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This study aims to describe the nicotine metabolite ratio among tobacco smokers and electronic cigarette (e-cigarette) users and nonusers. We analyzed pooled data from a longitudinal and a cross-sectional study of the adult population from the city of Barcelona. The final sample included information on 166 smokers, 164 e-cigarettes users with nicotine, 41 e-cigarette users without nicotine, 95 dual users (users of both products), and 508 nonusers. We used log-linear models to control for the potential confounding effect of the daily number of cigarettes smoked. Salivary nicotine metabolic rate assessment included the rate of nicotine metabolism (cotinine/nicotine) and the nicotine metabolite ratio (trans-3′-hydroxycotinine/cotinine). Exclusive users of e-cigarette without nicotine have the lowest rate of nicotine metabolism (Geometric mean: 0.08, p-values < 0.001) while cigarette smokers have the highest (Geometric mean: 2.08, p-values < 0.001). Nonusers have lower nicotine metabolic rate than cigarette smokers (Geometric means: 0.23 vs. 0.18, p-value < 0.05). Younger individuals (18–44 years) have a higher rate of nicotine metabolism than older individuals (45–64 years and 65–89) (Geometric means: 0.53 vs. 0.42 and 0.31, respectively, p-values < 0.01) and individuals with lower body mass index (21–25 kg/m2) have a higher rate of nicotine metabolism than the rest (26–30 kg/m2 and 31–60 kg/m2) (Geometric means: 0.52 vs. 0.35 and 0.36, respectively-values < 0.01). Nicotine metabolic rates are useful biomarkers when reporting smoking status and biological differences between individuals. [ABSTRACT FROM AUTHOR]

(1) Background: Exposure to environmental tobacco smoke has decreased in recent years in Spain, due to the implementation of tobacco control policies. However, there is no regulation that protects against second-hand smoke (SHS) in outdoor environments. Our goal is to describe the smoking prohibition signage in public spaces and to characterize tobacco consumption in outdoor environments describing the SHS exposure in children. (2) Methods: A cross-sectional study using direct observation was carried out with a convenience sample (n = 179) that included hospitality venues with terraces, schools and healthcare facilities in the municipality of Sant Cugat del Vallès (Barcelona, Spain). The observations were made without notifying the owners by one single field researcher between April and June 2018. The variables were evaluated by signage and signs of tobacco consumption (ashtrays, cigarette butts and presence of smokers). (3) Results: Smoke-free zone signage outside public spaces was present in 30.7% of all venues, with only 50.9% correctness. When analysing terraces of hospitality venues, in 35.8% of them there were children present with 66.7% of tobacco consumption. (4) Conclusions: Our results show a low prevalence of antismoking signage, without an impact on tobacco consumption regardless of the presence of children. [ABSTRACT FROM AUTHOR]

Background: Due to the change in screen time usage in the last decade, there is needed to add more evidence about the relationship of screen time and sleep duration. Objective: To assess the association between screen time and sleep duration among Spanish children between 1 and 14 years old. Methods: We used data from the 2017 Spanish National Health survey, conducted on a representative sample of the Spanish population. We categorised daily leisure screen time as 0‐59, 60‐119, 120‐179, and ≥180 minutes. We classified sleep duration, depending on the age, as proper sleep duration and short sleep duration. We calculated unadjusted, and adjusted prevalence ratio (PR) and 95% confidence interval (CI) of short sleep duration according to daily leisure screen time after adjusting for potential confounders. PR's were derived from fitting generalised linear models with Poisson distribution and robust variance. Results: Of the 5517 Spanish children aged 1‐14 years, 44.3% spent 120 minutes or more of daily leisure screen time and 23.6% had short sleep duration. 24.5% and 28.2% of children spending between 120 and 179 minutes and exceeding 180 minutes of daily leisure screen time suffered short sleep duration, respectively. In the adjusted model, higher patterns of daily leisure screen time were associated with short sleep duration: adjusted PR120‐179 = 1.34 (95% CI 1.18, 1.54) and adjusted PR≥180 = 1.48 (95% CI 1.27, 1.73). Conclusions: Around one out of four Spanish children between 1 and 14 years old, exceeding 120 minutes of daily leisure screen time, had short sleep duration. More scientific research is needed for institutions to work on providing novel healthcare programmes that consider these new determinants of child health. [ABSTRACT FROM AUTHOR]

Introduction Second-hand smoke (SHS) exposure has been associated with increased risks of respiratory and heart diseases. However, little is known about the potential effects of SHS on psychological distress. The aim of this study is to examine the association of SHS exposure at home with psychological distress in Spain. Methods A cross-sectional survey about SHS exposure, socio-demographic and health related variables, and psychological distress, measured with the 12-item version of the General Health Questionnaire (GHQ-12) with a cut-off score ≥ 3, was conducted from 2011–2012 among a representative sample of the adult population (aged ≥ 15 years) of Spain. From the total sample (n = 21,007), we used the subsample of never-smokers (n = 11,214). We computed the odds ratios (OR) and their 95% confidence intervals (95% CI) for scoring ≥ 3 on the GHQ by means of unconditional multiple logistic regression models adjusted for sex and age. Results In the subsample, 9.7% (n = 1,090) responded that they were exposed to SHS at home. The prevalence of subjects scoring ≥ 3 on the GHQ was higher for the sample exposed to SHS (22.7%) than for the non-exposed sample (18.9%; OR: 1.39; CI: 1.19–1.62). This association was also present when stratified for sex, age, marital status, socio-economic status, perceived general health, presence of any chronic disease, and alcohol intake. Conclusions Exposure to SHS at home is associated with psychological distress. Further investigation is necessary to determine if this association is causal. Avoiding SHS exposure at home could have beneficial effects on psychological distress. [ABSTRACT FROM AUTHOR]

