@article{pmid31505203,

title = {Burden of disease attributable to second-hand smoke exposure: A systematic review},

author = {Carreras G and Lugo A and Gallus S and Cortini B and Fernández E and López MJ and Soriano JB and López-Nicolás A and Semple S and Gorini G and TackSHS Project Investigators},

doi = {10.1016/j.ypmed.2019.105833},

issn = {1096-0260},

year  = {2019},

date = {2019-12-01},

journal = {Prev Med},

volume = {129},

pages = {105833},

abstract = {Our aim was to provide a systematic review of studies on the burden of disease due to second-hand smoke (SHS) exposure, reviewing methods, exposure assessment, diseases causally linked to SHS, health outcomes, and estimates available to date. A literature review of studies on the burden of disease from SHS exposure, available in PubMed and SCOPUS, published 2007-2018 in English language, was carried out following the PRISMA recommendations. Overall, 588 studies were first identified, and 94 were eligible. Seventy-two studies were included in the systematic review. Most of them were based on the comparative risk assessment approach, assessing SHS exposure using mainly surveys on exposure at home/workplaces. Diseases more frequently studied were: lung cancer, ischemic heart disease, stroke, chronic obstructive pulmonary disease, asthma and breast cancer in adults; lower respiratory tract infection, otitis media, asthma, sudden infant death syndrome and low birth weight in children. The SHS exposure assessment and the reported population attributable fractions (PAF) were largely heterogeneous. As an example, the PAF from lung cancer varied between 0.6% and 20.5%. Moreover, PAF were estimated applying relative risks and SHS exposures with no consistent definitions or with different age classes. The research gap on the SHS exposure burden is shrinking. However, estimates are not yet available for a number of countries, particularly the Middle Eastern and African countries, and not all diseases with the strongest evidence of causation, such as sudden infant death syndrome, have been explored. Moreover, in some cases the applied methodology revealed relatively low quality of data.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31488415,

title = {False-Positive Results in a Population-Based Colorectal Screening Program: Cumulative Risk from 2000 to 2017 with Biennial Screening},

author = {Ibáñez-Sanz G and Garcia M and Milà N and Hubbard RA and Vidal C and Binefa G and Benito L and Moreno V and Adverse Effects on Colorectal Cancer Screening in Catalonia (EACC) Study Working Group},

doi = {10.1158/1055-9965.EPI-18-1368},

issn = {1538-7755},

year  = {2019},

date = {2019-11-01},

journal = {Cancer Epidemiol Biomarkers Prev},

volume = {28},

number = {11},

pages = {1909--1916},

abstract = {BACKGROUND: The aim of this study was to estimate the cumulative risk of a false-positive (FP) result in a fecal occult blood test (FOBT) through 7 screening rounds and to identify its associated factors in a population-based colorectal cancer screening program.nnMETHODS: Retrospective cohort study, which included participants ages 50 to 69 years of a colorectal cancer screening program in Catalonia, Spain. During this period, 2 FOBTs were used (guaiac and immunochemical). A discrete-time survival model was performed to identify risk factors of receiving a positive FOBT with no high-risk adenoma or colorectal cancer in the follow-up colonoscopy. We estimated the probability of having at least 1 FP over 7 screening rounds.nnRESULTS: During the period of 2000 to 2017, the cumulative FP risk was 16.3% (IC: 14.6%-18.3%), adjusted by age, sex, and type of test. The median number of screens was 2. Participants who began screening at age 50 years had a 7.3% [95% confidence interval (CI), 6.35-8.51] and a 12.4% (95% CI, 11.00-13.94) probability of an FP with 4 screening rounds of guaiac-based test and immunochemical test, respectively. Age, the fecal immunochemical test, first screening, and number of personal screens were factors associated with an FP result among screenees.nnCONCLUSIONS: The cumulative risk of an FP in colorectal screening using FOBT seems acceptable as the colonoscopy, with its high accuracy, lengthens the time until additional colorectal screening is required, while complication rates remain low.nnIMPACT: It is useful to determine the cumulative FP risk in cancer screening for both advising individuals and for health resources planning.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31008504,

title = {Sociodemographic factors associated with secondhand smoke exposure and smoking rules in homes with children},

author = {Arechavala T and Continente X and Pérez-Ríos M and Schiaffino A and Fernández E and López MJ},

doi = {10.1093/eurpub/ckz054},

issn = {1464-360X},

year  = {2019},

date = {2019-10-01},

journal = {Eur J Public Health},

volume = {29},

number = {5},

pages = {843--849},

abstract = {BACKGROUND: This study aims to identify sociodemographic characteristics associated with secondhand smoke (SHS) exposure and the adoption of smoking bans in homes with children in Spain.nnMETHODS: We performed, in 2016, a cross-sectional study to a representative sample of Spanish households with children under 12 years old. We administered a telephone survey to the parents asking about smoking patterns at home, children's SHS exposure and sociodemographic characteristics. Poisson regression models with robust variance were built to assess sociodemographic characteristics associated with household SHS exposure and the adoption of smoking rules.nnRESULTS: In this study participated 2411 families, 25.8% of which reported exposure at home and 84.4% implemented smoking bans. SHS exposure was associated with having one (aPR = 2.09; 95% CI: 1.43-3.04) or two Spanish parents (aPR = 1.71; 95% CI: 1.24-2.36), lower educational attainment (primary: aPR = 1.74; 95% CI: 1.45-2.10; secondary: aPR = 1.37; 95% CI: 1.17-1.60 compared with university studies), a family structure different from two-parent family (aPR = 1.38; 95% CI: 1.14-1.67) and parents between 31 and 40 years (aPR = 0.75; 95% CI: 0.57-0.99) and 41-50 years (aPR = 0.62; 95% CI: 0.47-0.81) compared with 18- to 30-year-old parents. The adoption of smoking bans was associated with two-parent family (aPR = 1.09; 95% CI: 1.01-1.17), living with non-smokers (aPR = 1.46; 95% CI: 1.31-1.62), parents of foreign origin (aPR = 1.09; 95% CI: 1.04-1.14) and younger children (0-3 years: aPR = 1.05; 95% CI: 1.01-1.09) compared with the oldest children (8-11 years).nnCONCLUSION: The parent's origin and the family structure were associated with SHS exposure and the adoption of smoking bans at home. Moreover, the number of smokers living at home was relevant for the adoption of smoking bans, and the educational attainment for SHS exposure. These factors should be taken into consideration when designing or implementing smoke-free home programmes.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31221812,

