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Abstract Background Prenatal or early childhood secondhand tobacco smoke (SHS) exposure increases obesity risk. However, the potential mechanisms underlying this association are unclear, but obesogenic eating behaviors are one pathway that components of SHS could perturb. Our aim was to assess associations of prenatal and early childhood SHS exposure with adolescent eating behaviors. Methods Data came from a prospective pregnancy and birth cohort (N = 207, Cincinnati, OH). With multiple informant models, we estimated associations of prenatal (mean of 16 and 26 weeks of gestation maternal serum cotinine concentrations) and early childhood cotinine (average concentration across ages 12, 24, 36, and 48 months) with eating behaviors at age 12 years (Child Eating Behaviors Questionnaire). We tested whether associations differed by exposure periods and adolescent’s sex. Models adjusted for maternal and child covariates. Results We found no statistically significant associations between cotinine measures and adolescent’s eating behaviors. Yet, in females, prenatal cotinine was associated with greater food responsiveness (β: 0.23; 95% CI: 0.08, 0.38) and lower satiety responsiveness (β: -0.14; 95% CI: -0.26, -0.02); in males, prenatal and postnatal cotinine was related to lower food responsiveness (prenatal: β: -0.25; 95% CI: -0.04, -0.06; postnatal: β: -0.36; 95% CI: -0.06, -0.11). No significant effect modification by sex or exposure window was found for other eating behaviors. Conclusion Prenatal and early childhood SHS exposures were not related to adolescent’s eating behavior in this cohort; however, biological sex may modify these associations.

Abstract Background Despite multiple recommendations and strategies implemented at a national and international level, cigarette smoking, alcohol consumption, and cannabis use during pregnancy remains high in most countries. The objective of this study was to examine key stakeholders’ perception of the treatment interventions adopted in Spain, to identify political, organizational and personal factors associated with successful implementation, and to propose strategies for improvement. Methods A qualitative study with a phenomenological approach was conducted in 2022. The target groups were: (1) clinical decision makers in the field of addiction science, (2) health professionals who carry out treatment interventions, and (3) pregnant individuals who use tobacco, alcohol or cannabis. Two focus groups and eight in-depth interviews were conducted, recorded, and transcribed. Exploratory analysis and inductive open coding was performed, codes were merged into categories, and subcategories were identified. Results The analysis resulted in 10 subcategories which were further merged into three main categories: (1) Degree of adoption and utility of treatment interventions implemented; (2) Needs and demands with respect to the organization of treatment interventions; and, (3) Personal barriers to and facilitators for treatment. Respondents reported that despite multiple national and regional cessation initiatives, treatment interventions were rarely adopted in clinical practice. Health care administrators demanded reliable records to quantify substance use for better planning of activities. Health care professionals advocated for additional time and training and both echoed the importance of integrating cessation interventions into routine prenatal care and creating in-house specialized units. The difficulty in quitting, lack of awareness of risk for foetus and child and the controversial advice were identified as barriers by pregnant individuals. Conclusions Consistent with previous work, this study found that cessation strategies implemented by the health authorities are not effective if they are not accompanied by organizational and behavioral changes. The current study identifies a set of factors that could be pivotal in ensuring the success of treatment interventions targeting tobacco, alcohol and cannabis use among pregnant individuals.

Introduction: The factors and patterns associated with antibiotic consumption in infants are unclear. Our aim was to assess the cumulative incidence of antibiotic consumption from birth to 16 months and identify factors associated with antibiotic consumption among infants aged 4–16 months. Material and methods: We conducted a cross-sectional study in 2016 in a sample of 18 882 women from Galicia, Spain, who had given birth to a live child between September 1, 2015 and August 31, 2016. We calculated the cumulative incidence of antibiotic consumption based on maternal reports regarding the infant’s consumption from birth to 14 months obtained through interviews; we did not estimate consumption at ages 15 and 16 months due to the small sample size. To assess which factors were associated with antibiotic consumption, we carried out a nested case-control study matching cases and controls for birth month on a 1:1 ratio. Results: The cumulative incidence of antibiotic consumption among infants aged 0–14 months increased from 7.5% to 66.0%. The case-control study included data for 1852 cases and 1852 controls. Daycare attendance (OR: 3.8 [95% CI: 3.2–4.6]), having older siblings (OR: 1.8 [95% CI: 1.6–2.1]), health care visits to private clinics (OR: 1.6 [95% CI: 1.4–2.0]), and passive smoking (OR: 1.3 [95% CI: 1.1–1.6]) were associated with an increased probability of antibiotic consumption. Maternal age between 30–39 years or 40 years and over at the time of birth was associated with a decreased probability of antibiotic consumption (OR: 0.8 [95% CI, 0.7–1.0] and OR: 0.6 [95% CI: 0.5–0.8], respectively). Conclusions: Some of the factors associated with antibiotic consumption in infants are modifiable and should be considered in the development of public health measures aimed at reducing antibiotic consumption. Resumen: Introducción: Los factores y patrones asociados al consumo de antibióticos en los lactantes no están claros. Nuestro objetivo fue evaluar la incidencia acumulada de consumo de antibióticos desde el nacimiento hasta los 16 meses e identificar los factores asociados al consumo de antibióticos entre lactantes de 4 a 16 meses. Material y métodos: Se realizó un estudio transversal en 2016 que incluyó una muestra de la población de 18.882 mujeres españolas de Galicia que habían dado a luz a un niño vivo entre el 1 de septiembre de 2015 y el 31 de agosto de 2016. Se calculó la incidencia acumulada de consumo de antibióticos a partir de los resultados de la entrevista a la madre sobre el consumo del lactante desde el nacimiento hasta los 14 meses; no se estimó a los 15 y 16 meses debido al reducido tamaño muestral. Para valorar las características asociadas al consumo de antibióticos se anidó en el estudio transversal un estudio de casos y controles emparejando por mes de nacimiento, un control por caso. Resultados: La incidencia acumulada de consumo de antibióticos entre los lactantes de 0 a 14 meses de edad aumentó del 7,5% al 66,0%. Para el estudio de casos y controles, se obtuvo información de 1.852 casos y de 1.852 controles. La asistencia a la guardería (OR: 3,8 [IC 95%: 3,2–4,6]), tener hermanos/as mayores (OR: 1,8 [IC 95%: 1,6–2,1]), las consultas sanitarias en la clínica privada (OR: 1,6 [IC 95%:1,4–2,0]) o haber estado expuesto al humo ambiental de tabaco (OR: 1,3 [IC 95%: 1,1–1,6]) se asociaron con un mayor riesgo de consumo de antibióticos. Tener madres de entre 30 y 39 años o de 40 años y más en el momento del parto se asoció con un menor riesgo de consumo de antibióticos (OR: 0,8 [IC 95%: 0,7–1,0] y OR: 0,6 [IC 95%: 0,5–0,8], respectivamente). Conclusiones: Algunos de los factores asociados al consumo de antibióticos en los lactantes pueden ser modificables y deben ser considerados en el desarrollo de medidas de salud pública dirigidas a reducir el consumo de antibióticos.

Resumen: Introducción: Los factores y patrones asociados al consumo de antibióticos en los lactantes no están claros. Nuestro objetivo fue evaluar la incidencia acumulada de consumo de antibióticos desde el nacimiento hasta los 16 meses e identificar los factores asociados al consumo de antibióticos entre lactantes de 4 a 16 meses. Material y métodos: Se realizó un estudio transversal en 2016 que incluyó una muestra de la población de 18.882 mujeres españolas de Galicia que habían dado a luz a un niño vivo entre el 1 de septiembre de 2015 y el 31 de agosto de 2016. Se calculó la incidencia acumulada de consumo de antibióticos a partir de los resultados de la entrevista a la madre sobre el consumo del lactante desde el nacimiento hasta los 14 meses; no se estimó a los 15 y 16 meses debido al reducido tamaño muestral. Para valorar las características asociadas al consumo de antibióticos se anidó en el estudio transversal un estudio de casos y controles emparejando por mes de nacimiento, un control por caso. Resultados: La incidencia acumulada de consumo de antibióticos entre los lactantes de 0 a 14 meses de edad aumentó del 7,5% al 66,0%. Para el estudio de casos y controles, se obtuvo información de 1.852 casos y de 1.852 controles. La asistencia a la guardería (OR: 3,8 [IC 95%: 3,2-4,6]), tener hermanos/as mayores (OR: 1,8 [IC 95%: 1,6-2,1]), las consultas sanitarias en la clínica privada (OR: 1,6 [IC 95%:1,4-2,0]) o haber estado expuesto al humo ambiental de tabaco (OR: 1,3 [IC 95%: 1,1-1,6]) se asociaron con un mayor riesgo de consumo de antibióticos. Tener madres de entre 30 y 39 años o de 40 años y más en el momento del parto se asoció con un menor riesgo de consumo de antibióticos (OR: 0,8 [IC 95%: 0,7-1,0] y OR: 0,6 [IC 95%: 0,5-0,8], respectivamente). Conclusiones: Algunos de los factores asociados al consumo de antibióticos en los lactantes pueden ser modificables y deben ser considerados en el desarrollo de medidas de salud pública dirigidas a reducir el consumo de antibióticos. Abstract: Introduction: The factors and patterns associated with antibiotic consumption in infants are unclear. Our aim was to assess the cumulative incidence of antibiotic consumption from birth to 16 months and identify factors associated with antibiotic consumption among infants aged 4 to 16 months. Material and methods: We conducted a cross-sectional study in 2016 in a sample of 18,882 women from Galicia, Spain, who had given birth to a live child between September 1, 2015 and August 31, 2016. We calculated the cumulative incidence of antibiotic consumption based on maternal reports regarding the infant's consumption from birth to 14 months obtained through interviews; we did not estimate consumption at ages 15 and 16 months due to the small sample size. To assess which factors were associated with antibiotic consumption, we carried out a nested case-control study matching cases and controls for birth month on a 1:1 ratio. Results: The cumulative incidence of antibiotic consumption among infants aged 0 to 14 months increased from 7.5% to 66.0%. The case-control study included data for 1,852 cases and 1,852 controls. Daycare attendance (OR: 3.8 [95% CI: 3.2-4.6]), having older siblings (OR: 1.8 [95% CI: 1.6-2.1]), health care visits to private clinics (OR: 1.6 [95% CI: 1.4-2.0]), and passive smoking (OR: 1.3 [95% CI: 1.1-1.6]) were associated with an increased probability of antibiotic consumption. Maternal age between 30-39 years or 40 years and over at the time of birth was associated with a decreased probability of antibiotic consumption (OR: 0.8 [95% CI, 0.7-1.0] and OR: 0.6 [95% CI: 0.5-0.8], respectively). Conclusions: Some of the factors associated with antibiotic consumption in infants are modifiable and should be considered in the development of public health measures aimed at reducing antibiotic consumption.

