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Introducción Existen muy pocos estudios sobre el consumo de sustancias psicoactivas (SPA) en jóvenes de territorios indígenas y en estudiantes semipresenciales o nocturnos. En Inírida, municipio de la Amazonía colombiana, preocupaba un posible problema de consumo nunca caracterizado. Objetivo Caracterizar el consumo de alcohol, tabaco y SPA en adolescentes de Inírida escolarizados en jornada nocturna y semipresencial. Métodos Encuesta CICAD/SIDUC, ajustada al contexto cultural, al 95% de los 284 estudiantes de la jornada elegida (n=262). Se utilizó estadística descriptiva y análisis de correspondencias múltiples. Resultados Actualmente consume alcohol el 59%; cigarrillo, el 28%; marihuana, el 21%; basuco, el 3%; éxtasis, el 1%; cocaína, el 1%, e inhalables, el 1%. El 61% considera que en el colegio y alrededores hay disponibilidad de drogas y es fácil conseguir marihuana (62%) y basuco (35%). Se ofrecen drogas con mayor frecuencia en el barrio (56%) y las fiestas (30%). Las personas que más les ofrecen drogas son conocidos (35%) y amigos (29%). El 51% manifiesta haber recibido actividades de prevención del consumo. Conclusiones La población presenta mayor consumo de las sustancias estudiadas que el referente nacional y de la Orinoquía y Amazonía, excepto en cocaína e inhalables. Se corrobora la situación de consumo y se proponen acciones participativas. Introduction There are very few studies on the consumption of psychoactive substances (PAS) among young people from indigenous territories and evening or blended learning students. In Inírida, a municipality in the Colombian Amazon, there were concerns about a possible consumption issue that had never been characterised before. Objective To characterise the consumption of alcohol, tobacco and PAS in Inírida among teenage evening and blended learning students. Methods The Inter-American Uniform Drug Use Data System (SIDUC) survey developed by the Inter-American Drug Abuse Control Commission (CICAD) was adapted to the cultural context and carried out on 95% of 284 evening and blended learning students (262). Descriptive statistics and multiple correspondence analyses were used. Results Currently, 59% consume alcohol; 28% tobacco; 21% marijuana; 3% cocaine paste; 1% ecstasy (MDMA); 1% cocaine; and 1% inhalants. Also, 61% believe that drugs are available inside and around the vicinity of their school, and that marijuana (62%) and cocaine paste (35%) are easily acquired. Drugs are most commonly offered in neighbourhoods (56%) and at parties (30%). Those offering the highest quantity of drugs are acquaintances (35%) and friends (29%). And 51% stated that they had participated in preventive activities related to consumption. Conclusions The population has a higher consumption of the substances studied in comparison with the national reference, that of Orinoquía and Amazonía, with the exception of cocaine and inhalants. The consumption situation was confirmed, so participatory actions are proposed.

Introduction: Cigarette smoking is a major risk factor in the development of chronic obstructive pulmonary disease (COPD). Serotonin levels have been associated with COPD and smoking has been as a significant modulator. Elevated levels of serotonin are responsible for bronchoconstriction and pulmonary vasoconstriction and also nicotine dependence, thus serotonin response could be affected by genetic polymorphisms in transporters and receptors of serotonin. Objectives: The aim of the current study was to analyze the effect of SLC6A4 (5HTT_LPR) (rs25531) and HTR2A-1438G/A (rs6311) genetic polymorphisms on the relation between smoking habits and COPD. Methods: The association between SLC6A4 (5HTT_LPR) (rs25531), HTR2A-1438G/A (rs6311), smoking degree and COPD was analyzed in a total of 77 COPD patients (active smokers) and 90 control subjects (active healthy smokers). The DNA was extracted of peripheral leukocytes samples and genotyping was performed using an allele specific polymerase chain reaction. Results: The distribution of SLC6A4 genotypes did not vary between healthy smokers and COPD patients (P=0.758). On the other hand, the A allele of HTR2A (rs6311) was significantly associated with COPD incidence in the trend model (P=0.02; 1.80 [1.04-3.11]). Among all smokers, this allele was also associated with the number of pack years smoked (P=0.02) and also, we observed a marginal association with FEV1/FVC values (P=0.06). Conclusion: Our results point a possible role of the A allele of HTR2A (rs6311) in COPD pathogenesis, suggesting that this effect depends partly on tobacco consumption due to a gene-by-environment interaction. Introducción Fumar cigarrillos es un factor de riesgo importante en el desarrollo de la enfermedad pulmonar obstructiva crónica (EPOC). Los niveles de serotonina se han asociado con la EPOC y el tabaquismo ha sido un modulador significativo. Los niveles elevados de serotonina son responsables de la broncoconstricción y la vasoconstricción pulmonar y también de la dependencia a la nicotina, por lo que la respuesta serotoninérgica podría verse afectada por polimorfismos genéticos en los transportadores y receptores de la serotonina. Objetivos El objetivo del presente estudio fue analizar el efecto de los polimorfismos genéticos SLC6A4 (5HTT_LPR) (rs25531) y HTR2A -1438G/A (rs6311) en la relación entre el hábito tabáquico y la EPOC. Métodos Se analizó la asociación entre SLC6A4 (5HTT_LPR) (rs25531), HTR2A -1438G/A (rs6311), grado de tabaquismo y EPOC en un total de 77 pacientes con EPOC (fumadores activos) y 90 sujetos control (fumadores activos sanos). El ADN se extrajo de muestras de leucocitos periféricos y el genotipado se realizó mediante una reacción en cadena de polimerasa específica de alelo. Resultados La distribución de los genotipos SLC6A4 no varió entre fumadores sanos y pacientes con EPOC ( P=0,758). Por otro lado, el alelo A de HTR2A (rs6311) se asoció significativamente con la incidencia de EPOC en el modelo de tendencia ( P=0,02; 1,80 [1,04–3,11]). Entre todos los fumadores, este alelo también se asoció con el número de años de paquetes fumados ( P=0,02) y también observamos una asociación marginal con los valores de FEV1/FVC ( P=0,06). Conclusión Nuestros resultados apuntan un posible papel del alelo A de HTR2A (rs6311) en la patogénesis de la EPOC, lo que sugiere que este efecto depende en parte del consumo de tabaco debido a una interacción gen-ambiente. Grant of SEPAR (2006) 4.872 JCR (2019) Q1, 11/64 Sistema Respiratorio 0.287 SJR (2019) Q3, 95/149 Pulmonary and Respiratory Medicine No data IDR 2019 UEM

Resumen: Las VI Guías Europeas de Prevención Cardiovascular recomiendan combinar las estrategias poblacional y de alto riesgo, con los cambios de estilo de vida como piedra angular de la prevención, y proponen la función SCORE para cuantificar el riesgo cardiovascular. Esta guía hace más hincapié en las intervenciones específicas de las enfermedades y las condiciones propias de las mujeres, las personas jóvenes y las minorías étnicas. No se recomienda el cribado de aterosclerosis subclínica con técnicas de imagen no invasivas. La guía establece cuatro niveles de riesgo (muy alto, alto, moderado y bajo), con objetivos terapéuticos de control lipídico según el riesgo. La diabetes mellitus confiere un riesgo alto, excepto en sujetos con diabetes tipo 2 con menos de 10 años de evolución, sin otros factores de riesgo ni complicaciones, o con diabetes tipo 1 de corta evolución sin complicaciones. La decisión de iniciar el tratamiento farmacológico de la hipertensión arterial dependerá del nivel de presión arterial y del riesgo cardiovascular, teniendo en cuenta la lesión de órganos diana. Siguen sin recomendarse los fármacos antiplaquetarios en prevención primaria por el riesgo de sangrado. La baja adherencia al tratamiento exige simplificar el régimen terapéutico e identificar y combatir sus causas. La guía destaca que los profesionales de la salud pueden ejercer un papel importante en la promoción de intervenciones poblacionales y propone medidas eficaces, tanto a nivel individual como poblacional, para promover una dieta saludable, la práctica de actividad física, el abandono del tabaquismo y la protección contra el abuso de alcohol. Abstract: The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than

ResumenObjetivosEl tabaquismo es causa de muerte prematura y prevenible, que se inicia en la adolescencia. Se describe el consumo de tabaco en escolares durante 2008 y la tendencia en los últimos 20 años en Barcelona.Material y métodosEstudio de análisis de la tendencia del consumo. Se comparan datos de ocho encuestas realizadas entre 1987 y 2008 en 2° y 4° cursos de Educación Secundaria Obligatoria (ESO) y 2° de Bachillerato o Ciclos Formativos de Grado Medio. Se utilizó el cuestionario FRESC. Se presentan datos del consumo regular y diario de tabaco en 2008 y sus factores asociados, y se comparan con los de estudios precedentes. Se calculan los porcentajes de cambio anual mediante regresión joinpoint y se estratifica por sexo y curso académico.ResultadosEn 2008 fumaban regularmente en ESO el 6,1% de los chicos y el 4,5% de las chicas de 2° curso, y el 15,8% y el 20,4% de 4° curso; en 2° curso de Bachillerato y Ciclos los porcentajes eran, respectivamente, el 26,1% y el 33,1%. Entre los factores asociados al consumo regular, en los tres cursos se observó una fuerte asociación entre consumo de tabaco y cannabis, así como tener amigos fumadores y un bajo rendimiento escolar. A los 15-16 años de edad, la disminución media anual desde 1996 hasta 2008 era del 6,8% en las chicas y del 6,1% en los chicos.ConclusionesEl consumo de tabaco en los adolescentes está disminuyendo desde hace algunos años en Barcelona. Hay una asociación muy intensa entre el consumo de tabaco y el de cannabis.AbstractObjectivesSmoking is a preventable cause of early death and the habit starts in adolescence. The aim of this study was to describe tobacco consumption in secondary school students in 2008 and trends in the last 20 years in Barcelona.Material and methodsWe analyzed the trend in tobacco consumption by comparing data from 8 surveys carried out between 1987 and 2008 in the 8th (2nd year of Compulsory Secondary Education), 10th (4th year of Compulsory Secondary Education) and 12th (2nd year of Compulsory Secondary Education) years of secondary school. The FRESC questionnaire was used. Data on regular and daily consumption and associated factors in 2008 were gathered and compared with those corresponding to the previous studies. Percentages of annual change were calculated with Joinpoint regression and data were stratified by sex and year of education.ResultsIn 2008, 6.1% of boys and 4.5% of girls in the 8th year, 15.8% and 20.4% of those in the 10th year, respectively, and 26.1% and 33.1% of those in the 12th year, respectively, were regular smokers. A strong association was noted between regular smoking and cannabis consumption in three school years, as well as with having friends who were smokers and poor school performance. At 15-16 years old, the average annual decrease from 1996 to 2008 was 6.8% in girls and 6.1% in boys.ConclusionsAdolescent smoking has been decreasing in the last few years in Barcelona. There is a strong association between tobacco use and cannabis consumption.

ResumenObjetivosAnalizar aquellos factores asociados al consumo de tabaco en adolescentes para plantear futuras intervenciones de promoción de la salud desarrolladas por las escuelas y centros de atención primaria.DiseñoEstudio transversal, muestreo por conglomerados bietápico.EmplazamientoSe incluyeron 97 centros escolares de Cataluña, 2005-2006.ParticipantesSe obtuvieron 9.340 cuestionarios completos de estudiantes entre 14-16 años.Mediciones principalesEncuesta autoadministrada que recogía variables sociodemográficas, académicas, estado de salud, familiares, relaciones sexuales, sustancias adictivas, estados de ánimo y variables de opinión sobre el consumo. Se analizó la asociación de estas variables con la variable dependiente fumador/no fumador y también fueron analizadas como factores que aumentaban la probabilidad de ser fumador mediante modelos multinivel.ResultadosSe incluyeron 4.653 chicos y 4.687 chicas, con una edad media de 15,2 años. El 71,1% de los estudiantes eran no fumadores, el 75% de los chicos y el 67,3% de las chicas. Aumentaban la probabilidad de ser fumador (OR e IC 95%): ser chica 0,60 (0,53-0,68), cursar 4.o ESO 1,27 (1,12-1,43), tener un rendimiento escolar bajo 3,38 (2,74-4,17), tener una autopercepción de salud regular/mala 2,81 (2,21-3,58), tener padres fumadores 1,68 (1,45-1,95), consumir alcohol 5,05 (4,35-5,86), tener 3 o más problemas de estado de ánimo 1,22 (1,05-1,41), vivir sin ningún progenitor 1,59 (1,07-2,38), estar de acuerdo en que exista publicidad sobre tabaco 1,64 (1,45-1,85), y opinar que el tabaco ayuda a relajarse 3,57 (3,23-4,17).ConclusionesAunque la mayoría de los estudiantes eran no fumadores, el consumo de tabaco era más prevalente en las chicas. Factores sociodemográficos, socioculturales, del entorno y opinión se asociaban con el consumo de tabaco entre los jóvenes.AbstractObjectiveThe aim of this study was to analyze those factors associated with cigarette smoking in adolescent school children, in order to plan future school interventions for promoting good health strategies developed by the schools and Primary Health Care professionals.DesignCross-sectional study with a two-stage cluster sampling.SettingThe study included 97 schools, and was carried out in 2005-06 in Catalonia (Spain).Participants14-16 year-old secondary school children.Main measuresThe survey was based on a self-administered paper-based questionnaire that collected sociodemographic variables, academic level, health status, family variables, sexual relations, addictive substances, mood state, and variables related to opinions on cigarette smoking The association between these variables and smoker/non-smoker variable was analyzed, as well as factors that could increase the probability of becoming a smoker using multilevel models.ResultsA total of 9340 completed questionnaires, including 4653 from males, were received from the pupils, with a mean age of 15.2 years. The results showed that 71.1% of pupils were non-smokers, 75% of whom were males and 67.3% of females. The following factors increased the probability of becoming a smoker (OR and 95%CI): being a female 0.60 (0.53-0.68), being in the 4th year 1.27 (1.12-1.43), low academic performance 3.38 (2.74-4.17), self-reported regular/poor health status 2.81 (2.21-3.58), smoking parents 1.68 (1.45-1.95), alcohol consumption 5.05 (4.35-5.86), having 3 or more problems of mood state 1.22 (1.05-1.41), living without parents 1.59 (1.07-2.38), agreeing with tobacco industry advertising 1.64 (1.45-1.85) and believing that tobacco acts as a relaxant 3.57 (3.23-4.17).ConclusionsAlthough the majority of pupils were non-smokers, smoking was more prevalent among females. The factors associated with cigarette smoking in the adolescents included sociodemographic, sociocultural, and personal environmental factors, as well as their opinions on the habit.

Introduction In teenagers with perennial allergic rhinitis, exposure to tobacco cigarette smoke increases the count of eosinophils in the nasal mucosa; the recruitment of eosinophils arises from the combined action of a number of cellular and molecular signals, including eotaxin. Objective To assess the effect of exposure to tobacco cigarette smoke on the count of immunoreactive cells to eotaxin-1 and eosinophils on the nasal mucosa of children and teenagers with perennial allergic rhinitis. Methods In a cross-sectional study, forty-four patients were evaluated (aged 7–19 years old): 22 with and 22 with no exposure to tobacco cigarette smoke. After replying to 2 validated questionnaires, on Asthma and Allergies in Childhood and on the severity of nasal symptoms, nasal mucosal samples were obtained by scraping the middle one-third of the inferior turbinates. Then counts of immunoreactive cells to eotaxin-1 and eosinophils were assessed by immunohistochemistry. Results Patients with exposure to tobacco cigarette smoke showed higher cell counts of both eotaxin-1 and eosinophils than patients with no exposure to the smoke, with no correlation between the two variables. However, both counts, of eotaxin-1 and eosinophils, were related to the cotinine/creatinine ratio. Conclusions Exposure to tobacco cigarette smoke can increase eotaxin-1 and the count of eosinophils in the nasal mucosa of young patients with perennial allergic rhinitis.

