@article{pmid33905602,

title = {Environmental and individual exposure to secondhand aerosol of electronic cigarettes in confined spaces: Results from the TackSHS Project},

author = {Amalia B and Fu M and Tigova O and Ballbè M and Castellano Y and Semple S and Clancy L and Vardavas C and López MJ and Cortés N and Pérez-Ortuño R and Pascual JA and Fernández E},

doi = {10.1111/ina.12841},

issn = {1600-0668},

year  = {2021},

date = {2021-09-01},

journal = {Indoor Air},

volume = {31},

number = {5},

pages = {1601--1613},

abstract = {Secondhand electronic cigarette (e-cigarette) aerosol (SHA) might impair indoor air quality and expose bystanders. This study aims to investigate exposure to SHA in controlled conditions of enclosed settings simulating real-world scenario. An experiment was performed in a car and in a room, in which SHA was generated during a 30-minute ad libitum use of an e-cigarette. The experiment was replicated on five consecutive days in each setting. We measured PM , airborne nicotine concentrations, and biomarkers of exposure to SHA, such as nicotine metabolites, tobacco-specific nitrosamines, propylene glycol, and glycerol in bystanders' saliva samples before, during, and after the exposure period. Self-reported health symptoms related to exposure to SHA were also recorded. The results showed that the highest median PM concentration was recorded during the exposure period, being 21 µg/m in the room setting and 16 µg/m in the car setting-about twofold increase compared to the baseline. Most concentrations of the airborne nicotine and all biomarkers were below the limit of quantification in both settings. Bystanders in both settings experienced some short-term irritation symptoms, expressed as dry throat, nose, eyes, and phlegm. In conclusion, short-term use of an e-cigarette in confined spaces increased indoor PM level and caused some irritation symptoms in bystanders.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32441557,

title = {Lung function changes in patients with chronic obstructive pulmonary disease (COPD) and asthma exposed to secondhand smoke in outdoor areas},

author = {Keogan S and Alonso T and Sunday S and Tigova O and Fernández E and López MJ and Gallus S and Semple S and Tzortzi A and Boffi R and Gorini G and López-Nicolás Á and Radu-Loghin C and Soriano JB and Clancy L and TackSHS Project Investigators (all listed in Appendix)},

doi = {10.1080/02770903.2020.1766062},

issn = {1532-4303},

year  = {2021},

date = {2021-09-01},

journal = {J Asthma},

volume = {58},

number = {9},

pages = {1169--1175},

abstract = {BACKGROUND: Further evidence is needed on the effects that short- and long-term exposure to secondhand smoke (SHS) have on the respiratory health of patients with lung disease. Within the TackSHS project we aimed to assess the acute respiratory effects in lung function that result from short-term SHS exposure among patients with asthma and chronic obstructive pulmonary disease (COPD).nnMETHODS: The study design was an intervention trial with measurements before/after exposure to SHS in legal outdoor smoking areas. We studied patients with asthma or COPD from Czechia, Ireland, and Spain. Forced spirometry, peak flow and carbon monoxide (CO) measurements were performed pre- and 24 h post- exposure.nnRESULTS: Overall, 60 patients were studied, 30 with asthma, and 30 with COPD; 35 (58.3%) were female. There were no significant differences observed in exhaled CO between pre- and 24 h post-exposure neither in women ( = 0.210), nor in men ( = 0.169).A statistically significant decrease in forced vital capacity (FVC) was seen, overall, in asthma participants ( = 0.02) and in forced expiratory volume in the first second (FEV), ( = 0.02), FVC ( = 0.04) and peak expiratory flow rate (PEFR) ( = 0.04) in female asthmatic participants. The observed decreases in respiratory measurements in COPD were not significant. There were no reported increases in symptoms, respiratory medication, or use of health services 24 h after the exposure.nnCONCLUSION: We conclude that acute, short-term SHS exposure had a statistically significant effect on spirometry in female asthma patients but did not significantly modify spirometric indices 24 h later in COPD patients.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33149260,

title = {Burden of disease from exposure to secondhand smoke in children in Europe},