Background: In 2006, Spain implemented a national smoke-free legislation that prohibited smoking in enclosed public places and workplaces (except in hospitality venues). In 2011, it was extended to all hospitality venues and selected outdoor areas (hospital campuses, educational centers, and playgrounds). The objective of the study is to evaluate changes in exposure to secondhand smoke among the adult non-smoking population before the first law (2004-05) and after the second law (2011–12). Methods: Repeated cross-sectional survey (2004–2005 and 2011–2012) of a representative sample of the adult (≥16 years) non-smoking population in Barcelona, Spain. We assess self-reported exposure to secondhand smoke (at home, the workplace, during leisure time, and in public/private transportation vehicles) and salivary cotinine concentration. Results: Overall, the self-reported exposure to secondhand smoke fell from 75.7% (95%CI: 72.6 to 78.8) in 2004-05 to 56.7% (95%CI: 53.4 to 60.0) in 2011–12. Self-reported exposure decreased from 32.5% to 27.6% (−15.1%, p<0.05) in the home, from 42.9% to 37.5% (−12.6%, p = 0.11) at work/education venues, from 61.3% to 38.9% (−36.5%, p<0.001) during leisure time, and from 12.3% to 3.7% (−69.9%, p<0.001) in public transportation vehicles. Overall, the geometric mean of the salivary cotinine concentration in adult non-smokers fell by 87.2%, from 0.93 ng/mL at baseline to 0.12 ng/mL after legislation (p<0.001). Conclusions: Secondhand smoke exposure among non-smokers, assessed both by self-reported exposure and salivary cotinine concentration, decreased after the implementation of a stepwise, comprehensive smoke-free legislation. There was a high reduction in secondhand smoke exposure during leisure time and no displacement of secondhand smoke exposure at home. [ABSTRACT FROM AUTHOR]

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Introduction: The time to first cigarette smoked after waking up appears to be a good predictor of plasma and urine cotinine levels; however, collection of blood and urine is difficult in population-based studies and may influence participation. We aimed to test whether time to first cigarette is associated with salivary cotinine. Methods: We used data from a cross-sectional study on a representative sample of the general population of Barcelona, Spain. We gathered information on smoking by means of a questionnaire and collected saliva for cotinine analysis. Of 1,245 participants, 22.9% were daily smokers, and the final sample for analysis consisted of 210 daily smokers. Results: There were significant associations between salivary cotinine and time to first cigarette, between cigarette consumption and time to first cigarette, and between salivary cotinine and cigarette consumption. Salivary cotinine had decreased as time to first cigarette increased. After adjusting for cigarette consumption and sex, there were significant differences in mean salivary cotinine according to time to first cigarette (≤5 min: 219.2 ng/ml; 6–30 min: 175.8 ng/ml; 31–60 min: 168.5 ng/ml; >60 min: 137.2 ng/ml). All paired comparisons were significant (p < .001) except in the 6- to 30-min group versus the 31- to 60-min group (p = .701). Conclusions: After adjustment for the number of cigarettes smoked in the last 24 hr, time to first cigarette is associated with salivary cotinine concentration. [ABSTRACT FROM PUBLISHER]

Introduction: A smoke-free law went into effect in Spain on 1 January 2006, affecting all enclosed workplaces except hospitality venues, where only partial bans were implemented. The objective was to evaluate the impact of the law among hospitality workers who smoke. [ABSTRACT FROM PUBLISHER]

Background: A smoke-free law came into effect in Spain on 1st January 2006, affecting all enclosed workplaces except hospitality venues, whose proprietors can choose among totally a smoke-free policy, a partial restriction with designated smoking areas, or no restriction on smoking on the premises. We aimed to evaluate the impact of the law among hospitality workers by assessing second-hand smoke (SHS) exposure and the frequency of respiratory symptoms before and one year after the ban. Methods and Finding: We formed a baseline cohort of 431 hospitality workers in Spain and 45 workers in Portugal and Andorra. Of them, 318 (66.8%) were successfully followed up 12 months after the ban, and 137 nonsmokers were included in this analysis. We obtained self-reported exposure to SHS and the presence of respiratory symptoms, and collected saliva samples for cotinine measurement. Salivary cotinine decreased by 55.6% after the ban among nonsmoker workers in venues where smoking was totally prohibited (from median of 1.6 ng/ml before to 0.5 ng/ml, p<0.01). Cotinine concentration decreased by 27.6% (p = 0.068) among workers in venues with designated smoking areas, and by 10.7% (p = 0.475) among workers in venues where smoking was allowed. In Portugal and Andorra, no differences between cotinine concentration were found before (1.2 ng/ml) and after the ban (1.2 ng/ml). In Spain, reported respiratory symptom declined significantly (by 71.9%; p<0.05) among workers in venues that became smoke-free. After adjustment for potential confounders, salivary cotinine and respiratory symptoms decreased significantly among workers in Spanish hospitality venues where smoking was totally banned. Conclusions: Among nonsmoker hospitality workers in bars and restaurants where smoking was allowed, exposure to SHS after the ban remained similar to pre-law levels. The partial restrictions on smoking in Spanish hospitality venues do not sufficiently protect hospitality workers against SHS or its consequences for respiratory health. [ABSTRACT FROM AUTHOR]

Background: Characterizing and comparing the determinant of cotinine concentrations in different populations should facilitate a better understanding of smoking patterns and addiction. This study describes and characterizes determinants of salivary cotinine concentration in a sample of Spanish adult daily smoker men and women. Methods: A cross-sectional study was carried out between March 2004 and December 2005 in a representative sample of 1245 people from the general population of Barcelona, Spain. A standard questionnaire was used to gather information on active tobacco smoking and passive exposure, and a saliva specimen was obtained to determine salivary cotinine concentration. Two hundred and eleven adult smokers (>16 years old) with complete data were included in the analysis. Determinants of cotinine concentrations were assessed using linear regression models. Results: Salivary cotinine concentration was associated with the reported number of cigarettes smoked in the previous 24 hours (R² = 0.339; p < 0.05). The inclusion of a quadratic component for number of cigarettes smoked in the regression analyses resulted in an improvement of the fit (R² = 0.386; p < 0.05). Cotinine concentration differed significantly by sex, with men having higher levels. Conclusion: This study shows that salivary cotinine concentration is significantly associated with the number of cigarettes smoked and sex, but not with other smoking-related variables. [ABSTRACT FROM AUTHOR]