ResumenEn Chile, la prevalencia de tabaquismo en mayores de 15 años es 40,6%. El tabaquismo activo y pasivo provoca enfermedad cardiovascular como consecuencia del efecto del monóxido de carbono y nicotina a través de inducción de un estado de hipercoagulación, aumento del trabajo cardíaco, vasoconstricción coronaria, liberación de catecolaminas, alteración del metabolismo de los lípidos y alteración de la función endotelial.Se estima que en el mundo mueren 5.4millones de personas prematuramente al año debido al uso de tabaco y subirá a 10millones para el 2025. En Chile más de 41 personas mueren cada día por enfermedades asociadas al tabaco y el gasto anual en estas enfermedades es US$1.100millones. Al analizar los datos chilenos del estudio INTERHEART el tabaco fue el factor de riesgo más importante, con un 42% (95%IC 33.2-51.4%) de los infartos atribuibles al hábito de fumar, lo que se explica por las altas tasas de consumo. Hay una importante reducción de riesgo al dejar de fumar.SummaryIn Chile, the prevalence of smoking in older than 15 years old is 40.6%. Active and passive smoking produces cardiovascular disease due to effect of carbon monoxide and nicotine, though the induction of an increased coagulation and cardiac work, coronary artery constriction, catecholamine releases, abnormal lipid metabolism and endothelial dysfunction.It is estimated that 5.4million people died each year prematurely worldwide due to tobacco use and this will rise to 10million in year 2025. In Chile more than 41 persons died each day for diseases associated with tobacco, and the smoking associated diseases expenses are US 1.100million a year. When Chilean data of the INTERHEART study is analyzed, smoking was the most important risk factor for myocardial infarction, with 42% (95%IC 33.2-51.4%) of the infarctions attributable to smoking, and this can be explained by the high tobacco consumption rate in the Chilean population. An important risk reduction is observed when smoking stops.

Objectives: To assess the impact of the Law 42/2010, on the health measures on smoking, on the prevalence of the exposure to environmental tobacco smoke (ETS), the repercussions in frequently visited places, and support of the new legislation. Design: A before-after evaluation by comparing two cross-sectional studies the comparison of two transverse surveys. Place: Primary Care, Delicias district (115,446 inhabitants) of Zaragoza city, including the Delicias Sur, Delicias Norte, Bombarda and Univérsitas basic health districts. Participants: A total of 387 users in 2009, and 400 in 2011 with ages between 20 and 79 years old assigned to the participating Primary Care Centres. Main measurements: Prevalences and mean exposure times, with their confidence intervals (CI). The differences were then calculated using the Chi-squared test and Analysis of Variance (ANOVA). Results: The exposure prevalence to the ETS in 2011 was shown to be lower and statistically significant than that found before the implementation of the new legislative measure, falling from the 61.9% to the 40.5% (CI 95% = 35.8-45.4%), with 61.5% of those polled being in favour of the new law (CI 95% = 59.2-68.75), and 80.5% (79,08-86.44) mentioned still going to the same places with the same frequency. Conclusions: The impact has been favourable, decreasing the exposure by more than 20%, with this fall being more marked in the population that currently define themselves as non-smokers. There is population support for the new legislation. Finally, there has been no observed fall in the frequency of visits to the same places. Objetivo: Evaluar el impacto de la Ley 42/2010 de medidas sanitarias frente al tabaquismo en la prevalencia de exposición referida al humo ambiental del tabaco (HAT), la repercusión en frecuentación de lugares y el apoyo a la nueva legislación. Diseno: ˜ Estudio de evaluación antes-después mediante comparación de 2 encuestas transversales. Emplazamiento: Atención Primaria, distrito de Delicias (115.446 habitantes) de la ciudad de Zaragoza, incluye a las zonas básicas de salud de Delicias Sur, Delicias Norte, Bombarda y Univérsitas. Participantes: Se incluyeron 387 usuarios en 2009 y 400 en 2011 de edades entre 20 y 79 anos ˜ usuarios de los centros participantes. Mediciones principales: Prevalencias y medias de tiempos de exposición, así como sus intervalos de confianza. Posteriormente se calcularon sus diferencias mediante test de chi cuadrado y análisis de la varianza (ANOVA). Resultados: La prevalencia de exposición referida al HAT en el 2011 se muestra inferior y estadísticamente significativa a la hallada antes de la aplicación de la nueva medida legislativa, pasando del 61,9 al 40,5% (IC al 95% = 35,8-45,4%). El 61,5% de los encuestados se situaban a favor de la nueva ley (IC al 95% = 59,2-68,75). El 80,5% (79,08-86,44) referían seguir acudiendo a los mismos con la misma frecuencia.68,75).El80,5% (79,08-86,44) referían seguir acudiendo a los mismos con la misma frecuencia. Conclusiones: El impacto ha sido favorable, disminuyéndose las exposiciones en más de un 20%, siendo más marcado este descenso en la población que actualmente se define como no fumadora. Existe apoyo poblacional a la nueva legislación. Y no se objetiva descenso en la frecuentación de locales.

Resumo: Introdução: De acordo com a abordagem MPOWER, adotada em 2008 pela OMS, a monitorização da epidemia tabágica é necessária como forma de avaliar a eficácia das medidas preventivas desenvolvidas no controlo do consumo de tabaco em adolescentes e adultos. Objetivo: Determinar a prevalência do consumo de tabaco em adolescentes escolarizados portugueses, por regiões. Material e métodos: A amostra é constituída por 8764 alunos, 4060 do sexo masculino e 4704 do sexo feminino, e é representativa dos alunos do ensino regular público português. Os dados foram recolhidos no ano letivo de 2008/2009 através de um questionário de auto-relato. Resultados: Na amostra total, 10,2% dos rapazes e 9,1% das raparigas são consumidores regulares de tabaco. O consumo aumenta com a idade, sendo que, aos 15 anos, 12,3% dos rapazes e 8,6% das raparigas consomem tabaco regularmente e 6,1% dos rapazes e 4,0% das raparigas consomem tabaco ocasionalmente. Relativamente à prevalência por região, a mais elevada prevalência de consumo regular de tabaco regista-se no Alentejo (14,7%), seguindo-se os Açores (11,8%), e a mais baixa regista-se no Algarve (4,1%). Conclusão: A prevalência do consumo de tabaco em adolescentes escolarizados portugueses varia de acordo com a região do país e de forma similar ao que acontece na população adulta portuguesa. Abstract: Introduction: According to the MPOWER approach adopted in 2008 by the WHO, monitoring smoking epidemics is necessary in order to assess the effectiveness of the preventive measures used in smoking control in adolescents and adults. Objectives: To determine the prevalence of smoking in Portuguese school-aged adolescents by region. Material and methods: The sample is made up of 8764 students, 4060 boys and 4704 girls, and is representative of the Portuguese students in regular public education. The data was collected in the 2008/2009 academic year, through a quantitative self-report questionnaire. Results: In the total sample, 10.2% of boys and 9.1% of girls are regular smokers. Smoking increases with age. At 15 years old 12.3% of the boys and 8.6% of the girls are regular smokers and 6.1% of the boys and 4.0% of the girls are occasional smokers. Looking at prevalence by region, the highest prevalence of regular smoking is found in Alentejo (14.7%), followed by Azores (11.8%) and the lowest is found in Algarve (4.1%). Conclusions: The prevalence of smokers among Portuguese school-aged adolescents varies within the several regions of the country, similar to what happens in the adult Portuguese population. Palavras-chave: Consumo de tabaco, Prevalência, Prevenção, Adolescente, Keywords: Smoking, Prevalence, Prevention, Adolescent

ResumenObjetivoAnalizar la información sobre consumo de tabaco en adolescentes a partir de diversas encuestas escolares.DiseñoSe extraen de diversos estudios los datos relativos a prevalencia de fumadores diarios al final de la escuela secundaria obligatoria por sexo, analizando tendencias.EmplazamientoSe revisan los 5 estudios representativos de adolescentes en España: Encuesta Estatal sobre Uso de Drogas en Estudiantes de Secundaria (ESTUDES); Estudio de Comportamientos de los Escolares Relacionados con la Salud (ECERS-HBSC); Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles dirigido a población Juvenil (SIVFRENT-J); estudio de Factores de Riesgo en Estudiantes de Secundaria (FRESC); Estudio de Monitorización de las Conductas de Salud de los Adolescentes (EMCSAT).ResultadosLa prevalencia de fumadores diarios varía entre estudios, en varones entre 8,5 y 13,3% y en chicas entre 12,7 y 16,4%. Aunque se aprecian oscilaciones en algunos estudios, la tendencia entre 1993 y 2008 es de descenso. Con los datos más recientes se puede estimar un declive anual ponderado de la prevalencia de tabaquismo en la adolescencia del 6,47% anual para los varones y 6,96% para las chicas.ConclusionesHay un patrón de descenso de la prevalencia de fumadores diarios adolescentes en España a partir de los diversos estudios existentes, que ofrecen datos consistentes, aunque hay que mantener la vigilancia debido a la existencia de oscilaciones. Esto concuerda con la información derivada de las ventas y de encuestas en población adulta. En cualquier caso, sería deseable que el ritmo de cambio fuera más acentuado y constante.AbstractObjectiveTo analyse information on adolescent use of tobacco in Spain from different school surveys.DesignData on daily smoking prevalence by sex at the end of compulsory education is extracted and figures are compared, analysing trends.SettingThe five representative studies on adolescents in Spain are reviewed: The National Survey on Drug Use in Secondary School Children (Encuesta estatal sobre uso de drogas en estudiantes de secundaria (ESTUDES); Survey of Health Behaviour in School-aged Children (HBSC-ECERS); Surveillance System of Risk Factors Associated With Non-Transmittable diseases in the Young Population (Sistema de Vigilancia de Factores de Riesgo Asociados a Enfermedades No Transmisibles dirigido a población Juvenil)(SIVFRENT-J); Study of Risk Factors in Secondary School Children (Estudio de factores de riesgo en estudiantes de secundaria) (FRESC); Surveillance Study of Health Behaviour in Adolescents (Estudio de Monitorización de las Conductas de Salud de los Adolescentes) (EMCSAT).ResultsThe prevalence of daily smokers varies among studies, in boys from 8.5 to 13.3% and in girls from 12.7 to 16.4%. Although some series show variations, the trend from 1993 to 2008 is downwards. With data from recent years, weighted annual declines in smoking prevalence in adolescence can be estimated to be 6.47% for boys and 6.96% for girls.ConclusionsThere is a decreasing pattern in adolescent daily smoking prevalence in Spain from the different existing studies, which provide consistent data, although surveillance must be kept due to fluctuations. This is in agreement with tobacco sales statistics and health surveys in the adult population. However, the pace of change should be more rapid and constant.

OBJECTIVE To determine the motivations (attitudes, beliefs and experiences) for tobacco consumption among adolescents. METHODS This study was based on qualitative methodology using six 50-minute discussion groups with 6-8 adolescents per group during the 2008/09 school year. Purposive sampling was performed of 12-18 year-old adolescents attending a middle-class urban school (Jaen, Spain). The sample was stratified by educational level as the homogeneity criterion and gender and tobacco consumption as the heterogeneity criterion. Content analysis consisted of coding, triangulation of categories and obtaining and verifying the results. RESULTS There were 44 adolescents (54% male). The participants reported that smoking relaxed and improved self-image, providing security (boys) and improving relations with the opposite sex, as well as weight control (girls). The family encouraged smoking by providing a model to imitate, although many adolescents hid their smoking from their families. Friends constituted a pressure group to start or continue smoking. Starting secondary school marked the beginning of experimental use. Society tended to accept consumption and buying tobacco was easy for minors. University students were a role model and were free to smoke. The adolescents looked to their parents and educators/health workers to provide a model of abstinence and reported that they were well informed but only remembered powerful messages. Participants unanimously indicated that tobacco causes addiction, but in proportion to the duration of consumption, and were concerned only with the immediate symptoms caused by smoking. Teenage smokers associated multiple drug use with leisure time. CONCLUSIONS This study provides useful data on motivation that could be used to improve smoking prevention interventions among adolescents. The most important factors seem to be peer influence, parental attitudes, easy access to tobacco and symptoms of dependence.

ResumenEste artículo discute las posibilidades de la fiscalidad indirecta como mecanismo capaz de alterar los precios relativos de bienes y servicios, y por ende de incentivar a los ciudadanos a que adopten conductas saludables. Se revisan los casos del consumo de tabaco y la dieta inadecuada. La elección de estos dos casos responde, por un lado, a que son dos de las conductas con mayor incidencia en la morbimortalidad en España, y por otro a que sirven para subrayar tanto las potencialidades de la política fiscal (tabaco) como sus limitaciones (dieta inadecuada). Tras la discusión recomendamos aumentar progresivamente el impuesto especial mínimo sobre los cigarrillos y evitar que su valor sea erosionado por la inflación, así como alinear el nivel del impuesto mínimo especial sobre la picadura para liar con el soportado por los cigarrillos, para evitar el ya perceptible desplazamiento de la demanda hacia esa variedad. La principal recomendación en el caso de la dieta inadecuada es obtener una base de evidencia más sólida que la disponible en la actualidad en cuanto a la relación entre los precios de los alimentos y el índice de masa corporal en España. La escasa evidencia disponible para Estados Unidos, no obstante, sugiere que la capacidad de la intervención sobre los precios para reducir los problemas de sobrepeso y obesidad es muy limitada.AbstractThis article discusses the possibilities of indirect taxation as a mechanism that alters the relative prices of goods and services and hence encourages citizens to adopt healthy lifestyles. We review the case of smoking and unhealthy diet. These two cases were chosen because these are the two lifestyle factors with the greatest impact on morbidity and mortality in Spain and because they highlight the possibilities of tax policy (smoking) and its limitations (unhealthy diet). After discussion of these issues, we recommend gradually increasing the level of the minimum special tax on cigarettes and avoiding erosion of its value by inflation, as well as aligning the level of the minimum special tax on fine cut tobacco with that borne by cigarettes, to avoid the already perceived shift of demand toward the former variety. The main recommendation for the case of unhealthy diet is to obtain a more solid evidence base than that currently available on the relationship between food prices and body mass index in Spain. The scarce evidence available for the USA nevertheless suggests that the possibilities of price-based policies to reduce the problems of overweight and obesity are highly limited.