title = {Are smokers "hardening" or rather "softening"? An ecological and multilevel analysis across 28 European Union countries},

author = {Feliu A and Fernandez E and Martinez C and Filippidis FT},

doi = {10.1183/13993003.00596-2019},

issn = {1399-3003},

year  = {2019},

date = {2019-09-01},

journal = {Eur Respir J},

volume = {54},

number = {3},

abstract = {BACKGROUND: Tobacco control policies can reduce smoking prevalence. These measures may be less effective where smoking prevalence has significantly declined, as the remaining smokers have "hardened". Our aim was to empirically evaluate the "hardening hypothesis" at the population level in the European Union (EU) and explore factors associated with hardcore smoking.nnMETHODS: We conducted two separate analyses in the EU using data on smoking from the Eurobarometer surveys (2009-2017, n=112 745). 1) A panel-data fixed-effects linear regression to investigate changes over time in the percentage of hardcore smokers in relation to standardised smoking prevalence at the country level. 2) A multilevel logistic regression analysis with hardcore (daily smokers, ≥15 cigarettes per day who have not attempted to quit in the last 12 months) or light (<5 cigarettes per day) smoking as the dependent variable and time as the main independent variable, controlling for individual and ecological variables.nnRESULTS: We studied 29 010 current smokers (43.8% hardcore smokers and 14.7% light smokers). The prevalence of hardcore smoking among adult smokers increased by 0.55 (95% CI 0.14-0.96) percentage points per each additional percentage point in the overall smoking prevalence. The odds of being a hardcore smoker increased over time and were higher in middle-aged males and people with financial difficulties, while the odds of being a light smoker significantly declined among females.nnCONCLUSION: This study does not support the "hardening hypothesis" in the EU between 2009 and 2017, but suggests a softening of the smoking population. Existing tobacco control policies are likely to be suitable to further decrease smoking prevalence in Europe.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30663156,

title = {Changes in dietary intake, plasma carotenoids and erythrocyte membrane fatty acids in breast cancer survivors after a lifestyle intervention: results from a single-arm trial},

author = {Buckland G and Travier N and Arribas L and Del Barco S and Pernas S and Zamora E and Bellet M and Cirauqui B and Margelí M and Muñoz M and Tusquets I and Arcusa A and Javierre C and Moreno F and Valverde Y and Jansen E and Chajès V and Castro C and Agudo A},

doi = {10.1111/jhn.12621},

issn = {1365-277X},

year  = {2019},

date = {2019-08-01},

journal = {J Hum Nutr Diet},

volume = {32},

number = {4},

pages = {468--479},

abstract = {BACKGROUND: The influence of nutrition on breast cancer prognosis is still inconclusive and therefore dietary interventions incorporating dietary biomarkers are needed to confirm compliance with dietary goals and clarify biological mechanisms. The present study assessed whether a lifestyle intervention in breast cancer survivors could affect dietary biomarkers of fruit and vegetables and fatty acids.nnMETHODS: In this phase II single-arm trial, 37 overweight/obese early stage breast cancer patients completed a 12-week diet and exercise intervention. The intervention involved 1-h weekly diet sessions delivered by a dietician and 75-min bi-weekly physical activity sessions of moderate-to-high intensity led by trained monitors. Before and after the intervention, three 24-h dietary recalls were carried out to calculate nutrient intakes and, in addition, blood samples were taken to measure plasma carotenoids, vitamin E and retinol concentrations and erythrocyte membrane fatty acid (EFA) composition. Wilcoxon signed rank tests were used to assess changes in dietary and biomarkers measurements over the intervention period.nnRESULTS: After the intervention, there was a significant increase in the intake of dietary carotenoids (+15.1% compared to baseline) but not plasma carotenoids levels (+6.3%). Regarding the EFA levels, we observed a significant decrease in percentage of saturated fatty acids (-1.4%) and n-6 polyunsaturated fatty acids (-2.9%) and an increase in monounsaturated fatty acids (1.7%) and total and long-chain n-3 polyunsaturated fatty acids (by 13.1% and 13.7%, respectively). A favourable decrease in the ratio of long-chain n-6 to n-3 polyunsaturated fatty acids (-9.1%) was also observed.nnCONCLUSIONS: After a short-term diet and exercise intervention in overweight/obese breast cancer survivors, we observed significant changes in dietary nutrients and fatty acid biomarkers, suggesting positive dietary changes that could be relevant for breast cancer prognosis.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31132476,

title = {Changes in mammographic density over time and the risk of breast cancer: An observational cohort study},

author = {Román M and Sala M and Baré M and Posso M and Vidal C and Louro J and Sánchez M and Peñalva L and Castells X and BELE study group},