author = {Carreras G and Lachi A and Cortini B and Gallus S and López MJ and López-Nicolás Á and Lugo A and Pastor MT and Soriano JB and Fernandez E and Gorini G and TackSHS Project Investigators},

doi = {10.1038/s41390-020-01223-6},

issn = {1530-0447},

year  = {2021},

date = {2021-07-01},

journal = {Pediatr Res},

volume = {90},

number = {1},

pages = {216--222},

abstract = {BACKGROUND: Secondhand smoke (SHS) exposure at home and fetal SHS exposure during pregnancy are a major cause of disease among children. The aim of this study is quantifying the burden of disease due to SHS exposure in children and in pregnancy in 2006-2017 for the 28 European Union (EU) countries.nnMETHODS: Exposure to SHS was estimated using a multiple imputation procedure based on the Eurobarometer surveys, and SHS exposure burden was estimated with the comparative risk assessment method using meta-analytical relative risks. Data on deaths and disability-adjusted life years (DALYs) were collected from National statistics and from the Global Burden of Disease Study.nnRESULTS: Exposure to SHS and its attributable burden stalled in 2006-2017; in pregnant women, SHS exposure was 19.8% in 2006, 19.1% in 2010, and 21.0% in 2017; in children it was 10.1% in 2006, 9.6% in 2010, and 12.1% in 2017. In 2017, 35,633 DALYs among children were attributable to SHS exposure in the EU, mainly due to low birth weight.nnCONCLUSIONS: Comprehensive smoking bans up to 2010 contributed to reduce SHS exposure and its burden in children immediately after their implementation; however, SHS exposure still occurs, and in 2017, its burden in children was still relevant.nnIMPACT: Exposure to secondhand smoke at home and in pregnancy is a major cause of disease among children. Smoking legislation produced the adoption of voluntary smoking bans in homes; however, secondhand smoke exposure at home still occurs and its burden is substantial. In 2017, the number of deaths and disability-adjusted life years in children attributable to exposure to secondhand smoke in the European Union countries were, respectively, 335 and 35,633. Low birth weight caused by secondhand smoke exposure in pregnancy showed the largest burden. Eastern European Union countries showed the highest burden.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33129855,

title = {Third-hand exposure at homes: Assessment using salivary cotinine},

author = {Lidón-Moyano C and Fu M and Pérez-Ortuño R and Ballbè M and Garcia E and Martín-Sánchez JC and Pascual JA and Fernández E and Martínez-Sánchez JM},

doi = {10.1016/j.envres.2020.110393},

issn = {1096-0953},

year  = {2021},

date = {2021-05-01},

journal = {Environ Res},

volume = {196},

pages = {110393},

abstract = {BACKGROUND/OBJECTIVES: While exposure to secondhand smoke (SHS) is a well-established problem, exposure to third-hand smoke (THS) is scanty known and needs to be studied. The objective of this work is to characterize salivary cotinine concentrations among people who self-reported exposure to SHS and THS at home.nnMETHODS: Cross-sectional study of a representative sample (n = 736) of the adult population (≥16 years) from the city of Barcelona carried out in 2013-2014. A questionnaire on tobacco use and passive exposure was administered, and a saliva sample was collected for cotinine determination. For this study, the information of the non-smoker participants who provided saliva sample (n = 519) was used. The geometric means (GM) and geometric standard deviations (GSD) of the cotinine concentration were compared according to the type of self-reported exposure at home: (1) Not exposed to SHS or THS; (2) Exposed to SHS and THS; and (3) Only exposed to THS. We used log-linear models to compare the cotinine concentration of each exposed group with respect to the unexposed group, adjusting for sex, age, educational level, and tobacco exposure in other settings.nnRESULTS: The GM of the salivary cotinine concentration was 0.34 ng/ml (GSD = 0.16) among individuals reporting SHS and THS exposure, 0.22 ng/ml (GSD = 0.15) among those reporting only THS exposure and 0.11 ng/ml (GSD = 0.04) among those who declared not to be exposed to SHS nor THS (p-value for trend <0.001). The regression model showed a statistically significant increase in cotinine concentration among those exposed to SHS and THS (188% higher, 95% CI: 153%; 223%), and only exposed to THS (106% higher, IC95. %: 74.5%; 137.0%) when comparing with the unexposed group. No statistically significant differences in cotinine concentration were observed between those exposed to SHS and THS compared to the THS group (-25.8%, 95% CI: -69.5%; 17.9%).nnCONCLUSIONS/RECOMMENDATIONS: People exposed to third-hand smoke at home had quantifiable cotinine levels in saliva. No differences in cotinine levels were found between those exposed to second-hand and third-hand smoke at home. The reduction of exposure to third-hand smoke at home should be put into the agenda of tobacco control.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33388324,