Resumen: Objetivo: Explorar la opinión de distintos actores clave, en relación con los requisitos que deberían cumplir las intervenciones de cesación de consumo de tabaco, alcohol y/o cannabis durante el embarazo para que puedan ser implementadas y resulten aceptables y útiles. Diseño: Estudio cualitativo con aproximación fenomenológica. Sitio: Se realizó en España en 2022. Participantes: Gestores, profesionales sanitarios, embarazadas consumidoras de tabaco, alcohol y/o cannabis y sus parejas también consumidoras. Métodos: Los datos se recogieron mediante grupos focales y entrevistas en profundidad, hasta alcanzar la saturación del discurso y se transcribieron de manera exacta. Se realizó un análisis exploratorio y codificación abierta inductiva, se fusionaron los códigos en categorías y se identificaron subcategorías. Resultados: Se identificaron cuatro categorías y 18 subcategorías. Los resultados apuntan a que las intervenciones deberían de ser multicomponente. Entre las intervenciones más aceptadas por parte de las mujeres embarazadas y sus parejas, las consultas específicas de cesación, la información, el apoyo de un igual (aunque no precisan de qué manera) y los incentivos económicos. Entre otras opciones a considerar, la cooximetría, propuesta por gestores para obtener un registro objetivo. Conclusiones: Se extrae que esta intervención debe realizarse a nivel de la atención prenatal realizada en atención primaria. Existen dudas respecto de la frecuencia, fin y seguimiento de esta intervención multicomponente, así como a la posibilidad de incorporar a las parejas. Abstract: Objective: To explore the opinion of different key stakeholders regarding the requirements that tobacco, alcohol and/or cannabis cessation interventions should meet to be implemented and to be acceptable and useful during pregnancy. Design: A qualitative study with phenomenological approach. Site: The study was conducted in Spain in 2022. Participants: Decision makers, health professionals, pregnant women using tobacco, alcohol and/or cannabis and their partners who are also users. Methods: Data were collected through focus groups and in-depth interviews, until discourse saturation was reached and accurately transcribed. Exploratory analysis and inductive open coding were conducted, codes were merged into categories and subcategories were identified. Results: Four categories and 18 subcategories were identified. The results suggest that interventions should be multicomponent. Among the interventions most accepted by pregnant women and their partners were specific cessation consultations, information, peer support (although they did not specify how) and financial incentives. Among other options to consider, co-oximetry, proposed by managers to obtain an objective register. Conclusions: The conclusion is that this intervention should be carried out at the level of prenatal care in primary care. There are doubts regarding the frequency, purpose, and follow-up of this multicomponent intervention, as well as the possibility of incorporating couples.

Introduction Complete and accurate data on smoking prevalence at a local level would enable health authorities to plan context-dependent smoking interventions. However, national health surveys do not generally provide direct estimates of smoking prevalence by sex and age groups at the subnational level. This study uses a small-area model-based methodology to obtain precise estimations of smoking prevalence by sex, age group and region, from a population-based survey. Methods The areas targeted for analysis consisted of 180 groups based on a combination of sex, age group (15–34, 35–54, 55–64, 65–74, and ≥75 years), and Autonomous Region. Data on tobacco use came from the 2017 Spanish National Health Survey (2017 SNHS). In each of the 180 groups, we estimated the prevalence of smokers (S), ex-smokers (ExS) and never smokers (NS), as well as their coefficients of variation (CV), using a weighted ratio estimator (direct estimator) and a multinomial logistic model with random area effects. Results When smoking prevalence was estimated using the small-area model, the precision of direct estimates improved; the CV of S and ExS decreased on average by 26%, and those of NS by 25%. The range of S prevalence was 11–46% in men and 4–37% in women, excluding the group aged ≥75 years. Conclusions This study proposes a methodology for obtaining reliable estimates of smoking prevalence in groups or areas not covered in the survey design. The model applied is a good alternative for enhancing the precision of estimates at a detailed level, at a much lower cost than that involved in conducting large-scale surveys. This method could be easily integrated into routine data processing of population health surveys. Having such estimates directly after completing a health survey would help characterize the tobacco epidemic and/or any other risk factor more precisely.

Abstract Small cell lung cancer (SCLC) comprises approximately 10% of all lung cancer cases. Tobacco is its main risk factor; however, occupation might play a role in this specific lung cancer subtype. The effect of occupation on SCLC risk has been hardly studied and therefore we aim to assess the role of occupation on the risk of SCLC. To do this, we designed a multicentric, hospital-based, case–control study. Cases consisted exclusively in SCLC patients and controls were recruited from patients having minor surgery at the participating hospitals. Face to face interviews emphasizing occupation and tobacco consumption were held and residential radon was also measured. Logistic regression models were adjusted with odds ratios with 95%CI as estimations of the effect. 423 cases and 905 controls were included. Smoking prevalence was higher in cases compared to controls. Those who worked in known-risk occupations for lung cancer showed an OR of 2.17 (95%CI 1.33; 3.52), with a similar risk when men were analysed separately. The results were adjusted by age, sex, smoking and indoor radon exposure. Those who worked in known-risk occupations and were moderate or heavy smokers had a SCLC risk of 12.19 (95%CI 5.68–26.38) compared with never or moderate smokers who had not worked in such occupations. Occupation is a relevant risk factor of SCLC, and it seems that its effect is boosted when tobacco smoking is present.

Resumen: En los últimos años han salido a la luz muchos casos de mala conducta científica, algunos con importantes consecuencias, que han evidenciado las brechas que globalmente existen en cuanto a integridad científica. En España también se han dado casos notables de mala conducta científica en el ámbito de la investigación biomédica. Sin embargo, hasta el momento no se ha creado un organismo encargado de supervisar las fases de ejecución, análisis y publicación de las investigaciones biomédicas desde un punto de vista ético. Por lo tanto, en este contexto, consideramos que es necesaria la creación de una oficina que supervise la integridad científica en España y que actúe en caso de sospecha de mala conducta científica, llevando a cabo una investigación independiente y con capacidad sancionadora. La existencia de dicho organismo sería de especial importancia en el caso de las investigaciones financiadas con fondos públicos, ya que en ese caso el fraude en investigación supondría la malversación de dinero público. La creación de una oficina que realmente actúe frente a los casos detectados podría tener un efecto disuasorio sobre una potencial mala conducta de algunos investigadores, previniendo así situaciones de mala conducta científica. Abstract: In recent years, many cases of scientific misconduct have come to light, some with considerable consequences, highlighting the existing breaches in the scientific integrity globally. In Spain, there have also been high-profile cases of scientific misconduct. However, so far, no organism or agency has been created to monitor the execution, analysis and publication phases of biomedical research from an ethical point of view. Therefore, in this context, we consider that there is a need for the creation of an office which supervises research integrity in Spain which would act in cases of suspected scientific misconduct, carrying out an independent investigation and proposing public sanctions. The existence of such an organism would be of particular importance in the case of publicly funded research, since in that case research fraud would involve the misappropriation of public funds. The creation of an office that would act on detected cases could have a deterrent effect on potential misconduct by some researchers, thus preventing cases of scientific misconduct.

Objective: The need to generate evidence related to COVID-19, the acceleration of publication and peer-review process and the competition between journals may have influenced the quality of COVID-19 papers. Our objective was to compare the characteristics of COVID-19 papers against those of non-COVID-19 papers and identify the variables in which they differ. Method: We conducted a journal-matched case-control study. Cases were COVID-19 papers and controls were non-COVID-19 papers published between March 2020 and January 2021. Journals belonging to five different Journal Citations Reports categories were selected. Within each selected journal, a COVID-19 paper (where there was one) and another non-COVID-19 paper were selected. Conditional logistic regression models were fitted. Results: We included 81 COVID-19 and 143 non-COVID-19 papers. Descriptive observational studies and analytical observational studies had, respectively, a 55-fold (odds ratio [OR]: 55.12; 95% confidence interval [95%CI]: 7.41-409.84) and 19-fold (OR: 19.28; 95%CI: 3.09-120.31) higher likelihood of being COVID-19 papers, respectively, and also a higher probability of having a smaller sample size (OR: 7.15; 95%CI: 2.33-21.94). COVID-19 papers had a higher probability of being cited since their publication (OR: 4.97; 95%CI: 1.63-15.10). Conclusions: The characteristics of COVID-19 papers differed from those of non-COVID-19 papers published in the first months of the pandemic. In order to ensure the publication of good scientific evidence the quality of COVID-19-papers should be preserved. Resumen: Objetivo: La necesidad de generar evidencia relacionada con la COVID-19, la aceleración del proceso de revisión por pares y publicación, y la competencia entre revistas, pueden haber influido en la calidad de los artículos sobre la COVID-19. El objetivo fue comparar las características de los artículos sobre la COVID-19 con las de los artículos no COVID-19 e identificar las variables en las que difieren. Método: Se realizó un estudio de casos y controles emparejados por revista. Los casos eran artículos COVID-19 y los controles eran artículos no COVID-19 publicados en el mismo periodo. Se seleccionaron revistas pertenecientes a cinco categorías diferentes del Journal Citations Reports. Dentro de cada revista seleccionada, se escogió un artículo COVID-19 (cuando había uno) y otro artículo no COVID-19. Se ajustaron modelos de regresión logística condicional. Resultados: Se incluyeron 81 artículos COVID-19 y 143 artículos no COVID-19. Los estudios observacionales descriptivos y los estudios observacionales analíticos tenían, respectivamente, una probabilidad 55 veces mayor (odds ratio [OR]: 55,12; intervalo de confianza del 95% [IC95%]: 7,41-409,84) y 19 veces mayor (OR: 19,28; IC95%: 3,09-120,31) de ser artículos COVID-19 y de tener un tamaño de muestra menor (OR: 7,15; IC95%: 2,33-21,94). Los artículos más citados desde su publicación tenían 5 veces más probabilidades de ser artículos COVID-19 (OR: 4,97; IC95%: 1,63-15,10). Conclusiones: Los artículos COVID-19 parecen tener mayor impacto bibliométrico, a pesar de tener menor calidad metodológica. Para asegurar la publicación de buena evidencia científica se debe preservar la calidad de los artículos relacionados con la COVID-19.

Objetivo. Determinar la evolución de la mortalidad por cáncer de pulmón en Colombia en el período 1985-2018 en la población de 35 años y más e identificar cambios en la tendencia. Métodos. Análisis de series temporales de mortalidad. Se calcularon las tasas específicas y estandarizadas por sexo y grupos de edad. Mediante la regresión joinpoint se estimó el porcentaje de cambio anual de las tasas y se identificaron puntos de cambio. Resultados. En el período 1985-2018 se registraron 105 553 muertes por cáncer de pulmón en la población de 35 años y más. Las tasas estandarizadas muestran una tendencia decreciente en el período 1985-2005, excepto en mayores de 64 años. Conclusiones. La tendencia de las tasas de mortalidad por cáncer de pulmón es decreciente en Colombia. Es necesario potenciar medidas de prevención primaria y secundaria sobre el consumo de tabaco y vigilar otros factores de riesgo como el radón residencial o la ocupación.