doi = {10.1016/j.breast.2019.04.007},

issn = {1532-3080},

year  = {2019},

date = {2019-08-01},

journal = {Breast},

volume = {46},

pages = {108--115},

abstract = {BACKGROUND: The effect of changes in mammographic density over time on the risk of breast cancer remains inconclusive.nnMETHODS: We used information from four centres of the Breast Cancer Screening Program in Spain in the period 1996-2015. We analysed individual level data from 117,388 women first screened age 50-54, with at least two screening examinations. Breast density was determined using the BI-RADS classification (A to D in increasing order) at earliest and latest screening examination. Adjusted Poisson regression models were used to estimate the relative risk (RR) and 95% confidence intervals (95%CI) of the association between changes in mammographic density and breast cancer risk over time.nnRESULTS: During an average 5.8 years of follow-up, 1592 (1.36%) women had a breast cancer diagnosis. An increase in density category increased breast cancer risk, and a decrease in density decreased the risk, compared with women who remained in the same BI-RADS category. Women whose density category increased from B to C or B to D had a RR of 1.55 (95%CI = 1.24-1.94) and 2.32 (95%CI = 1.48-3.63), respectively. The RR for women whose density increased from C to D was 1.51 (95%CI = 1.03-2.22). Changes in BI-RADS density were similarly associated with the risk for invasive cancer than for ductal carcinoma in situ.nnCONCLUSIONS: Although a modest proportion of women changed BI-RADS density category, mammographic density changes modulated the risk of breast cancer and identified women at a differential risk. Using two longitudinal measures of BI-RADS density could help target women for risk-based screening strategies.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31337747,

title = {[Support to smoking regulation in private vehicles and public outdoor spaces]},

author = {Cartanyà-Hueso À and Lidón-Moyano C and Fu M and Ballbè M and Martín-Sánchez JC and González-Marrón A and Matilla-Santander N and Martínez-Sánchez JM},

issn = {2173-9110},

year  = {2019},

date = {2019-07-01},

journal = {Rev Esp Salud Publica},

volume = {93},

abstract = {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.nnMETHODS: 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.nnRESULTS: 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.nnCONCLUSIONS: 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.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30874373,

title = {Impact of an Online Training Program in Smoking Cessation Interventions in Hospitals},

author = {Martínez C and Castellano Y and Andrés A and Fu M and Feliu A and Antón L and Ballbè M and Fernández P and Cabrera S and Riccobene A and Gavilan E and Baena A and Margalef M and Tigova O and Quirós N and Guillen O and Company A and Fernández E},

doi = {10.1111/jnu.12469},

issn = {1547-5069},

year  = {2019},

date = {2019-07-01},

journal = {J Nurs Scholarsh},

volume = {51},

number = {4},

pages = {449--458},

abstract = {PURPOSE: To assess changes in the self-reported performance of smoking cessation interventions according to the 5A's model (Ask; Advise; Assess; Assist; and Arrange follow-up) among clinicians; and to identify the main barriers and facilitators in smoking cessation implementation before and after an online smoking cessation training program.nnDESIGN: Pre-post evaluation.nnMETHODS: We assessed self-reported smoking cessation interventions in the implementation of the 5A's model among clinicians working in Catalan hospitals (Spain). In addition, we assessed individual-, behavioral-, and organizational-level factors that act as barriers and facilitators in the implementation of the 5A's model. We used a questionnaire of 63 items reflecting each of the 5A's performance (scored from 0 = none to 10 = most possible). The questionnaire was completed both immediately before and 6 months after the training. We analyzed the data of those participants who had a clinical role and answered pre- and post-questionnaires. We used the nonparametric test for paired data (Wilcoxon) to examine changes in scores.nnFINDINGS: A total of 127 clinicians completed the pre-post questionnaire; 63.0% were registered nurses, 17.3% were nursing assistants, 7.9% were physicians, and 11.8% were other professionals (p < .001). Overall, there were significant increases in the implementation of the assist component (from a score of 4.5 to 5.2; p < .003) and arrange a follow-up component (from 3.6 to 4.5; p < .001) of the intervention. Scores in the perception of the level of overall preparation, preparedness in using smoking cessation drugs, level of competence, and organizational recognition improved (p < .001) at the follow-up; however, the score in the perception that implementing smoking cessation is part of their job decreased (from 6.3 to 4.4; p < .001).nnCONCLUSIONS: The online training had a positive impact on the implementation of assist and arrange follow-up components. Although self-preparedness in the management of smokers increased, the motivation and involvement of key professionals decreased. Organizational factors related to the incorporation of resources (such as protocols, records, etc.) should be improved for the correct progression of smoking cessation interventions within the institutions.nnCLINICAL RELEVANCE: Smoking cessation training programs should incorporate some motivational content to increase the engagement of health professionals in smoking cessation interventions in their clinical practice.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31337864,

title = {Prevalence of healthy lifestyles against cancer in Spanish women},

author = {Toribio MJ and Lope V and Castelló A and Salas D and Vidal C and Ascunce N and Santamariña C and Moreo P and Pedraz-Pingarrón C and Sánchez-Contador C and Aragonés N and Pérez-Gómez B and Pollán M},

