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BackgroundHospital workers have been the most frequently and severely affected professional group during the COVID-19 pandemic, and have a big impact on transmission. In this context, innovative tools are required to measure the symptoms compatible with COVID-19, the spread of infection, and testing capabilities within hospitals in real time. ObjectiveWe aimed to develop and test an effective and user-friendly tool to identify and track symptoms compatible with COVID-19 in hospital workers. MethodsWe developed and pilot tested Hospital Epidemics Tracker (HEpiTracker), a newly designed app to track the spread of COVID-19 among hospital workers. Hospital staff in 9 hospital centers across 5 Spanish regions (Andalusia, Balearics, Catalonia, Galicia, and Madrid) were invited to download the app on their phones and to register their daily body temperature, COVID-19–compatible symptoms, and general health score, as well as any polymerase chain reaction and serological test results. ResultsA total of 477 hospital staff participated in the study between April 8 and June 2, 2020. Of note, both health-related (n=329) and non–health-related (n=148) professionals participated in the study; over two-thirds of participants (68.8%) were health workers (43.4% physicians and 25.4% nurses), while the proportion of non–health-related workers by center ranged from 40% to 85%. Most participants were female (n=323, 67.5%), with a mean age of 45.4 years (SD 10.6). Regarding smoking habits, 13.0% and 34.2% of participants were current or former smokers, respectively. The daily reporting of symptoms was highly variable across participating hospitals; although we observed a decline in adherence after an initial participation peak in some hospitals, other sites were characterized by low participation rates throughout the study period. ConclusionsHEpiTracker is an already available tool to monitor COVID-19 and other infectious diseases in hospital workers. This tool has already been tested in real conditions. HEpiTracker is available in Spanish, Portuguese, and English. It has the potential to become a customized asset to be used in future COVID-19 pandemic waves and other environments. Trial RegistrationClinicalTrials.gov NCT04326400; https://clinicaltrials.gov/ct2/show/NCT04326400

Nursing students are part of the future health labor force; thus, knowing their knowledge and participation in tobacco control is of importance. Multicentre cross-sectional study conducted to assess nursing students' knowledge, attitudes, and training in tobacco dependence and treatment at 15 nursing schools in Catalonia. We employed a self-administered questionnaire. 4,381 students participated. Few respondents (21.1%) knew how to assess smokers' nicotine dependence, and less than half (41.4%) knew about the smoking cessation therapies. Most (80%) had been educated on the health risks of smoking, 50% about the reasons why people smoke and, one third on how to provide cessation aid. Students in the last years of training were more likely to have received these two contents. Nursing students lack sufficient knowledge to assess and treat tobacco dependence and are rarely trained in such subjects. Nursing curricula in tobacco dependence and treatment should be strengthened to tackle the first preventable cause of disease worldwide.

Noncommunicable diseases (NCDs), including cancer, are responsible for almost 70% of all deaths worldwide. Tobacco use is a risk factor common to most NCDs. This article discusses tobacco control policies and highlights major achievements and open challenges to reduce smoking prevalence and attributable morbidity and mortality in the 21st century. The introduction of the WHO Framework Convention on Tobacco Control in 2005 has been a key achievement in the field and has already facilitated a drop in both smoking prevalence and exposure to secondhand smoke. Indicatively, the size of the worldwide population benefiting from at least one cost-effective tobacco control policy has quadrupled since 2007. In addition, plain cigarette packaging has been successfully introduced as a tobacco control policy, surmounting efforts of the tobacco industry to challenge this based on trade and investment law. Nevertheless, tobacco control still faces major challenges. Smoking prevalence needs to be further reduced in a rather expedited manner. Smoke-free environments should be extended, and the use of plain tobacco packaging with large pictorial health warnings for all tobacco products should be further promoted in some parts of the world. Some of these measures will require prompt determination and diligence. For example, bold political decisions are needed to significantly increase real prices of tobacco products through excise taxes, ban added ingredients that are currently used to increase the attractiveness of tobacco products and ban the tobacco industrys corporate social responsibility initiatives. Finally, the debate on harm reduction strategies for tobacco control still needs to be resolved.