Introducción: Las organizaciones internacionales recomiendan mantener la lactancia materna (LM) durante los primeros 6 meses de vida. En Europa, la prevalencia de LM a los 6 meses está por debajo de las recomendaciones. Los objetivos son estimar la prevalencia de cese de LM mes a mes y conocer los motivos asociados al abandono de la LM durante el primer año de vida en Galicia. Metodología: Los datos proceden de la encuesta del Sistema de Información sobre Conductas de Riesgo para la Salud 2016 que incluyó a mujeres que habían dado a luz en los 12 meses previos (n = 6.436) en Galicia (España). Se estimaron las prevalencias de cese de LM en función de la edad del niño. Se clasificaron las causas de abandono en cinco categorías y se estimaron las frecuencias. Resultados: Se incluyeron a 5.177 madres con niños de 3-16 meses. Al año de vida, el 33,8% de los niños mantenían LM. La razón principal del abandono fue la hipogalactia (46,5%), seguida de la vuelta al trabajo (24,1%). Hasta los 4 meses, la hipogalactia y los problemas de salud fueron los motivos principales; entre los 4-7 meses, la vuelta al trabajo y la hipogalactia; y después de los 7 meses, el rechazo del bebé y la vuelta al trabajo. Conclusión: El abandono de la LM durante el primer año de vida es preocupante. Conocer cuándo se produce el abandono y sus razones pueden ayudar a los profesionales sanitarios a prevenirlo.

Resumen: Objetivo: Valorar los cambios en la realización de actividad física (AF) en el embarazo y después del parto y explorarlo en función de la edad y el nivel de estudios. Analizar si los profesionales sanitarios dieron recomendaciones sobre la AF. Diseño: Estudio observacional. Sitio: La información procede del Sistema de Información sobre Conductas de Riesgo de Galicia. Participantes: La población objetivo fueron mujeres gallegas (18-49 años) que dieron a luz entre septiembre-2015 y agosto-2016. Medidas principales: Se estimó la prevalencia de realización de caminatas, ejercicio físico (EF) y recomendaciones de realización de la AF en tres momentos (pre-embarazo, embarazo y tras parto). Resultados: Las caminatas aumentaron 34,0% durante el embarazo y el ejercicio disminuyó 21,0%. Tras el parto las caminatas disminuyeron 37,0% y el ejercicio 32,0%, en comparación con el embarazo. Las mujeres de menor edad y con menor nivel educativo son las que realizan menos AF; 72,6 y 22,1% de las mujeres declaró que un profesional sanitario les recomendó AF durante el embarazo y tras el parto, respectivamente. Conclusión: La AF realizada durante el embarazo es fundamentalmente la caminata, y preocupa su abandono tras el parto. Los profesionales sanitarios recomiendan AF principalmente durante el embarazo, pero poco tras el parto. Para mejorar estas prevalencias sería conveniente el refuerzo de la acción sanitaria. Abstract: Objective: To assess changes in physical activity (PA) during pregnancy and after giving birth and to explore this according to age and educational level. To analyze whether the health professionals gave recommendations on PA. Design: Observational study. Site: Information is derived from the Galician Risk Behavior Information System. Participants: The target population was Galician women (aged 18-49 years) who delivered between september-2015 and august-2016. Main measurements: The prevalence of walking, physical exercise and PA recommendations were estimated for three moments (pre-pregnancy, pregnancy and after delivery). Results: Walking during pregnancy increased by 34,0% and the performance of physical exercise decreased by 21,0%. After delivery, walking decreased by 37,0% and physical exercise decreased by 32,0% compared to pregnancy. Women of younger age and lower educational level were those who performed less PA. 72,6% and 22,1% of women declared that a healthcare professional recommended PA during pregnancy and after delivery, respectively. Conclusion: The PA performed by women during pregnancy is mainly walking, and there is a concern about the abandonment of PA practice after delivery. Healthcare professionals recommend PA mainly during pregnancy, but little is recommended after delivery. It may be desirable for the improvement of this prevalence to reinforce health action.

Introduction The prevalence of electronic cigarette (ecigs) use has increased dramatically in recent years, possibly due to the promotion by industry and the advocacy of some physicians which suggest ecigs as a “safer” alternative to tobacco during pregnancy. Evidence suggests that studies in favor of ecigs are more likely to be funded by industry and this could influence physicians’ recommendations. Our aim is to describe the studies conducted on ecigs during pregnancy, with emphasis on conflicts of interest (COI). Material and Methods We conducted a systematic literature search in PubMed to identify original articles on pregnant or postpartum women, published between 1/1/16-21/1/23, which analyzed the use of ecigs during pregnancy. The characteristics of the studies were collected, and a descriptive synthesis of the results was made. The conclusions (in favor, against, neutral) and the COI of the studies were assessed. We also evaluated their quality. Results The search yielded 193 results, and 23 were selected for full-text reading. 15 original articles were included: 4 qualitative and 11 cross-sectional studies. The studies had between 2-14 authors, and were conducted in the UK (5/15), the USA (9/15) and Australia (1/15). The median quality score was 6 out of 10. Of the 15 studies, 12 had a COI section and, of these, 7/12 acknowledged potential COI (4 with the pharmaceutical industry, 1 with the ecigs industry, 1 with a consumer engagement company and 1 with a journal). Of the 15 studies, 10 received funding (1 from the pharmaceutical industry, 3 from a university, 8 from public bodies and 2 from a charitable association). Authors of 5 studies reported financial ties with the pharmaceutical industry and one with both the pharmaceutical and ecig industries. Of the studies declaring a COI with industry (5), 1 was against ecigs benefit (the COI was posterior to the study), 2 were in favor, and 2 were neutral. Of those without COI with industry (10), 3 were against a benefit, 3 were in favor and 4 remained neutral. Conclusions The results are unclear about the relation between the presence of COI and the conclusions, however the number of studies on ecigs during pregnancy is limited. In any case, health professionals should be aware of the existence of COI when interpreting the results of these studies, as they may be influenced by industry.

Introduction Epidemiological studies that use surveys in the field of exposure to environmental tobacco smoke (ETS) are common because they have a reasonable cost and obtain detailed and retrospective information. Although, it should be noted that there is no agreement about which questions should be included. The aim of the study was to analyze how exposure to ETS is ascertained in studies that assessed exposure to ETS in childhood, in adulthood and in Health Surveys carried out in Spain or in its Autonomous Communities (AC). Material and Methods A PubMed search was conducted for original articles in English and Spanish published between 01/01/2012 and 31/12/2021. The variables analyzed were the scenarios of exposure to ETS, the verification of exposure, the intensity of exposure and present the wording of questions. The search was completed with a manual review of the wording the questionnaires included in the European Health Surveys (EES), National Health Survey (ENSE) and in surveys developed in the AC of Spain. Results A total of 64 studies were identified, 13 studying exposure to ETS in childhood and 51 in the adult population. In childhood, wording of questions was described in 5 out of 13 studies, being the only scenario ascertained by all home. The verification of exposure was evaluated unevenly, being more frequent questions oriented to cohabitation with smokers. In the adult population, the most evaluated scenario was home followed by work or place of studies; 15 of 51 studies included the question wording, 19 of 51 studies also evaluate exposure to ETS through biological markers, 18 through cotinine. The ENSEs carried out in 2006, 2011-2012 and 2017 as well as the EES of 2009, 2014 and 2020 included questions oriented to ascertain the prevalence of exposure to ETS. In the last year 9 AC asked about exposure to ETS. The most individually valued scenario was home followed by work or place of studies and closed places. The questions varied among the different surveys. Ascertaining exposure to ETS through questionnaires is study-dependent. This emphasizes the need for a standard set of valid and comparable questions to include in epidemiological studies.

Introduction Exposure to secondhand smoke (SHS) is associated with an increase in mortality and morbidity. The aim of this work is to estimate the impact of the exposure to SHS on mortality in Spain in the population aged 35 and over in the year 2020. Material and Methods Attributable mortality (AM) to SHS was estimated using a prevalence-dependent method. Prevalence of exposure was derived from a national representative crosssectional study and relative risks from metanalyses. AM estimations were accompanied by 95% confidence intervals (95%CI), which were calculated using a naive bootstrap procedure. AM, globally and by tobacco consumption, was estimated by sex, age group and cause of death. A sensitivity analysis was performed. Results In Spain, in 2020, 747 (95% CI 676-825) deaths in the population aged 35 and over were attributed to exposure to SHS, 279 (95%CI 256-306) due to lung cancer and 468 (95% CI 417-523) due to ischemic heart disease. 75.1% of the AM occurred in men, 561 deaths (95% CI 494-634). 60.9% of deaths attributed to SHS exposure occurred in non-smokers. Including Chronic Obstructive Pulmonary Disease and stroke in the estimation rose the mortality burden to 2,242 deaths. Conclusions Exposure to SHS is an important cause of death in Spain, associated with 1.5% of all deaths from lung cancer and ischemic heart disease in the population aged 35 and over. Most of the AM to SHS occurs in non-smokers. These data reinforce the need for health authorities to commit to reducing the exposure to SHS in any type of context and location.

Introduction It is estimated that tobacco causes more than 8 million deaths each year, of whom about 1.2 million occur due to exposure to second-hand smoke (SHS) 1 . Complete and accurate data on SHS exposure at a regional level would enable health authorities to plan context-dependent control interventions. However, due to limitations associated with sample size, national health surveys (NHS) do not allow for reliable prevalence estimates by sex and age group at a subnational level. Small-area estimation (SAE) methods could be a valid alternative to have meaningful prevalence at a subnational level 2-6 . The aim of this study is to apply a SAEmodel-based methodology to obtain reliable estimations of SHS exposure by sex and age group in the Autonomous Regions of Spain. Material and Methods The units of analysis were 180 areas defined on the basis of Spain’s territorial division into Autonomous Regions, as well as sex and age group (15-34, 35-54, 55-64, 65-74, 75 years and over). In each area, we estimated the prevalence of exposed (Ex) and non-exposed (NEx) to SHS in 2017, as well as their coefficients of variation (CV), applying a weighted ratio estimator (direct estimator) and a multinomial logistic model with random area effects 7 . The data source used for the SAE model was the Spanish NHS 2017. Results The range of Ex prevalence was 1-35% in men and 2-36% in women. The group aged 15-34 years was the most exposed to SHS, with an associated prevalence of 23%. When SHS exposure was estimated using the small-area model, the precision of direct estimates greatly improved; the CV of Ex and NEx decreased by an average of 92%. Conclusions This study proposes a methodology to obtain reliable estimates of SHS exposure in groups not covered in the design of a population health survey. The model applied is a good alternative to improve the precision of estimates at a detailed level, at a much lower cost than that involved in conducting large-scale surveys. Having such estimates directly after completion of a health survey would help characterize the prevalence of any risk factor with greater precision. This work has not been presented in any other conference or disseminated.

