laborde, Carla; Matute, María Isabel; Molina, Xaviera; Urrejola, Oscar; Aguilera, XimenaIntroduction: We tested if tobacco impressions were delivered differentially to prime-time TV watching minors by sex and socioeconomic status. Methods: Programs aired during prime-time for three random weeks in 2019 from the 15 highest audience channels in Chile were content-analyzed for the occurrence of tobacco for each one-minute interval of 92639 recorded. Such occurrences were categorized as actual use and whether they violated Chilean smoke-free law or tobacco brand appearances. We estimated the number of persons per hour (p/h) exposed to tobacco impressions for the 4 to 17 years age group by sex and socioeconomic status (SES). Results: Minors spent over a billion p/h watching TV during the observation period. Minors were exposed to tobacco explicit use, branding and smoke-free violation impressions for 9.7 million, 1.2 million, and 1.0 million p/h, respectively. The odds ratios (OR) of exposure to total tobacco impressions were always greater among boys with higher SES compared to boys with low SES. However, they were greater among girls of low SES compared to those of high SES for all types of impressions. The OR of exposure to tobacco branding was higher among girls of any SES compared to boys of any SES. Conclusions: Minors need protection from tobacco imagery on television, particularly girls of low SES. To that end, new legislation should implement all measures to counter depictions of tobacco in entertainment media, as recommended in the WHO FCTC Article 13 guidelines. This should require strong anti-tobacco advertisements before any TV program portraying tobacco targeting minor audiences, particularly girls of low SES. Given that Chile has one of the highest prevalences in the world of current cigarette smoking among young females, the potential contribution of tobacco impressions on TV to smoking differentials across female socioeconomic groups should be further studied.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.