doi = {10.1038/s41598-019-47180-x},

issn = {2045-2322},

year  = {2019},

date = {2019-07-01},

journal = {Sci Rep},

volume = {9},

number = {1},

pages = {10638},

abstract = {Modifying behavior towards healthier lifestyles could prevent a significant number of malignant tumors. We evaluated the prevalence of healthy habits against cancer in Spanish women free of this disease, taking as a reference the recommendations for cancer prevention included in the European Code Against Cancer (ECAC), and we explored the characteristics associated with it. Our population comprised 3,584 women recruited in a population-based cross-sectional study carried out in 7 breast cancer screening programs. Information was directly surveyed and used to calculate a score based on ECAC recommendations referred to bodyweight, physical activity, diet, breastfeeding, tobacco, alcohol and hormone replacement therapy use. The degree of adherence was estimated with a score that evaluated null (0 points), partial (0.5 points) and full adherence (1 point) of each specific recommendation. Associations were explored using binary and ordinal logistic regression models. The median score was 5.7 out of 9 points. Recommendations with lower adherence were those related to intake of red/processed meat and foods high in salt (23% of total adherence), physical activity (24%) and body weight (29%), and recommendations with greater adherence where those related to hormone replacement therapy use (91%), vegetable intake (84%), alcohol (83%) and tobacco (61%). Overall adherence was better among older women, parous women, and in those living in rural areas, and worse among women with higher caloric intake. These recommendations should be evaluated periodically. Screening programs can be an appropriate place to disseminate this information.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31298227,

title = {[Smoking control in Spain: current situation and priorities]},

author = {Villalbí JR and Suelves JM and Martínez C and Valverde A and Cabezas C and Fernández E},

issn = {2173-9110},

year  = {2019},

date = {2019-07-01},

journal = {Rev Esp Salud Publica},

volume = {93},

abstract = {This paper presents a strategic analysis of the prevention of smoking in Spain. After a review of the situation of the epidemic and of the current prevention policies with the data available in 2019, it identifies the main problems to improve the prevention of smoking, while proposing strategies and key actions for the future. Considering as major objectives reducing the initiation of smoking and helping smokers quit, the different strategies of action and the key actions to be developed. In addition to helping smokers to stop smoking from the health services, key preventive actions include several public policies including taxation, banning advertising and other forms of promotion, the regulation of tobacco packaging, the expansion of smoke-free spaces, and information to the public on its effects. Some of them have followed a positive path for prevention in Spain but for others there is wide room for improvement. The MPOWER strategy of the WHO offers a guide for the development of the most effective tobacco control policies. In its light it is recommended to put emphasis on actions related to expanding smoke-free areas, to develop distance support services to stop smoking, to periodically carry out advertising campaigns of wide coverage to encourage quitting, to reinforce support for quitting in health care services, to finance pharmacological treatments, to expand the advertising ban to electronic devices that release nicotine, and to increase the tax burden on tobacco and other products delivering nicotine.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30817956,

title = {Burden of respiratory disease attributable to secondhand smoke exposure at home in children in Spain (2015)},

author = {Continente X and Arechavala T and Fernàndez E and Pérez-Ríos M and Schiaffino A and Soriano JB and Carreras G and López-Nicolás Á and Gorini G and López MJ},

doi = {10.1016/j.ypmed.2019.02.028},

issn = {1096-0260},

year  = {2019},

date = {2019-06-01},

journal = {Prev Med},

volume = {123},

pages = {34--40},

abstract = {This study aimed to estimate the number of incident cases and hospital admissions attributable to secondhand smoke (SHS) exposure at home for asthma, otitis media (OM), and lower respiratory infections (LRI) in children in Spain. The burden of respiratory disease caused by SHS exposure was estimated in terms of incident cases and hospitalized cases for asthma, OM, and LRI. Estimates were calculated using the population attributable fraction. The age-specific (0-1 year, 0-4 years, 5-11 years, and 0-11 years) prevalence of SHS exposure in children was estimated through a telephone survey performed in a representative sample of Spanish households with children in 2016. The risk estimates for all diseases were selected from international meta-analyses. The number of hospitalized cases was obtained for each disease from the Hospital Minimum Data Set provided by the Ministry of Health of Spain. Incident cases were obtained from the Global Health Data Exchange. In 2015, SHS exposure caused an estimated total of 136,403 incident cases of the following respiratory diseases: 9058 (8.5%) cases of asthma, 120,248 (8.5%) of OM, and 7097 (13.5%) of LRI in children aged 0-14 years old in Spain. Likewise, SHS exposure caused a total of 3028 hospitalized cases, with 379 (8.5%) for asthma and 167 (8.5%) for OM in children 0-11 years old, and 2482 (11.6%) for LRI in children <2 years old. The high burden of respiratory disease attributed to SHS exposure supports the need to improve protection of children against SHS exposure by extending smoke-free regulations to homes and cars.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31236712,

title = {Communication Channels Used by Women to Contact a Population-Based Breast Cancer Screening Program in Catalonia, Spain},

author = {Travier N and Vidal C and Garcia M and Benito L and Medina P and Moreno V},

doi = {10.1007/s10916-019-1382-6},

issn = {1573-689X},

year  = {2019},

date = {2019-06-01},

journal = {J Med Syst},

volume = {43},

number = {8},

pages = {244},

abstract = {Communication is a corner stone of population-based breast cancer screening programs that need to invite all the women from their target population and provide them with balanced information on screening to guaranty informed participation. Invited women also need to be able to contact screening programs to get further information on screening procedures and/or cancel and reschedule appointments. This study describes the communication channels used by women invited for breast cancer screening to contact the program. The study population consisted of 141,684 women, aged 50-69 years, who were invited during 2015-2016 for screening by the Catalan Breast Cancer Screening Program (Spain). Multiple logistic regression models were performed to assess the association between age, screening history, socioeconomic status and reasons for contacting the program and the outcome variables (contact with the program; contact through information and communication technology (ICT) channels). Among the 141,684 women invited for BC screening, 22.5% contacted the screening office mainly to reschedule (42.2%) and cancel (29.2%) appointments. While the communication channel mostly used was the telephone, 24.8% of the women used ICT. ICT was more frequently used by women who had never been screened. Women who wanted to change their appointment were 65% (OR 1.65, 95%CI 1.54-1.76) more likely to use ICT than women who wanted to cancel it. This study showed the need to reinforce communication between women and breast cancer screening programs and the importance of offering communication channels suiting all women's needs to facilitate appointments' rescheduling and cancelling and therefore improve screening programs' efficiency.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30890542,