Introduction During pregnancy only half of women quit tobacco smoking despite the recommendations and strategies implemented. The consumption of cannabis and binge drinking seems to be rising in the last years. The objective of this study was to explore the perception of the main actors regarding the development and implementation of an enhanced intervention for tobacco, alcohol and cannabis cessation in Spain. Material and Methods A qualitative study was conducted using a phenomenological approach. The target population was: 1) policy and decision makers 2) health professionals involved in cessation and, 3) pregnant women-couples using tobacco, alcohol or cannabis. The information was collected in 2022, through 2 focus groups and 8 in-depth interviews. Data were collected until discourse saturation was reached and accurately transcribed. Exploratory analysis and inductive open coding were performed, codes were grouped into categories and subcategories were identified. Results Eight policy and decision makers, 9 health professionals and 8 pregnant women/couples took part. The analysis identified 5 categories and 20 subcategories Among the categories identified are the preferences of participants regarding interventions, the information provided or the acceptable cessation goals were identified. Decision makers & health professionals agreed on a brief motivational intervention and pregnant women preferred interventions combined with counseling, leaflets or social support. Women were against digital interventions and shocking messages. They also considered that at least the first intervention should be face-toface and the information provided should focus on the real risks that consumption implies for mother and partner. Conclusions The key considerations identified regarding the preferences and expectations of the participants on smoking, alcohol and cannabis interventions should be taken into consideration whilst acknowledging that some of these considerations might be context-dependent.

Objective: To characterize the prevalence of physical activity in the population aged ≥16 years integrating sedentarism and physical inactivity. Method: A cross-sectional study using data from the Galician Risk Behavior Data System (n = 12,928) was conducted. The population was classified into four categories: physically active (active and non-sedentary), active but sedentary (active and sedentary), lightly active (inactive and non-sedentary), and extremely sedentary (inactive and sedentary). Prevalences were calculated for each category and a multinomial logistic regression model was fitted. Results: 58.0% of the population was physically active and the remaining 42.0% presented some degree of sedentarism and/or physical inactivity. Men were more likely to be extremely sedentary. The risk of sedentarism decreased with age, and workers and/or students were prone to a higher risk of extreme sedentarism in comparison to those who reported other status. Extremely sendentary behaviors were also more common in people with higher educational levels, individuals living alone, residents of urban environments, and smokers. Conclusions: Joint evaluation of sedentarism and physical inactivity provides a more comprehensive and realistic picture of population behaviors related with physical activity. Since sedentarism is the most prevalent behavior, this study recommends that interventions be conducted at work and at academic environments. Resumen: Objetivo: Caracterizar la prevalencia de actividad física en la población ≥16 años integrando sedentarismo e inactividad física. Método: Se realizó un estudio transversal con datos del Sistema de Datos de Conductas de Riesgo de Galicia (n = 12.928). La población se clasificó en cuatro categorías: físicamente activa (activa y no sedentaria), activa pero sedentaria (activa y sedentaria), poco activa (inactiva y no sedentaria) y extremadamente sedentaria (inactiva y sedentaria). Se calcularon las prevalencias para cada categoría y se ajustó un modelo de regresión logística multinomial. Resultados: El 58,0% de la población era físicamente activa y el 42,0% restante presentaba algún grado de sedentarismo o inactividad física. Los hombres eran más propensos a ser extremadamente sedentarios. El riesgo de sedentarismo disminuía con la edad, y los trabajadores o estudiantes eran propensos a un mayor riesgo de sedentarismo extremo en comparación con los que declaraban otra condición. Los comportamientos extremadamente sedentarios también fueron más frecuentes en personas con niveles educativos más altos, personas que vivían solas, residentes en entornos urbanos y fumadores. Conclusiones: La evaluación conjunta del sedentarismo y la inactividad física proporciona una imagen más completa y realista de los comportamientos de la población relacionados con la actividad física. Dado que el sedentarismo es el comportamiento más prevalente, este estudio recomienda que se realicen intervenciones en el ámbito laboral y académico.

Resumen: El objetivo de este estudio fue proponer una versión reducida del Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ) que permita estimar prevalencias de inactividad física. Se incluyó el MLTPAQ en la encuesta del Sistema de Información sobre Conductas de Riesgo de Galicia. A cada actividad se le asoció un código de intensidad, en múltiplos de 1 MET, y se definió como físicamente inactivo un gasto energético semanal

Resumen: Objetivo: Conocer si en España los planes de salud autonómicos incluyen objetivos y medidas específicas relacionados con la actividad física. Método: Se realizó una búsqueda en las páginas web institucionales para identificar el plan de salud más reciente de cada comunidad autónoma. Se extrajo la información que incluían los planes de salud sobre objetivos y medidas, y grupos poblacionales a los que se dirigían dichas medidas. La búsqueda se completó el 24 de enero de 2022. Resultados: Se identificaron 16 planes de salud, de los cuales seis están vigentes en 2022; de estos, 15 incorporaban objetivos y medidas específicas sobre actividad física. La mayor parte de las acciones van destinadas a población general, población infanto-juvenil y personas mayores. Los planes de Cantabria, la Comunidad Valenciana y el País Vasco incluyen la actividad física de forma más extensa, proponiendo medidas para siete de los ocho grupos poblacionales identificados. Conclusiones: La mayor parte de los planes de salud incluyen medidas en relación con la actividad física y las dirigen a dos o más grupos poblacionales. La heterogeneidad en cuanto a objetivos, medidas específicas y grupos poblacionales es alta. Este estudio puede ayudar a las comunidades autónomas a revisar su plan de salud, actualizarlo y mejorarlo en materia de actividad física. Es conveniente que los diferentes planes de salud tengan un marco de propuestas homogéneo relacionado con la promoción de la actividad física. Abstract: Objective: To identify if the regional government health plans in Spain include specific objectives and measures related to physical activity. Method: Institutional websites were scanned to identify the most recent health plan of each regional government. The information included in the health plans on objectives and measures and the population groups targeted by these measures was extracted. The search was completed on 24 January 2022. Results: Sixteen health plans were identified of which six are in force in 2022; 15 of these have incorporated specific objectives and measures on physical activity. Most of the actions are focus on general population, children-adolescents and elderly population. The plans of Cantabria, the Comunitat Valenciana and País Vasco cover physical activity more widely, proposing measures for seven of the eight identified population groups. Conclusions: Most of the health plans include measures related to physical activity and target two or more population groups. The objectives, specific measures and population groups were highly heterogeneous. This study could serve to prompt regional governments to review their health plans, update them and improve them in terms of physical activity. It seems advisable that the different health plans should have a homogeneous framework of proposals related to the promotion of physical activity.

Resumen: Objetivo: Analizar la carga del consumo de tabaco en la mortalidad y en los años de esperanza de vida perdidos en población ≥35 años en Brasil en el periodo 1996-2019, e identificar cambios de tendencia en la mortalidad atribuida. Método: Para estimar la mortalidad atribuida se aplicó un método independiente de prevalencia que asume la tasa de mortalidad por cáncer de pulmón como indicador indirecto del riesgo acumulado asociado al consumo de tabaco. La mortalidad atribuida se estima a partir de la tasa de mortalidad por cáncer de pulmón y aplicando riesgos relativos de cinco cohortes estadounidenses. Se presentan la mortalidad atribuida, las tasas de mortalidad atribuida brutas y estandarizadas en global, por sexo, edad y causas de muerte. Se analizó la tendencia aplicando modelos de regresión joinpoint. Se calcularon los años de esperanza de vida perdidos a causa del tabaco. Resultados: Entre 1996 y 2019 el consumo de tabaco causó 2.389.831 muertes en Brasil. Las enfermedades cardiometabólicas fueron la primera causa de muerte en mujeres en todo el periodo y en hombres hasta 2015. Desde 2006, las tasas de mortalidad atribuida en los hombres, con independencia de la edad, muestran una tendencia decreciente, mientras que en las mujeres la evolución es diferente. Los años de esperanza de vida perdidos muestran un ligero descenso desde los primeros trienios y son más en los hombres. Conclusiones: El 8,5% de la mortalidad total en Brasil durante el periodo 1996-2019 se atribuye al consumo de tabaco. Es importante monitorizar la carga del consumo de tabaco en la mortalidad para fortalecer o implantar intervenciones frente al tabaquismo en Brasil. Abstract: Objective: To analyze the burden of tobacco consumption on mortality and years of life expectancy lost in population ≥35 years in Brazil in the period 1996-2019 and to identify trend changes in smoking-attributable mortality. Method: An independent prevalence method using the lung cancer mortality rate as a proxy for cumulative smoking risk was used to estimate smoking-attributable mortality. Smoking-attributable mortality is estimated from the lung cancer mortality rate and applying relative risks from 5 US cohorts. Smoking-attributable mortality, crude and standardized attributed mortality rates are presented overall, by sex, age and causes of death. Trend analysis was performed by applying joinpoint regression models. Years of life expectancy lost due to tobacco were calculated. Results: Tobacco consumption caused 2,389,831 deaths in Brazil between 1996-2019. Cardiometabolic diseases were the leading cause of death in women throughout the period and in men until 2015. Since 2006, smoking-attributable mortality rates in men, regardless of age, show a decreasing trend while in females the evolution is different. The years of life expectancy lost show a slight decrease since the first triennia and are higher in men. Conclusions: In Brazil, the 8.5% of total mortality between 1996-2019 is attributed to tobacco consumption. It is important to monitor the burden of the tobacco consumption on mortality in order to strengthen or implement interventions against smoking in Brazil.

Abstract Background Lung cancer (LC) is the most commonly diagnosed cancer and the leading cause of cancer-related death in both sexes worldwide. Although the principal risk factor in the western world is tobacco smoking, genetic factors, including alpha-1 antitrypsin deficiency (AATD), have been associated with increased risk. This study is the continuation of an earlier one published by the same group in 2015, aimed at analysing risk of LC in never-smokers, associated with carriers of the AATD genotype. Methods A multicentre case–control study was conducted in Spain across the period January 2011 to August 2019. Cases were non-smokers diagnosed with LC, and controls were composed of never-smoking individuals undergoing major non-cancer-related surgery. Data were collected on epidemiological characteristics, exposure to environmental tobacco smoke (ETS), residential radon levels, and alpha-1 antitrypsin (AAT) genotype. Results The study included 457 cases (42%) and 631 controls (58%), with a predominance of women (72,8%). The most frequent histological type was adenocarcinoma (77.5%), followed by squamous cell carcinoma (7.7%). No association of risk of LC was found with the status of AATD genotype carrier, both overall and broken down by age, sex, or exposure to ETS. Conclusions No risk association was found between being a carrier of an AAT deficiency genotype and LC among never-smokers. In order to establish the existence of an association, we consider it important to expand the studies in never smokers in different geographical areas as well as to include patients with previous chronic lung diseases to assess if it influences the risk.