Background and aimsGuidelines recommend the 5As model of brief intervention for providing smoking cessation support in clinical settings. This study assessed patient and hospital characteristics associated with self-reported receipt of the 5As (ask, advise, assess, assist and arrange).DesignMulti-center cross-sectional study.Setting and participantsAdult inpatients (n = 1047) were randomly selected from 13 hospitals in the Barcelona province of Spain in 2014-2015.MeasurementsWe explored participants' receipt of the 5As through a questionnaire. Given the progressiveness of the 5As, we recoded the fulfillment of the intervention as: A0 : no intervention; A1 : ask; A2 : ask and advise; A3 : A2 and assess; A4 : A3 and assist; and A5 : A4 and arrange a follow-up. We explored patient (e.g. age, sex, comorbidities) and hospital (e.g. type of hospital, unit) characteristics. We adjusted multi-level robust Poisson regression models to estimate the adjusted prevalence ratios (aPR) of the association between the recoded 5As intervention received.FindingsA total of 60.4% (n = 624) of patients had been asked (A1 ) about their smoking status. Among smokers, 46.5% (n = 90) were advised (A2 ), 26.6% (n = 48) assessed (A3 ) and 4.6% (n = 10) received all the components of the 5As (A5 ). Middle-aged smokers [aPR = 3.63; 95% confidence interval (CI) = 1.69-7.79] with a respiratory disease (aPR = 2.19; 95% CI = 1.11-4.34) were most likely to have been asked, advised and assessed (A3 ). The cessation intervention was most frequently performed by physicians.ConclusionsIn the Barcelona province of Spain, it appears that fewer than half of hospitalized patients who smoke were advised to quit and few received the full 'five As' brief intervention for smoking cessation.

BackgroundUp to 75% of inpatients with mental disorders smoke, and their life expectancy is decreased by up to 25 years compared to the general population. Hospitalized patients without monitoring after discharge quickly return to prehospitalization levels of tobacco use. The aim of the 061 QuitMental study is to assess the effectiveness of a multicomponent and motivational telephone-based intervention to stop smoking through a quitline addressed to smokers discharged from mental health hospital wards.MethodsA pragmatic randomized controlled trial, single blinded, will include 2:1 allocation to the intervention group (IG) and the control group (CG). The IG will receive telephone assistance to quit smoking (including psychological and psychoeducational support, and pharmacological treatment advice if required) proactively for 12 months, and the CG will receive only brief advice after discharge. The sample size, calculated with an expected difference of 15 points on smoking abstinence between groups (IG, 20% and CG, 5%), α = 0.05, β = 0.10, and 20% loss, will be 334 participants (IG) and 176 participants (CG). Participants are adult smokers discharged from psychiatric units of five acute hospitals. Measurements include dependent variables (self-reported 7-day point prevalence smoking abstinence (carbon monoxide verified), duration of abstinence, number of quit attempts, motivation, and self-efficacy to quit) and independent variables (age, sex, and psychiatric diagnoses). In data analysis, IG and CG data will be compared at 48 h and 1, 6, and 12 months post discharge. Multivariate logistic regression (odds ratio; 95% confidence interval) of dependent variables adjusted for potential confounding variables will be performed. The number needed to treat to achieve one abstinence outcome will be calculated. We will compare the abstinence rate of enrolled patients between groups.DiscussionThis trial evaluates an innovative format of a quitline for smokers with severe mental disorders regardless of their motivation to quit. If effective, the pragmatic nature of the study will permit transfer to routine clinical practice in the National Health System.Trial registrationClinicalTrials.gov, NCT03230955 . Registered on 24 July 2017.