title = {Burden of disease from second-hand tobacco smoke exposure at home among adults from European Union countries in 2017: an analysis using a review of recent meta-analyses},

author = {Carreras G and Lachi A and Cortini B and Gallus S and López MJ and López-Nicolás Á and Soriano JB and Fernandez E and Tigova O and Gorini G and TackSHS Project Investigators},

doi = {10.1016/j.ypmed.2020.106412},

issn = {1096-0260},

year  = {2021},

date = {2021-04-01},

journal = {Prev Med},

volume = {145},

pages = {106412},

abstract = {Smoke-free legislation reduced second-hand smoke (SHS) exposure in public places, and indirectly promoted private smoke-free settings. Nevertheless, a large proportion of adults is still exposed to SHS at home. The aim of this paper is to quantify the burden of disease due to home SHS exposure among adults in the 28-European Union (EU) countries for year 2017. The burdens by gender from lung cancer, chronic obstructive pulmonary disease (COPD), breast cancer, ischemic heart disease (IHD), stroke, asthma, and diabetes were estimated in an original research analysis using the comparative risk assessment method. Relative risks of death/diseases by gender for adults exposed to SHS at home compared to not exposed ones were estimated updating existing meta-analyses. Prevalence of home SHS exposure by gender was estimated using a multiple imputation procedure based on Eurobarometer surveys. Data on mortality and disability adjusted life years (DALYs) were obtained from the Global Burden of Disease, Injuries and Risk Factors Study. In 2017, 526,000 DALYs (0.36% of total DALYs) and 24,000 deaths (0.46% of total deaths) were attributable to home SHS exposure in the 28-EU countries, mainly from COPD and IHD. South-Eastern EU countries showed the highest burden, with proportion of DALYs/deaths attributable to SHS exposure on total higher than 0.50%/0.70%, whereas northern EU-countries showed the lowest burden, with proportions of DALYs/deaths lower than 0.25%/0.34%. The burden from SHS exposure is still significant in EU countries. More could be done to raise awareness of the health risks associated with SHS exposure at home.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33903637,

title = {The association between tobacco control policy implementation and country-level socioeconomic factors in 31 European countries},

author = {Feliu A and Filippidis FT and Joossens L and Amalia B and Tigova O and Martínez C and Fernández E},

doi = {10.1038/s41598-021-88194-8},

issn = {2045-2322},

year  = {2021},

date = {2021-04-01},

journal = {Sci Rep},

volume = {11},

number = {1},

pages = {8912},

abstract = {European countries have made significant progress in implementing tobacco control policies to reduce tobacco use; however, whether socioeconomic status (SES) of a country may influence the implementation of such policies is unknown. The aim of this study is to assess the association between country-level SES and the implementation level of tobacco control policies in 31 European countries. An ecological study using data from Eurostat, Human Development Reports on several SES indicators and the Tobacco Control Scale (TCS) of 2016 was conducted to measure country-level tobacco control policies. We analysed the relationship between SES indicators and the TCS by means of scatter-plots and Spearman's rank correlation coefficients (r) and multivariable linear regression analysis. In Europe, no statistically significant association was found between SES factors and the level of implementation of tobacco control policies. Only public spending on tobacco control was associated with all SES factors, except for Gini Index (an income inequality index). The strongest associations of TCS scores for this policy domain were found with the Human Development Index (r = 0.586; p < 0.001) and the Gross Domestic Product per capita (in Euros) (r = 0.562; p = 0.001). The adjusted linear regression model showed an association of tobacco control policy implementation with countries' geographical location (Western Europe, β = - 15.7; p = 0.009, compared to Northern Europe). In conclusion, no association was found between SES factors and the level of implementation of tobacco control policies in 31 European countries; policymakers should be aware that tobacco control policies could be successfully implemented despite socioeconomic constraints, especially when these policies are of low cost and cost-effective (i.e., smoke-free bans and taxation).},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33858559,