title = {Longitudinal Adherence to Immunochemical Fecal Occult Blood Testing vs Guaiac-based FOBT in an Organized Colorectal Cancer Screening Program},

author = {Benito L and Travier N and Binefa G and Vidal C and Espinosa J and Milà N and Garcia M},

doi = {10.1158/1940-6207.CAPR-18-0091},

issn = {1940-6215},

year  = {2019},

date = {2019-05-01},

journal = {Cancer Prev Res (Phila)},

volume = {12},

number = {5},

pages = {327--334},

abstract = {Longitudinal adherence is a critical component of the efficacy of stool-based screening programs because they should be repeated every 1-2 years. Few data have been published on the uptake in multiple rounds of fecal occult blood test-based (FOBT) colorectal cancer (CRC) screening. We calculated two measures of longitudinal adherence to biennial FOBT (guaiac fecal occult blood test:gFOBT or fecal immunochemical test:FIT) to better understand its impact on the programmatic effectiveness of a population-based CRC screening program (2000-2017). Ongoing population-based CRC program of men and women aged 50-69 years. Variables: Age at first CRC screening invitation, sex, number of screening invitations, number of screens, deprivation score, and uptake rate. Logistic regression models were used to assess the independent effect of sex, age at first invitation, deprivation, and the type of screening test offered on adherence. The uptake rate for guaiac fecal occult blood test (gFOBT) was 23.9%, and for the fecal immunochemical test (FIT), it was 37.4%. The overall rate of consistently screened invitees after seven rounds of screening was 14.2%, being 20.6% for those individuals who used FIT and 14.3% for those who used gFOBT. Factors associated with continued participation (consistent vs. inconsistent screenees) showed that the longitudinal adherence was associated with age, screening test used, and number of invitations. Continued participation was lower in individuals who were screened using FIT than among those screened using gFOBT [OR, 0.68; 95% confidence interval (CI), 0.57-0.81]. The overall rate of consistently screened invitees for colorectal cancer screening was higher with FIT than gFOBT. Studying the rate of individuals being current for screening may help to anticipate potential benefits before the long-term outcome data are available.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31199306,

title = {The Notijoves Project: Protocol for a Randomized Controlled Trial About New Communication Technologies and Gamification to Promote Partner Notification of Sexually Transmitted Infections Among Young People},

author = {Carnicer-Pont D and Loureiro-Varela E and Manresa JM and Martinez M and Avecilla À and Montero-Pons L and Falguera-Puig G},

doi = {10.2196/12896},

issn = {1929-0748},

year  = {2019},

date = {2019-05-01},

journal = {JMIR Res Protoc},

volume = {8},

number = {6},

pages = {e12896},

abstract = {BACKGROUND: An increase in sexually transmitted infections (STIs) as well as an increase in the use of new information and communication technologies among young people in Catalonia is the inspiration behind the idea of designing a smartphone app to promote partner notification of STIs.nnOBJECTIVE: The main objective of this study is to design a Web-based tool adapted to smartphones for partner notification of STIs among youth who are 16 to 24 years old. Additionally, the objective is to evaluate the Web-based tool's role in increasing the patient referral partner notification.nnMETHODS: This is a multicenter randomized controlled trial with a proportional stratification of the sample by center and random allocation of participants to the 3 arms of the study (simple Web-based intervention, game Web-based intervention, and control). This study is being conducted by midwives, gynecologists, and physicians in the sexual and reproductive areas of the primary health care centers.nnRESULTS: The primary outcome measure is the number and proportion of partner notifications. Additional outcome measures are the yield of early diagnosis and treatment of those exposed and infected, acceptability, barriers, and preferences for partner notification. Expected results include an increase in the yield of partner notification, early diagnosis and treatment among youth using Web-based interventions compared with those receiving the traditional advice to notify, and a description of sexual networks among those participating in the study.nnCONCLUSIONS: The Notijoves is expected to have a sustainable positive impact in the partner notification practice among youth and contribute to increasing the awareness of STI prevention.nnINTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/12896.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30771628,

title = {Comparison of TSNAs concentration in saliva according to type of tobacco smoked},

author = {Cartanyà-Hueso À and Lidón-Moyano C and Fu M and Perez-Ortuño R and Ballbè M and Matilla-Santander N and Martín-Sánchez JC and Pascual JA and Fernández E and Martínez-Sánchez JM},

doi = {10.1016/j.envres.2018.12.006},

issn = {1096-0953},

year  = {2019},

date = {2019-05-01},

journal = {Environ Res},

volume = {172},

pages = {73--80},

abstract = {OBJECTIVE: 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).nnMETHODS: 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.nnRESULTS: 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.nnCONCLUSIONS: 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.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30583124,

title = {Prevalence and determinants of tobacco, e-cigarettes, and cannabis use among nursing students: A multicenter cross-sectional study},

author = {Martínez C and Baena A and Castellano Y and Fu M and Margalef M and Tigova O and Feliu A and Laroussy K and Galimany J and Puig M and Bueno A and López A and Fernández E},