Abstract It is not known whether residential radon exposure may be linked to the development of chronic obstructive pulmonary disease (COPD) and/or have an influence on the functional characteristics or exacerbations of COPD. The aim of this study was therefore to ascertain whether there might be an association between residential radon concentrations and certain characteristics of COPD. We analyzed COPD cases drawn from a case–control study conducted in an area of high radon exposure. Data were collected on spirometric pulmonary function variables, hospital admissions, and smoking. Radon measurements were taken using alpha-track-type CR-39 detectors individually placed in patients’ homes. All statistical analyses were performed using the IBM SPSS v22 computer software program. The study included 189 COPD cases (79.4% men; median age 64 years). The median radon concentration was 157 Bq/m3. No differences were found between radon concentration and sex, age or severity of breathing obstruction as measured by FEV1%. It should be noted, however, that 48.1% of patients with FEV1% 600 Bq/m3 exhibited no different characteristics in lung function. Exposure to radon does not appear to have an influence on the clinical characteristics of smokers and ex-smokers with COPD. As exposure to residential radon increases, there is no trend towards a worsening of FEV1%. Further studies are thus needed to analyze this possible association in never-smokers with COPD.

Introduction Home is one of the main places for children’s secondhand smoke (SHS) exposure. The implementation of smoke-free rules at home might be influenced by caregivers’ risk perception of SHS exposure. This study aimed to analyze factors related to caregivers’ risk perception of SHS exposure in children. Methods We conducted a cross-sectional telephone survey among a representative sample of 2411 parents or legal guardians of children aged

Abstract Foot problems are highly prevalent conditions, being a frequent reason for medical and podiatric consultation. The aim of this study was to compare the differences of quality of life (QoL) related to foot health in people with and without the presence of foot problems. A case–control study was carried out in an outpatient centre, where a clinician recorded data related to sociodemographic and clinical characteristics. In addition, self-reported data on foot health-related quality of life were recorded using the Spanish version of the Foot Health Status Questionnaire. The sample consisted of 498 participants (249 cases and 249 controls), with a median age of 30 years and an interquartile range of 23 years. The differences between the groups were statistically significant for gender, age, footwear, general health, foot health, and physical activity. Cases showed lower scores for the domain of footwear, physical activity and vitality compared to controls. Foot pathologies have a negative impact on quality of life related to foot health, and the domains of footwear, general health and physical activity seem to be the factors that are associated with the presence of alterations and foot deformities.

BackgroundEurope has had a large variability in COVID-19 incidence between and within countries, particularly after June 2020. We aim to assess the variability between European countries and regions located in a given country.MethodsWe used ECDC information including countries having 7 regions or more. The metric used to assess the regional variability within a country was the intercuartilic range in a weekly basis for 32 weeks between June 29th 2020 and February 1st 2021. We also calculated each country's overall variability across the 32 weeks using the distances from the regional curves of the 14-day incidence rates to the corresponding national curve, using the L2 metric for functional data. We afterwards standardised this metric to a scale from 0 to 100 points. We repeated the calculations excluding island regions.ResultsThe variability between and within countries was large. Slovenia, Spain and Portugal have the greatest variability. Spain and Slovenia held also the top three places for the greatest number of weeks (Spain for 19 weeks and Slovenia for 10) with the highest variability. For variability among the incidence curves across the 32-week period, Slovenia, Portugal and Spain ranked first in functional variability, when all the regions were analysed but also when the island regions were excluded.ConclusionsThese differences might be due to how countries tackled the epidemiological situation. The persistent variability in COVID-19 incidence between regions of a given country suggests that governmental action may have an important role in applying epidemiological control measures.

BackgroundSerum cotinine has become the most widely used biomarker of secondhand smoke exposure (SHS) over time in all ages. The aim of this study was to review the serum cotinine cut-points used to classify children under 5 years as exposed to SHS.MethodsA systematic review performed in the Pubmed (MEDLINE) and EMBASE databases up to April 2021 was conducted using as key words "serum cotinine", "tobacco smoke pollution" (MeSH), "secondhand smoke", "environmental tobacco smoke" and "tobacco smoke exposure". Papers which assessed SHS exposure among children younger than 5 years old were included. The PRISMA 2020 guidelines were followed. Analysis was pre-registered in PROSPERO (registration number: CRD42021251263).Results247 articles were identified and 51 fulfilled inclusion criteria. The selected studies were published between 1985-2020. Most of them included adolescents and adults. Only three assessed postnatal exposure exclusively among children under 5 years. None of the selected studies proposed age-specific cut-points for children < 5 years old. Cut-point values to assess SHS exposure ranged from 0.015 to 100 ng/ml. The most commonly used cut-point was 0.05 ng/ml, derived from the assay limit of detection used by the National Health and Nutrition Examination Survey (NHANES).ConclusionsNo studies have calculated serum cotinine age-specific cut-points to ascertained SHS exposure among children under 5 years old. Children's age-specific cut-points are warranted for health research and public health purposes aimed at accurately estimating the prevalence of SHS exposure and attributable burden of disease to such exposure, and at reinforcing 100% smoke-free policies worldwide, both in homes, private vehicles and public places.

Resumen: Objetivo: El objetivo principal del estudio es analizar la relación entre la exposición al humo ambiental de tabaco (HAT) en niños/as y el asma, las sibilancias y la salud percibida. Método: Estudio transversal mediante encuesta telefónica a una muestra representativa de 2411 menores de 12 años de España. Se describió la exposición al HAT en el ámbito privado y en el ámbito público, así como la prevalencia de asma, sibilancias y mala salud percibida autodeclaradas. La asociación entre los indicadores de salud y la exposición al HAT se analizó mediante modelos multivariados de regresión de Poisson con variancia robusta según edad y nivel de estudios. Resultados: La prevalencia de exposición al HAT en menores fue del 29,2% en el ámbito privado y del 42,5% en el ámbito público. No se observó asociación entre la exposición al HAT y el asma, las sibilancias y la mala salud percibida en menores de 5 años. En menores de 6-11 años con padres/madres con estudios primarios o secundarios, presentar asma (razón de prevalencia ajustada [RPa]: 2,1; intervalo de confianza del 95% [IC95%]: 1,2-3,8) y una peor salud percibida (RPa: 1,6; IC95%: 1,1-2,1) se asociaron positivamente con la exposición al HAT en el ámbito privado. En menores con progenitores o tutores con estudios universitarios se observó una asociación negativa entre presentar asma (RPa: 0,3; IC95%: 0,1-0,7) y sibilancias (RPa: 0,3; IC95%: 0,1-0,8) y la exposición al HAT. Conclusiones: Existen diferencias en la asociación entre la exposición al HAT y el asma, las sibilancias y una peor salud percibida según el nivel de estudios. Se deberían planificar intervenciones con perspectiva de equidad dirigidas a disminuir la exposición al HAT en la infancia. Abstract: Objective: This study aimed to estimate the association between second-hand smoke (SHS) exposure in children and asthma, wheezing and perceived health. Method: A cross-sectional study based on a telephone survey was performed on a representative sample of 2411 children under 12 years old in Spain. Exposure to SHS in private and public settings, and the prevalence of asthma, wheezing and perceived poor health were described. The association between health indicators and SHS exposure was analyzed using multivariate Poisson regression models with robust variance according to age and educational level. Results: The prevalence of SHS exposure in children was 29.2% in private settings and 42.5% in public settings. There was no association between SHS exposure and asthma, wheezing and perceived poor health in children ≤5 years. In children aged 6-11 years with parents with primary/secondary education, presenting asthma (adjusted prevalence ratio [aPR]: 2.1; 95% confidence interval [95%CI]: 1.2-3.8) and worse perceived health (aPR: 1.6; 95%CI: 1.1-2.1) were positively associated with SHS exposure in private settings. In children with parents with university studies, a negative association between SHS exposure and asthma (aPR: .3; 95%CI: 0.1-0.7) and wheezing (aPR: 0.3; 95%CI: 0.1-0.8) was observed. Conclusions: There are differences in the association between SHS exposure and asthma, wheezing and poor perceived health according to educational level. Interventions with an equity perspective aimed at reducing SHS exposure in childhood should be implemented.

Resumen: Objetivo: Valorar la asociación entre la prevalencia de exposición al humo ambiental del tabaco (HAT) en los niños y niñas españoles y diferentes determinantes socioeconómicos. Método: Se analizó información de 5495 menores de 15 años incluidos en la Encuesta Nacional de Salud de España 2011-2012. Se realizaron análisis crudos de las variables de interés y se ajustó un modelo de regresión logística multivariante para evaluar la relación de variables socioeconómicas con la exposición al HAT total, en el hogar y en medios de transporte y lugares públicos cerrados. Resultados: La prevalencia de exposición al HAT total en menores de 15 años fue del 11,8%. La odds ratio de la prevalencia (ORP) de exposición en el hogar resultó el doble para los/las mayores de 5 años (ORP: 2,19 para 6-9 años y 2,28 para 10-14 años) que para los/las más pequeños/as. Un nivel de estudios de los progenitores inferior y medio se asoció con mayor exposición (ORP: 1,97 y 1,29), al igual que las clases sociales IV-VI (ORP: 1,42). Una composición del hogar diferente a «pareja con hijos/as» y residir en viviendas más pequeñas también se relacionó con una mayor exposición. Los resultados de exposición total son muy similares a los de exposición en el hogar (11,5%) debido a la baja prevalencia de exposición en medios de transporte y lugares públicos cerrados (0,8%). Conclusión: En España, los/las menores de 15 años con peor situación socioeconómica presentan mayor prevalencia de exposición al HAT. Estas desigualdades deben considerarse al establecer y desarrollar estrategias de salud pública. Abstract: Objective: To assess the association between exposure to environmental tobacco smoke (ETS) and different socioeconomic determinants among Spanish children. Method: We analyzed the data of 5495 children included in the 2011-2012 Spanish National Health Survey. We estimated the prevalence of exposure to ETS and adjusted logistic regression models to identify variables related to exposure to ETS: total exposure and exposure in the home in addition to ETS exposure in enclosed public places/transport. Results: Total exposure to ETS among children aged 15 and younger was 11.8%, 11.5% of whom were exposed at home and 0.8% in enclosed public places/transport. The prevalence odds ratio (POR) of exposure at home increased with age (6-9 years: 2.19; 10-14 years: 2.28), in children with parents of low or medium education levels (1.97 and 1.29), of social class IV-VI (1.42), among those living in a household with a composition other than a “couple with children” (1.43), and in smaller-sized homes (1.39). Total exposure results were similar to home exposure results. Conclusion: The prevalence of ETS is higher among children younger than 15 years with a more difficult economic situation. These inequalities must be considered in the establishment and development of public health policies.