Background: Diverse projects and guidelines to assist hospitals towards the attainment of comprehensive smoke-free policies have been developed. In 2006, Spain government passed a new smoking ban that reinforce tobacco control policies and banned completely smoking in hospitals. This study assesses the progression of tobacco control policies in the Catalan Network of Smoke free Hospitals before and after a comprehensive national smoking ban. Methods: We used the Self-Audit Questionnaire of the European Network for Smoke-free Hospitals to score the compliance of 9 policy standards (global score = 102). We used two cross-sectional surveys to evaluate tobacco control policies before (2005) and after the implementation of a national smoking ban (2007) in 32 hospitals of Catalonia, Spain. We compared the means of the overall score in 2005 and 2007 according to the type of hospital, the number of beds, the prevalence of tobacco consumption, and the number of years as a smoke-free hospital. Results: The mean of the implementation score of tobacco control policies was 52.4 (95% CI: 45.4-59.5) in 2005 and 71.6 (95% CI: 67.0-76.2) in 2007 with an increase of 36.7% (p < 0.01). The hospitals with greater improvement were general hospitals (48% increase; p < 0.01), hospitals with > 300 beds (41.1% increase; p < 0.01), hospitals with employees' tobacco consumption prevalence 35-39% (72.2% increase; p < 0.05) and hospitals that had recently implemented smoke-free policies (74.2% increase; p < 0.01). Conclusion: The national smoking ban appears to increase tobacco control activities in hospitals combined with other non-bylaw initiatives such as the Smoke-free Hospital Network. [ABSTRACT FROM AUTHOR]

Background: The objective was to compare the pattern of exposure to second-hand smoke (SHS) among non-smokers in the general population and in hospitality workers. Methods: We used the adult (16–64 years) non-smokers of two independent studies (general population and hospitality workers) in Spain. We assessed the exposure to SHS by means of questionnaire and salivary cotinine concentration. Results: The salivary cotinine concentration by sex, age, educational level, day of week of saliva collection, and exposure to SHS were always higher in hospitality workers than in the general population. Conclusion: Our results indicated that non-smoker hospitality workers have higher levels of exposure to SHS than general population. [ABSTRACT FROM PUBLISHER]

Background: Total lockdown due to COVID-19 pandemic might have potentially increased screen time in children. This study aims to describe the smartphone and tablets usage in children under 48 months living in Barcelona during the COVID-19 confinement. Methods: Cross-sectional study using a non-probabilistic sample of parents with children under 48 months living in Barcelona (Spain) during COVID-19 confinement (n = 313). We calculated percentages of exposure to smartphones and tablets. Moreover, for those children were exposed, we calculated unadjusted and adjusted Geometric Mean Ratios (GMR) of daily smartphones and tablets usage and their 95% confidence intervals (95% CI) trough Generalized Linear Models with Gamma family and link log. Associations were adjusted for potential confounders. Results: During COVID-19 confinement, 67.5% of children under 48 months were daily exposed to smartphones and tablets. Further, those children who were exposed during meals, as well as before going to bed, spend longer durations using them, aGMR = 2.38 (95% CI 1.73, 3.34) and aGMR = 1.95 (95% CI 1.34, 2.91) respectively. Conclusion: Two out of three children under 48 months living in Barcelona were daily exposed to smartphones and tablets during total lockdown due to COVID-19. Taking this findings into account cohort studies are needed to assess any change in the screen time patterns due to total confinement in order to allow the Government help families, particularly those more vulnerable, in a possible pandemic resurgence. [ABSTRACT FROM AUTHOR]

Objective/background: In some territories, such as Spain, daytime starts with around 1 h of difference between the easternmost and westernmost areas, but the time zone is the same in these areas. This difference might have an effect on children's sleep. The aim of this study is to assess if there are differences in the prevalence of short sleep duration between children under 15 years from easternmost (Catalonia) and westernmost (Galicia) continental territory areas in Spain.Methods: Cross-sectional study using data from the 2017 Spanish National Health Survey (n = 6106). The final sample includes 1004 children under 15 years living in Catalonia and Galicia. We categorized sleep duration according to the National Sleep Foundation recommendations with respect to age in (1) not short sleep duration and (2) short sleep duration. We calculated overall percentages of short sleep duration, and unadjusted and adjusted Prevalence Ratios (PR) with 95% Confidence Intervals (95% CI), according to area and stratified by confounders and covariates. Unadjusted and adjusted PR were obtained through generalized linear models with Poisson family and robust variance. We adjusted the associations for confounders.Results: Children from Galicia were less likely to have short sleep duration than children from Catalonia, aPRGalicia = 0.61 (95% CI: 0.45,0.83).Conclusions: Children living in the same country, potentially with a similar timetable, could be having shorter sleep durations according to their longitude position. Further studies are needed in order to consider promoting policies to apply timetables based on the sun position instead of on the national time zone. [ABSTRACT FROM AUTHOR]

To compare tobacco-specific nitrosamines (TSNAs) measured in saliva according to different types of tobacco smoked in a sample of smokers of the city of Barcelona (Spain). We used data from a cross-sectional study of a sample of the adult smoking population of Barcelona, Spain in 2013–2014 (n = 165). We classified smokers in five groups according to the type of tobacco smoked: a) manufactured cigarettes only, b) roll-your-own (RYO) cigarettes only, c) dual smokers (both manufactured and RYO cigarettes), d) manufactured plus other types of tobacco products different from RYO and e) other types of tobacco products different from manufactured and RYO cigarettes. We calculated the geometric mean (GM) and geometric standard deviation (GSD) of TSNAs concentration in saliva (pg/mL), including N'-nitroaonornicotine (NNN), 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) according to the five tobacco groups. We also described all TSNAs concentration in each tobacco group stratified by the number of cigarettes smoked per day. Smokers from the RYO cigarette group had higher TSNAs concentration than smokers from the manufactured cigarette group: 13 pg/mL vs 4.9 pg/mL of NNN, 1.9 pg/mL vs 1.7 pg/mL in NNK and 1.1 pg/mL vs 0.9 pg/mL of NNAL. There were significant differences in NNN concentrations between smokers of RYO vs manufactured cigarettes. The higher the number of cigarettes smoked, the higher the TSNAs concentrations. After adjusted by number of cigarettes smoked, there were not statistically significant differences in TSNAs between RYO and manufactured cigarettes. Our data shows that RYO cigarette is at least as hazardous as manufactured cigarettes. Regulating RYO tobacco prices could be an effective strategy to control tobacco use. • We compare TSNAs in saliva according to type of tobacco. • TSNAs concentrations increase with the number of cigarettes smoked. • RYO cigarette smokers have higher TSNAs than manufactured cigarette smokers. • Increase RYO cigarette's price should be done in order to be more strictly regulated. [ABSTRACT FROM AUTHOR]