title = {The right to smoke and the right to smoke-free surroundings: international comparison of smoke-free psychiatric clinic implementation experiences},

author = {Freiburghaus T and Raffing R and Ballbè M and Gual A and Tönnesen H},

doi = {10.1192/bjo.2021.35},

issn = {2056-4724},

year  = {2021},

date = {2021-04-01},

journal = {BJPsych Open},

volume = {7},

number = {3},

pages = {e81},

abstract = {BACKGROUND: In Scandinavia, people with a severe mental disorder have a reduced life expectancy of 15-20 years compared with the general public. Smoking is a major contributor, and smoke-free policies are increasingly adopted in psychiatric clinics around the world. We compared potential facilitators and barriers among staff and management, for the implementation of smoke-free psychiatric clinics.nnAIMS: To investigate the attitudes and experiences regarding smoke-free policies among managers and staff involved in the implementation processes of smoke-free psychiatric clinics at hospitals in Malmö (Sweden) and Barcelona (Spain).nnMETHOD: We used a qualitative methodology, with 15 semi-structured interviews. The interviews were conducted with each participant individually, and were subsequently transcribed. The data were analysed with systematic text condensation.nnRESULTS: There were notable differences in how the smoke-free policies were carried out and experienced, and attitudes regarding the policy changes differed in the two settings. Key differences were the views on the right to smoke in compulsory care and to stay in smoke-free surroundings supported by smoking cessation intervention; the prioritisation of staff facilitation of smoking breaks; and views on smoking and smoke-free psychiatry. In contrast, participants agreed on the importance of staff education and management support. A smoking ban by law and belonging to a network of smoke-free hospitals were also relevant.nnCONCLUSIONS: Staff education, and support from staff and management for the patients' right to stay in smoke-free surroundings, facilitated successful implementation of smoke-free policies in the psychiatric clinics, whereas supporting the right to smoke was a barrier.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32594125,

title = {Gaining insight into the implementation of an e-learning smoking cessation course in Latin American countries},

author = {Vides-Porras A and Cáceres P and Company A and Guillen O and Arrien MA and Castellano Y and Margalef M and Yantuche W and Fernández E and Martínez C and Group of Hospital Coordinators in the Fruitful Project},

doi = {10.1093/heapro/daaa054},

issn = {1460-2245},

year  = {2021},

date = {2021-04-01},

journal = {Health Promot Int},

volume = {36},

number = {2},

pages = {349--362},

abstract = {Continuous medical education focused on health problems emerging in low- and middle-income countries (LMICs) is scarce. Although tobacco consumption is increasing in LMICs, there is a lack of tobacco cessation training programs in these countries. To promote smoking cessation interventions in Bolivia, Guatemala and Paraguay, we adapted an e-learning program developed in Catalonia (Spain). This process evaluation study reports on reach, dose and satisfaction of participants with the course, as well as the contextual factors of its application. We conducted a multiple method evaluation, which included a survey and several focus groups, each one specific to the same type of healthcare professional (nurses, doctors, other professionals). Two hundred and ninety-two participants registered into the online course. The motivation for undertaking the course was different between doctors and nurses. The main sources of difficulty in enrolling and finishing the course were the technical problems experienced when accessing the platform, and lack of acquaintance with computers and the Internet in general. Our results show that implementing e-learning education in hospitals from LMICs is feasible, especially when there are similarities between participating countries and the country in which the original program was developed. However, several elements such as strong organizational commitment, technical support and resources and adequate communication channels should be provided to facilitate enrollment and training completion. Efforts to improve Internet access should be made to avoid jeopardizing students' motivation to enroll and complete online training.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33533185,