Smoke-free legislation has been shown to positively impact reducing secondhand smoke (SHS) exposure, especially in countries that have implemented comprehensive legislation rather than partial bans. Also, secondhand aerosols (SHA) that come from the heating of tobacco or liquids, with or without nicotine, in electronic nicotine delivery systems (ENDS) have been proven to increase levels of harmful substances in the air. Therefore, protection against SHS and SHA exposure and expansion of smoke- and aerosol-free environments (SAFE) should be taken into account when creating or trying to expand or enforce clean air policies. This article aims to present the protocol for a consultation with experts on tobacco and nicotine control in order to identify best practices, barriers, and opportunities for the expansion of SAFE in Europe. We identified experts among policymakers, researchers, and tobacco regulators in European countries and invited them to participate in the consultation by completing an online survey designed, programmed, and pilot-tested using Survey Monkey. The responses to the questionnaire contained quantitative and qualitative information that was thematically analyzed. The experts’ consultation allowed us to produce a report on barriers and opportunities for SAFE, a report and a position paper on SAFE best practices, a web-based repository of best practices, and a weight of evidence paper that assembles evidence supporting the expansion of SAFE on indoor and outdoor spaces. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Quitlines are known to be effective in helping people quit smoking, including those with mental health conditions. It is particularly important to address smoking in this population as the prevalence of smoking ranges from 40% to 75%. However, professionals working in quitlines often face barriers due to their limited training and resources to effectively support these smokers quit, especially if they are not mental health professionals. Therefore, training programmes should be developed to enhance their knowledge and skills in providing smoking cessation support to this vulnerable population. What the paper adds to existing knowledge?: The '061 QUIT‐MENTAL study' evaluated the efficacy of a proactive telephone‐based intervention for smoking cessation among smokers with severe mental health disorders. Conducted through a quitline service in Catalonia, Spain, the study focused on training non‐mental health specialized nurses and other health professionals to provide evidence‐based interventions for promoting smoking cessation among individuals with mental health disorders. The objective of this study is to assess the changes in nurses' knowledge and readiness to treat smokers with mental health conditions, while also capturing their insights and perceptions regarding the facilitators and barriers to providing smoking cessation interventions. The training and insights of the nurses were integral to conducting this research and providing valuable information for the future sustainability of such interventions. This is particularly important as quitlines hold the potential to offer cessation support to these patients at the community level. What are the implications for practice?: While the training programme was successful in improving non‐mental health specialized nurses' knowledge and motivation skills to help patients with mental health disorders quit smoking, they encountered obstacles in delivering this intervention over the phone. These difficulties were mainly due to challenges in reaching participants and delivering the intervention as detailed in the protocol. The study highlights the need of reducing barriers for providers in attending to these patients, particularly if they are non‐mental health specialized professionals. By minimizing the stigmatization associated with caring for mentally ill individuals and promoting coordination with specialists, innovative approaches may be introduced to alleviate the burden of tobacco‐related diseases among this population. Introduction: The viewpoint of those who implement a programme for the first time is crucial for understanding its impact and ensuring its long‐term viability. The 061 QUIT‐MENTAL study was a pragmatic randomized controlled trial evaluating a proactive telephone‐based intervention addressed to mental health patients conducted by non‐psychiatric specialized nurses. Aim: We assessed nurses' knowledge of smoking cessation interventions addressed to this population before and after receiving training and their insights after delivering the intervention. Method: Mixed methods study: (1) Pre‐post evaluation to assess self‐reported knowledge, self‐efficacy and opinions about smoking cessation. (2) In‐depth interviews with key nurses to ascertain their perceptions regarding the impact of the training received in delivering the study intervention. Results: The training enhanced nurses' knowledge of psychological and pharmacological resources to aid these patients, as well as their ability to increase their motivation to quit. However, nurses reported difficulties in delivering population‐based interventions to individuals with mental health disorders. These challenges primarily arose from participants being hard to reach, exhibiting low motivation to quit, struggling to comprehend instructions or follow recommendations, and nurses feeling unsure about their capacity to assist individuals with mental illnesses in quitting, despite the training they received. Discussion: Despite the training and protocol designed to facilitate the delivery of the intervention, nurses faced difficulties in providing population‐based interventions to individuals with mental health disorders. Implications for Practice: Future quitline programmes aimed at the population with mental health disorders should strive to reduce barriers for providers in attending to these patients, particularly if they are non‐mental health specialized professionals. By minimizing the stigmatization associated with caring for mentally ill individuals and promoting coordination with specialists, innovative approaches may be introduced to alleviate the burden of tobacco‐related diseases among this population. [ABSTRACT FROM AUTHOR]

Introduction: There is no consensus on the questions that should be included in questionnaires to properly ascertain exposure to secondhand tobacco smoke (SHS). The objective of this study is to analyze the questions included in studies which have assessed SHS exposure in Spain. Methods: A scoping review was performed, using PubMed, Embase and Web of Science databases, selecting original articles published in English and Spanish, across the period 2012–2021. We extracted data from each study regarding its design, target population, sample size or geographical scope; we also collected data regarding how studies dealt with exposure to SHS including assessment and intensity of SHS, exposure setting, geographical scope, and the verbatim questions used. Results: Finally, 75 studies were identified. In the 23 studies carried out in children, verbatim questions were included in 8 studies, and the setting most studied was the home. SHS exposure was assessed during pregnancy and postnatally by 8 studies, the verbatim questions used were described in 2 studies, being exposure ascertained at home and workplace. In the adult population, 14 of 44 studies described the verbatim questions; the setting most studied was the home. Verbatim questions varied among studies. Conclusions: Questionnaire-based assessment of SHS exposure is highly heterogeneous, hindering comparability between studies. Therefore, it is necessary to set a standard questionnaire to assess exposure to SHS. [ABSTRACT FROM AUTHOR]