Objective To describe the voluntary adoption of smoke-free homes and social attitudes in Spain towards banning smoking in vehicles in which children are present. Methods Cross-sectional study of a representative sample of the adult Spanish population age range, 18–75 years (n=1036). The field work was conducted via a computer-assisted telephone survey in March and April 2016. Survey respondents answered questions about smoking rules at home and attitudes towards a smoking ban in cars with or without children. Home smoking rules were defined as complete (smoking not allowed anywhere in the house), partial (smoking allowed in some areas inside the house) or absent (smoking allowed everywhere). Results Most (83.0%) of the surveyed population had some type of smoking restriction in place at home (45.6% complete and 37.5% partial). There were significant differences between groups according to age group (the highest prevalence was 86.1% from 66 to 75 years and the lowest prevalence was 77.8% from 46 to 65 years) and smoking status (the highest prevalence was 89.4% in people who had never been smokers and the lowest prevalence was 75.0% in current smokers) with regards to the prevalence of smoke-free homes (p<0.05), with partial bans more prevalent in smoking households (49.0%). Most (61.6%) of the population favored banning smoking in cars, and 90.1% supported a ban in cars carrying minors. Attitudes towards smoking regulation in cars (with or without children) varied significantly by age group (the highest prevalence was 81.9% from 66 to 75 years and the lowest prevalence was 54.5% from 18 to 45 years) and smoking status (the highest prevalence was 71.4% in people who had never been smokers and the lowest prevalence was 46.0% in current smokers). However, no significant differences were found with regard to attitudes towards smoking regulation in cars carrying children, regardless of sex, age, social class, or smoking status. Conclusion Approximately half of the adult population in Spain have implemented a complete smoke-free rule at home. More than 9 out of 10 adults favor regulating smoking in cars in the presence of minors. These findings support the expansion of smoke-free regulations to include private vehicles, particularly when minors are in the car. [ABSTRACT FROM AUTHOR]

Objective: We assessed whether the salivary cotinine content of daily smokers varied with the readiness to quit and smoking characteristics. Methods: This cross-sectional study was conducted in Barcelona, Spain (n =1245) in 2004–2005. We administered a questionnaire to assess smoking behaviour and collected saliva to determine the cotinine content. We determined the distribution of 278 adult daily smokers across different stages of change and categorised them by individual and smoking characteristics. We used medians and interquartile ranges (IQR) to relate cotinine concentrations to different stages of change, tobacco consumption, and nicotine dependence based on the Fagerström Test for Nicotine Dependence (FTND). Results: Around 68%, 22%, and 11% of smokers were in precontemplation, contemplation, and preparation stages, respectively. A mean of 17.0 cigarettes was smoked daily, with no differences among stages of change. The median cotinine concentration was 151.3ng/ml (IQR: 83.2–227.8ng/ml), with no differences among stages of change. The cigarette consumption scores, FTND, and time to first cigarette of the day were positively associated with cotinine concentration. Conclusions: The cotinine concentration was similar among the stages of change, but varied within each stage according to the number of cigarettes smoked, time to first cigarette of the day, and nicotine dependence. [Copyright &y& Elsevier]

Abstract: Objectives: To describe second-hand smoke in the hospitals of the Catalan Network for Smoke-free Hospitals using Particulate Matter (PM2.5) and to assess the association between second-hand smoke exposure in main entrances (outdoors) and halls and between PM2.5 and airborne nicotine concentrations. Methods: Cross-sectional study carried out in 2009 in the 53 hospitals affiliated with the network. We measured PM2.5 (μg/m3) in all hospitals and measured airborne nicotine concentrations (μg/m3) in a subsample of 11 hospitals. For each assessment, we measured nine locations within the hospitals, computing medians, means, geometric means, interquartile ranges (IQRs), and 95% confidence intervals (CI) of the means and the geometric means. Further, we used Spearman’s linear correlation coefficient r sp) to explore the association between PM2.5 concentrations in halls and main entrances and between PM2.5 and nicotine concentrations. Results: The overall median of the 429 PM2.5 measurements was 12.48μg/m3 (IQR: 8.84–19.76μg/m3). The most exposed locations were outdoor smoking points (16.64μg/m3), cafeterias (14.82μg/m3), and main entrances (14.04μg/m3); dressing rooms were the least exposed (6.76μg/m3). PM2.5 concentrations in halls were positively correlated with those in main entrances (r sp=0.591, 95% CI: 0.377–0.745), as were PM2.5 values and nicotine concentrations (r sp=0.644, 95% CI: 0.357–0.820). Conclusions: Second-hand smoke levels in hospitals were low in most locations, with the highest levels observed in outdoor locations where smoking is allowed (smoking points and entrances). Smoking in main entrances was associated with increased second-hand smoke levels in halls. Use of PM2.5 to evaluate second-hand smoke is feasible and shows a good correlation with airborne nicotine values. [Copyright &y& Elsevier]

Abstract: The aim of this study was to assess the exposure to second-hand smoke (SHS) in 90 primary health care centres in Catalonia, Spain. We conducted a cross-sectional study between March and October 2006. We measured vapour-phase nicotine as a marker of SHS in main halls, staff rooms, direction areas, and continued care. Sampler devices were exposed for 7 days, and samples were analysed by gas chromatography/mass spectrometry. We compared the median airborne nicotine concentrations with the non-parametric test for medians by sanitary region, sampled location, affiliation to the Smoke-free Primary Health Care Programme, and urban–rural area. From 300 sampler devices installed, 4 were lost, and detectable levels of nicotine were found in 89 samples (30.0%) in 48 different centres (53.3%). The overall median was 0.01μg/m3, with an interquartile range (IQR) of 0.01–0.07μg/m3. Median nicotine levels by locations were: reception hall 0.01μg/m3 (IQR: 0.01–0.06); staff room 0.01μg/m3 (IQR: 0.01–0.08); direction area 0.01μg/m3 (IQR: 0.01–0.01); continued care 0.01μg/m3 (IQR: 0.01–0.07). Results showed that airborne nicotine levels were very low, with 46.7% of primary health centres being free of SHS. [Copyright &y& Elsevier]