doi = {10.1016/j.nedt.2018.11.018},

issn = {1532-2793},

year  = {2019},

date = {2019-03-01},

journal = {Nurse Educ Today},

volume = {74},

pages = {61--68},

abstract = {BACKGROUND: Nurses are important agents in public health, which includes being active in tobacco control. Studies show that nurses who smoke are less inclined to offer smoking cessation aid. Nursing students, as the future labor force of nursing, are one of the key groups to monitor.nnOBJECTIVES: To identify the prevalence and determinants of use of several tobacco products, e-cigarettes, and cannabis among nursing students in Catalonia.nnDESIGN: Cross-sectional multicenter study.nnSETTINGS: 15 university nursing schools in Catalonia (Spain) in 2015-2016.nnPARTICIPANTS: Nursing students attending class at the day of the survey.nnMETHODS: An anonymous, self-administered questionnaire based on the Global Health Professional Survey was designed. The questions included information on consumption of several tobacco products (manufactured cigarettes, roll your own cigarettes, etc.), e-cigarettes, and cannabis. We estimated the prevalence of use (%) and computed multilevel logistic regressions models, at two levels, to calculate the odds ratios (OR) and their corresponding 95% confidence intervals (CI), adjusting for several individual sociodemographic variables and the nursing school as a grouping variable.nnRESULTS: 4381 students participated in the study (57.2% of Nursing students in Catalonia at the time of the survey). 29.7% (95%CI: 27.2-32.2) were smokers (18.4% daily and 11.3% occasionally). 66.4% smoked manufactured cigarettes, 47.0% roll your own cigarettes, 10.0% waterpipe, and 0.4% e-cigarettes. The main predictors of smoking were: being ≥25 years (OR = 2.57, 95%CI: 2.03-3.26) and belonging to other Spanish regions (OR = 1.82, 95%CI: 1.30-2.54). 71.5% had low nicotine dependence as defined by the Heavy Smoking Index. Among 11.5% (95%CI: 10.6-12.4) of students used cannabis (daily or occasionally), and men presented higher odds of use (OR = 2.81, 95%CI: 2.11-3.73) than women.nnCONCLUSIONS: Tobacco and cannabis use is high among nursing students. It is necessary to carry out early tobacco and cannabis cessation programs among young nursing students.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30594532,

title = {Testing behavioral interventions to optimize participation in a population-based colorectal cancer screening program in Catalonia, Spain},

author = {Stoffel S and Benito L and Milà N and Travier N and Binefa G and Vidal C and Espinosa J and Moreno V and Garcia M},

doi = {10.1016/j.ypmed.2018.12.013},

issn = {1096-0260},

year  = {2019},

date = {2019-02-01},

journal = {Prev Med},

volume = {119},

pages = {58--62},

abstract = {The aim of the study was to measure the effect of three cost-neutral behavioral interventions on participation compared to the standard invitation letter in a population-based colorectal cancer screening program in 2014. For that purpose, a four-arm randomized field trial was conducted among 5077 individuals aged 50 to 69 years. Over an 8-week period, each week was randomly allocated to the intervention or the control conditions. Individuals assigned to the intervention conditions additionally received a prompt to write down the date to pick up the screening test in a pharmacy. Two of the three intervention groups also included an additional paragraph in the invitation letter on either: 1) the high proportion of individuals participating regularly (social norms condition) or 2) the importance of regular participation (benefit condition). We measured screening participation before and after receiving a reminder letter six weeks after the screening invitation. An overall 8.0 percentage point increase in CRC screening was achieved as a direct result of receiving a reminder letter; however none of the intervention strategies influenced participation. The only significant difference was found for newly invited individuals. There, participation rates decreased from 34.9% to 24.2% when the invitation mailing mentioned the importance of regular participation (OR: 0.60; 95% CI: 0.38-0.95). While none of the intervention strategies improved participation rates we found that praising the benefit of regular screening may discourage individuals who have never been invited before as the continuous behavior may be perceived as a large request. Nevertheless, the reminder letter boosted participation rates independently of the intervention assigned.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30205255,

title = {Exploring individual and contextual factors contributing to tobacco cessation intervention implementation},

author = {Andrés A and Castellano Y and Fu M and Feliu A and Ballbè M and Antón L and Baena A and Fernández E and Martínez C},

doi = {10.1016/j.addbeh.2018.08.003},

issn = {1873-6327},

year  = {2019},

date = {2019-01-01},

journal = {Addict Behav},

volume = {88},

pages = {163--168},

abstract = {BACKGROUND: Previous research suggests that smoking cessation interventions are poorly implemented. This study reports the development and testing of a questionnaire including knowledge, attitude, behavioral, and organizational (KABO) factors affecting the implementation of smoking cessation practices in hospitals by health care providers and organizations.nnMETHODS: An initial pool of 44 items was developed to assess the individual knowledge, attitudes, and beliefs of health professionals towards smoking cessation practices according to the 5 A's intervention model, as well as organizational barriers and opportunities for its implementation. Items were measured in a scale from 0="Not at all/Never" to 10 = "Completely/Always". Data were collected from health workers (n = 702) in Catalonia. The validity of the instrument was measured by: (a) analyzing the items, (b) assessing the internal structure, (c) estimating the internal consistency, and (d) analyzing the relationship between this tool and the 5 A's intervention model.nnRESULTS: Seven domains were extracted: individual skills, positive organizational support, attitudes and beliefs, individual commitment, organizational resources, beliefs about patient desire/readiness to quit, and organizational endorsement. These domains explained 69.7% of the variance, and allowed for the development of a refined 26-item version of the questionnaire. Both the seven domains and the total scale showed adequate internal consistency.nnCONCLUSIONS: Psychometric testing indicates that the KABO questionnaire is a reliable and valid instrument for assessing the main barriers and facilitators to smoking cessation intervention implementation. Individual factors better explained the implementation of smoking cessation interventions in hospitals, and the seven identified domains can be used for further investigations into how the implementation of evidence-based practices impacts smoking cessation performance.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30635072,