Resumen: Objetivos: En el año 2011, solo el 18% de la población en Galicia sabía qué es la EPOC. Desde entonces, se han realizado actividades para dar a conocer esta enfermedad. El objetivo de este estudio fue evaluar la situación actual sobre el conocimiento de la EPOC en población gallega. Metodología: Estudio transversal, mediante encuestas telefónicas. Se analizan variables incluidas en un cuestionario específico, relacionadas con el conocimiento de la enfermedad. Resultados: Fueron 872 encuestados, 53% mujeres, edad media 54 años. Un 63% con estudios secundarios/universitarios. El 40% sabe qué es la EPOC. En cambio, más del 90% de los encuestados conocen otras enfermedades de alta frecuencia (diabetes, ictus, asma). Los factores más asociados con el conocimiento de la EPOC fueron el género femenino, tener estudios secundarios/universitarios y haber realizado previamente una espirometría. Conclusiones: El conocimiento actual de la EPOC en población gallega es del 40%, superior al del año 2011, pero todavía está lejos del de otras enfermedades prevalentes. Abstract: Objectives: In 2011, only 18% of the population in Galician knew the COPD. Since then, activities have been carried out to publicize this disease. The objective of this study was to evaluate the current situation regarding the knowledge of COPD in the Galician population. Methodology: Cross-sectional study, through telephone surveys. Variables included in the questionnaire, related to knowledge of the disease, were analyzed. Results: 872 respondents, 53% women, mean age 54 years. 63% with secondary/university studies. 40% has knowledge of COPD. In contrast, more than 90% of respondents know other high-frequency diseases (diabetes, stroke, asthma). The factors most associated with knowledge of COPD were female gender, having secondary/university studies, and having previously performed spirometry. Conclusions: The knowledge of COPD in the Galician population is 40% now, higher than in 2011, but it is far from that of other prevalent diseases.

Objectives Cotinine is the gold standard to estimate prevalence of secondhand tobacco smoke (SHS) exposure, and assay limit of detection (LOD) cut-points are typically used regardless of age. Our aim was to compare the concordance between mother-reported SHS exposure and serum cotinine categorising children as exposed with the assay LOD or age-specific cut-points.Design Data from the Health Outcomes and Measures of the Environment (HOME) Study, a prospective pregnancy and birth cohort.Setting Hospital or participants’ homes.Participants 389 pregnant women aged 18 years and older, between 13 and 19 weeks of gestation, living in a five-county region of the Cincinnati, Ohio metropolitan area, and with follow-up on their children at birth and ages 12, 24, 36 and 48 months.Primary and secondary outcome measures Children’s serum cotinine, mother-reported active smoking and SHS exposure were available at birth and during follow-up visits. We used Cohen’s kappa index to assess concordance between maternal self-report and child’s serum cotinine concentrations. We estimated optimal age-specific cut-points, their sensitivity–specificity and positive–negative predictive values with receiver operating characteristic curves.Results Self-reported exposure and cotinine data were available for 280 women who gave birth to singleton child. When applying the assay LOD (0.015 ng/mL), concordance between maternal report and serum cotinine, without accounting for age, was below 0.23 at all times. When using age-specific cut-points (12 months: 0.11 ng/mL; 24 months: 0.08 ng/mL; 36 months: 0.05 ng/mL and 48 months: 0.04 ng/mL), concordance improved, being low at 12 months (0.39), moderate at 24 and 36 months (0.47 and 0.43) and high at 48 months (0.62).Conclusions Concordance between mother-reported SHS exposure among children under 5 years and serum cotinine improved considerably after applying the cohort-specific and age-specific cut-points. Future studies are necessary to verify these results.

Resumen: Introducción y objetivos: El exceso de peso, fundamentalmente la obesidad, en edad pediátrica aumenta el riesgo de morbimortalidad en la edad adulta. El objetivo de este trabajo es estimar la prevalencia, global y en función de la edad y del sexo, de bajo peso, normopeso, exceso ponderal y de obesidad abdominal en los escolares gallegos de 6 a 15 años en el curso escolar 2013-2014. Material y métodos: Los datos proceden de un estudio transversal realizado en una muestra representativa por sexo y edad de escolares gallegos de 6 a 15 años. A partir de mediciones realizadas en los centros escolares se estimaron las prevalencias de bajo peso, normopeso, sobrepeso y obesidad, aplicando los puntos de corte propuestos por Cole, y la prevalencia de obesidad abdominal a partir de los puntos de corte de Taylor. Resultados: Se pesaron y midieron 7.438 escolares en los 137 centros educativos participantes. La prevalencia de sobrepeso fue de 24,9% y la de obesidad, de 8,2%. El 25,8% presentaban obesidad abdominal. El 4% de los escolares con normopeso tenían obesidad abdominal. Conclusiones: Estos datos ponen de manifiesto que se deben promover medidas de prevención primaria a edades tempranas encaminadas a disminuir la prevalencia de este factor de riesgo y a evitar complicaciones futuras. La prevalencia de exceso de peso, si no se tiene en cuenta la obesidad abdominal, se estaría infraestimando. Abstract: Introduction and objectives: The excess of weight, mainly obesity, during childhood and adolescence increases morbimortality risk in adulthood. The aim of this article is to estimate both the overall prevalence, as well as according to age and gender, of underweight, overweight, obesity and abdominal obesity among schoolchildren aged between 6-15-years-old in the school year 2013-2014. Material and methods: Data were taken from a cross-sectional community-based study carried out on a representative sample, by gender and age, of the Galician population aged between 6 and 15 years-old. The prevalence of underweight, overweight, and obese children (Cole's cut-off criteria) and abdominal obesity (Taylor's cut-off criteria) were estimated after performing objective measurements of height, weight and waist circumference at school. Results: A total of 7,438 students were weighed and measured in 137 schools. The prevalence of overweight and obese individuals was 24.9% and 8.2%, respectively. The prevalence of abdominal obesity was 25.8%, with 4% of children with normal weight having abdominal obesity. Conclusions: These data highlight the need to promote primary prevention measures at early ages in order to decrease the occurrence of the premature onset of disease in the future. The prevalence of excess weight is underestimated if abdominal obesity is not taken into consideration.

Introduction and objectives: The excess of weight, mainly obesity, during childhood and adolescence increases morbimortality risk in adulthood. The aim of this article is to estimate both the overall prevalence, as well as according to age and gender, of underweight, overweight, obesity and abdominal obesity among schoolchildren aged between 6 and 15-years-old in the school year 2013–2014. Material and methods: Data were taken from a cross-sectional community-based study carried out on a representative sample, by gender and age, of the Galician population aged between 6 and 15-years-old. The prevalence of underweight, overweight, and obese children (Cole's cut-off criteria) and abdominal obesity (Taylor's cut-off criteria) were estimated after performing objective measurements of height, weight and waist circumference at school. Results: A total of 7438 students were weighed and measured in 137 schools. The prevalence of overweight and obese was 24.9% and 8.2%, respectively. The prevalence of abdominal obesity was 25.8%, with 4% of children with normal weight having abdominal obesity. Conclusions: These data highlight the need to promote primary prevention measures at early ages in order to decrease the occurrence of premature onset of disease in the future. The prevalence of excess weight is underestimated if abdominal obesity is not taken into consideration. Resumen: Introducción y objetivos: El exceso de peso, fundamentalmente la obesidad, en edad pediátrica aumenta el riesgo de morbimortalidad en la edad adulta. El objetivo de este trabajo es estimar la prevalencia, global y en función de la edad y del sexo, de bajo peso, normopeso, exceso ponderal y de obesidad abdominal en los escolares gallegos de 6 a 15 años en el curso escolar 2013-2014. Material y métodos: Los datos proceden de un estudio transversal realizado en una muestra representativa por sexo y edad de escolares gallegos de 6 a 15 años. A partir de mediciones realizadas en los centros escolares se estimaron las prevalencias de bajo peso, normopeso, sobrepeso y obesidad, aplicando los puntos de corte propuestos por Cole, y la prevalencia de obesidad abdominal a partir de los puntos de corte de Taylor. Resultados: Se pesaron y midieron 7.438 escolares en los 137 centros educativos participantes. La prevalencia de sobrepeso fue de 24,9% y la de obesidad, de 8,2%. El 25,8% presentaban obesidad abdominal. El 4% de los escolares con normopeso tenían obesidad abdominal. Conclusiones: Estos datos ponen de manifiesto que se deben promover medidas de prevención primaria a edades tempranas encaminadas a disminuir la prevalencia de este factor de riesgo y a evitar complicaciones futuras. La prevalencia de exceso de peso, si no se tiene en cuenta la obesidad abdominal, se estaría infraestimando.

Resumen: Introducción y objetivos: Bajo el término malnutrición se agrupa la malnutrición por exceso, por defecto y por retraso en el crecimiento. Su prevalencia, a nivel poblacional, se puede estimar mediante variables antropométricas. El objetivo de este trabajo es estimar la prevalencia de malnutrición en los escolares gallegos de 6 a 15 años en el curso escolar 2013-2014. Métodos: Estudio transversal sobre una muestra representativa por sexo y edad de la población gallega de 6 a 15 años. Se estimó la prevalencia de obesidad, bajo peso y baja estatura en función del sexo y la edad utilizando los criterios de referencia propuestos por la Organización Mundial de la Salud. Resultados: Se pesaron y midieron 7.438 escolares. En global, el 16,4% de los escolares presentaban malnutrición. La prevalencia de obesidad fue del 14,8%, la de bajo peso, del 0,7%, y la de baja estatura para la edad, del 1%. La obesidad fue más prevalente entre los niños; respecto al bajo peso o baja estatura cuando aparecieron diferencias, las prevalencias fueron más altas entre las niñas. Conclusiones: En Galicia, 16 de cada 100 escolares de 6 a 15 años presentaban malnutrición, siendo la malnutrición por exceso u obesidad la manifestación más frecuente. La prevalencia de bajo peso y baja estatura no superaron el 1%. Estos datos ponen de manifiesto que se deben promover medidas de prevención primaria a edades tempranas encaminadas a disminuir la malnutrición, especialmente por exceso o adiposidad. Abstract: Introduction and aims: The term malnutrition includes malnutrition due to excess or obesity, underweight as well as stunted growth. Its prevalence in a population can be estimated using anthropometric variables. The aim of this study is to estimate the prevalence of malnutrition in Galician schoolchildren aged 6 to 15 years in the school year 2013-2014. Methods: A cross-sectional study was conducted on a representative sample by gender and age of the Galician population of 6 to 15 years old. The prevalence of obesity, underweight, and short stature was estimated by age and gender using the reference standards proposed by the World Health Organisation. Results: Of the total of 7,438 schoolchildren weighed and measured, 16.4% had malnutrition. The prevalence of obesity was 14.8%, underweight was 0.7%, and short stature for age was estimated at 1%. Obesity was more prevalent among boys. As regards underweight and short stature, when there were differences, prevalence was higher among girls. Conclusions: In Galicia, 16 out of every 100 schoolchildren aged 6 to 15 years had malnutrition, with that due to excess or obesity being the most frequent. Prevalence of underweight and short stature did not exceed 1%. This data shows that primary prevention measures should be promoted at an early age to reduce malnutrition due to excess or adiposity, in particular.