This study measured changes in healthcare professionals' (HCPs) performance in tobacco cessation intervention before and 6 months after a health system intervention. The intervention involved exposure to online training for staff and the implementation of a structured organizational change-level practice model that included some strategies, comprising establishing tobacco cessation steering groups with champions in each hospital, developing tailored protocols and guidelines within each organization, conducting on-site workshops for clinicians, and creating posters and pocket materials summarizing the intervention. Pre–post evaluation in four hospitals in Barcelona province (Catalonia, Spain). We assessed the knowledge, attitudes, behaviors, and organizational factors (KABO) and the performance of each of the components of the 5As Model for Treating Tobacco Use according to a scale from 0 ("Never") to 10 ("Always") among HCPs. We performed Wilcoxon signed-rank tests for paired samples and assessed changes in performance by performing linear regression. A total of 255 HCPs completed the pre–post evaluation. All components of the 5As Model increased, with "Assist" and "Arrange a follow-up" showing the greatest improvement. Several KABO dimensions significantly increased, including individual skills (mean score: 3.3–5.7, P <.001), attitudes and beliefs (4.8–5.4, P <.001), individual commitment (5.9–6.6, P <.001), and perception of having positive organizational support (4.3–4.7, P <.001). An increase in each point in individual skills and support of the organization was associated with increased rates of 5As delivery, with the greatest associations found for "Assist" (0.60 and 0.17, respectively) and "Arrange a follow-up" (0.71 and 0.18, respectively). The intervention was successful in increasing HCPs individual skills , attitudes and beliefs , individual commitment , and perception of having positive organizational support and the performance of all components of the 5As. Future research should focus on strategies that promote organizational support, a dimension that is essential to increasing Assist and Arrange, which were less implemented at baseline. [ABSTRACT FROM AUTHOR]

Introduction: While indoor smoking restrictions are common, outdoor restrictions are still rare. We explored opinions and support for regulating smoking in different indoor and outdoor environments among adults who smoke and those who recently quit smoking, in Spain. Methods: The 2021 ITC EUREST-PLUS Spain Survey is a cross-sectional study conducted among a nationally representative sample of 1006 adults aged ≥18 years who smoked cigarettes (n=867) or had recently quit smoking (n=139). Using Poisson regression with robust variance, we estimated adjusted prevalence and prevalence ratios of favorable opinions on regulating smoking in different indoor and outdoor environments and support for regulation in unregulated outdoor environments, by sociodemographic and smoking-related characteristics. Results: There were highly favorable opinions for regulating smoking in places with minors (>95% in primary and secondary playgrounds, and cars with preschool children and minors) and outdoor transportation (60–80%). There were less favorable opinions for regulating smoking in outdoor terraces of bars/pubs and restaurants (15–20%). Support for further total outdoor regulations on smoking was moderate for markets/shopping centers, public building entrances and swimming pools (40–60%), and low for restaurants/bars/pubs (29.2%). Having quit smoking, having no significant others who smoke and/or believing that cigarette smoke is harmful to others, were factors positively associated with favorable opinions and support for regulating smoking. Conclusions: The settings in Spain with the most favorable opinions for regulation among adults who smoke and have recently quit smoking are places with minors, private cars with others and outdoor areas of public transportation, while the settings with the least favorable opinions were outdoor terraces of bars, pubs, and restaurants. Support for further total outdoor smoking bans is generally moderate, but low for restaurants, bars, and pubs. Overall, these findings suggest the feasibility of extending smoke-free policies to other public and private settings to protect others from tobacco smoke exposure. [ABSTRACT FROM AUTHOR]

Introduction: The use of emerging tobacco and nicotine products affects tobacco use behaviors among college students. Thus, we aimed to examine transitions in tobacco use patterns and identify their predictors among smokers in a cohort of nursing students in Catalonia (Spain). Methods: We conducted a prospective longitudinal study of Catalan nursing students between 2015–2016 and 2018–2019. We examined transitions in tobacco use patterns between baseline and follow-up among smokers from: 1) daily to nondaily smoking, 2) non-daily to daily smoking, 3) cigarette-only use to polytobacco use, 4) poly-tobacco use to cigarette-only use, 5) between products, 6) reducing consumption by ≥5 cigarettes per day (CPD); and 7) quitting smoking. We applied a Generalized Linear Model with a log link (Poisson regression) and robust variance to identify predictors of reducing cigarette consumption by ≥5 CPD and quitting smoking, obtaining both crude and adjusted (APR) prevalence ratios and their 95% confidence intervals (CIs). Results: Among daily smokers at baseline, 12.1% transitioned to non-daily smoking at follow-up, while 36.2% of non-daily smokers shifted to daily smoking. Among cigarette-only users, 14.2% transitioned to poly-tobacco use, while 48.4% of polytobacco users switched to exclusive cigarette use. Among all smokers (daily and non-daily smokers), 60.8% reduced their cigarette consumption by ≥5 CPD and 28.3% quit smoking. Being a non-daily smoker (APR=0.33; 95% CI 0.19–0.55) and having lower nicotine dependence (APR=0.78; 95% CI 0.64–0.96) were inversely associated with reducing cigarette consumption, while being a non-daily smoker (APR=1.19; 95% CI: 1.08–1.31) was directly associated with quitting smoking. Conclusions: Nursing students who smoked experienced diverse transitions in tobacco use patterns over time. Evidence-based tobacco use preventive and cessation interventions are needed to tackle tobacco use among future nurses. [ABSTRACT FROM AUTHOR]