Publications by authors named "Giuseppe Gorini"

144 Publications

Moderate-severe coronary calcification predicts long-term cardiovascular death in CT lung cancer screening: The ITALUNG trial.

Eur J Radiol 2021 Nov 16;145:110040. Epub 2021 Nov 16.

Clinical Epidemiology and Clinical Governance Support Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy.

Purpose: Coronary artery calcifications (CAC) are very strong indicators for increased cardio-vascular (CV) risk and can be evaluated also in low-dose computed tomography (LDCT) for lung cancer screening. We assessed whether a simple and fast CAC visual score is associated with CV mortality.

Methods: CAC were retrospectively assessed by two observers using a 4-score (absent, mild, moderate and severe) scale in baseline LDCT obtained in 1364 participants to the ITALUNG trial who had 55-69 years of age and a smoking history ≥20 pack-years. Correlations with CV risk factors at baseline and with CV mortality after 11 years of follow-up were investigated.

Results: CAC were absent in 470 (34.5%), mild in 433 (31.7%), moderate in 357 (26.2%) and severe in 104 (7.6%) subjects. CAC severity correlated (≤0.001) with age, male sex, pack-years, history of arterial hypertension or diabetes, obesity and treated hypercholesterolemia. Twenty-one CV deaths occurred. Moderate or severe CAC were significantly associated with higher CV mortality after adjustment for all other known risk factors (ARR = 2.72; 95 %CI:1.04-7.11). Notably, also in subjects with none or one only additional CV risk factor, the presence of moderate-severe CAC allowed to identify a subgroup of subjects with higher CV death risk (RR = 3.66; CI95%:1.06-12.6).

Conclusions: Moderate or severe CAC visually assessed in LDCT examinations for lung cancer screening are independently associated with CV mortality.
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http://dx.doi.org/10.1016/j.ejrad.2021.110040DOI Listing
November 2021

Electronic cigarette use in 12 European countries. Results from the TackSHS survey.

J Epidemiol 2021 Nov 13. Epub 2021 Nov 13.

Consortium for Biomedical Research in Respiratory Diseases (CIBERES).

Background: Limited data on electronic cigarette prevalence, patterns and settings of use are available from several European countries.

Methods: Within the TackSHS project, a face-to-face survey was conducted in 2017-2018 in 12 European countries (Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania and Spain). Overall, 11,876 participants, representative of the population aged ≥15 years in each country, provided information on electronic cigarette.

Results: 2.4% (95% confidence interval, CI: 2.2-2.7) of the subjects (2.5% among men and 2.4% among women; 0.4% among never, 4.4% among current- and 6.5% among ex-smokers) reported current use of electronic cigarette, ranging from 0.6% in Spain to 7.2% in England. Of the 272 electronic cigarette users, 52.6% were dual users (i.e., users of both electronic and conventional cigarettes) and 58.8% used liquids with nicotine. In all, 65.1% reported using electronic cigarette in at least one indoor setting where smoking is forbidden, in particular in workplaces (34.9%), and bars and restaurants (41.5%). Multivariable logistic regression analysis showed that electronic cigarette use was lower among older individuals (p for trend <0.001) and higher among individuals with high level of education (p for trend 0.040). Participants from countries with higher tobacco cigarette prices more frequently reported electronic cigarette use (odds ratio 3.62; 95% CI: 1.80-7.30).

Conclusions: Considering the whole adult population of these 12 European countries, more than 8.3 million people use electronic cigarettes. The majority of users also smoked conventional cigarettes, used electronic cigarettes with nicotine and consumed electronic cigarettes in smoke-free indoor areas.
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http://dx.doi.org/10.2188/jea.JE20210329DOI Listing
November 2021

Italians do it … less. COVID-19 lockdown impact on sexual activity: Evidence from a large representative sample of Italian adults.

J Epidemiol 2021 Oct 9. Epub 2021 Oct 9.

Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri.

Background: To explore how sexual activity was impacted by COVID-19 lockdown measures in the general adult population.