Introduction and aims: The term malnutrition includes malnutrition due to excess or obesity, underweight as well as stunted growth. Its prevalence in a population can be estimated using anthropometric variables. The aim of this study is to estimate the prevalence of malnutrition in Galician schoolchildren aged 6–15 years in the school year 2013–2014. Methods: A cross-sectional study was conducted on a representative sample by gender and age of the Galician population of 6–15 years old. The prevalence of obesity, underweight, and short stature was estimated by age and gender using the reference standards proposed by the World Health Organisation. Results: 7438 schoolchildren weighed and measured 16,4% presented malnutrition. The prevalence of obesity was 14.8%, underweight was 0.7%, and short stature for age was estimated at 1%. Obesity was more prevalent among boys. As regards underweight and short stature, when there were differences, prevalence was higher among girls. Conclusions: In Galicia, 16 out of every 100 schoolchildren aged 6–15 years had malnutrition, with that due to excess or obesity being the most frequent. Prevalence of underweight and short stature did not exceed 1%. This data shows that primary prevention measures should be promoted at an early age to reduce malnutrition due to excess or adiposity, in particular. Resumen: Introducción y objetivos: Bajo el término malnutrición se agrupa la malnutrición por exceso, por defecto y por retraso en el crecimiento. Su prevalencia, a nivel poblacional, se puede estimar mediante variables antropométricas. El objetivo de este trabajo es estimar la prevalencia de malnutrición en los escolares gallegos de 6 a 15 años en el curso escolar 2013–2014. Métodos: Estudio transversal sobre una muestra representativa por sexo y edad de la población gallega de 6 a 15 años. Se estimó la prevalencia de obesidad, bajo peso y baja estatura en función del sexo y la edad utilizando los criterios de referencia propuestos por la Organización Mundial de la Salud. Resultados: Se pesaron y midieron 7.438 escolares. En global, el 16,4% de los escolares presentaban malnutrición. La prevalencia de obesidad fue del 14,8%, la de bajo peso, del 0,7%, y la de baja estatura para la edad, del 1%. La obesidad fue más prevalente entre los niños; respecto al bajo peso o baja estatura cuando aparecieron diferencias, las prevalencias fueron más altas entre las niñas. Conclusiones: En Galicia, 16 de cada 100 escolares de 6 a 15 años presentaban malnutrición, siendo la malnutrición por exceso u obesidad la manifestación más frecuente. La prevalencia de bajo peso y baja estatura no superaron el 1%. Estos datos ponen de manifiesto que se deben promover medidas de prevención primaria a edades tempranas encaminadas a disminuir la malnutrición, especialmente por exceso o adiposidad.

Resumen: Objetivo: Evaluar y corregir, usando escalas de siluetas corporales, el impacto de la no respuesta en las prevalencias de bajo peso, sobrepeso y obesidad en niños/as de 6-15 años de edad. Método: Estudio transversal realizado en 2013 con 8145 escolares gallegos/as de 6-15 años. Quienes aceptaron participar fueron pesados/as y medidos/as, y a partir del índice de masa corporal se estimaron las prevalencias de bajo peso, sobrepeso y obesidad. Los/las profesores/as valoraron a todo el alumnado mediante escalas de siluetas corporales, y las valoraciones se usaron para estimar las prevalencias corregidas por la no respuesta. Aplicando el teorema de Bayes se estimaron las tasas de participación en función del estado ponderal. Resultados: La tasa de participación fue del 92,3% para los/las de 6-11 años y del 90% para los/las de 12-15 años. En ambos grupos, las prevalencias de bajo peso y sobrepeso fueron similares entre participantes y no participantes, pero la obesidad fue mayor entre los no participantes, sobre todo a los 12-15 años (6,3% vs. 12,2%; p

Background Retracted articles continue to be cited after retraction, and this could have consequences for the scientific community and general population alike. This study was conducted to analyse the association of retraction on citations received by retracted papers due to misconduct using two-time frames: during a postretraction period equivalent to the time the article had been in print before retraction; and during the total postretraction period.Methods Quasiexperimental, pre–post evaluation study. A total of 304 retracted original articles and literature reviews indexed in MEDLINE fulfilled the inclusion criteria. Articles were required to have been published in a journal indexed in MEDLINE from January 2013 through December 2015 and been retracted between January 2014 and December 2016. The main outcome was the number of citations received before and after retraction. Results were broken down by journal quartile according to impact factor and the most cited papers during the preretraction period were specifically analysed.Results There was an increase in postretraction citations when compared with citations received preretraction. There were some exceptions however: first, citations received by articles published in first-quartile journals decreased immediately after retraction (p

IntroductionFirst study of social inequalities in tobacco-attributable mortality (TAM) in Spain considering the joint influence of sex, age, and education (intersectional perspective).MethodsData on all deaths due to cancer, cardiometabolic and respiratory diseases among people aged ≥35 years in 2016 were obtained from the Spanish Statistical Office. TAM was calculated based on sex-, age- and education-specific smoking prevalence, and on sex-, age- and disease-specific relative risks of death for former and current smokers vs lifetime non-smokers. As inequality measures, the relative index of inequality (RII) and the slope index of inequality (SII) were calculated using Poisson regression. The RII is interpreted as the relative risk of mortality between the lowest and the highest educational level, and the SII as the absolute difference in mortality.ResultsThe crude TAM rate was 55 and 334 per 100,000 in women and men, respectively. Half of these deaths occurred among people with the lowest educational level (27% of the population). The RII for total mortality was 0.39 (95%CI: 0.35-0.42) in women and 1.61 (95%CI: 1.55-1.67) in men. The SII was -41 and 111 deaths per 100,000, respectively. Less-educated women aged ConclusionsTAM is inversely associated with educational level in men and younger women, and directly associated with education in older women. This could be explained by different smoking patterns. Appropriate tobacco control policies should aim to reduce social inequalities in TAM.

Abstract We aimed to know if radon concentration is associated with municipal mortality due to brain cancer in Galicia, Spain. We designed an ecological study taking as study unit Galician municipalities. To be included, municipalities had to have at least three radon measurements. We correlated radon concentrations with municipal mortality due to these malignant tumors during the period 1999–2008. We calculated the relative risk of dying of brain cancers for each municipality and correlated this value with municipal radon concentration using Spearman’s Rho. 251 municipalities were included, with close to 3,500 radon measurements and an average of 14 radon measurements at each municipality. We observed a significant correlation between residential radon with brain cancer mortality for males and females and the intensity of the correlation was higher for females. These results were reinforced when the analysis was restricted to municipalities with more than 5 radon measurements: Spearman’s Rho 0.286 (p-value

There is little information on chronic obstructive pulmonary disease (COPD) mortality trends, age of death, or male:female ratio. This study therefore sought to analyze time trends in mortality with COPD recorded as the underlying cause of death from 1980 through 2017, and with COPD recorded other than as the underlying cause of death. We conducted an analysis of COPD deaths in Galicia (Spain) from 1980 through 2017, including those in which COPD was recorded other than as the underlying cause of death from 2015 through 2017. We calculated the crude and standardized rates, and analyzed mortality trends using joinpoint regression models. There were 43,234 COPD deaths, with a male:female ratio of 2.4. Median age of death was 82 years. A change point in the mortality trend was detected in 1996 with a significant decrease across the sexes, reflected by an annual percentage change of −3.8%. Taking deaths into account in which COPD participated or contributed without being the underlying cause led to an overall 42% increase in the mortality burden. The most frequent causes of death when COPD was not considered to be the underlying cause were bronchopulmonary neoplasms and cardiovascular diseases. COPD mortality has decreased steadily across the sexes in Galicia since 1996, and age of death has also gradually increased. Multiple-cause death analysis may help prevent the underestimation of COPD mortality.

Resumen: Objetivo: Valorar los cambios en el consumo de tabaco y estudiar de forma detallada el consumo de tabaco de liar y de cigarrillos electrónicos en la población gallega desde 2007 hasta 2015. Métodos: Información aportada por cinco estudios transversales, independientes, realizados entre 2007 y 2015 en mayores de 15 años (n = 8000/año). Se estimaron prevalencias de consumo, acompañadas de sus intervalos de confianza del 95%, global, en función del sexo y en grupo de edad, ámbito de residencia y nivel de estudios. Resultados: La prevalencia de consumo de tabaco fue del 25,4% en 2007 y del 21,8% en 2015. En 2007, el 1,8% de los fumadores consumían tabaco de liar, y en 2015 eran el 18,6%. El consumo del tabaco de liar entre fumadores aumentó en todos los grupos estudiados. La prevalencia de consumo de cigarrillos electrónicos fue, en 2014 y 2015, del 0,7%. En el ámbito urbano es donde se observan prevalencias más altas de consumo de cigarrillos electrónicos. Conclusión: Entre 2007 y 2015, la prevalencia de consumo de tabaco ha disminuido en Galicia y ha aumentado la prevalencia de fumadores que consumen tabaco de liar. El uso de cigarrillos electrónicos es bajo y más frecuente entre los fumadores, aunque no exclusivo. El auge del tabaco de liar y la introducción de los cigarrillos electrónicos reflejan la importancia de mantener sistemas de vigilancia que puedan identificar de forma inmediata cambios de comportamiento asociados al consumo de tabaco. Abstract: Objective: To assess changes in smoking prevalence and study roll-your-own (RYO) tobacco and e-cigarette use in the Galician population between 2007 and 2015. Methods: Data were obtained from five independent, cross-sectional studies carried out in Galicia (Spain) between 2007-2015 in the population aged 16 and over (n = 8,000/year). Prevalence of use was estimated, with 95% confidence intervals, overall, according to sex and by age group, area of residence and level of education. Results: Smoking prevalence decreased from 25.4% in 2007 to 21.8% in 2015. In 2007, 1.8% of current smokers declared that they had smoked RYO tobacco, compared to 18.6% in 2015. Among smokers, RYO tobacco consumption increased across all demographic groups. In both 2014 and 2015, ever use of e-cigarettes was 0.7%. E-cigarette use was more frequent in urban settings. Conclusion: Smoking prevalence decreased in Galicia between 2007 and 2015, and there has been rapid growth in the prevalence of RYO tobacco use. Although smokers are more likely to use e-cigarettes, both former and never smokers declared their use. The boom of RYO cigarettes and the emergence of e-cigarettes highlight the importance of having continuous surveillance systems to identify smoking behavioural changes. Palabras clave: Prevalencia, Estudio transversal, Epidemiología, Cigarrillos electrónicos, Productos del tabaco, Keywords: Prevalence, Cross-sectional study, Epidemiology, Electronic cigarettes, Tobacco products