title = {Effectiveness of a telephone-based intervention for smoking cessation in patients with severe mental disorders: study protocol for a randomized controlled trial},

author = {Ballbè M and Martínez C and Feliu A and Torres N and Nieva G and Pinet C and Raich A and Mondon S and Barrio P and Hernández-Ribas R and Vicens J and Costa S and Vilaplana J and Alaustre L and Vilalta E and Blanch R and Subirà S and Bruguera E and Suelves JM and Guydish J and Fernández E},

doi = {10.1186/s13063-018-3106-5},

issn = {1745-6215},

year  = {2019},

date = {2019-01-01},

journal = {Trials},

volume = {20},

number = {1},

pages = {38},

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

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid29472445,

title = {Impact of tobacco control policies on smoking prevalence and quit ratios in 27 European Union countries from 2006 to 2014},

author = {Feliu A and Filippidis FT and Joossens L and Fong GT and Vardavas CI and Baena A and Castellano Y and Martínez C and Fernández E},

doi = {10.1136/tobaccocontrol-2017-054119},

issn = {1468-3318},

year  = {2019},

date = {2019-01-01},

journal = {Tob Control},

volume = {28},

number = {1},

pages = {101--109},

abstract = {BACKGROUND: Tobacco use is still highly prevalent in Europe, despite the tobacco control efforts made by the governments. The development of tobacco control policies varies substantially across countries. The Tobacco Control Scale (TCS) was introduced to quantify the implementation of tobacco control policies across European countries OBJECTIVE: To assess the midterm association of tobacco control policies on smoking prevalence and quit ratios among 27 European Union (EU) Member States (EU27).nnMETHODS: Ecological study. We used the TCS in EU27 in 2007 and the prevalence of tobacco and quit ratios data from the Eurobarometer survey (2006 (n=27 585) and 2014 (n=26 793)). We analysed the relationship between the TCS scores and smoking prevalence and quit ratios and their relative changes (between 2006 and 2014) by means of scatter plots and multiple linear regression models.nnRESULTS: In EU27, countries with higher scores in the TCS, which indicates higher tobacco control efforts, have lower prevalence of smokers, higher quit ratios and higher relative decreases in their prevalence rates of smokers over the last decade. The correlation between TCS scores and smoking prevalence (r=-0.444; P=0.02) and between the relative changes in smoking prevalence (r=-0.415; P=0.03) was negative. A positive correlation was observed between TCS scores and quit ratios (r=0.373; P=0.06). The percentage of smoking prevalence explained by all TCS components was 28.9%.nnCONCLUSION: EU27 should continue implementing comprehensive tobacco control policies as they are key for reducing the prevalence of smoking and an increase tobacco cessation rates in their population.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31713528,

title = {Dissemination of health technologies: Trends in the use of diagnostic test in breast cancer screening},

author = {Natal C and Fernandez-Somoano A and Torá-Rocamora I and Vidal C and Castells X and Tardón A and Benign Lesion Study Group and Benign Lesion Study Group},

doi = {10.1016/j.jhqr.2019.02.007},

issn = {2603-6479},

year  = {2019},

date = {2019-01-01},

journal = {J Healthc Qual Res},

volume = {34},

number = {4},

pages = {177--184},

abstract = {OBJECTIVE: To analyse trends in the use of diagnostic test in breast cancer screening programs in Spain.nnMATERIALS AND METHODS: Retrospective study of 542,695 women who had undergone at least one screening mammogram in any of the screening centres of three administrative regions in Spain, between 1996 and 2011. Process measures were: overall recall rate, overall invasive test rate, and rates of each type of invasive test (fine-needle aspiration biopsy, core-needle biopsy and surgical biopsy). As results measures were included detection of benign lesions rate, ductal in situ cancer rate and invasive cancer rate. Adjusted by age rates were estimated year by year for each measure and, also, the annual percent of change and its corresponding joint points.nnRESULTS: Core-needle biopsy rates decreased between 1996 and 1999 and changed trends in 1999-2011 with an increase of 4.9% per year. Overall recall rate declined by 4.6% from 1999 to 2004, invasive test rate declined between 1996 and 2004 by 24.3%. Fine-needle aspiration biopsy rate changes were: a 22.4% declined per year (1996-1998), and 13.5% declined per year (1998-2005). Benign lesions rate decreased from 1996 to 2011, 21.4% per year (1996-2001) and 6.0% (2001-2011). Ductal carcinoma in situ and invasive cancer had no-statistically significant changes.nnCONCLUSION: The introduction of core-needle biopsy was slow and not concurrent with the reduction in the use of other diagnostic tests, but also represented a reduction in the rate of overall diagnostic tests and in the detection rate of benigns lesions without affecting the cancer detection rates.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30913217,

title = {Effect of information about the benefits and harms of mammography on women's decision making: The InforMa randomised controlled trial},

author = {Pérez-Lacasta MJ and Martínez-Alonso M and Garcia M and Sala M and Perestelo-Pérez L and Vidal C and Codern-Bové N and Feijoo-Cid M and Toledo-Chávarri A and Cardona À and Pons A and Carles-Lavila M and Rue M and with the InforMa Group},