Abstract: Objective: To assess changes in secondhand smoke exposure by means of airborne nicotine concentrations in public hospitals of Catalonia (Spain) before and after a comprehensive national smoking ban. Methods: We monitored vapor-phase nicotine concentrations in 44 public hospitals in Catalonia (Spain) before the smoking ban (September–December 2005) and one year after (September–December 2006). We installed 5–7 sampling devices per hospital for 7 days in different places (228 pairs of samples), and 198 pairs of samples were available for the final analysis. Results: The median nicotine concentration declined from 0.23 μg/m3 (interquartile range: 0.13–0.63) before the law to 0.10 μg/m3 (interquartile range: 0.02–0.19) after the law (% decline=56.5, p <0.01). We observed significant reductions in the median nicotine concentrations in all hospital locations, although secondhand smoke exposure was still present in some places (main hospital entrance, emergency department waiting rooms, fire escapes, and cafeterias). Conclusions: Secondhand smoke in hospitals has decreased after the ban. Assessment of airborne nicotine concentrations appears to be an objective and feasible system to monitor and reinforce the compliance of smoke-free legislations in this setting. [Copyright &y& Elsevier]

to characterize the smartphones and tablets use pattern in a sample of children up to 5 years old and assess with which variables it is associated., cross-sectional study of 410 parents of children up to 5 years of age. Data were obtained from an online questionnaire. Questions about the time and pattern of daily use of smartphones and tablets were collected. We calculated the overall percentage (and 95% confidence interval) and median (and interquartile range) of each device's use time and according to the variables associated with the child, and the respondent's characteristics., an estimated 44.7% (95% CI: 37; 51) of children used both smartphones and/or tablets daily. The median use time for smartphones and tablets separately was 30 minutes per day for smartphones (8.6-38.6) and 30 (17.1- 60.0) for tablet. In children who have free access to the devices, 11.6% (95% CI: 6; 16) use these devices up to 30 minutes after waking up on weekdays, 15.4% (95% CI: 10; 21) during weekends and 14.0% (95% CI: 8; 19) use smartphone and/or tablet up to 1 hour before going to bed., more than 4 out of 10 children in our sample used smartphones and/or tablets daily. Community nursing may be a viable avenue for implementing educational programs focused on promoting healthy practices in children's electronic device usage given the pattern of excessive screen use in the pediatric population.

Objective: To assess the relation between leisure screen time and emotional and behavioral problems in Spanish children aged 4-14 years., Study Design: This cross-sectional study used a representative sample of children aged 4-14 years included in the 2017 Spanish National Health Survey (n = 4073). Emotional and behavioral problems of children were assessed through the parent-report Strengths and Difficulties Questionnaire. Daily leisure screen time in minutes was categorized as 0-59, 60-119, 120-179, and ≥180. We calculated adjusted prevalence ratios (aPR) and their 95% CIs of being at risk of developing emotional and behavioral problems. Associations were adjusted for potential confounding variables., Results: Children spending 180 minutes or more of daily leisure screen time compared with children spending less than 1 hour were more likely to be at risk of developing emotional and behavioral problems: aPR ≥180 : 2.19 (95% CI 1.53-3.14), emotional symptomology: aPR ≥180 : 2.09 (95% CI 1.37-3.18), conduct problems aPR ≥180 : 1.85 (95% CI 1.34-2.54), peer problems aPR ≥180 : 1.78 (95% CI 1.15-2.75), and to behave less prosocially: aPR ≥180 : 2.20 (95% CI 1.43-3.37)., Conclusions: We have found significant associations between daily leisure screen time and emotional and behavioral problems in Spanish children between 6 and 14 years of age. However, these findings should be confirmed in cohort studies, so institutions might consider including screen time as a new risk factor for children., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: Lung cancer mortality is increasing in women. In Spain, estimates suggest that lung cancer mortality may soon surpass breast cancer mortality, the main cause of cancer mortality among women. The aim of this study was to estimate the proportion of women at high risk of developing lung cancer in a group of participants in a population-based breast cancer screening program., Methods: Cross-sectional study in a sample of women who participated in a population-based breast cancer screening program in 2016 in Hospitalet de Llobregat (n=1,601). High risk of lung cancer was defined according to the criteria of the National Lung Screening Trial (NLST) and the Dutch-Belgian randomized lung cancer screening trial (NELSON)., Results: Around 20% of smokers according to NLST criteria and 40% of smokers according to NELSON criteria, and around 20% of former smokers according to both criteria, are at high risk of developing lung cancer. A positive and statistically significant trend is observed between the proportion of women at high risk and nicotine dependence measured with the brief Fagerström test., Conclusions: A high proportion of participants in this breast cancer screening program have a high risk of developing lung cancer and would be eligible to participate in a lung cancer screening program. Population-based breast cancer screening programs may be useful to implement lung cancer primary prevention activities., (Copyright © 2019 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To know the support of tobacco regulation is a very important issue to advance in the tobacco control policies and reduce the passive exposure to tobacco. The aim of this study was to describe the attitudes towards forbidding smoking in private vehicles and public outdoor spaces., Methods: This is a cross-sectional study of a representative sample (n=736) of the adult population (24+ years old) from Barcelona, Spain in 2013-2014. We calculated the percentages of individuals who had a favourable attitude towards smoking regulation in private vehicles and public outdoor spaces, their adjusted Odds ratios (aOR) and their 95% confidence intervals (95%CI) according to sex, age, educational level and smoking status through logistic regression. We used weighted data for all analyses in order to keep the representativeness of the population of Barcelona in 2013-2014., Results: 61.7% of participants supported forbidding smoking in private vehicles and 89.5% supported forbidding it only in the presence of minors. The support to smoking regulation in public outdoor spaces varied from 42.5% to 84.7% in different settings. Smokers showed a less favourable attitude towards an extension of the smoking regulation to other settings: outdoor areas of university centres, outdoor areas of shopping centres and beaches and outdoor pools., Conclusions: A wide support exists to extend the smoking regulation to private vehicles, especially in the presence of children, and public outdoor spaces. This wide support could favour the extension of smoking regulation to these places to improve the population's health and to contribute to denormalise tobacco use among the population.