Introduction Children are particularly vulnerable to the health effects of secondhand smoke (SHS). The objectives of this study are to describe SHS exposure of children younger than 12 years in Spain and to identify potential social inequalities associated with SHS exposure. Material and Methods A cross-sectional study was conducted in a representative sample of the population younger than 12 years in Spain. A computerassisted telephone interview was conducted with parents or legal guardians in 2016, to assess the children’s SHS exposure at home, in the car, at school and at the nursery gates, in public transport, and during leisure time. The socio-demographic variables included were the child’s age and sex, the highest educational attainment at home, and occupational social class. Prevalence and 95% confidence intervals were calculated for SHS exposure in each setting and for overall exposure. Results In all, 71.8% of the children were exposed to SHS: 25.8% were exposed at home, 4.6% in the car, 8.2% in public transport, 31.9% at outdoor nursery or school gates, and 48% during leisure time. The higher the educational attainment at home, the lower the exposure (38.8% for primary school or lower, 28.7% for secondary school and 20.8% university level). The more deprived the social class, the higher the exposure (21.7% class I-II, 23.4% class III-IV and 31.1% class V-VII). SHS exposure in cars and overall exposure also decreased with higher educational achievement. Conclusions In Spain, a large proportion of children are still exposed to SHS. Furthermore, there are clear social inequalities. To reduce SHS exposure, there is an urgent need for evidence-based interventions with an equity perspective.

Background Children are especially vulnerable to the detrimental health effects of secondhand smoke (SHS), which has been widely linked to asthma and otitis media (OM), among other diseases. This study aimed to estimate hospital admissions and disability-adjusted life years (DALY) attributable to SHS exposure in terms of asthma and OM among children under 5 years old in Spain during the year 2015. Methods The prevalence of SHS exposure in children under 5 was estimated through a telephone survey performed in 2016 in a representative sample of Spanish households with children. The Rate risks for asthma and otitis media were selected from different published international meta-analysis. The number of hospital admissions were obtained for each disease from the Minimum Basic Data Set provided by the Ministry of Health of Spain. Information about DALYs were obtained from estimations made by the World Health Organization. Both hospital admissions and DALYs attributable to SHS exposure were calculated using the population attributable fraction (PAF). Results 25.7% of children under 5 are exposed to SHS at home (any household member reported smoking either inside or on balconies or terraces). According to the literature, SHS exposure increases the risk of both asthma and OM by 1.32. The estimated percentage of children presenting each disease attributable to SHS exposure at home is 7.6%. In 2015, the number of children with at least one hospital admission for asthma (n=2,451) and OM (n=1,226) attributable to SHS exposure was 186 and 93, respectively. Likewise, attributable DALYs were 273 for asthma and 159 for OM. Conclusions 7.6% of burden disease for asthma and OM among young children is due to SHS exposure at home. This figure highlights the need of implementing smoke-free home interventions to reduce hospital admissions and DALYs for asthma and OM.

Background Children are particularly vulnerable to the effects of secondhand smoke (SHS), mainly due to presenting a respiratory and immune systems in development and a faster respiratory rate. The objective of this study is to describe the potential social inequalities in SHS exposure in households with children under 12 in Spain. Methods Cross-sectional study in a representative sample of population under 12 years of age in Spain. The sample size was 2,411 individuals, being proportional by regions, size of municipality of residence, sex and age groups. A telephone survey was administered to parents or legal tutors in 2016. It included sociodemographic variables and variables related to SHS exposure at home. A descriptive bivariate analysis of the main SHS exposure variables according to educational level and social class (based on occupation) was carried out. Results 25.8% of children are exposed to SHS at home (smoking reported either inside or on balconies or terraces). An exposure gradient is observed according to the level of studies of the household's main earner, being the prevalence of exposure higher as the educational level decreases (37.9% in primary studies or lower, 27.8% in secondary studies and 20% in university studies, p < 0.05). This reverse gradient is maintained by social class (31.1% in class V-VII (most deprived), 23.4% in class III-IV and 21.7% in class I-II (most affluent), p < 0.05). There are no significant differences according to the sex of the child. Conclusions In Spain, one out of every four children is exposed to SHS at home. This exposure presents a clear socioeconomic gradient, being children living in more deprived families at higher risk of SHS exposure. Interventions aiming to reduce SHS exposure in children, with a perspective of equity, are urgently needed.

Objetivo: El objetivo de este trabajo fue estimar la prevalencia de la inactividad física en Galicia en el tiempo libre en 2007-2011, así como el impacto que supone en ella el considerar otras actividades cotidianas. Métodos: Estudios transversales en mayores de 15 años (n = 19235). La actividad física se caracterizó mediante el cuestionario Minnesota. En el año 2011 se estimó la inactividad física considerando otras actividades cotidianas. Resultados: Entre 2007 y 2011, la prevalencia de inactividad física en el tiempo libre en Galicia fue estable (p = 0,249), próxima al 50%, y más alta en las mujeres y en la población que trabaja o estudia. La inactividad física disminuyó (47% a 16%) cuando se tuvieron en cuenta las actividades cotidianas. Conclusiones: La prevalencia de inactividad física fue alta y estable en los años estudiados. Tener en cuenta otras actividades de la vida cotidiana hizo disminuir de forma importante esta prevalencia.

Objetivo: La estimación de la prevalencia de exposición al humo ambiental de tabaco (HAT) permite aproximar el impacto de las leyes orientadas al control del tabaquismo. El objetivo de este trabajo fue conocer cómo varió la prevalencia de exposición autodeclarada al HAT en Galicia entre los años 2005 (previo a la Ley 28/2005) y 2011 (posterior a la Ley 42/2010). Métodos: Información aportada por cinco estudios transversales telefónicos independientes de base poblacional entre los años 2005 y 2011 en población de 16 a 74 años de edad (n = 34.419). Se estimaron prevalencias de exposición acompañadas de intervalos de confianza del 95% en función del ámbito de exposición autodeclarada y del consumo de tabaco. Resultados: En 2005, antes de la implementación de la Ley 28/2005, un 95% de la población declaró estar expuesta al HAT; en 2011, después de la implementación de la Ley 42/2010, esta prevalencia fue del 28%. En función del ámbito donde se produce la exposición al HAT, el descenso más importante en 2006, tras la implantación de la Ley 28/2005, fue en el trabajo, y en 2011 en los lugares de ocio. La prevalencia de exposición en el hogar disminuyó al inicio del periodo a estudio y después se mantuvo sin cambios. Conclusiones: En Galicia, en el periodo 2005-2011 disminuyó de forma importante la prevalencia autodeclarada de exposición al HAT, en especial después de la implantación de las Leyes 28/2005 y 42/2010. No obstante, uno de cada cuatro gallegos de 16 a 74 años de edad declararon estar expuestos en 2011.

Introducción: En los últimos años, las encuestas de salud y los estudios epidemiológicos sobre el tabaquismo han incorporado preguntas sobre la exposición al humo ambiental de tabaco, aunque no existe un cuestionario estandarizado. Métodos: Entre enero y mayo de 2008 se revisaron las encuestas que contenían preguntas sobre exposición a tabaquismo pasivo realizadas en España desde las administraciones públicas, las sociedades científicas y organismos de investigación. Se han revisado los literales, que se han clasificado según tipo de estudio, población diana, ámbito geográfico y lugar de exposición. Resultados: Se identificaron 27 encuestas que incluían tabaquismo pasivo. La mayoría correspondían a encuestas de salud (81,5%) e iban dirigidas a población general (70,4%). El ámbito geográfico más común era el autonómico (48,1%) y el lugar de exposición más común el hogar (88,9%). Discusión: Los resultados muestran una enorme variabilidad en las preguntas utilizadas. Es necesario homogeneizar las preguntas sobre exposición al tabaquismo pasivo si queremos comparar los resultados.Introduccion: In the last few years, health surveys and epidemiological studies on smoking have introduced questions on environmental tobacco smoke (ETS) exposure. However, a standardized questionnaire is lacking. Methods: Between January and May 2008, we reviewed surveys containing items on ETS exposure carried out in Spain by public administrations, scientific societies and research institutes. The wording of the questions was reviewed and classified according to the study type, target population, geographical setting and place of exposure. Results: We identified 27 surveys that included questions on passive smoking. Most were health surveys (81.5%) and were aimed at the general population (70.4%). The most frequent geographical setting consisted of autonomous regions (48.1%) and the most common place of exposure was the home (88.9%) Discussion: The results show wide variability in the questions used. Questionnaire items on ETS exposure should be homogenized to allow comparison of the results of surveys.

Objetivo: Evaluar los cambios en las expectativas y las actitudes sobre la Ley 28/2005 de medidas sanitarias frente al tabaquismo de los trabajadores de la hostelería tras 2 años de su entrada en vigor. Métodos: Estudio longitudinal de una cohorte de trabajadores del sector de la hostelería de cinco comunidades autónomas (n=431) antes de la entrada en vigor de la ley y 24 meses después. Se comparararon el conocimiento de la ley, las expectativas de cumplimiento y los conocimientos sobre los efectos adversos del tabaquismo pasivo antes y después de la ley. Resultados: De los 431 trabajadores participantes iniciales se obtuvo respuesta de 219 a los 2 años (tasa de seguimiento del 50,8%). El 79,0% de los trabajadores conocía el proyecto de ley antes de su entrada en vigor, frente al 94,1% que afirmó conocerla después (pObjective: To assess changes in hospitality workers' expectations and attitudes towards the Spanish smoking law before and 2 years after the smoking ban. Methods: We performed a longitudinal study of a cohort (n=431) of hospitality workers in five regions in Spain before the law came into effect and 24 months later. Expectations and attitudes towards the ban and knowledge about the effect of second-hand smoke on health were compared before and after the ban. Results: We recruited 431 hospitality workers in the baseline survey and 219 were followed-up 24 months later (overall follow-up rate of 50.8%). The percentage of hospitality workers who knew the law was 79.0% before it was passed and was 94.1% 24 months later (p