R E S U M O - Introdução: A aplicação de leis de Saúde Pública na área das determinantes da saúde relacionadas com os estilos de vida e comportamentos, onde se incluem as lutas contra o consumo nocivo de álcool e contra o tabagismo, necessita de ser analisada e discutida tendo em consideração a complexidade muito própria desta realidade, de onde nunca se podem dissociar as medidas a tomar dos vários actores sociais envolvidos. De facto, nestas áreas, as actividades de lobby da indústria bem como dos agentes de distribuição e de venda, denotando a existência de interesses concorrentes com os das políticas de Saúde Pública, interferindo nos resultados destas e impedindo a sua efectividade. Material e métodos: Tendo por fundo esta premissa, o presente artigo elabora uma breve reflexão sobre os pontos fortes e fracos do uso dos instrumentos legais em Saúde Pública, tomando como exemplo as leis do álcool e do tabaco portuguesas, em relação às quais, situações de ambiguidade, indefinição prática, faltas de controlo e de sancionamento efectivo do seu incumprimento, impedem uma efectividade das mesmas, ilustrando com exemplos recentes as armadilhas à Saúde Pública que podem surgir mesmo em leis cujo objecto é o de reduzir o consumo de substâncias com risco para a saúde e os seus potenciais danos. Tal é o caso da lei norte-americana n.º 111-31 de 22 de Junho de 2009 que deu à FDA (Food and Drug Administration) o poder de controlar os produtos do tabaco e que tem sofrido duras críticas por parte das autoridades em Saúde Pública. Afirmamos o poder incontestável do instrumento legislativo para mudar comportamentos e atitudes, manifestando, contudo, a preocupação de que a lei é ainda um instrumento de Saúde Pública mal explorado e pouco avaliado. Identificar as forças e fraquezas nas leis de Saúde Pública é uma tarefa tão complexa quanto a multidisciplinaridade das ciências e a diversidade social dos actores envolvidos. Uma das premissas do processo de elaboração e implementação das leis de saúde pública, é, pois, a necessidade de um conhecimento aprofundado do contexto a que estas mesmas leis se vão aplicar, incluindo o ambiente e os actores sociais que delas são alvo. Os efeitos potenciais da lei são difíceis de prever à partida ou de padronizar, contudo, de acordo com alguns autores que recentemente se têm debruçado sobre o tema, podemos tentar analisar e avaliar o processo legislativo em Saúde Pública e os resultados obtidos com o recurso a um modelo lógico. Sabemos que apesar do consumo de álcool e danos a ele associados bem como do consumo de tabaco e da exposição ao fumo deste estarem plenamente documentados no que diz respeito ao risco para a saúde individual e colectiva, as políticas públicas preconizadas estão ainda longe de serem efectivas para debelar estas práticas, pelo que todas as discussões em torno do problema de uma ideal concepção da lei nos parecem essenciais para se poder começar a atingir os resultados pretendidos em Saúde Pública e não apenas os resultados possíveis face aos interesses em jogo. Conclusão: Com a reflexão apresentada neste artigo, gostaríamos de munir os actores e organismos que actuam em prol da Saúde Pública em Portugal de alguns instrumentos e argumentos de discussão que permitam promover a acção da lei nas áreas acima mencionadas, de uma forma mais esclarecida e pró-activa, bem como de contribuir para o desenvolvimento da investigação em Direito da Saúde Pública, nomeadamente através da construção e utilização de métodos eficazes de avaliação do impacto das leis e das políticas relativas às epidemias comportamentais relacionadas com o estilo de vida, no sentido de melhorar os seus resultados e assim potenciar uma sociedade mais saudável. A B S T R A C T - Introduction: The application of laws of Public Health in the area of health determinants related to lifestyles and behaviors, which include the fight against harmful use of alcohol and tobacco control, needs to be analyzed and discussed taking into account the very particular complexity of this reality, where it is not possible to decouple the action to be taken from the various social stakeholders involved. Indeed, in these areas, the lobbying activities of industry and distribution and sales sectors, show the existence of competing interests with the policies of Public Health, interfering in the results of these and preventing their effectiveness. Material and methods: Taking as a background the above mentioned assumption, this article presents a brief reflection on the strengths and weaknesses of the use of legal instruments in Public Health, taking as example the Portuguese laws on alcohol and tobacco, for which situations of ambiguity and imprecision in its enforcement and a lack of effective monitoring and sanctioning of its non-compliance have put a stop to a effectiveness of the same legislation in practice. The article also shows recent foreign examples which illustrate the pitfalls that can arise even in Public Health laws with clear objectives to reduce the consumption of health hazardous substances and their potential harm. Such is the case with U.S. Law No. 111-31 of 22 June 2009 which gave the FDA (Food and Drug Administration) the power to control tobacco products and has been the aim of harsh criticism from Public Health authorities and academics. In this article, although affirming the undeniable power of the legislative instrument to change attitudes and behaviors we, express, however, some concerns respecting the fact that the law is still an unexplored and poorly evaluated instrument in the Public Health domain. To identify the strengths and weaknesses in the laws concerning public health is indeed as complex as the multidisciplinary sciences and the social diversity of the actors there involved. Therefore, one of the premises of the drafting and implementation of future good public health laws is the need of a thorough understanding of the context to which these same laws will apply, including the environment and stakeholders who are their main target. The potential effects of the law are difficult to predict or to standardize, however, in the line of some authors who have focused recently on the subject, this article supports the use of a logical model to analyze and evaluate the legislative process in Public Health and its obtained results. Knowing that although alcohol consumption and the harm associated with it as well as the dangers of tobacco use and environment tobacco smoking are fully documented with regard to individual and collective health risks, public policies advocated are still far from be effective to curb these life style behaviors, it appears to be essential to deepen the discussion on the question of an ideal conception of Public Health Law in order to start to achieve more desired results in public health and not just the possible outcomes from the clash with the interests at stake. Conclusion: With the reflections in this article, we wish to equip the actors and bodies acting on behalf of Public Health in Portugal with some tools and arguments that will benefit the discussion to promote a better action of the law in the areas mentioned above. This also includes a more enlightened and pro-active legislation procedure, and a contribution to the development of research in Public Health Law, plus the construction and use of effective methods of evaluating the impact of laws and policies concerning behavioral outbreaks related to lifestyle in order to improve their results and thereby to promote a healthier society. info:eu-repo/semantics/publishedVersion

ResumenObjetivoEvaluar la influencia de la publicidad de tabaco en los hábitos de consumo.DiseñoRevisión sistemática.Fuente de datosPubMed, Ovid, Scielo, Mediclatina, Elsevier-Doyma e Isooc (CSIC) (enero 2000-septiembre 2008).MétodosSe han incluido 44 artículos de ámbito nacional o internacional que relacionan el consumo de tabaco con alguna práctica publicitaria o de promoción. Se han eliminado los artículos que no se centran en el impacto de la publicidad y la promoción del tabaco sobre la conducta de consumo y las investigaciones referidas a prevención, a intervención o a prohibición a través de campañas, medidas, planes y leyes antitabaco. El análisis de los artículos se ha centrado en los actores identificados, la metodología empleada y la temática.ResultadosLa publicidad influye en el consumo de tabaco. Los mensajes publicitarios llevan a iniciar el hábito (5 artículos) y a mantener el hábito (3 artículos), construyen el concepto y la imagen de la persona fumadora (5 artículos) y usan diferentes estrategias publicitarias (22 artículos).ConclusionesLa publicidad desarrollada por las industrias tabacaleras emplea diversas estrategias de influencia directa en el consumo de tabaco de la población.AbstractObjectiveTo evaluate the influence of tobacco advertising on consumer habits.DesignSystematic review.Data sourcesPubMed, Ovid, Scielo, Mediclatina, Elsevier-Doyma, Isooc (CSIC) (January 2000-September 2008)MethodsA total of 44 national and international articles, linking the consumption of tobacco with any promotional or advertising practice. Articles not focused on the impact of advertising and promotion of cigarettes and research on prevention, intervention, plans and laws were removed.ResultsAdvertising influences tobacco consumption. Publicity leads to starting smoking (5 articles) and maintaining the habit (3 articles). It uses the relationship between advertising and smoker's image and concept (5 articles) and different advertising strategies (22 articles).ConclusionsThe advertising developed by the tobacco industry uses different strategies of influence on the consumption of cigarettes in the population.

El cine ha sido durante muchos años un fiel colaborador de la industria del tabaco, fomentando, mediante la presencia del cigarrillo en las películas, que niños y jóvenes se conviertan en adictos a la nicotina. El movimiento de prevención del tabaquismo en Estados Unidos ha documentado suficientemente estos hechos, y hoy existen demostraciones científicas suficientes acerca de la estrecha relación entre la presencia del tabaco en las películas y el inicio de su consumo por niños y jóvenes. Desde hace años se han creado grupos de trabajo que están presionando a la industria del cine y fomentando el debate social con anuncios en los principales medios de comunicación, para conseguir que Hollywood acepte su responsabilidad y cambie de actitud. Smoke Free Movies, una iniciativa liderada por la Universidad de California, está consiguiendo importantes avances para limitar la presencia de los cigarrillos en las películas americanas. En Europa en general, y en España en particular, este tipo de iniciativas son aún incipientes. El Movimiento de Prevención del Tabaquismo español debería aprovechar la experiencia americana para impulsar políticas similares. Algunas medidas de eficacia probada son la certificación, en los títulos de crédito, de no haber recibido pago alguno por mostrar tabaco en la película, la proyección de anuncios publicitarios antitabaco antes de las películas en que salgan cigarrillos, no permitir la identificación de marcas y no subvencionar películas que estimulen el consumo de tabaco.

Resumo: Em Janeiro 2008, foi implementada, em Portugal, uma nova medida legislativa que condiciona o consumo de tabaco em espaços colectivos fechados. Como a exposição passiva ao fumo do tabaco provoca a exacerbação dos sintomas de asma, tornou-se pertinente conhecer a percepção dos doentes asmáticos sobre as repercussões desta nova lei no seu bem-estar.Foi realizado um estudo descritivo transversal, numa amostra de conveniência, constituída por 96 doentes asmáticos da consulta de Pneumologia do Hospital Pulido Valente e do Hospital de Santa Marta, de Lisboa. Os dados foram recolhidos a partir de um questionário padronizado com respostas voluntárias, anónimas e confidenciais. Para tratamento estatístico recorreu-se ao programa Epi InfoTM e foi aplicado o teste qui-quadrado para análise dos resultados (α=5%).Dos doentes inquiridos, a percentagem dos que estiveram expostos a fumo de tabaco até Dezembro 2007 foi de 67,7%, com maior prevalência no grupo de indivíduos activos. Apesar de a maioria dos inquiridos não referir alterações no seu bem-estar, 39,6% referiu alterações positivas (melhoria na realização de actividades diárias, diminuição dos sintomas ou menor necessidade de recorrer a medicação SOS). Destes indivíduos, que indicaram alterações positivas, 81,6% deixaram de estar expostos após entrada da nova lei e 65,8% indicaram-na como factor responsável.Os resultados deste estudo, apenas dois meses após a implementação legal, reforçam a importância da aplicação de medidas legais eficazes que evitem a exposição ao fumo de tabaco, como forma de redução da exacerbação dos sintomas e de melhoria do bem-estar dos doentes asmáticos.Rev Port Pneumol 2009; XV (1): 27-42 Abstract: January 2008 saw new legislation implanted in Portugal restricting smoking in closed public spaces. As second-hand smoke worsens asthma symptoms, it is important to understand how asthma patients feel this new legislation impacts on their well-being.A descriptive cross-sectional study was conducted in a convenience sample formed of 96 asthma patients who had Pulmonology appointments at the Pulido Valente and Santa Marta Hospitals. All data was collected from a standardised questionnaire with volunteer, anonymous and confidential answers. Epi InfoTM software was used for statistical processing purposes, and the results analysed using the chi-squared test (α=5%).67.7% of the patients polled were exposed to second-hand smoke until December 2007, with a higher percentage in those currently in work. A considerable percentage (39.6%) described positive changes (measured by improved performance of daily life activities, decrease in symptoms or lesser recourse to SOS medication), even though the majority did not recognise any improvement. 81.6% of those who noted positive changes said they were no longer exposed to second-hand smoke with the passing of the new legislation, and 65.8% stated that the smoking ban was the factor responsible for those changes.These results, only two months after the implementation of the legislative ban on smoking in public spaces, underline the importance of approving effective measures to create and enforce smoke-free environments, reducing worsening of symptoms and improving asthma patientsâ well-being.Rev Port Pneumol 2009; XV (1): 27-42 Palavras-chave: Asma, tabaco, exposição, fumo, fumo passivo, lei, Key-words: Asthma, tobacco, exposure, smoke, second-hand smoke, legislation

ResumenSe presentan las acciones de los servicios de salud pública en Barcelona para conseguir un mejor cumplimiento de la Ley 28/2005 de medidas sanitarias frente al tabaquismo. Éstas se concentran en una primera fase informativa y una segunda en la que se activan los mecanismos de ejercicio de la autoridad sanitaria.La implantación de la Ley en centros de trabajo, educativos y medios de transporte se saldó sin incidentes relevantes salvo sucesos aislados en algún centro universitario o medio de ransporte. En el sector alimentario el proceso ha sido más complejo. Se calculan 17,5 denuncias ciudadanas por 100.000 personas-año. Las inspecciones desencadenadas por denuncias ciudadanas provocaron la apertura de 3,3 expedientes sancionadores por 100.000 personas-año, en general por incluir al menos una falta grave.La implantación de la Ley ha precisado políticas activas de comunicación y el ejercicio real de la autoridad sanitaria. Esto ha comportado una notable carga de trabajo para los servicios de salud pública.AbstractThis paper presents the actions taken by the public health services in the city of Barcelona (Catalonia, Spain) to improve compliance with the requirements of the new 28/2005 tobacco control law. These were essentially informative at first, with a second phase where authority enforcement mechanisms were activated.In workplaces, educational settings and transport the law was incorporated without incidents nor relevant complaints, except for isolated incidents in some university or mass transport settings. In food establishments the process has been more complex. Estimating the frequency of related events, there are 17.5 formal citizen complaints for 100,000 person-years. Inspections generated by citizen complaints resulted in 3.3 administrative proceedings for 100,000 person-years, mostly for incurring in serious violations.Effectively enforcing the law required active information and communication policies, as well as the real enforcement by health authority. This caused an important workload to the public health services.

Resumo: Introdução â A prevalência de hábitos tabágicos em Portugal e na Europa ronda os 19,2 e 33%, respectivamente. Não existem, porém, dados precisos quanto à prevalência de hábitos tabágicos na popoulação asmática. Objectivos â Determinar a prevalência de hábitos tabágicos e sua repercussão numa amostra populacional asmática. Material e métodos â Cento e dez doentes asmáticos observados em consultas consecutivas de asma foram classificados como não fumadores, ex-fumadores ou fumadores, de acordo com os seus hábitos tabágicos. Subsequentemente, baseados numa avaliação clínica e funcional, foram incluídos num de quatro grupos: asma persistente severa (APS), persistente moderada (APM), persistente ligeira (APL) e intermitente (AI). Resultados â Entre os 110 doentes (65% do sexo feminino), com idades compreendidas entre os 18 e 78, 8% eram fumadores, 9% ex-fumadores e 83% não fumadores. Distribuição entre os asmáticos: â Fumadores â 0% APS, 56% APM, 33% APL, 11%AI; â Ex-fumadores â 10% APS, 30% APM, 50% APL, 10%AI; â Não fumadores â 7%APS, 27%APM, 36%APL, 30%AI;A avaliação funcional foi globalmente pior em doentes com exposição (actual ou prévia) a tabaco. Conclusão â A prevalência de hábitos tabágicos nesta amostra populacional foi de 8%, consideravelmente inferior à sua prevalência na população portuguesa (19,2%). A análise e comparação do grau de severidade de asma e da sua avaliação funcional revelou resultados piores na população de fumadores e ex-fumadores. Estes reforçam o papel da exposição ao tabaco como factor de agravamento da asma e, consequentemente, do seu prognóstico. Estudos posteriores podem revelar-se importantes na comprovação dos bem conhecidos riscos dos hábitos tabágicos, contribuindo para alertar a população asmática neste sentido. Rev Port Pneumol 2008; XIV (5): 617-624 Abstract: Setting â The smoking rate in Portugal is 19.2% and 33% in Europe. There is no precise data on the smoking rate of the asthmatic population. Aim â To determine the smoking rate and its repercussions on an asthmatic population sample. Design â One hundred and ten asthmatic patients observed in asthma consultations were classified as non-smokers, former-smokers or smokers. Subsequently, based on functional and clinical criteria, they were classified as having Severe Persistent (SPA), Moderate Persistent (MoPA), Mild Persistent (MiPA) and Intermittent (IA) Asthma. Results â 8% of 110 patients (65% female) aged 18 to 78 years were smokers, 9% former-smokers, 83% non-smokers. Among the asthmatics:â smokers: 0% SPA, 56% MoPA, 33% MiPA, 11% IA;â former smokers: 10% SPA, 30%MoPA, 50% MiPA, 10% IA;â non-smokers: 7% SPA, 27% MoPA, 36% MiPA, 30% IA. Patients with exposure to smoking had worse functional evaluation than those without exposure. Conclusion â In this population sample the rate of current smoking habits (8% of current smokers) was considerably low than in Portugal (19.2%). Analysis and comparison of asthma severity and functional evaluation detected worse results in both current and former smokers. These reinforce the role of tobacco exposure in asthma aggravation and worsening of its prognosis. Further studies may be important to prove and alert the asthmatic population, in particular, to the well-known risks of smoking. Rev Port Pneumol 2008; XIV (5): 617-624 Palavras-chave: Asma, tabaco, GINA, VEMS, Key-words: Asthma, smoking, GINA, FEV1