Background: The aim of this study is to assess the impact of the Spanish tobacco control legislation on smoking behavior and salivary cotinine concentration among smokers., Methods: We used data from a longitudinal study, before (2004-2005) and after (2013-2014) the implementation of the two national smoking bans (in 2006 and 2011), in a representative sample of adults (≥16 years old) from Barcelona (Spain). We only analyzed a subsample of continuing smokers (n = 116). We conducted a survey on smoking behavior and obtained saliva sample for cotinine analyses. For this report, we analyzed a subsample of continuing smokers (n = 116). We calculated geometric means (GM)., Results: Among continuing smokers, salivary cotinine concentration significantly increased by 28.7% (GM from 91.7 ng/ml to 117.3 ng/ml, p = 0.015) after the implementation of the two Spanish smoke-free bans. Nonetheless, no pattern of change was observed in the self-reported number of cigarettes smoked daily., Conclusions: Our study shows a significant increase in the salivary cotinine concentration among adult continuing smokers after both Spanish legislations. This increase could be due to differences in smoking topography (increase in the depth of inhalation when smoking) along with changes in the type of tobacco smoked (increase in smoking roll-your-own cigarettes or mixed use of roll-your-own and manufactured cigarettes). Our results suggest the need to extend tobacco control policies, focusing on the reduction of use of any type of tobacco product and implementing better treatment to help smokers stop smoking., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Mental health units have usually been exempted from complete smoke-free policies. The aim of this study was to compare the self-reported level of exposure to secondhand smoke (SHS) of patients and staff in psychiatric units to objective measures, and examine preference for different types of smoking bans., Methods: Cross-sectional survey about ban preferences and self-reported exposure to SHS by means of a self-administered questionnaire administered to patients and staff from 65 inpatient psychiatric units in Catalonia (95.5% of all units). We measured air concentrations of particulate matter ≤ 2.5 μm (PM2.5 in µg/m(3)) as a marker of SHS in these units., Results: 600 patients and 575 professionals completed the questionnaire. 78.7% of them were objectively exposed to SHS (PM2.5>10 μm/m(3)) but 56.9% of patients and 33.6% of staff believed they were not exposed at all and 41.6% of patients and 28.4% of staff believed the environment was not at all unhealthy. Nurses had a higher smoking prevalence than psychiatrists (35.8% vs 17.2%; p<0.001), and nurses had a higher perception of being moderately highly exposed to SHS (40.3% vs 26.2%; p<0.001). PM2.5 levels were significantly different depending on the type of smoking ban implemented but unrelated to the perception of SHS levels by both patients and staff. Only 29.3% of staff and 14.1% of patients strongly supported total smoking bans., Conclusions: Patients and staff have substantial misperceptions about the extent of their exposure to SHS and low awareness about the harmful environment in which they stay/work. This might have an influence on the preference for less restrictive smoke-free bans. It is particularly noteworthy that less that one-third of mental health staff supported smoke-free units, suggesting an urgent need for further education about the harmful health effects of SHS., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objective: To describe where smokers smoke outdoors, where non-smokers are exposed outdoors to secondhand smoke (SHS), and attitudes towards smoke-free outdoor areas after the implementation of national smoke-free legislation., Design: This cross-sectional study was conducted between June 2011 and March 2012 (n=1307 participants)., Setting: Barcelona, Spain., Participants: Representative, random sample of the adult (≥16 years) population., Primary and Secondary Outcomes: Proportion of smoking and prevalence of exposure to SHS in the various settings according to type of enclosure. Percentages of support for outdoor smoke-free policies according to smoking status., Results: Smokers reported smoking outdoors most in bars and restaurants (54.8%), followed by outdoor places at work (46.8%). According to non-smokers, outdoor SHS exposure was highest at home (42.5%) and in bars and restaurants (33.5%). Among non-smoking adult students, 90% claimed exposure to SHS on university campuses. There was great support for banning smoking in the majority of outdoor areas, which was stronger among non-smokers than smokers. Over 70% of participants supported smoke-free playgrounds, school and high school courtyards, and the grounds of healthcare centres., Conclusions: Extending smoking bans to selected outdoor settings should be considered in further tobacco control interventions to protect non-smokers from SHS exposure and to establish a positive model for youth. The majority of public support for some outdoor smoke-free areas suggests that it is feasible to extend smoking bans to additional outdoor settings., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objective: The aim of this study is to describe trends in the consumption of manufactured and roll-your-own cigarettes between 1991 and 2012 in Spain, and to project these trends up to 2020., Methods: We estimated daily consumption per capita during 1991-2012 using data on sales of manufactured cigarettes (20-packs) and rolling tobacco (kg) from the Tobacco Market Commission, and using data of the Spanish adult population from the National Statistics Institute. We considered different weights (0.5, 0.8 and 1 g) to compute the number of rolled cigarettes per capita. We computed the annual per cent of change and assessed possible changes in trends using joinpoint regression, and projected the consumption up to 2020 using Bayesian methods., Results: Daily consumption per capita of manufactured cigarettes decreased on average by 3.0% per year in 1991-2012, from 7.6 to 3.8 units, with three trend changes. However, daily consumption per capita of roll-your-own cigarettes increased on average by 14.1% per year, from 0.07 to 0.92 units of 0.5 g, with unchanged trends. Together, daily consumption per capita decreased between 2.9% and 2.5%, depending on the weight of the roll-your-own cigarettes. Projections up to 2020 indicate a decrease of manufactured cigarettes (1.75 units per capita) but an increase of roll-your-own cigarettes (1.25 units per capita)., Conclusions: While the consumption per capita of manufactured cigarettes has decreased in the past years in Spain, the consumption of roll-your-own cigarettes has increased at an annual rate around 14% over the past years. Whereas a net decrease in cigarette consumption is expected in the future, use of roll-your-own cigarettes will continue to increase., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

The aim was to assess the validity of self-reported exposure to second-hand smoke (SHS) in 50 hospitality venues of Madrid (Spain) in 2010, taking as a reference vapour-phase nicotine measured by active sampling. The questions posed in the questionnaire permitted distinguishing between the different levels of SHS. However, the moderate relationship found (Spearman׳s correlation=0.387, p<0.001) suggests that intensity of exposure to SHS in hospitality venues, based solely on self-reported information, should be used with caution., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The objective of this work was to study the feasibility of following up a representative sample of the adult population of Barcelona 8 years after the baseline study. We selected a random sample (n=100) of the 1161 participants who consented to be re-contacted. We contacted 66 participants: 52 (78.8%) agreed to participate in the follow-up, three (4.5%) had died, four (6.1%) had moved, and seven (10.6%) declined to participate in the follow-up. The participation rate in the feasibility study was 52%. In conclusion, the results of our study show a good feasibility of conducting a follow-up study 8 years after the baseline study., (Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.)