title = {Tobacco control policies in the 21st century: achievements and open challenges},

author = {Peruga A and López MJ and Martinez C and Fernández E},

doi = {10.1002/1878-0261.12918},

issn = {1878-0261},

year  = {2021},

date = {2021-03-01},

journal = {Mol Oncol},

volume = {15},

number = {3},

pages = {744--752},

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

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33385392,

title = {Toward a correct measure of third-hand exposure},

author = {Lidón-Moyano C and Fu M and Perez-Ortuño R and Ballbè M and Garcia E and Martín-Sánchez JC and Pascual JA and Fernández E and Martínez-Sánchez JM},

doi = {10.1016/j.envres.2020.110686},

issn = {1096-0953},

year  = {2021},

date = {2021-03-01},

journal = {Environ Res},

volume = {194},

pages = {110686},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33278471,

title = {How widespread is electronic cigarette use in outdoor settings? A field check from the TackSHS project in 11 European countries},

author = {Amalia B and Rodríguez A and Henderson E and Fu M and Continente X and Tigova O and Semple S and Clancy L and Gallus S and Fernández E and López MJ and TackSHS Project Investigators},

doi = {10.1016/j.envres.2020.110571},

issn = {1096-0953},

year  = {2021},

date = {2021-02-01},

journal = {Environ Res},

volume = {193},

pages = {110571},

abstract = {Exposure to secondhand aerosol from electronic cigarettes (e-cigarettes) may pose harms to bystanders, but they are used in many indoor settings. Less evidence exists on e-cigarette use in outdoor settings. This study aims to assess the use of e-cigarettes in outdoor settings in Europe. A cross-sectional study was conducted at the entrances of primary schools (N = 200), children's playgrounds (N = 200), and outdoor hospitality venues (N = 220) during 2017-2018 in major cities of 11 European countries. We performed 30-min observations and recorded e-cigarette use at three-time points: at 0 min, 15 min, and 30 min. We described the number and proportion of settings with e-cigarette use observed at any of the three-time points according to country and other contextual variables. Results showed that there were 22 (11.0%) school entrances, eight (4.0%) playgrounds, and 47 (21.3%) outdoor hospitality venues where e-cigarette use was observed at any time point. School entrances and outdoor hospitality venues with observed e-cigarette use were more frequently found in countries with a higher prevalence (≥1.4%) of e-cigarette use (school entrances: 18.0% vs. 4.0%; p = 0.002, outdoor hospitality venues: 26.7% vs. 15.0%, p = 0.036). In conclusion, the outdoor setting with the highest visibility of e-cigarette use was outdoor areas of hospitality venues. Although still limited, e-cigarettes were also used in outdoor settings frequented by children. Governments should consider measures to restrict e-cigarette use outdoors to protect the health of bystanders, particularly in areas where children may be present.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32151468,

title = {Outreach HIV testing using oral fluid and online consultation of the results: Pilot intervention in Catalonia},

author = {Agustí C and Muñoz R and González V and Villegas L and Fibla J and Meroño M and Capitán A and Fernàndez-López L and Platteau T and Casabona J},

doi = {10.1016/j.eimc.2020.01.020},

issn = {2529-993X},

year  = {2021},

date = {2021-01-01},

journal = {Enferm Infecc Microbiol Clin (Engl Ed)},

volume = {39},

number = {1},

pages = {3--8},

abstract = {INTRODUCTION: The aim of the intervention was to describe the feasibility and cost-effectiveness of offering HIV testing in outreach interventions and subsequent consultation of the results through a secure web page.nnMETHODS: The HIV test was offered "in situ" to men who have sex with men (MSM), migrant sex workers and trans women recruited in places of leisure and sex. Four collaborating NGOs recruited the participants and assisted them to register on the study website (www.swab2know.eu) through a tablet or the smartphone of the same participant. The samples were sent to the reference laboratory and the results were published on the website.nnRESULTS: 834 participants (612 MSMs, 203 women sex workers and 19 trans women) were recruited. In total 22 reagent results (2.6%) were detected: 21 among MSMs (3.4%) and 1 in a trans women (5.3%). While 82.6% of MSMs consulted their outcome, only 39.9% and 26.3% of women sex workers and trans women respectively consulted their outcome CONCLUSIONS: Providing self-sampling in outreach activities, dispatch and analysis in a reference laboratory as well as online communication of test results is feasible. A high proportion of participants with a HIV reactive result were detected among MSMs and trans women.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32123139,