Setting: The smoking rate in Portugal is 19.2% and 33% in Europe. There is no precise data on the smoking rate of the asthmatic population. Aim: To determine the smoking rate and its repercussions on an asthmatic population sample. Design: One hundred and ten asthmatic patients observed in asthma consultations were classified as non-smokers, former-smokers or smokers. Subsequently, based on functional and clinical criteria, they were classified as having Severe Persistent (SPA), Moderate Persistent (MoPA), Mild Persistent (MiPA) and Intermittent (IA) Asthma. Results: 8% of 110 patients (65% female) aged 18 to 78 years were smokers, 9% former-smokers, 83% non-smokers. Among the asthmatics: â smokers: 0% SPA, 56% MoPA, 33% MiPA, 11% IA; â former smokers: 10% SPA, 30%MoPA, 50% MiPA, 10% IA; â non-smokers: 7% SPA, 27% MoPA, 36% MiPA, 30% IA. Patients with exposure to smoking had worse functional evaluation than those without exposure. Conclusion: In this population sample the rate of current smoking habits (8% of current smokers) was considerably low than in Portugal (19.2%). Analysis and comparison of asthma severity and functional evaluation detected worse results in both current and former smokers. These reinforce the role of tobacco exposure in asthma aggravation and worsening of its prognosis. Further studies may be important to prove and alert the asthmatic population, in particular, to the well-known risks of smoking. Resumo: Introdução: A prevalência de hábitos tabágicos em Portugal e na Europa ronda os 19,2 e 33%, respectivamente. Não existem, porém, dados precisos quanto à prevalência de hábitos tabágicos na popoulação asmática. Objectivos: Determinar a prevalência de hábitos tabágicos e sua repercussão numa amostra populacional asmática. Material e métodos: Cento e dez doentes asmáticos observados em consultas consecutivas de asma foram classificados como não fumadores, ex-fumadores ou fumadores, de acordo com os seus hábitos tabágicos. Subsequentemente, baseados numa avaliação clínica e funcional, foram incluídos num de quatro grupos: asma persistente severa (APS), persistente moderada (APM), persistente ligeira (APL) e intermitente (AI). Resultados: Entre os 110 doentes (65% do sexo feminino), com idades compreendidas entre os 18 e 78, 8% eram fumadores, 9% ex-fumadores e 83% não fumadores. Distribuição entre os asmáticos: â Fumadores â 0% APS, 56% APM, 33% APL, 11%AI; â Ex-fumadores â 10% APS, 30% APM, 50% APL, 10%AI; â Não fumadores â 7%APS, 27%APM, 36%APL, 30%AI;A avaliação funcional foi globalmente pior em doentes com exposição (actual ou prévia) a tabaco. Conclusão: A prevalência de hábitos tabágicos nesta amostra populacional foi de 8%, consideravelmente inferior à sua prevalência na população portuguesa (19,2%). A análise e comparação do grau de severidade de asma e da sua avaliação funcional revelou resultados piores na população de fumadores e ex-fumadores. Estes reforçam o papel da exposição ao tabaco como factor de agravamento da asma e, consequentemente, do seu prognóstico. Estudos posteriores podem revelar-se importantes na comprovação dos bem conhecidos riscos dos hábitos tabágicos, contribuindo para alertar a população asmática neste sentido. Key-words: Asthma, smoking, GINA, FEV1, Palavras-chave: Asma, tabaco, GINA, VEMS

Objectives: We aimed to show an area-level association between the frequency of intestinal metaplasia (IM) in Helicobacter pylori-infected patients and tobacco consumption. Methods: We systematically reviewed the literature to retrieve data on the prevalence of IM in different countries and performed an ecological analysis to quantify the association between the prevalence of IM among infected subjects and smoking, using data on national tobacco availability. Articles evaluating IM in the general population or in dyspeptic patients were identified by a MEDLINE search. We selected one study per country, giving preference to those for which the study design/populations evaluated provided the highest external validity and inter-study comparability of methodology. Results: This systematic review of published data retrieved information for 29 countries from 5 continents depicting a wide variation in the prevalence of IM among H. pylori-infected subjects in different regions, ranging from 3% in Argentina to 55% in New Zealand. In countries exhibiting a simultaneously high prevalence of infection and low incidence of gastric cancer, IM was also relatively infrequent (Thailand, 6%; India, 8.2%; Nigeria, 11.1%; Gambia, 11.8%; Saudi Arabia, 15.5%; Iran, 15.6%; Egypt, 24.4%). A significant correlation was observed between IM prevalence in infected subjects and tobacco availability (r = 0.45; p = 0.02). Conclusions: Our results show that the concept of the African and Asian «enigmas» may be extended to precancerous lesions. Tobacco availability was positively associated with the prevalence of IM among H. pylori-infected subjects at an area level.

ObjetivosConocer la evolución del consumo de alcohol, tabaco y otras drogas entre adolescentes de una zona urbana.DiseñoDescriptivo, transversal, mediante encuesta autoadministrada.EmplazamientoInstituto de enseñanza secundaria (zona urbana de clase media).ParticipantesUn total de 678 alumnos durante los años 1997, 2001 y 2004.Mediciones y resultados principalesSe recogieron datos de la edad, el sexo y el consumo de sustancias tóxicas.Los resultados se exponen según el año de estudio. Se estudian 172, 249 y 257 adolescentes, respectivamente, con mediana de 14 años (intervalo, 12-17 años) e igualdad de sexos. Se incrementa el número de adolescentes que no han consumido ningún tóxico (21±3,1%, 34±3,0%, 56±3,1%; p90%), disminuye el uso de cocaína y aumentan las drogas de diseño. La edad influye en el consumo, pero no el sexo.ConclusionesEn los últimos 8 años ha disminuido el consumo de tóxicos entre los adolescentes, sobre todo por una menor ingesta de alcohol. Sin embargo, aparecen nuevas formas de consumo de alcohol y otras drogas, sobre todo durante el fin de semana, y se incrementa el consumo diario de tabaco.ObjectivesTo find the evolution of the consumption of alcohol, tobacco and other drugs among adolescents in an urban area.DesignDescriptive, cross-sectional study using a self-administered questionnaire.SettingSecondary school (middle-class urban area).Participants and measurementsSix hundred and seventy-eight students took part in the years 1997, 2001, and 2004.Measurements and main resultsThe questionnaire included questions on age, sex and consumption of toxic substances.The following figures are given in order of the year of study.We studied 172, 249, and 257 adolescents, with a mean age of 14 (interval, 12-17) and equality of sexes. The proportion of adolescents with no consumption of toxic substances increased (21%±3.1%; 34%±3.0% 56%±3.1%; P90%), cocaine use fell and design drug use increased. Age affected consumption, but sex did not.ConclusionsIn the last 8 years the consumption of toxic substances among adolescents has dropped, mainly because of less alcohol consumption. However, new forms of consumption of alcohol and other illegal drugs, especially at weekends, emerged and daily consumption of tobacco increased.

Resumo: O tabaco está implicado na carcinogénese multiorgâni-ca, com identificação de mais de cinquenta substâncias carcinogénicas que induzem mutações, alterando o ciclo celular, a resposta auto-imune e a regulação endócrina. É um dos nove factores identificados responsáveis por um terço de mortes por neoplasias malignas juntamente com erros dietéticos, obesidade, sedentarismo, consumo de álcool, promiscuidade sexual, toxicodependência e po-luição ambiental geral e limitada. Está implicado nas doenças cardiovasculares que representam a primeira causa de morte nos países civilizados e, no aparelho respiratório, é o factor principal para o desenvolvimento de DPOC (doença pulmonar obstrutiva crónica), RB-ILD (bron-quiolite respiratória e doença pulmonar intersticial), DIP (pneumonia intersticial descamativa), bronquiolite e fi-brose intersticial bronquiolocêntrica, histiocitose de células de Langerhans, pneumonia eosinofílica, sarcoidose, metaplasia epidermóide do epitélio respiratório e carcinoma bronco-pulmonar. O estado inflamatório crónico sistémico induzido pelo tabaco constitui a base de desenvolvimento de alterações genéticas também dependentes dos contaminantes do tabaco.Rev Port Pneumol 2007; XIII (3): 383-389 Abstract: Tobacco is implicated in multisystemic carcinogenesis through more than fifty identified carcinogenic metabolites that produce mutations responsible for alterations in cell cycle, immune response and endocrine regulation. Is one of nine risk factors identified in one third of cancer deaths together with obesity, sedentary, alcohol consumption, sexual promiscuity, drug addiction, and open and closed air contamination. Answering for cardiovascular diseases as the first cause of death in civilized world, tobacco is also pointed as the major factor implicated in the development of COPD (chronic obstructive pulmonary disease), RB-ILD (respira-tory bronchiolitis and interstitial lung disease), DIP (desquamative interstitial pneumonia), bronchiolitis and bronchiolocentric interstitial fibrosis, Langerhans cells histiocytosis, eosinophilic pneumonia, sarcoidosis, epidermoid metaplasia in respiratory epithelium and lung cancer. The chronic tobacco induced inflammatory state is the basis for the acquisition of genetic alterations dependent on the tobacco contaminants.Rev Port Pneumol 2007; XIII (3): 383-389 Palavras-chave: Tabaco, morfologia pulmonar, Key-words: Tobacco, lung morphology

ObjetivoInvestigar si la carrera a pie influye sobre el hábito tabáquico.DiseñoEstudio de casos y controles, con emparejamiento 1:1. Observación longitudinal retrospectiva.EmplazamientoAtención primaria. Ciudad de Toledo.ParticipantesCasos: 48 corredores voluntarios sanos de 47 ± 7,8 años de edad. Controles: 48 sujetos sanos, emparejados por sexo y año de nacimiento, elegidos al azar entre la población adscrita al medico investigador.Mediciones principalesHábito tabáquico y gramos semanales de alcohol mediante cuestionario, peso, talla, presión arterial y frecuencia cardíaca de reposo. Se obtuvieron las odds ratio (OR) de las proporciones de sujetos que fumaban o habían fumado alguna vez, de los que seguían fumando y de las probabilidades de abandono del tabaco de cada grupo.ResultadosLa OR de la proporción de sujetos que fumaban o habían fumado entre los grupos de corredores (54,2%) y controles (70,9%) era de 0,486 (intervalo de confianza [IC] del 95%, 0,205-1,149; χ2=2,8; p=0,093). La OR para continuación del hábito entre los grupos de corredores (8,4%) y controles (41,7%) era de 0,127 (IC del 95%, 0,035-0,456; χ2=14,0; p=0,0002). En el grupo de corredores había abandonado el tabaco el 45,8% y en el de controles, el 31,2% (OR=7,85; IC del 95%, 1,89-32,52; χ2=11,8; p=0,0007). El 50% de los corredores que fumaban lo había dejado desde que comenzó a correr y el 76,9% de éstos lo había dejado justo en el momento de comenzar a correr.ConclusionesHay una asociación negativa entre carrera a pie y tabaco. Si un fumador decide comenzar a correr regularmente, tiene muchas probabilidades de dejar de fumar y mantenerse así.ObjectiveTo investigate whether running influences smoking habits.DesignStudy of cases and controls, with 1:1 pairing. Retrospective longitudinal observational study.SettingPrimary care City of Toledo, Spain.ParticipantsCases: 48 healthy volunteer runners of 47±7.8 years of age. Controls: 48 healthy subjects, paired by gender and year of birth, chosen at random from the medical list assigned to the medical researcher.Principal measurementsSmoking habits and alcohol consumption in grams per week using a questionnaire, weight, height, blood pressure, and heart rate at rest. The odds ratio (OR) was obtained on the proportion of subjects who smoked or smoked at some time, those who continued smoking and the probabilities of giving up tobacco in each group.ResultsThe OR of the proportion of subjects who smoked or had smoked between the groups of runners (54.2%) and controls (70.9%) was 0.486 (95% confidence interval [CI], 0.205-1.149; χ2=2.8; P=.093). The OR for continuing the habit between groups of runners (8.4%) and controls (41.7%) was 0.127 (95% CI, 0.035-0.456; χ2=14.0; P=.0002). In the group of runners, 45.8% had stopped smoking, as well as 31.2% of the controls (OR=7.85; 95% CI, 1.89-32.52; χ2=11.8; P=.0007); 50% of the runners who smoked had given it up since starting to run and 76.9% of these had given it up just at the time of starting to run.ConclusionsThere is a negative association between running and tobacco. If a smoker decides to run regularly he/she has high probabilities of giving up smoking and continue to do so.

ObjetivoConocer las opiniones, las prácticas actuales, las barreras percibidas y la predisposición al cambio con respecto al consejo para dejar de fumar (CF) ofertado a los pacientes por los diferentes profesionales sanitarios (PS) de atención primaria.DiseñoEstudio descriptivo, transversal.EmplazamientoCentros de salud del Área Sanitaria 9, de Madrid.ParticipantesParticiparon 480 PS, entre médicos de familia, pediatras, residentes de medicina familiar y comunitaria, y enfermería.MedicionesMediante cuestionario autocumplimentado y anónimo se recogen variables sociodemográficas, sobre actitudes, creencias y utilización de estrategias en CF y sobre barreras percibidas para darlo, así como la predisposición al cambio.ResultadosContestó al cuestionario el 75,2% (el 94,2, 61,1, 51,6 y 88% de los médicos, enfermeros, pediatras y residentes, respectivamente). El 72% pregunta de manera habitual, con un incremento hasta el 92,4% en las enfermedades relacionadas con el tabaquismo, sin diferencias respecto al sexo, el PS, el hábito tabáquico y la formación previa. El 85,8% ofrece realizar un seguimiento y el 63,5% proporciona consejos escritos. El 75% de los no fumadores se considera modelo social, frente al 40% de los fumadores. Las principales barreras son la falta de tiempo y la baja motivación en los pacientes. El 93,5% cree que es necesaria una formación específica para proporcionar CF.ConclusionesSe pregunta y se ofrece CF, independientemente del hábito tabáquico del PS. A pesar de las barreras, hay una adecuada utilización de las estrategias para proporcionar CF. Hay buena predisposición al cambio para optimizar el CF.ObjectiveTo get to know the opinions, current practices, perceived barriers and stage of change in respect to the smoking cessation advice (SCA) offered to patients by the different health professionals (HP) from primary care.DesignDescriptive cross-sectional study.LocationÁrea Sanitaria 9’s Health Centers, inMadrid, Spain.Participants480 HPs, including primary care doctors, pediatricians, primary care residents, and nursery staff.MeasurementsUsing a self-filled and anonymous questionnaire, we will gather sociodemographic variables and from the HP’s office, regarding the attitudes towards tobacco, efficiency beliefs and use of strategies in the advice, and the perceived barriers to give it, as well as the state of change.Results75.2% of the HPs filled the questionnaire (94.2%, 61.1%, 51.6%, and 88% by doctors, nurses, pediatricians, and residents respectively). 72% ask regularly, this rate increasing to 92.4% over tobacco-related diseases. No differences were made between sexes, professional types, tobacco habits, or previous attendance to courses. 85.8% offers tracing and 63.5% give written advices. Nearly 75% of non-smokers are considered social role models, that against only 40% of smokers. The main barriers found were lack of time and low motivation from the patients. 93.5% consider an specific education necessary to give efficient SCA.ConclusionsInquiries are made and SCA is given, independently of the smoking habits of the SCA. Likewise, there is a good state of change by the HPs to optimize the treatment of tobacco dependency.