doi = {10.1371/journal.pone.0214057},

issn = {1932-6203},

year  = {2019},

date = {2019-01-01},

journal = {PLoS One},

volume = {14},

number = {3},

pages = {e0214057},

abstract = {BACKGROUND: In Spain, women invited to breast screening are not usually informed about potential harms of screening. The objective of the InforMa study is to assess the effect of receiving information about the benefits and harms of breast screening on informed choice and other decision-making outcomes, in women approaching the age of invitation to mammography screening.nnMETHODS: Two-stage randomised controlled trial. In the first stage, 40 elementary territorial units of the public healthcare system were selected and randomised to intervention or control. In the second stage, women aged 49-50 years were randomly selected. The target sample size was 400 women. Women in the intervention arm received a decision aid (DA) with detailed information on the benefits and harms of screening. Women in the control arm received a standard leaflet that did not mention harms and recommended accepting the invitation to participate in the Breast Cancer Screening Program (BCSP). The primary outcome was informed choice, defined as adequate knowledge and intentions consistent with attitudes. Secondary outcomes included decisional conflict, worry about breast cancer, time perspective, opinions about the DA or the leaflet, and participation in the BCSP.nnRESULTS: In the intervention group, 23.2% of 203 women made an informed choice compared to only 0.5% of 197 women in the control group (p < 0.001). Attitudes and intentions were similar in both study groups with a high frequency of women intending to be screened, 82.8% vs 82.2% (p = 0.893). Decisional conflict was significantly lower in the intervention group. No differences were observed in confidence in the decision, anxiety, and participation in BCSP.nnCONCLUSIONS: Women in Spain lack knowledge on the benefits and harms of breast screening. Providing quantitative information on benefits and harms has produced a considerable increase in knowledge and informed choice, with a high acceptance of the informative materials.nnTRIAL REGISTRATION: Trial identifier NCT03046004 at ClinicalTrials.gov registry. Registered on February 4 2017. Trial name: InforMa study.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30599878,

title = {Mammographic breast density: How it affects performance indicators in screening programmes?},

author = {Posso M and Louro J and Sánchez M and Román M and Vidal C and Sala M and Baré M and Castells X and BELE study group},

doi = {10.1016/j.ejrad.2018.11.012},

issn = {1872-7727},

year  = {2019},

date = {2019-01-01},

journal = {Eur J Radiol},

volume = {110},

pages = {81--87},

abstract = {OBJECTIVES: To investigate how breast density affects screening performance indicators in a digital mammography context.nnMETHODS: We assessed the effect of breast density over the screen-detected and interval cancers rates, false-positives, specificity, sensitivity, recall rate, positive predictive value of recall (PPV-1), and PPV of invasive tests (PPV-2). Radiologists classified breast density using the BIRADS System. We used generalized estimating equations to account for within-woman correlation by means of the robust Huber-White variance estimator.nnRESULTS: We included 177,164 women aged 50-69 years who underwent 499,251 digital mammograms from 2004 to 2015 in Spain. According to the fibroglandular tissue percentage, 24.7% of mammograms were classified as BI-RADS 1 (<25% glandular), 54.7% as BI-RADS 2 (25-50% glandular), 14.0% as BI-RADS 3 (51-75% glandular) and 6.6% as BI-RADS 4 (>75% glandular). Overall, women with BI-RADS 3 had the highest screen-detected cancer rate (5.9 per 1000) and BI-RADS 4 the highest interval cancer rate (2.4 per 1000). Sensitivity decreased from 89.2% in women with BI-RADS 1 to 67.9% in BI-RADS 4. Both PPV-1 and PPV-2 decreased from 10.4% to 5.7% and from 49.8% to 32.4% in women with BI-RADS 1 and BI-RADS 4, respectively. Women aged 60-69 years with BI-RADS 4 had the lowest sensitivity (54.9%) and the highest interval cancer rate (3.8 per 1000).nnCONCLUSIONS: Performance screening measures are negatively affected by breast density falling to a lower sensitivity and PPV, and higher interval cancer rate as breast density increases. Particularly women aged 60-69 years with >75% glandular breasts had the worst results and therefore may be candidates for screening using other technologies.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30377020,

title = {Secondhand exposure to aerosol from electronic cigarettes: pilot study of assessment of tobacco-specific nitrosamine (NNAL) in urine},

author = {Martínez-Sánchez JM and Ballbè M and Pérez-Ortuño R and Fu M and Sureda X and Pascual JA and Peruga A and Fernández E},

doi = {10.1016/j.gaceta.2018.07.016},

issn = {1578-1283},

year  = {2019},

date = {2019-01-01},

journal = {Gac Sanit},

volume = {33},

number = {6},

pages = {575--578},

abstract = {OBJECTIVE: To assess the levels of a tobacco-specific nitrosamine (NNAL) in non-smokers passively exposed to the second-hand aerosol (SHA) emitted from users of electronic cigarettes (e-cigarettes).nnMETHOD: We conducted an observational study involving 55 non-smoking volunteers divided into three groups: 25 living at home with conventional smokers, 6 living with e-cigarette users, and 24 in control homes (smoke-free homes). We obtained urine samples from all volunteers to determine NNAL.nnRESULTS: We detected NNAL in the urine of volunteers exposed to e-cigarettes (median:0.55 pg/mL; interquartile range: 0.26-2.94 pg/mL). The percentage of urine samples with quantifiable NNAL differed significantly among the three groups of homes: 29.2%, 66.7% and 76.0%, respectively (p=0.004).nnCONCLUSIONS: We found NNAL nitrosamine in urine samples from people exposed to SHA from e-cigarettes. However, these results could be confirmed with more studies with larger sample sizes.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}