title = {Exposure to secondhand aerosol of electronic cigarettes in indoor settings in 12 European countries: data from the TackSHS survey},

author = {Amalia B and Liu X and Lugo A and Fu M and Odone A and van den Brandt PA and Semple S and Clancy L and Soriano JB and Fernández E and Gallus S and TackSHS Project Investigators},

doi = {10.1136/tobaccocontrol-2019-055376},

issn = {1468-3318},

year  = {2021},

date = {2021-01-01},

journal = {Tob Control},

volume = {30},

number = {1},

pages = {49--56},

abstract = {INTRODUCTION: Exposure to secondhand aerosol from e-cigarette (SHA) may pose harmful effects to bystanders. This study aims to investigate the prevalence, duration and determinants of SHA exposure in various indoor settings in 12 European countries.nnMETHODS: In 2017-2018, we conducted a cross-sectional study, the TackSHS survey, on a representative sample of the population aged ≥15 years in 12 European countries (Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania and Spain). We described the prevalence and duration of exposure to SHA in several indoor settings among 11 604 e-cigarette non-users. Individual-level and country-level characteristics associated with SHA exposure were also explored using multilevel logistic regression analyses.nnRESULTS: Overall, 16.0% of e-cigarette non-users were exposed to SHA in any indoor setting at least weekly, ranging from 4.3% in Spain to 29.6% in England. The median duration of SHA exposure among those who were exposed was 43 min/day. 'Other indoor settings' (eg, bar and restaurant) was reported as the place where most of e-cigarette non-users were exposed (8.3%), followed by workplace/educational venues (6.4%), home (5.8%), public transportation (3.5%) and private transportation (2.7%). SHA exposure was more likely to occur in certain groups of non-users: men, younger age groups, those with higher level of education, e-cigarette past users, current smokers, those perceiving SHA harmless and living in countries with a higher e-cigarette use prevalence.nnCONCLUSIONS: We found inequalities of SHA exposure across and within European countries. Governments should consider extending their tobacco smoke-free legislation to e-cigarettes to protect bystanders, particularly vulnerable populations such as young people.nnTRIAL REGISTRATION NUMBER: NCT02928536.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32173050,

title = {[Informed choice in breast cancer screening: the role of education]},

author = {Pons-Rodríguez A and Martínez-Alonso M and Perestelo-Pérez L and Garcia M and Sala M and Rué M and en nombre del grupo InforMa and El grupo InforMa está formado por},

doi = {10.1016/j.gaceta.2020.01.002},

issn = {1578-1283},

year  = {2021},

date = {2021-01-01},

journal = {Gac Sanit},

volume = {35},

number = {3},

pages = {243--249},

abstract = {OBJECTIVE: To evaluate the effect of receiving information about the benefits and harms of breast cancer screening in informed choice, according to educational level.nnMETHOD: Secondary analysis of a randomized, controlled study, in four screening programs, in Catalonia and the Canary Islands (Spain). We analyzed 400 women who were going to be invited to participate for the first time. The intervention group received a decision aid that showed the benefits and harms of screening. The control group received a standard brochure that recommended participating in the screening program. Educational level was grouped into two categories, low and high. The primary outcome was informed choice defined as adequate knowledge and consistency between attitudes and intentions.nnRESULTS: The intervention produced a greater increase in knowledge in women with a high educational level compared to those with a lower educational level. Among women who received the intervention, informed choice was almost three times higher in those with a high educational level (27% versus 11%). No differences were observed between educational levels in decisional conflict, confidence in the decision, anxiety and worry about breast cancer, in the intervention and control groups.nnCONCLUSIONS: A decision aid for breast cancer screening had much more impact on informed choice among women with a high educational level. In women with low educational level, the attitude towards screening improved and there was an increase in the intention to be screened.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}