Objetivos: Para poder realizar un abordaje integral de las políticas referidas al tabaquismo hay que conocer el mapa de los actores relacionados con el tabaco y sus vínculos políticos. En este trabajo se pretende presentar una primera aproximación en España. Métodos: Análisis de la prensa, publicaciones de la industria y entrevistas con personas clave. Se identifican los actores pro tabaco activos en España, que se han podido clasificar según su naturaleza, la esfera en que se mueven y su ámbito territorial preferente. Resultados: Se identifican las empresas tabaqueras, entre las que destacan Altadis y Philip Morris por su dominio del mercado, las organizaciones del comercio minorista (estanqueros), las organizaciones «pantalla» creadas por la industria (Club de Fumadores por la Tolerancia), las de cultivadores y las empresas de transformación. La distribución está dominada por Logista, filial de Altadis. Hay que tener en cuenta también las empresas de vending y de productos complementarios (mecheros, fósforos y papel). Se identifican los vínculos de estos actores con la Administración pública, donde destaca el papel que desempeña el Comisionado para el Mercado de Tabacos, así como los Ministerios de Agricultura, Hacienda y Economía. Se identifican también las relaciones con la patronal, algunos partidos políticos y sindicatos, así como con otros sectores empresariales con gran influencia social, como los medios de comunicación y la publicidad. Conclusiones: El mapa de los actores pro tabaco en España es complejo y supera los límites de la estricta industria tabaquera. La comprensión de este entramado es fundamental para poder plantear políticas integrales de prevención. Objectives: For a comprehensive approach to policies on smoking, the map of actors related to tobacco and their political ties needs to be identified. The present article constitutes the first attempt at this task in Spain. Methodology: Analysis of the press, industry publications, and interviews with key people. Active actors favoring smoking in Spain were identified and classified according to their characteristics, the sphere in which they act, and their preferred territorial arena. Results: We identified tobacco companies (Altadis and Philip Morris dominate the market), tobacco trade organizations (tobacconists), front-line organizations created by the tobacco industry (The Smokers for Tolerance Club), organizations of tobacco growers, and processing companies. Distribution to retailers is dominated by Logista, owned by Altadis. Other sectors to take into account are vending companies and those manufacturing related products (cigarette paper, matches or lighters). The contacts of these actors with the public administration are reviewed, notable among which are the role of the Commissioner for the Tobacco Market, the Ministry of Agriculture, the Ministry of Finance and the Ministry of the Economy. Ties were also found with employers' organizations, some political parties, and unions, as well as with other sectors with social influence such as the media and advertising sectors. Conclusions: The map of actors favoring smoking in Spain is complex and goes beyond the confines of the tobacco industry. Understanding this web is crucial to promoting comprehensive prevention policies.

ResumenObjetivoValorar la asociación de la situación laboral, el tipo de estudios y el estado civil con el consumo de tabaco en una cohorte de licenciados y diplomados universitarios españoles, donde predominan los profesionales sanitarios.MetodosSe realizó un análisis transversal de los datos basales de los 7.508 primeros participantes del Proyecto SUN (Seguimiento Universidad de Navarra). Los sujetos fueron clasificados según su consumo de tabaco. Las variables independientes fueron: situación laboral, estado civil, nivel más alto de estudios completado, número de hijos, gramos de alcohol ingerido al día, índice de masa corporal y edad. En el análisis multivariante se ajustaron 3 grupos de modelos de regresión logística no condicional: a) fumadores frente al conjunto formado por nunca fumadores más ex fumadores; b) fumadores frente a nunca fumadores, y c) fumadores de 15 o más cigarrillos al día frente al conjunto formado por fumadores de menos de 15 cigarrillos/día, nunca fumadores y ex fumadores.ResultadosEn los varones no se encontró ninguna asociación entre la situación laboral y ser fumador en ninguna de las 3 comparaciones. Por el contrario, entre las mujeres se observó que haber cursado la diplomatura de enfermería se asociaba a una mayor prevalencia de tabaquismo, con una prevalencia del 48,5% de fumadoras actuales entre las enfermeras. Entre las mujeres, también era más frecuente el consumo de tabaco en las estudiantes. Para las estudiantes, la prevalencia de grandes fumadoras (≥ 15 cigarrilos/día) mostraba una odds ratio de 1,81 (intervalo de confianza del 95%, 1,28-2,57). Haber realizado un doctorado se asociaba inversamente con el tabaquismo en ambos sexos.ConclusionesDentro de un gran colectivo español con niveles educativos superiores, la prevalencia de fumadoras actuales es mayor en las mujeres que han completado una diplomatura. Es preocupante, desde el punto de vista sociosanitario, que entre las enfermeras la prevalencia de tabaquismo sea más alta que en la media de las mujeres universitarias.AbstractObjectiveThe objective of this study was to assess the association between employment, educational level, marital status, and smoking in a large cohort of Spanish university graduates (3- and 5-year degrees), with a predominance of health professionals.MethodsA cross-sectional analysis of the baseline data of the first 7,508 participants in the follow-up study of the University of Navarre (SUN Project) was performed. The subjects were classified according to their smoking status. Independent variables were: employment, marital status, highest educational level attained, number of children, alcohol consumption (g/day), body mass index, and age. In the multivariate analysis, 3 non-conditional logistic regression models were built using the following outcomes: a) smokers vs never-smokers plus exsmokers; b) smokers vs never-smokers; c) smokers of 15 or more cigarettes a day vs smokers of less than 15 cigarettes a day plus never-smokers and ex-smokers.ResultsAmong men, no association was found between employment and smoking status in any of the comparisons. In contrast, among women, being a nurse was associated with a higher prevalence of smoking. The prevalence of current smokers among nurses was 48.5%. Female students were also more likely to smoke and had a higher risk of being heavy smokers (OR = 1.81; 95% CI, 1.28-2.57). A lower prevalence of smoking was found among participants of both sexes who had completed a doctorate.ConclusionsAmong a large Spanish collective with higher education, the prevalence of smoking was higher in women with a shorter college degree. The prevalence of smoking among nurses was higher than the average among women graduates, which is a cause for concern.

El acuerdo alcanzado en 1998 entre las tabaqueras y la mayoría de los estados de Estados Unidos puso a disposición pública millones de páginas de documentos internos, muchos de ellos con información que la industria hubiera preferido mantener en secreto. La revisión de dichos documentos supone un recurso importante para la lucha internacional contra el tabaquismo, ya que se han archivado electrónicamente, y su acceso se ha facilitado a todo el mundo a través de Internet. Estos documentos proporcionan a los impulsores de las políticas de prevención información relevante y de utilidad. Para favorecer su uso, este estudio describe y enumera los archivos electrónicos con documentos internos de la industria tabaquera, presenta el proceso para su investigación y describe documentos que desvelan las tácticas que en los años setenta, ochenta y noventa emplearon las tabaqueras para manipular la política y a la sociedad en beneficio de sus intereses comerciales en España.

ResumenObjetivoDescribir las tendencias en el consumo de tabaco, alcohol y cannabis entre los adolescentes escolarizados entre 1987 y 1999 de la ciudad de Barcelona.MétodosEncuestas transversales realizadas a muestras representativas de escolares de segundo curso de Educación Secundaria Obligatoria (ESO) entre 1987 y 1999. Los cuestionarios eran anónimos y autocontestados. Se dispone de datos de 5.013 escolares de la ciudad de Barcelona que participan en alguna de las 5 encuestas.ResultadosTras disminuir de forma uniforme entre 1987 y 1996, en 1999 se observa un aumento del 13,4% en el consumo regular (diario o semanal) de tabaco y del 38,7% en el consumo experimental de tabaco, respecto a las prevalencias observadas en 1996. Con respecto al consumo de alcohol, se observa una disminución global del 14% de los escolares que ha bebido al menos medio vaso de alcohol entre 1987 y 1999. El consumo problemático de alcohol se iguala en ambos sexos, y la proporción que declara haberse emborrachado alguna vez es en 1999 superior en las chicas (14,0%) que en los chicos (10,5%). Mientras en 1996 un 6,9% declaraba haber probado cannabis, la proporción en 1999, sin diferencias entre sexos, era del 7,3% de la población estudiada.ConclusionesEn el período estudiado se observa un aumento del consumo regular de tabaco, una disminución del consumo de alcohol y una estabilización del consumo de cannabis. Las diferencias entre ambos sexos tienden a desaparecer.AbstractObjectiveTo describe trends in tobacco, alcohol, and cannabis consumption among secondary school pupils in Barcelona between 1987 and 1999.MethodsCross-sectional surveys administered to representative samples of pupils in the second year of secondary school between 1987 and 1999. The questionnaires were anonymous and self-completed. We present data from 5013 secondary school pupils from Barcelona who participated in one of the five surveys.ResultsRegular smoking (daily and weekly) showed a uniform decrease between 1987 and 1996. The results of the last survey (1999) showed an increase over those the 1996 survey, ranging from 13.4% for regular smoking to 38.7% for experimental smoking. Between 1987 and 1999, the percentage of schoolchildren who reported drinking at least half a glass of alcohol at some time showed an overall decrease of 14.0%. No differences in sex were found in problematic alcohol consumption, while a higher proportion of girls (14.0%) than boys (10.5%) reported getting drunk at some time. Whereas in 1996, 6.9% of the population studied had smoked cannabis at some time, in 1999 this proportion was 7.3%, with no differences between sexes.ConclusionsDuring the study period regular smoking increased, alcohol consumption decreased and cannabis consumption tended to level-off. Differences between boys and girls tended to disappear.

Objetivo. Determinar el papel de los factores de virulencia de Helicobacter pylori, el sexo y el consumo de tabaco y alcohol en el desarrollo de úlcera péptica en pacientes infectados por H. pylori. Pacientes y métodos. Se estudiaron 174 pacientes dispépticos que acudieron consecutivamente a realizarse una gastroscopia. El diagnóstico de infección por H. pylori se realizó por cultivo y/o histología. La presencia de anticuerpos específicos anti-H. pylori se determinó mediante western-blot. Se recogió el consumo de tabaco y alcohol. Resultados. Ciento veinticinco pacientes (32 con úlcera, 12 con duodenitis y 81 con dispepsia funcional) fueron diagnosticados de infección por H. pylori con anticuerpos IgG frente a la bacteria. La detección de las proteínas CagA y VacA, el sexo masculino y el consumo elevado de alcohol y tabaco se asociaron con el hallazgo de úlcera péptica. En el análisis multivariante sólo los anticuerpos anti-CagA (odds ratio [OR]: 4,1; intervalo de confianza [IC] 95%: 1,1-15,3; p = 0,036), anti-VacA (OR: 3,9; IC 95%: 1,4-10,8; p = 0,009) y el sexo masculino (OR: 3,1; IC 95%: 1,2-8,3; p = 0,02) se asociaron con la enfermedad ulcerosa. Conclusiones. Las proteínas CagA y VacA y el sexo masculino contribuyen de manera independiente al riesgo de padecer úlcera péptica en pacientes infectados por H. pylori. Objective Demonstrate the role of the virulence factors of Helicobacter pylori, the sex, and tobacco and alcohol use in the development of peptic ulcer in patients infected by H. pylori. Patients and methods One hundred and seventyfour patient with dyspepsia were studied after they went consecutively for gastroscopy. The diagnosis of infection by H. pylori was carried out by culture and/or histology. Through western-blot the presence of specific anti-H. pylori antibodies was determined. The tobacco and alcohol use data were collected. Results One hundred and twenty-five patients (32 with ulceration, 12 with duodenitis and 81 with functional dyspepsia) showed H. pylori infection with anti-bacterium IgG antibodies. The detection of the proteins CagA and VacA, male sex and heavy consumption of alcohol and tobacco were associated with the finding of peptic ulcer. In the multivariate analysis only anti-CagA antibodies (OR: 4.1; 95% CI: 1.1-15.3; p = 0.036), anti-VacA (OR: 3.9; 95% CI: 1.4-10.8; p=0.009) and male sex (OR: 3.1; 95% CI: 1.2-8.3; p = 0.02) were associated with the ulcerative disease. Conclusions The proteins CagA and VacA, and the male sex, contribute independent risk factors for peptic ulcer in patients infected by H. pylori. 0.257 JCR (2003) Q4, 93/102 Medicine, general & internal UEM

ResumenObjetivosValorar si el tabaco de liar supone un problema en materia de salud pública y consumo.MétodosSe estudia el 70% del mercado español. En materia de salud pública, se analizan los contenidos de nicotina, alquitrán y monóxido de carbono del humo, y se comparan con los de los cigarrillos convencionales. En materia de consumo, se examina el etiquetado.ResultadosLos contenidos de nicotina, alquitrán y monóxido de carbono alcanzan valores de hasta el 70%, el 85% y el 84%, respectivamente, más de lo permitido para los cigarrillos convencionales. El 67% de las muestras no indican los contenidos de nicotina y alquitrán, y el 100% el monóxido de carbono. A pesar de la existencia de etiquetado, éste no garantiza una información suficiente al consumidor.ConclusionesEl tabaco de liar supone un problema tanto en materia de salud pública como en consumo. Por ello, sería necesaria alguna medida que permita resolver esta cuestión.AbstractObjectivesTo study whether fine-cut tobacco poses a problem for public health and consumer affairs.MethodsWe analyzed up to 70% of the fine-cut tobacco market in Spain. Regarding public health, the contents of nicotine, tar and carbon monoxide were analyzed and compared with levels in conventional cigarettes. Concerning consumer affairs, the labeling of samples was checked.ResultsThe contents of nicotine, tar and carbon monoxide reached values of 70%, 85% and 84%, respectively. These values are higher than those allowed in conventional cigarettes. A total of 67% of the samples analyzed did not show nicotine and tar contents on the labeling. None of the labels showed carbon monoxide contents. The presence of labeling per se did not guarantee sufficient information for consumers.ConclusionsFine-cut tobacco is a problem in both public health and consumer affairs. Solutions are required to resolve both problems.