Aim: To analyse the association between tobacco smoking, exposure to second-hand smoke (SHS) and reports of wheezing and asthma in a sample of schoolchildren., Methods: A structured questionnaire was administered to 1766 students (7th grade, aged 12-13 years) at 25 schools in Terrassa, Spain (2006). We determined the prevalence of active smoking, exposure to SHS and reports of wheezing and asthma, and their association by means of prevalence odds ratios (OR) and 95% confidence intervals (CI)., Results: 97.5% of children were nonsmokers, 1.5% were experimental smokers and 1% were regular smokers. 41.1% of children reported exposure to SHS at home, 40.0% at school, 53.9% in their leisure time and 33.2% while using private or public transportation. Wheezing was reported by 9.2% of children, and 9.2% reported asthma. A significant association was found between smoking tobacco and wheezing: OR in experimental smokers = 3.0 (95% CI 1.2-7.7), and OR in active smokers = 4.2 (95% CI 1.4-12.5). Exposure to SHS while using transportation was associated with wheezing (OR = 1.4; 95% CI 1.0-2.0). Tobacco smoking and exposure to SHS were not associated with asthma., Conclusion: Active and experimental smokers, and those who reported exposure to SHS while using public or private transportation, had higher likelihood of reporting wheezing. No association between active or passive smoking and asthma was observed., (©2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Background: Second-hand smoke is associated with adverse health effects. Many countries have extended smoke-free policies to public buildings and workplaces such as hospitals, but mental health units have usually been exempted from complete smoke-free bans. The objective of this study was to evaluate second-hand smoke levels in mental health units with different types of smoking bans. Method We conducted a cross-sectional study to evaluate second-hand smoke in 64 mental health inpatient units (95.5% of the all such units) in Catalonia, Spain. We measured air concentrations of particulate matter <2.5 μm (PM2.5) as a marker of second-hand smoke in different locations at each unit., Results: The geometric mean (95% confidence interval) of the PM2.5 concentration was 8.81 μg/m(3) (8.06-9.56) in units with indoor and outdoor smoking bans, 13.80 μg/m(3) (13.23-14.36) in units with indoor smoking bans that allowed smoking in outdoor areas, 24.29 μg/m(3) (23.50-25.03) in units with indoor smoking rooms and 51.00 μg/m(3) (49.83-52.04) in units that allowed smoking in common indoor areas (P < 0.05). The regression model adjusted for confounding variables showed a linear increase of PM2.5. The PM2.5 concentration in smoking rooms was 286.50 μg/m(3) (283.95-288.89)., Conclusions: Only units with indoor and outdoor smoking bans had PM2.5 levels below the standard recommended WHO levels of 10 μg/m(3). Units with more permissive smoking policies had PM2.5 levels from second-hand smoke that have harmful health effects.

Objectives: To assess the variability in the number of cigarettes smoked per person per day in Spain according to the information source (health surveys versus legal sales)., Methods: We compared cigarette consumption per person per day (population aged ≥16 years) obtained from the national health surveys in Spain and the official data on legal tobacco sales between 1993 and 2009., Results: Cigarette consumption per person per day decreased between 1993 and 2009. Over the entire period, the number of cigarettes smoked per person per day according to legal sales exceeded that reported by national health surveys (up to 46.9%)., Conclusion: The difference in data on the number of cigarettes smoked between national health surveys and legal sales has increased in the last few years in Spain., (Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.)

Background: The Catalan Network of Smoke-free Hospitals coordinates a smoking cessation program addressed to hospital workers. The program included training in tobacco cessation, a common software, and free access to pharmacological treatments., Objective: This study aimed to evaluate the effectiveness of the Catalan Network of Smoke-free Hospitals smoking cessation program for abstinence among workers of the 33 participating hospitals., Methods: A total of 930 hospital workers (in 33 hospitals) attended the cessation units between July 2005 and December 2007. The program included active follow-up during 6 months after quitting. We calculated 6-month abstinence probabilities by means of Kaplan-Meier curves according to gender, age, years of tobacco consumption, profession, Fagerström Test for Nicotine Dependence (FTND) score, and use of pharmacotherapy., Results: Overall abstinence probability was 0.504 (95% confidence interval [CI]: 0.431-0.570) at 6 months of follow-up. Abstinence was higher in men (0.526, 95% CI = 0.398-0.651) than in women (0.495, 95% CI = 0.410-0.581). Physicians had higher abstinence (0.659, 95% CI = 0.506-0.811) than nurses (0.463, 95% CI = 0.349-0.576). Workers with high nicotine dependence (FTND > 7) had lower abstinence probability (0.376, 95% CI = 0.256-0.495) than workers, with FTND score equal or below 6 (0.529, 95% CI = 0.458-0.599). We observed the highest abstinence probabilities in workers treated with combined pharmacotherapy (0.761, 95% CI = 0.588-0.933)., Conclusion: Significant predictors of abstinence were smoking 10 to 19 cigarettes/day, having present low or medium FTND score, and using combined treatment (nicotine replacement therapy and bupropion)., Implications for Practice: The results show the feasibility and success of a smoking cessation program for hospital workers coordinated at the regional level.

There is scant information on nicotine dependence in smokers not seeking cessation treatment. This study analyses the relationship between nicotine dependence, measured by the Fagerström Test for Nicotine Dependence (FTND), and salivary cotinine concentration in a sample of smokers from the general population. We conducted a cross-sectional study (2004-2005) of a representative sample of the general population of Barcelona, Spain (n=1245). The analysis included 196 daily smokers aged more than 16 years. Information on smoking was obtained by questionnaire and cotinine concentration was determined in saliva. Geometric means of cotinine concentration by every single FTND item were computed, and multivariate linear regression was used to explore the relationship among these variables. Participants smoked a mean of 17.0 cigarettes per day, and the mean FTND score was 3.27 (95% confidence interval: 2.92-3.61). Around 17% of subjects (95% confidence interval: 12.0-22.5%) had high nicotine dependence. Cotinine concentration differed significantly by nicotine dependence levels. In a multiple linear regression model including the sum of the FTND items 2, 3, and 6, and the single FTND items 1, 4, and 5, adjusted for sex, the time to first cigarette after waking up (item 1), the number of cigarettes smoked daily (item 4), and smoking more in the first hours of the day (item 5) were significantly related to salivary cotinine concentration (R(2)=0.414). Salivary cotinine levels were associated with nicotine dependence as measured by the FTND, especially with the items on daily tobacco consumption, time to first cigarette after waking up, and smoking more in the first hours of the day.