RESUMO: A contribuição dos Portugueses para a divulgação do tabaco no mundo ocorreu no século XVI. Às folhas desta planta originária da América foram atribuídas propriedades curativas pelo médico espanhol Nicolas Monardes. Só em meados do século XX foi possível demonstrar a actividade patogénica do tabaco. Desde então, têm-se multiplicado as evidências da sua nocividade em múltiplas patologias, particularmente cardiovascular e pulmonar. A relativa aceitabilidade social do tabaco em alguns países, como Portugal, e a dependência que lhe está associada limitam a luta antitabágica. Os custos do tabaco, económicos e para a saúde, têm levado à formulação de diversas recomendações com o objectivo de tratar esta dependência. As grandes orientações destas recomendações passam pela necessária sensibilização e motivação dos fumadores para a cessação tabágica, e pela administração de meios farmacoterapêuticos eficazes adjuvantes da abstinência ao tabaco. Este trabalho aborda a problemática da utilização destes fármacos, em particular a terapêutica de substituição da nicotina e a bupropiona, e relembra a necessidade de implementar uma política de saúde vocacionada para a prevenção primária.REV PORT PNEUMOL 2002; VIII (2): ABSTRACT: In the XVI century the Portuguese have contributed to the introduction of tobacco in the world. The tobacco plant came from America and its therapeutic properties were attributed to the leaves by a Spanish physician. The pathogenic effects of tobacco were shown only in the middle of the XX century. Since then many reports have demonstrated the harmful role of tobacco in several diseases, particularly in cardiovascular and pulmonary areas. The still existing relatively good social acceptability of tobacco in some countries, namely Portugal, and the associated dependence have limited the fight against smoking. The concerns related to the health and economic costs associated to tobacco consumption leaded to the formulation of several guidelines addressing the treatment of tobacco dependence. Such guidelines are aimed to sensitise and motivate the smokers to the smoking cessation, and to recommend effective medicinal products which may help in the tobacco abstinence. The objective of this paper is to describe and explore the use of these drugs, in particular nicotine replacement therapy and bupropion, and to remind the need to implement a health policy directed to the primary prevention of tobacco consumption.REV PORT PNEUMOL 2002; VIII (2): Palavras-chave: Tabaco, dependência da nicotina, mentol, farmacogenética, cessação tabágica, farmacoterapia, recomendações terapêuticas, terapêutica de substituição da nicotina, bupropiona, Key-words: Tobacco smoke, nicotine dependence, menthol, pharmacogenetics, smoking cessation, drug therapy, clinical guidelines, nicotine replacement therapy, bupropion

[ES] Objetivo Se valoran los efectos que tendría una intervención destinada a reducir el uso de tabaco en la población española de fumadores sobre la morbilidad, la mortalidad y los costes asociados al consumo de tabaco. Método Se ha adaptado el modelo Health and Economic Consequences of Smoking patrocinado por la OMS y desarrollado por The Lewin Group. La intervención propuesta incluye el acceso a asistencia farmacológica de un 35% de los fumadores que intentan dejar de fumar, y obtienen una tasa global de cesación al año del 7,2%. Las enfermedades estudiadas son: cáncer de pulmón, enfermedad coronaria, enfermedad cerebrovascular, EPOC, asma y bajo peso al nacer. Se estiman los casos de enfermedad y muerte atribuibles al consumo de tabaco evitados y la reducción en el coste sanitario debidos a la intervención, proyectados a 20 años. Resultados Sin intervención, en el año 1 del modelo 2.136.094 fumadores padecen alguna de las condiciones clínicas atribuibles al consumo de tabaco, el coste asistencial es de 4.286 millones de euros y las muertes atribuibles son 26.537. La intervención propuesta evita 2.613, 9.192, 17.415 y 23.837 casos de enfermedad atribuible al consumo de tabaco en los años 2, 5, 10 y 20 del modelo, respectivamente. Los costes asistenciales acumulados evitados son 3,5 millones de euros en el año 2 y 386 millones de euros a los 20 años. Las muertes acumuladas evitadas son 284 en el año 2 y 9.205 a los 20 años de la intervención. La intervención añade un total de 78.173 años de vida al final del período considerado. Conclusiones La disponibilidad de nuevas intervenciones eficaces en el tratamiento del tabaquismo y el incremento de la accesibilidad a las mismas pueden contribuir de forma relevante a la reducción de la morbilidad, la mortalidad y los costes sanitarios asociados al tabaquismo en España. [EN] We estimated the effect that a smoking cessation intervention in the Spanish population of smokers would have on smoking-related morbidity, mortality and health care costs. We adopted the model Health and Economic Consequences of Smoking sponsored by the WHO Health Organization and developed by the The Lewin Group. The smoking cessation intervention proposed includes pharmacological treatment to 35% of smokers who are trying to quit smoking and obtains a quit rate of 7.2%. The diseases studied are: lung cancer, heart disease, stroke, chronic obstructive pulmonary disease, asthma exacerbation, and low birth weight. The smoking-related cases of disease and of averted death and the reduction in health care expenditure due to the intervention were estimated. Without intervention, at year 1 of the model, 2,136,094 smokers would be affected by some smoking-related disease; health care expenditure would be 4,286 million e and deaths attributable to smoking would total 26,537. The proposed intervention would prevent 2,613, 9,192, 17,415 and 23,837 cases of smoking-related disease at years 2, 5, 10 and 20 of the model, respectively. The saving in accumulated health care costs would amount to 3.5 million e at year 2 and 386 million e over 20 years. The accumulated prevented deaths are 284 at year 2 and 9,205 over 20 years. The intervention would save a total of 78,173 life-years by the end of the period considered. The availability of new effective smoking cessation interventions and the increase in accessibility to such interventions may contribute significantly to reducing morbidity, mortality and health care costs associated with smoking in Spain. Sí

ObjetivoEstimar la prevalencia de los factores de riesgo cardiovascular: hipertensión arterial (HTA), hipercolesterolemia, diabetes mellitus (DM), obesidad y tabaquismo en el Área de Salud 20 de la Comunidad Valenciana.DiseñoEstudio observacional descriptivo transversal.EmplazamientoEstudio poblacional realizado en el Área de Salud 20 de la Comunidad Valenciana (comarca de la Vega Baja del río Segura).PacientesPersonas 3 20 años de edad residentes en dicha área. Muestreo aleatorio polietápico proporcional con definición de cuotas muestrales según tipo de residencia (urbano, periurbano y rural), según grupos de edad y sexo. Tamaño muestral calculado de 2.550 personas. Se excluyen las embarazadas y las personas diagnosticadas de enfermedad psíquica o física incapacitante (n = 134). Se incluye el resto (n = 2.416).MedicionesMediante entrevista personal se cumplimenta un cuestionario y se realiza una exploración física básica. Posteriormente se practica una extracción sanguínea. Se recogen las siguientes variables: filiación, datos socioeconómicos, enfermedades previas (cardiovasculares, HTA, hipercolesterolemia, DM), hábito tabáquico, índice de masa corporal, presión arterial, hemograma y bioquímica estándar. Se han utilizado los criterios diagnósticos preconizados por el último consenso para cada factor.ResultadosDe las 2.416 personas elegibles, participan 1.886 (78,06%). Prevalencias halladas: HTA conocida: 30,3 ± 2,1% (mujeres: 34,1 ± 2,9%, varones: 25,8 ± 2,9%); hipercolesterolemia conocida: 22,6 ± 1,9%; diabetes conocida: 8,4 ± 1,2%; tabaquismo: 33,6 ± 2,1% (mujeres: 25,4 ± 2,7%; varones: 42,2 ± 3,3%; grupo de edad 20–39 años: 56,9 ± 3,8%), y obesidad: 31,6 ± 2,1% (mujeres: 34,6 ± 2,9%; varones: 28,1 ± 3%; grupo de edad 3 60 años: 46,7 ± 3,9%). Se presentan los datos de detección.ConclusionesSe han encontrado prevalencias elevadas de hipertensión arterial, hipercolesterolemia, diabetes y obesidad, superiores a las halladas en el ámbito nacional. El tabaquismo es menos frecuente, aunque en los jóvenes es muy prevalente. La hipertensión conocida y la obesidad son más prevalentes en mujeres que en varones.ObjectiveTo calculate the prevalence of cardiovascular risk factors: hypertension, hypercholesterolaemia, diabetes mellitus (DM), obesity and tobacco dependency, in Health Area 20 of the Community of Valencia.DesignCross-sectional, descriptive, observational study.SettingPopulation study carried out in Health Area 20 of the Community of Valencia (Vega Baja del río Segura county).Patients≥20 years-old people, living in this area. Multi-stage randomised sample proportional to the definition of sample quotas according to the kind of residence (urban, peri-urban or rural), age groups and sex. Calculated sample size of 2550 people. Pregnant women and people diagnosed with incapacitating psychiatric or physical illnesses (134) were excluded. The rest (2416) were included.MeasurementsA questionnaire was filled out in a face-to-face interview and a basic physical examination was made. A blood sample was taken. The following variables were recorded: personal details, social and economic details, previous illnesses (cardiovascular, hypertension, hypercholesterolaemia, DM), tobacco habit, Body Mass Index, blood pressure, haemogram and standard biochemical test. The most recently agreed and recommended diagnostic criteria were used for each factor.Results1886 people of the 2416 eligible took part (78.06%). Prevalence was as follows: hypertension, 30.3±2.1% (women, 34.1±2.9%; men, 25.8±2.9%); hypercholesterolaemia, 22.6±1.9%; diabetes, 8.4±1.2%; tobacco dependency, 33.6±2.1% (women, 25.4±2.7%; men, 42.2±3.3%; 20–39 years old age-group, 56.9±3.8%), and obesity, 31.6±2.1% (women, 34.6±2.9%; men, 28.1±3%; age group ≥60 years old, 46.7±3.9%). Detection data were shown.ConclusionsHigh presence of hypertension, hypercholesterolaemia, diabetes and obesity, greater than the country-wide level. Tobacco dependency was less common, though very high in young people. Known hypertension and obesity are more common in women than men.

ResumenLas políticas de control del tabaquismo han vivido un importante impulso en cuanto a la protección de la población frente a la exposición involuntaria al humo ambiental de tabaco, pero estos avances han sido menores en lo que se refiere a la desnormalización de la conducta de fumar. Se describe una experiencia de sensibilización dirigida al ámbito escolar (especialmente a padres y madres), que incluye la señalización de los espacios de entrada y salida (vía pública) de los centros de educación primaria de la ciudad de Terrassa como «entornos sin humo». Se colocó un cartel con la inscripción «Entorno sin humo. Educamos entre todos» en la fachada de 50 de los 54 centros de educación primaria de la ciudad. Se constató una muy buena aceptación de la propuesta. Nuestra experiencia pone de relieve la posibilidad de llevar a cabo, desde la iniciativa local, acciones que ayuden a desnormalizar el consumo de tabaco sin necesidad de recurrir al desarrollo normativo.AbstractTobacco control policies have undergone a major boost in terms of protecting people from involuntary exposure to environmental tobacco smoke, but less progress has been made in the denormalization of smoking behaviour. We describe an experience focused on the educational environment, which included marking the waiting areas (streets) of primary schools in the city of Terrassa as «Smoke-free environments». We placed a placard with the inscription «Smoke-free environment. We educate together» on the front of 50 out of 54 primary schools in the city. The proposal was well accepted. Our experience highlights the possibility of carrying out actions, based on local initiatives, that help to denormalize smoking without the need for legislative enforcement.

ResumenObjetivoDescribir las tendencias entre 1986 y 1996, en el estudio MONICA-Cataluña, de la prevalencia de fumadores de cigarrillos entre 25 y 64 años de edad, según el nivel educativo, y validarlas bioquímicamente.MétodosTres encuestas-exámenes de salud transversales en muestras aleatorias independientes de la población general del centro de Cataluña, realizadas en los años 1986-1988, 1990-1992 y 1994-1996, siguiendo el protocolo del estudio MONICA de la Organización Mundial de la Salud. El tiocianato sérico se determinó por el método de Bowler.ResultadosSe examinaron 2.571, 2.934 y 3.485 varones y mujeres con tasas de respuesta del 74, 67 y 72% en cada examen, respectivamente. La prevalencia de fumadores de cigarrillos ajustada por edad descendió un 5,1% (IC del 95%: –1,5 a –8,7) en varones y aumentó un 8,5% (IC del 95%: +5,6 a +11,4) en mujeres. En 1994-1996, la prevalencia fue del 46,5% en varones y del 23,9% en mujeres. El mayor descenso se produjo en varones de 55 a 64 años (– 9,9%) y el mayor incremento en mujeres de 35 a 44 años (+14,8%). Los valores de tiocianato en sangre confirmaron estas tendencias disminuyendo de 78,9 a 73,9 mmol/l (p = 0,07) en varones y aumentando de 43,7 a 49,8 mmol/l (p < 0,01) en mujeres durante el período estudiado. Las fumadoras de cigarrillos aumentaron entre las mujeres de menor nivel educativo (+10%) y disminuyeron entre las universitarias (– 6%), mientras que en los varones el consumo de cigarrillos se redujo por igual en todos los niveles educativos. Los valores de tiocianato sérico confirmaron esta relación con el nivel educativo.ConclusionesLa prevalencia de fumadores de cigarrillos en los varones disminuyó de 1986 a 1996, pero la prevalencia era todavía alta en 1996. Las mujeres presentaban un patrón de adquisición progresiva del tabaquismo sobre todo las de menor nivel educativo.SummaryObjectiveTo describe trends from 1986-1996 in the prevalence of cigarette smoking between ages 25 to 64 in the MONICA- Catalonia study, according to educational level, and to validate these trends biochemically.MethodsThree cross-sectional surveys in independent random samples of the general population of central Catalonia area carried out in 1986-88, 1990-92 and 1994-96 following the World Health Organization’s MONICA protocol. Serum thiocyanate was determined by the Bowler method.ResultsA total of 2,571, 2,934 and 3,485 men and women were examined with response rates of 74, 67 and 72% in each survey respectively. The age-adjusted cigarette smoking prevalence decreased in men by –5.1% (95% CI: –1.5 to –8.7) and increased in women by +8.5% (95% CI: +5.6 to +11.4). The prevalence was 46.5% in men and 23.9% in women in 1994-96. The greatest decrease was in men aged 55-64 (–9.9%) and the greatest increase was in women aged 35-44 (+14.8%). These trends were confirmed by serum thiocyanate levels, which decreased from 78.9 to 73.9 mmol/l (p = 0.07) in men and increased from 43.7 to 49.8 mmol/l (p < 0.01) in women during the study period. Cigarette smoking increased in less educated women (+10%) and decreased in university women (–6%), while cigarette smoking in men decreased irrespective of educational level. Serum thiocyanate levels confirmed the relationship with educational level.ConclusionsThe prevalence of cigarette smoking decreased in men between 1986 and 1996 but remained high in 1996. Women showed a pattern of progressive adoption of smoking, especially those with lower educational level.

Objetivos1. Estudiar los factores predictivos de la cesación tabáquica y correlacionar las categorías del Programa de Ayuda al Fumador (PAF) con niveles de motivación y dependencia utilizando cuestionarios breves. 2. Conocer el porcentaje de la categoría «ganadores» al año utilizando la metodología del PAF.DiseñoProspectivo, observacional, de intervención y no controlado sobre una muestra de fumadores no seleccionados que acuden a consultas de atención primaria.EmplazamientoCuatro centros de salud urbanos de Zaragoza y Barcelona.IntervencionesIntervención sistemática sobre los fumadores atendiendo a la fase del cambio (categoría PAF). Utilización de cuestionarios de motivación-dependencia y validación bioquímica de la abstinencia.PacientesSe incluyeron 362 pacientes, de los cuales participaron finalmente un total de 288 fumadores (79,5%). La media de edad fue de 40,85 (DE, 15,7); varones (60,8%).Mediciones y resultados principalesUn 21,4% de los fumadores presentaba patología relacionada con el tabaco. El número de intentos previos para dejar de fumar era de 1,6 (DE, 2,9). Los pacientes fumaban una media de 13,4 cigarrillos desde hacía 22,2 años de media (DE, 15,7). La media de edad en el inicio del consumo fue de 17 años (DE, 4,7). El nivel de motivación inicial según el test de Richmond fue de 4,78 (DE, 3,2) y el promedio de dependencia según el test de Fagerström modificado (TFm) fue de 0,6 (DE, 0,7). El número de intervenciones PAF fue de 1,9 (DE, 2,9). Al final, un 15,6% de los pacientes tenía categoría «ganador», siendo confirmados en el 95,6% por validación bioquímica. El modelo de regresión logística confirmó que los factores predictivos de la cesación tabáquica fueron la edad, los niveles iniciales de motivación y el número de cigarrillos inicial.ConclusionesLos test breves de motivación (Richmond) y, en menor medida, de dependencia (TFm) fueron buenos predictores de la cesación tabáquica y se pueden recomendar en atención primaria.Objectives1. To study the factors predicting the giving-up of tobacco and to correlate the categories in the Smoker's Aid Programme (SAP) with levels of motivation and dependency, using brief questionnaires. 2. To find the annual percentage in the «winners» category, using the SAP methodology.DesignProspective, observational, intervention study without a control group of a random sample of smokers attending primary care clinics.SettingFour urban health centres in Zaragoza and Barcelona.InterventionsSystematic intervention on smokers in the change phase (SAP category). Use of questionnaires on motivation/dependency and of biochemical checks that they had actually given up. Patients. 362 patients of whom 288 smokers (79.5%) took part. Average age was 40.85 (SD: 15.7). 60.8% were males.Measurements and main results21.4% of the smokers had tobacco-related pathology. The number of previous attempts to give up smoking was 1.6 (SD: 2.9) Patients smoked an average of 13.4 cigarettes for 22.2 years (SD: 15.7). Average age at start of consumption was 17 (SD: 4.7). Initial motivation on the Richmond Test was 4.78 (SD: 3.2); and average dependency according to the modified Fagerström Test (TFm) was 0.6 (SD: 0.7). The number of SAP interventions was 1.9 (SD: 2.9). By the end 15.6% of the patients had achieved «winner» status, which was confirmed in 95.6% of them by the biochemical test. The logistic regression model confirmed that the factors predicting giving up tobacco were age, the initial levels of motivation and the initial number of cigarettes.ConclusionsThe short tests of motivation (Richmond) and, to a lesser extent, dependency (TFm) were good predictors of giving up tobacco and can be recommended in primary care.

ResumenFundamentola actual epidemia de tabaquismo es responsable de más muertes que ninguna otra anterior. La jóvenes son el principal objetivo de la publicidad de la industria tabaquera. En este estudio se pretende averiguar la prevalencia de tabaquismo en adolescentes y su entorno, así como la concordancia entre encuesta y cotinina sérica y la prevalencia total de exposición (activa más pasiva).Sujetos y MétodosEstudio transversal en 439 alumnos de educación secundaria. Se les realizó extracción de sangre y un cuestionario anónimo sobre su consumo de tabaco y el existente en su entorno. Se analizó la concordancia entre ambos métodos.ResultadosEl 56% de los adolescentes había fumado en alguna ocasión. La prevalencia declarada de tabaquismo fue del 34% (IC95%= 29,49-38,51), llegando al 40% en las chicas y al 23% en los chicos. La concordancia entre cotinina y declaración sólo fue alta para fumadores activos (Kappa = 0,68 para uno o más cigarrillos/día y 0,76 para 10 o más cigarrillos/ día). La prevalencia de tabaquismo en el entorno familiar, social y escolar era significativamente más alta entre los fumadores (80%, 71% y 88%, respectivamente) que entre los no fumadores (65%, 24% y 78%). La combinación de cuestionario más cotinina detectó una prevalencia total de exposición superior al 64%.ConclusionesLa altísima prevalencia de exposición al tabaco y la asociación entre el consumo de los adolescentes y el de su entorno reclaman programas educativos contra el tabaco que incluyan los ámbitos familiar, social y escolar. La concordancia entre declaración y cotinina es buena sólo a partir de frecuencias diarias de consumo.SummaryBackgroundThe tobacco smoking epidemic is causing more deaths than anyone before. Young population is the main aim of tobacco advertisements. We estimated the prevalence of tobacco use among adolescents and their environment, the agreement of questionnaire and serum cotinine and the total prevalence of exposure (active plus pasive).Subjects and MethodsCross-sectional study in 439 highschool students. We obtained a blood sample and anonimously inquired about their tobacco consumption and the existence of smokers in their environment. We analized the agreement between both methods.Results56% have ever smoked tobacco. Declared prevalence of consumption was 34% (CI95%= 29.49-38.51), being 40% among girls and 23% among boys. The agreement between cotinine and declaration was high only in voluntary smokers (Kappa = 0.68 for 1 o more cigarettes/day and Kappa = 0.76 for 10 or more cigarettes/day). Smoking prevalence of the famliy, friends and school among smokers was higher (80%, 71% and 88%, respectively) than among non smokers (65%, 24% and 78%). Combining questionnaire and cotinine it was estimated that total prevalence of exposure was larger than 64%.ConclusionsThe high prevalence of exposure and the asociation of tobacco smoking among adolescents and their environment demands an educational program against tobacco including family, social and school environments. The agreement between declaration and serum cotinine is high only when consumption is daily.

ResumenObjetivosEn los últimos años se han desarrollado intervenciones comunitarias que pretenden ofrecer un estímulo para dejar de fumar a los fumadores que se plantean hacerlo, entre las que se encuentra la iniciativa «Quit and Win» («Déjalo y Gana»), promovida por la Organización Mundial de la Salud. En este estudio se evalúa el impacto de la intervención en una muestra de los participantes en la edición de 1996 de la ciudad de Barcelona.MétodosAl año del concurso se realizó un cuestionario telefónico de seguimiento a una muestra de un tercio de los participantes, preguntando sobre la situación actual en relación al hábito tabáquico, así como detalles de la participación en el concurso, incluyendo motivación y abstención durante la totalidad del período del concurso.ResultadosUn total de 941 tarjetas válidas fueron recibidas correspondientes a residentes en Barcelona, lo que representa un índice de participación del 0,23% de la totalidad de fumadores. Se eligieron para el seguimiento 307 personas, de las que 18 fueron excluidas por tratarse de ex-fumadores. De los restantes 289 participantes, se obtuvo respuesta válida de 196 personas, de las que 82 (41,8%) se encontraban abstinentes en el momento de la encuesta. La intención de dejar de fumar definitivamente como principal motivación para inscribirse en el concurso, y el mantenimiento de la abstinencia durante la totalidad de la duración del concurso (un mes) se asociaron significativamente a la abstención al año. La concordancia global de la declaración de los participantes y la declaración de los testimonios en una submuestra (n=18) fue del 81,3%.ConclusionesAl año de la intervención se ha observado una elevada proporción de fumadores abstinentes, superior a la descrita en anteriores estudios, que podrían explicarse en parte por la autoselección de los participantes que respondieron en el seguimiento. En conjunto, este tipo de iniciativas pueden ser útiles para promover el abandono en personas predispuestas.SummaryObjectivesIn recent years community intervention plans for motivating smokers to stop smoking have been developed. One of these programs is the «Quit and Win» initiative of the World Health Organization. Our study evaluated the impact of this intervention in a sample of persons who participated in the 1996 edition of the program in Barcelona, Spain.MethodsOne year after the contest, a telephone follow-up survey was carried out in one-third of the participants. Subjects were questioned about their current smoking status and their participation in the contest, including motivation and whether they had remained abstinent throughout the contest.ResultsA total of 941 valid cards were received from Barcelona residents, equivalent of 0.23% of all smokers. A selection was made of 307 persons for follow-up, 18 of which were excluded because they were former smokers. From the remaining 289 participants, we obtained valid responses from 196, 82 (41.8%) of which were abstinent when the survey was made. Participating in the contest with the intention to stop smoking permanently and continued abstinence throughout the contest period (one month) were significantly associated with abstention one year later. The overall agreement between participants’ statements and the statements of a subsample (n=18) was 81.3%.ConclusionsOne year after the intervention the proportion of abstinent smokers was higher than in earlier studies. However, self-selection by the participation who responded to the follow-up questionnaire could have contributed to the final result. Overall, such initiatives could be useful in motivating predisposed persons to stop smoking.

ResumenObjetivoEstudiar la relación entre consumo de tabaco, alcohol y ejercicio y las actitudes sobre estos hábitos y el rasgo de personalidad de Búsqueda de Sensaciones en escolares.Sujetos y métodosEstudio descriptivo transversal realizado en la ciudad de Lérida en 1990 sobre una muestra de 423 escolares de sexto curso de EGB y 393 de octavo, obtenida por muestreo aleatorio por conglomerados y estratificado por la titularidad de la escuela. Se analizó el consumo de tabaco y de alcohol, el nivel de ejercicio y las actitudes, entre otras variables, mediante el cuestionario FRISC. En octavo curso se añadió el Cuestionario de Búsqueda de Sensaciones sobre personalidad.ResultadosLas puntuaciones para la Búsqueda de Emociones (BEM), la Desinhibición (DES), la Sinceridad y la global de Búsqueda de Sensaciones (BS) fueron superiores para los varones. Los más deportistas tienen actitudes hacia el ejercicio más favorables y puntuaciones en BEM y DES superiores. Fumadores y bebedores tienen actitudes favorables hacia los dos hábitos, son contrarios a la prohibición de anuncios y muestran puntuaciones superiores en todas las subescalas y el global de la BS. Existe una correlación entre las actitudes favorables hacia el tabaco (-0,38) y alcohol (-0,51) y la subescala DES. Las actitudes hacia el alcohol también se correlacionan con la puntuación global de BS.DiscusiónExiste una estrecha relación entre hábitos, actitudes y personalidad. Si bien el abordaje para la modificación de hábitos insaludables se debe plantear desde una perspectiva multifactorial, el cuestionario de BS podría ser un elemento útil parar detectar personas que precisen buscar nuevas sensaciones y reorientar esta tendencia hacia hábitos más saludables.SummaryObjetiveTo study the relation between tobacco and alcohol use and exercise, attitudes toward these habits, and the Sensation-Seeking personality trait in students.Subjects and methodsA transversal descriptive study was carried out in the city of Lérida in 1990 in a sample of 430 sixth-grade students and 383 eighth-grade students. The sample was obtained by random sampling of aggregates and stratified by the titularity of the school. An analysis was made of the tobacco and the alcohol use, the levels of physical exercise and the attitudes, among other variables, using the FRISC questionnaire. In eighth grade students, the Sensation-Seeking personality questionnaire was added.ResultsThe overall scores for Emotion Seeking (EMS), Disinhibition (DIS), Sincerity, and the overall score for Sensation Seeking (SS) were higher for males. The students most active in sports had more favorable attitudes toward exercise and higher EMS and DIS scores. Smokers and drinkers had favorable attitudes toward these habits, opposed their prohibition, and had higher scores for all the subscales and the overall SS. There was a correlation between favorable attitudes toward tobacco (-0.38) and alcohol (-0.51), and the DIS score. Attitudes toward alcohol also correlated with the overall SS score.DiscussionThere was a close relation between habits, attitudes, and personality. Although the approach for modifying unhealthy habits should be proposed from a multifactorial perspective, the SS questionnaire could be a useful element for detecting persons who feel the need to seek new sensations and refocusing this tendency on healthier habits.

ResumenObjetivosEste trabajo pretende describir el consumo de tabaco, de alcohol y de drogas no institucionalizadas entre la población escolarizada española pre-adolescente y adolescente a mitad de los años noventa (en 1994).MétodosLa información ha sido recogida en el marco de un estudio transversal periódico sobre los estilos de vida de los escolares europeos, con énfasis particular en los hábitos relacionados con la salud. En el presente trabajo se presentan resultados de la última encuesta realizada en España dentro de este estudio (1994), con una muestra representativa del alumnado español de 11, 13, 15, 17 y 18 años de edad (n = 6.711). Se utilizó un cuestionario anónimo que los propios alumnos cumplimentaron en sus aulas. El sistema de muestreo ha sido aleatorio, estratificado, proporcional, polietápico y por conglomerados.ResultadosEn 1994, el 49% del alumnado español de las edades citadas ha probado el tabaco. El 24% lo fuma esporádica o regularmente. La proporción de chicas fumadoras es mayor que la de los chicos (27% frente a 20%). La proporción de fumadores pasa de un 3% a los 11 años a un 47% a los 18 años. Un tercio (33%) del alumnado de 18 años fuma diariamente.El 84% del alumnado de las edades estudiadas manifiesta haber probado uno o varios tipos de bebidas alcohólicas. El 21% las consume regularmente (al menos una vez a la semana). Este tipo de consumo regular es algo más frecuente entre los chicos (24%) que en las chicas (19%). El 46% del alumnado de 18 años consume bebidas alcohólicas regularmente y el 66% se ha embriagado una o más veces.Casi la quinta parte (18%) del alumnado de 13 a 18 años manifiesta haber probado algún tipo de droga no institucionalizada, mientras que el consumo actual se reduce al 8%. La cannabis es la droga que más alumnos han probado (18%) y la más consumida actualmente (8%), seguida por la cocaína y la heroína. Los chicos han probado drogas no institucionalizadas en mayor proporción que las chicas.DiscusiónEl análisis de los datos muestra que el tabaquismo adolescente afecta cada vez más a las chicas. El consumo de alcohol sigue ampliamente generalizado entre los pre-adolescentes y adolescentes españoles. Se inicia en la infancia y se arraiga y consolida en la adolescencia. Los resultados sugieren, en relación a las diferencias de género en el consumo de tabaco, de alcohol y de drogas no institucionalizadas, que hay una fuerte tendencia a la homogeneización entre ambos sexos a este respecto. Es necesario enfatizar las medidas preventivas de las drogodependencias entre los pre-adolescentes y adolescentes españoles.SummaryObjectivesThis study was undertaken in the mid-1990s (1994) to describe the use of tobacco, alcohol, and non-institutionalized drugs among pre-adolescent and adolescent spanish students.MethodsInformation was collected within the framework of a periodic transversal study of life styles among European students, with particular emphasis on health-related habits. In the current study we present the results of the last survey carried out in Spain within the context of this study (1994), which involved a representative sample of Spanish students 11, 13, 15, 17 and 18 years-old (n = 6,711). An anonymous questionnaire was completed by the students in class. The survey sampling uses proportionate stratification and multistage sampling.ResultsIn 1994, 49% of the Spanish students in this age group had tried tobacco. Twenty-four percent were sporadic or regular smokers. There was a large proportion of female smokers than male smokers (27% vs 20%). The overall proportion of smokers increased from 3% at 11 years to 47% at 18 years. One third (33%) of the 18-year-old students smoked daily.Eighty-four percent of the students of this age indicated that they had tried one or more types of alcoholic beverage. Twentyone percent consumed alcohol regularly (at least once a week). Regular alcohol use was somewhat more common among males (24%) than among females (19%). Forty-six percent of the 18-year-old students consumed alcoholic beverages regularly and 66% had been intoxicated one or more times.Almonst one fifth (18%) of the 13-to-18 year-old students indicated that they had tried some type of non-institutionalized drug, although the current rate of consumption was 8%. Cannabis was the drug most frequently tried (18%) and the drug most often consumed at present (8%), followed by cocaine and heroin. More males than females had tried non-institucionalized drugs.DiscussionAnalysis of the data revealed that adolescent tobacco use is increasingly frequent among females. Alcohol use continues to be widespread among Spanish pre-adolescents and adolescents. Alcohol use begins in childhood and becomes consolidated in adolescence. The results suggest, in relation to gender differences in the use of tobacco, alcohol, and non-institucionalized drugs, that there is a strong tendency toward the homogenization of these habits between genders. It is necessary to emphasize the preventive measures of drug dependence among Spanish pre-adolescents and adolescents.