Objective: To describe the nicotine dependence and readiness to quit smoking in the smoker population., Methods: Cross-sectional study on a representative sample of the Spanish population of >=18 years old. We gathered information by means of telephone interviews conducted between June and July of 2006. We studied the nicotine dependence with the Fagerström Test for Nicotine Dependence (FTND) and the readiness to quit according to the stages of change from the Transtheoretical Model in a sample of cigarette smokers., Results: 22.5% of participants (95% CI: 20.9-24.2%) smokers cigarettes. They smoked an average of 14.4 cigarettes per day (standard deviation 9.15) and the mean FTND score was 2.8, with no differences by the stages of change. 64.3% (95% CI: 60.3-68.2%) of smokers were in the precontemplation stage, 25.4% (95% CI: 21.8-28.9%) in contemplation, and 10.4% (95% CI: 7.9-12.9%) in preparation, with no differences by sex. The most nicotine dependent smokers (FTND>=6) had mainly primary studies, started to smoke at earlier ages, and smoked more cigarettes per day., Conclusions: Most Spanish smokers have low nicotine dependence and are in precontemplation stage. Smoking cessation programmes should be addressed to reduce dependence, help smokers to progress through the stages of change, and, consequently, reduce the prevalence of smokers in the population.

Objectives: To describe second-hand smoke in the hospitals of the Catalan Network for Smoke-free Hospitals using Particulate Matter (PM(2.5)) and to assess the association between second-hand smoke exposure in main entrances (outdoors) and halls and between PM(2.5) and airborne nicotine concentrations., Methods: Cross-sectional study carried out in 2009 in the 53 hospitals affiliated with the network. We measured PM(2.5) (μg/m(3)) in all hospitals and measured airborne nicotine concentrations (μg/m(3)) in a subsample of 11 hospitals. For each assessment, we measured nine locations within the hospitals, computing medians, means, geometric means, interquartile ranges (IQRs), and 95% confidence intervals (CI) of the means and the geometric means. Further, we used Spearman's linear correlation coefficient r(sp)) to explore the association between PM(2.5) concentrations in halls and main entrances and between PM(2.5) and nicotine concentrations., Results: The overall median of the 429 PM(2.5) measurements was 12.48 μg/m(3) (IQR: 8.84-19.76 μg/m(3)). The most exposed locations were outdoor smoking points (16.64 μg/m(3)), cafeterias (14.82 μg/m(3)), and main entrances (14.04 μg/m(3)); dressing rooms were the least exposed (6.76 μg/m(3)). PM(2.5) concentrations in halls were positively correlated with those in main entrances (r(sp)=0.591, 95% CI: 0.377-0.745), as were PM(2.5) values and nicotine concentrations (r(sp)=0.644, 95% CI: 0.357-0.820)., Conclusions: Second-hand smoke levels in hospitals were low in most locations, with the highest levels observed in outdoor locations where smoking is allowed (smoking points and entrances). Smoking in main entrances was associated with increased second-hand smoke levels in halls. Use of PM(2.5) to evaluate second-hand smoke is feasible and shows a good correlation with airborne nicotine values., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Objective: 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<0.05). We observed an increase in support to the smoke-free ban in all public places, including bars and restaurants (54.1% to 65.8%; p<0.05). The percentages of support for the current ban, perception of compliance with the ban by employees and customers, and knowledge of the effect of second-hand smoke on health also increased., Conclusions: Knowledge and support to the Spanish smoking law among hospitality workers increased 2 years after the implementation of the ban., (Copyright 2009 SESPAS. Published by Elsevier Espana. All rights reserved.)

Objective: To assess the optimal cut-point for salivary cotinine concentration to identify smoking status in the adult population of Barcelona., Methods: We performed a cross-sectional study of a representative sample (n=1,117) of the adult population (>16 years) in Barcelona (2004-2005). This study gathered information on active and passive smoking by means of a questionnaire and a saliva sample for cotinine determination. We analyzed sensitivity and specificity according to sex, age, smoking status (daily and occasional), and exposure to second-hand smoke at home. ROC curves and the area under the curve were calculated., Results: The prevalence of smokers (daily and occasional) was 27.8% (95% CI: 25.2-30.4%). The optimal cut-point to discriminate smoking status was 9.2 ng/ml (sensitivity=88.7% and specificity=89.0%). The area under the ROC curve was 0.952. The optimal cut-point was 12.2 ng/ml in men and 7.6 ng/ml in women. The optimal cut-point was higher at ages with a greater prevalence of smoking. Daily smokers had a higher cut-point than occasional smokers., Conclusions: The optimal cut-point to discriminate smoking status in the adult population is 9.2 ng/ml, with sensitivities and specificities around 90%. The cut-point was higher in men and in younger people. The cut-point increases with higher prevalence of daily smokers.

Objectives: To estimate the prevalence of self-reported exposure to secondhand smoke (SHS) in different settings and to describe salivary cotinine concentration and its determinants among non-smokers., Methods: Cross-sectional study of a representative sample (N=775) of adult non-smokers in Barcelona, Spain (years 2004-2005). We assessed exposure to SHS using a questionnaire and measurement of salivary cotinine concentration. We calculated prevalence rates of self-reported exposure and medians and geometric means of salivary cotinine concentration. We adjusted for potential confounding factors with multinomial logistic regression models., Results: The prevalence rate of self-reported exposure to SHS among non-smokers in any setting was 75.7% (95% CI: 72.7%-78.8%). The prevalence of exposure to SHS tended to decrease with age. The geometric mean of cotinine concentrations among non-smokers was 1.49 ng/ml (95% CI: 1.39-1.60 ng/ml) among all subjects, and 1.80 ng/ml (95% CI: 1.37-2.35 ng/ml) in subjects who reported exposure to SHS in all settings. In bivariate and multivariate analyses, the cotinine concentration increased with the number of smokers and the number of cigarettes smoked per day in the presence of non-smokers in the household., Conclusions: In this population, self-reported exposure to SHS is very high. Salivary cotinine concentrations in non-smokers are associated with exposure at home.