ResumenAntecedentes y objetivosLas principales causas de mortalidad prematura entre los jóvenes se asocian a comportamientos de riesgo, con frecuencia relacionados entre sí, que suelen adoptarse durante la adolescencia. El objetivo del estudio es describir el patrón de consumo de sustancias adictivas y de pr´cticas sexuales entre los jóvenes escolarizados en 4o de ESO, 2o BUP y 2o FP1 de Barcelona en 1996, y tambien las interrelaciones entre estos comportamientos y diversas variables sociodemogr´ficas.Material y métodosEstudio transversal. Muestra aleatoria de 35 aulas del último curso de secundaria obligatoria y equivalentes (946 alumnos de 15,8 a˜os de edad media) estratificada por tipo de estudios, titularidad, nivel socioeconomico del barrio de escolarización y tamaño del centro. El instrumento de medida es un cuestionario validado previamente. Se estudia el consumo de tabaco, alcohol, cannabis, las relaciones sexuales y el género, la edad, el dinero semanal disponible y el nivel de instrucción de los padres. Se ha realizado un análisis bivariado mediante la prueba de χ2 y multivariado mediante el ajuste de un modelo log-lineal para cada género.ResultadosUn 27% consume tabaco a diario y un 31% consume alcohol semanalmente. El 15% ha mantenido relaciones coitales, entre los que un 79% usa siempre o casi siempre preservativos. Entre las chicas se interrelaciona el consumo de tabaco con el de alcohol (OR = 4,2), de marihuana (OR = 5,9) y el haber mantenido relaciones sexuales (OR = 3,9), y con menos intensidad la edad, el dinero y el tipo de estudios. El consumo de alcohol se asocia al de tabaco y al de marihuana (OR = 4,2). Las relaciones sexuales se relacionan con el tabaco, con la edad (OR = 3,4), con el tipo de estudios (OR = 2,4) y con el consumo de marihuana (OR = 2,8). Entre los chicos se interrelaciona el consumo de tabaco con el de alcohol (OR = 2,7), el de marihuana (OR = 7,6) y el haber mantenido relaciones sexuales (OR = 4,4), y con menos intensidad el dinero y el tipo de estudios. El consumo de alcohol se asocia al de tabaco y al de marihuana (OR = 5,5). Las relaciones sexuales se relacionan con el tabaco y con la edad (OR = 2,5).DiscusiónLas conductas de riesgo entre los estudiantes de 4° de ESO y equivalentes se relacionan intensamente entre sí, tanto entre los chicos como entre las chicas, y son más frecuentes entre los mayores, entre los que disponen de más dinero semanalmente y entre los que estudian formación profesional.SummaryBackground and objectivesThe main premature mortality causes among youngsters are related to risk behaviors, usually iniciated in adolescence. The study objective is to describe substance use and sexual behaviours among 10th grade Barcelona students in 1996 (last year of compulsory education), as well as the interrelations beween these variables and several sociodemographic variables.MethodsCross sectional study. Random sample including 35 10th grade classrooms (958 students whose mean age is 15.8 years old) stratified by academical or vocational studies, public or private school, school neighbourhood socioeconomical level and school size. Measurement instrument is a previously validated questionnaire. Tobacco, alcohol, and cannabis consumption, sexual intercourse as well as gender, age, weekly available money, parental instruction and type of studies are studied. Bivariate χ2 analysis and multivariate gender specific log-linear model are performed.Results27% of the students smoke daily and 31% drink alcohol weekly. 15% have had sexual intercourse, and among those 79% use always or almost always condoms. Among girls tobacco consumption is related to alcohol (OR = 4.2), to cannabis (OR = 5.9) and sexual intercourse (OR = 3.9), and, less strongly, with age, available money and vocational studies. Alcohol is associated with tobacco and cannabis use (OR = 4.2). Having had sexual intercourse is related to tobacco use, age (OR = 3.4), vocational studies (OR = 2.4) and cannabis experience (OR = 2.8). Among boys tobacco consumption is related to alcohol, (OR = 2.7), to cannabis (OR = 7.6) and sexual intercourse (OR = 4.4), and, less strongly, to available money and type of studies. Alcohol consumption is associated with tobacco and cannabis use (OR = 5.5). Sexual intercourse is related to tobacco use and age (OR = 2.5).DiscussionRisk behaviors among final year secondary school students are strongly and significantly interrelated, both among boys and among girls, and are more frequent among older students, those with more money available and those in vocational curricula.

ObjetivoEstudiar el coste-efectividad del consejo sanitario antitabaco en Atención Primaria.MétodosRealizamos un análisis coste-efectividad en el ámbito de la Atención Primaria. Como eficacia del consejo utilizamos resultados propios. Para evaluar la efectividad de la cesación tabáquica nos basamos en las tablas vitales del «25-state Cancer Prevention Study», descontados al 5%. Los costes se han calculado a partir de las tarifas usadas para facturación de servicios prestados en centros de Atención Primaria a no beneficiarios de la Seguridad Social. Se realizó un análisis de sensibilidad sobre diferentes aspectos con posible influencia en el resultado.ResultadosEl coste-efectividad osciló entre 67.621 y 89.619 pesetas por año de vida salvado para los hombres y entre 116.225 y 137.748 pesetas para las mujeres, en función de la edad. La relación más favorable, para ambos sexos, está entre los 45 y 54 años. En el grupo de 35 a 39 años, para los médicos, era de 89.419 y 163.934 pesetas para hombres y mujeres respectivamente, y para el personal de enfermería oscilaba entre 43.955 y 81.523 para hombres y entre 80.584 y 149.460 pesetas para mujeres en función de la cifra que se considere como sueldo.ConclusionesEs una intervención con una relación coste-efectividad muy favorable, al menos, equiparable a la de otras medidas preventivas habitualmente aceptadas. El consejo de enfermería es menos efectivo que el médico, pero es, al menos, igual de eficiente en términos de coste por año de vida salvado.ObjectiveTo study the cost-effectiveness of simple anti-smoking advice in Primary health care.MethodsWe accomplish a cost-effectiveness analysis in the area of the Primary health care. As efficiency of the advice we use own results. To evaluate the smoking cessation we base on vital tables of the «25-State Cancer Prevention Study», discounted to the 5%. The costs have been calculated as of the tariffs used for services billing lent in primary health centers to not beneficiary of the social security. It was accomplished a sensibility analysis on different aspects with possible influence on the result.ResultsThe cost-effectiveness oscillated between 67.621 and 89.619 pesetas by year of life saved for the men and between 116.225 and 137.748 pesetas for the women, in function of the age. The relationship most favorable, for both sexes, it is between 45 and 54 years. In the group of 35 to 39 years, for the physicians, was of 89.419 and 163.934 pesetas for men and women respectively, and for the nursing personnel was oscillating between 43.955 and 81.523, for men; and between 80.584 and 149.460 pesetas for women in function of the considered salary.ConclusionsIt is an intervention with a very favorable relationship cost-effectiveness, at least, comparable to that of other customarily accepted preventive measures. The nursing advice is less effective that the physician advice, but it is, at least, equal of efficient in terms of cost by year of life saved.

ResumenObjetivoDescribir diversas variables e índices antropométricos y determinados estilos de vida (consumo de tabaco, alcohol y café, y la actividad física en el tiempo libre) en mujeres de hábitat rural y urbano de más de 45 años.MétodosEstudio transversal. Partiendo de la población de todas las mujeres de la isla de Gran Canaria de más de 45 años, a partir del Censo Electoral de 1991, se obtuvo aleatoriamente una población muestral de 1221 mujeres, a las que se les administró un cuestionario y practicó una exploración física que incluyó la medida de talla y peso con ropa ligera. La obesidad se estableció en base al índice de Quetelet (IQ) definido como el peso (en kg) dividido por la talla (en m) al cuadrado.ResultadosLas mujeres de más de 45 años que viven en un hábitat rural tienen más peso, más superficie corporal, mayor IQ, menos consumo de tabaco y mayor actividad física en el tiempo libre que las mujeres de su misma edad que viven en un hábitat urbano. No se apreciaron diferencias en la talla ni en el consumo de alcohol o de café.ConclusionesExisten diferencias estadísticamente significativas entre las mujeres de hábitat rural y urbano en relación a las variables antropométricas: peso, superficie corporal e IQ que muestran valores más elevados en la población rural mientras que determinados estilos de vida como el consumo de tabaco y el sedentarismo, por el contrario son más elevados en la población urbana.SummaryBackgroundTo compare several anthropometric variables, obesity and some life-style (tobacco, coffee and alcohol consumption and physical activity during leisure time) in women 45 years old and older.MethodsFrom the 1991 electoral roll, we obtained a population of 1221 women aged more than 45 years living in the island of Gran Canaria. A questionnaire and a physical examination including weight and height with light clothes was performed in every woman. Obesity was defined according to the Quetelet index, and weight (in kg) divided by height (in m) at square.ResultsRural women aged more than 45 years old are heavier, have a larger corporal surface, have a higher Quetelet index, smoke less and do greater activity during leisure time than urban women the same age. We found no differences either in alcohol or coffee consumption.ConclusionsThere are statistically significant differences between women that live in rural and urban habitats. Anthropometric variables (weight, corporal surface, Quetelet index) show higher values in rural women than in urban ones. On the other hand, tobacco consumption and sedentarism have a higher prevalence in the urban women compared to rural ones.

ResumenDado que se dispone de suficientes evidencias sobre la relación causal entre la exposición al tabaco y la mortalidad por cáncer de pulmón, nos hemos propuesto cuantificardicha relación en la población española en el periodo 1940 a 1988, a través de métodos observacionales. Para ello se ha realizado un estudio de series temporales con datos agregados. La información sobre la mortalidad por cáncer de pulmón y la exposición al tabaco y a otras variables potencialmente predictoras de esta enfermedad se ha elaborado a partir de estadísticas oficiales. El análisis de los datos se ha realizado por métodos gráficos y de regresión lineal múltiple.Se ha observado que tanto la mortalidad por cáncer de pulmón como el consumo de tabaco, de lípidos y el nivel de riqueza han aumentado en España de forma muy importante a lo largo del periodo de estudio. Una vez controlado el efecto de la ingesta de lípidos y de alcohol, por cada gramo per capita y día de aumento en el consumo de tabaco desde 1940 hasta la actualidad se ha producido, tras 15 años de exposición, un aumento cercano al 19% en la mortalidad por cáncer de pulmón en España.Se concluye que el creciente consumo de tabaco en el periodo estudiado ha contribuido sustancialmente a la epidemia de cáncer de pulmón experimentada en la población española en dichos años. Este hecho proporciona evidencias adicionales en las que basar los programas de lucha antitabáquica en España.SummaryBecause the causal relationship between tobacco smoking and lung cancer has been clearly established, we have set out to measure its magnitude among the Spanish population in the time period 1940–1988 using observational methods. To do so, we have carried a time series study of ecological data. Information on lung cancer mortality, tobacco smoking and other potential predictors of lung cancer has been elaborated from official statistics. Data analysis has been performed by graphical methods and multiple linear regression techniques.Lung cancer mortality, tobacco smoking, total lipid intake and the Spanish wealth, as measured by national per caput income and gross domestic product, have increased very importantly over the study period. After controlling for the effect of lipids and alcohol intake, for every gram/per caput/day of increase in tobacco smoking in the period 1940–1988, there has been a 19% increase in lung cancer mortality with a 15 years lag.We conclude that tobacco smoking hasfueled the lung cancer epidemic in Spain during the study period. This finding provides additional arguments for the implementation of tobacco control programmes in our country.

ObjetivoDescribir el grado de señalización, consumo y venta de tabaco en las instalaciones del transporte metropolitano de Barcelona.DiseñoEstudio observacional, descriptivo.EmplazamientoComunitario.MétodosSe seleccionó al azar una muestra de 54 estaciones, en las que se valoró la presencia de usuarios fumando, de personal fumando, de señalización sobre el consumo de tabaco y de venta de tabaco.InteraccionesEn cada estación se realizaron observaciones de al menos 5 minutos en andenes, vestíbulo de acceso y pasillos y/o escaleras.Mediciones y resultados principalesSe registraron usuarios fumando en un 87% de las observaciones y colillas en el 97,5% de los casos, mientras que únicamente se observó personal de la compañía fumando en un 5,6%. En el 72,2% de las entradas se detectaron puntos de venta de tabaco. Los usuarios que fueron observados fumando se distribuyeron por igual en ambos sexos, si bien los varones en su mayoría eran adultos de edad media (64,3%) y las mujeres eran mayoritariamente jóvenes (60,6%). Se registró algún tipo de señalización en el 64,2% de las observaciones.ConclusionesEl grado de señalización y cumplimiento por parte del personal es elevado, aunque el consumo de tabaco por los usuarios es habitual. La venta de tabaco en las estaciones es muy frecuente. Los resultados justifican la adopción de intervenciones específicas dirigidas a mejorar el cumplimiento de las normativas.ObjectiveTo describe the extent of no-smoking notices, consumption and sales of tobacco in Barcelona´s underground transport installations.DesignDescriptive, observation study.SettingCommunity.MethodsA sample of 54 stations was selected at random. The presence of users smoking, staff smoking, notices about tobacco consumption and tobacco sales were evaluated.InteractionsPlatforms, entrance hall and corridors and/or stairs were observed for at least 5 minutes at each station.Measurements and main resultsUsers smoking were recorded in 87% of the observations, and cigarette stubs in 97.5% of observations, whereas company staff were only seen smoking in 5.6%. In 72.2% of the entrances there were tobacco sales-points. The users observed smoking were divided equally between the sexes, although the men were mainly middle-aged adults (64.3%) and the women were mainly young (60.6%). In 64.2% of the observations, some sort of notice was seen.ConclusionsBoth notices and compliance by staff are high, although users habitually consume tobacco. Tobacco sales-points at stations are very common. The findings justify the adoption of specific measures designed to improve compliance with the regulations.

ResumenSe estudia la prevalencia del consumo de tabaco en Mallorca, analizando las variables relacionadas con el mismo, a través de una encuesta domiciliaria de una muestra de 300 sujetos seleccionados al azar del censo electoral de 1986, entre los individuos con edades comprendidas entre 18 y 75 años.De las 297 encuestas válidas, la prevalencia de fumadores fue del 34%; 15% eran exfumadores y 50% no fumadores; entre las mujeres de menos de 40 años la prevalencia de fumadoras fue del 60%. Existe una relación directa entre prevalencia de fumadores y nivel de estudios, sólo para el sexo femenino. Se advierte una mayor proporción de fumadores entre los inmigrantes (44%) con respecto a los nacidos en Mallorca (30%), y entre los habitantes de la capital (41%) respecto a los que residen en el resto de la isla (25%).La prevalencia del consumo de tabaco presenta en Mallorca un patrón equiparable al observado en áreas geográficas y culturales de similares característicasSummaryThe prevalence of tobacco consumption has been estimated in the population of Majorca, by means of a survey based on interviews of a random sample ol 300 individuals between the ages of 18 and 75, selected from the 1986 electoral census of the Island.From the 297 valid questionnaires, the prevalence of smokers was 34%; 15% were ex-smokers and 50% non-smokers. Among women younger than 40 years old the prevalence of smokers was 60%. A direct relationship between level of education and prevalence of smokers was observed for women. Immigrants from the mainland of Spain formed a major proportion of smokers (44%) compared to the Majorcans (30%), and also among those living in the main city (41%) with respectose living in other areas (25%).The prevalence of tobacco consumption in Majorca shows a similar pattern to that of other geographical and cultural areas with similar characteristics.

ResumenSe revisa la literatura relativa a programas desarrollados en el medio escolar tendentes a prevenir el uso de tabaco y otras sustancias adictivas entre los adolescentes. Se describen los ejes fundamentales de dichos programas. Los programas que refuerzan las habilidades para resistir la presión social para el consumo de sustancias adictivas son los que obtienen mejores resultados, pues consiguen reducciones significativas en el inicio del tabaquismo y resultados prometedores, aunque no tan inequivocas, en relación con el abuso del alcohol y de otras drogas. La duración de estos programas oscila de ocho a doce horas en un año, en general entre sexto y octavo curso.Otras propuestas de duración similar, basadas en la mejora de la autoestima, el desarrollo de actividades alternativas al consumo de drogas o la simple transmisión de información sobre las mismas, no han mostrado resultados positivos apreciables al ser aplicados en estas edades.SummaryWe review the literature on school programs of prevention of consumption of tobacco and other addictive substances among adolescents. We describe the keys of these programs. The programs emforcing the abilities to ressist the social pressure to the consumption of addictive substances report better results and they achieve significant reduction in the initiation of tobacco consumption. They also report promising results for alcohol and other addictive substances, but they are not so clearly supported. Average duration of the programs is between 8 and 12 ours a year, generally in 6th and 8th course.Other purposes of similar duration based on: self-estim, the development of activities other than drug consumption, or the simple information on drugs, have not shown significant positive results for these ages.