Methods: A cross-sectional survey was conducted on 6,003 Italian adults aged 18-74 years, representative of the Italian general population. Study subjects were recruited at the time of the Nation-wide stay-at-home order (from April 27 to May 3, 2020). We identified characteristics associated to decreased frequency of sex during lockdown, differentiating between cohabiting and non-cohabiting subjects.

Results: Over one third (35.3%) of Italians reported to have changed (8.4% increased and 26.9% decreased) their sexual activity during lockdown. When focusing on cohabitants (N=3,949, 65.8%), decreased sexual activity (20.7%) was more frequently reported by men (22.3%; compared to women, multivariable odds ratio=1.23; 95% confidence interval=1.05-1.44), younger (p for trend <0.001), more educated subjects (p for trend=0.004), subjects living in smaller houses (p for trend=0.003), and those reporting longer time spent outdoor before the lockdown (p for trend <0.001).

Conclusions: COVID-19 lockdown drastically altered people's day-to-day life and is likely to have impacted on lifestyle habits and behavioral risk factors, including sexual attitudes and practice. This is the first national population-level study exploring changes in sexual life in this COVID-19 era. As we report sexual practice to have been affected by lockdown restrictions, we suggest these changes are to be explored beyond imposed social distancing, into mental health, social, and other determinants.
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http://dx.doi.org/10.2188/jea.JE20210055DOI Listing
October 2021

The impact of COVID-19 lockdown on gambling habit: A cross-sectional study from Italy.

J Behav Addict 2021 Jul 20;10(3):711-721. Epub 2021 Jul 20.

1 Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.

Background And Aims: Few preliminary studies have shown an impact of COVID-19 confinement on gambling habits. We aim to evaluate short-term effects of lockdown restrictions on gambling behaviors in Italy.

Methods: Within the project Lost in Italy, a web-based cross-sectional study was conducted on a representative sample of 6,003 Italians aged 18-74 years, enrolled during April 27-May 3 2020, and were asked to report gambling activity before the lockdown and at the time of interview.

Results: The prevalence of participants reporting any gambling decreased from 16.3% before lockdown to 9.7% during lockdown. Traditional gambling decreased from 9.9 to 2.4% and online gambling from 9.9 to 8.0%. Among gamblers, median time of gambling grew from 4.5 to 5.1 h/month. Among non-players before lockdown, 1.1% started playing. Among players before lockdown, 19.7% increased gambling activity. Multivariate analysis showed an increase in gambling activity in younger generations (p for trend = 0.001), current smokers (odds ratio, OR 1.48), users of electronic cigarettes (OR 1.63), heated tobacco products (OR 1.82), cannabis (OR 5.16), psychotropic drugs (OR 3.93), and subjects having hazardous alcohol drinking (OR 1.93). Self-reported low quality of life (OR 1.97), low sleep quantity (OR 2.00), depressive symptoms (OR 3.06) and anxiety symptoms (OR 2.93) were significantly related to an increase in total gambling activity during lockdown.

Discussion And Conclusions: Although gambling substantially decreased during lockdown, time spent in gambling slightly increased. The strong relationship found between compromised mental health and addictive behaviors calls for urgent policies to prevent vulnerable populations from increasing and developing severe gambling addiction.
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http://dx.doi.org/10.1556/2006.2021.00033DOI Listing
July 2021

Design and optimization of an advanced time-of-flight neutron spectrometer for deuterium plasmas of the large helical device.

Rev Sci Instrum 2021 May;92(5):053547

State Key Laboratory of Nuclear Physics and Technology, Peking University, Beijing 100871, China.

A time-of-flight neutron spectrometer based on the Time-Of-Flight Enhanced Diagnostic (TOFED) concept has been designed and is under development for the Large Helical Device (LHD). It will be the first advanced neutron spectrometer to measure the 2.45 MeV D-D neutrons (DDNs) from helical/stellarator plasmas. The main mission of the new TOFED is to study the supra-thermal deuterons generated from the auxiliary heating systems in helical plasmas by measuring the time-of-flight spectra of DDN. It will also measure the triton burnup neutrons (TBNs) from the d+t reactions, unlike the original TOFED in the EAST tokamak. Its capability of diagnosing the TBN ratios is evaluated in this work. This new TOFED is expected to be installed in the basement under the LHD hall and shares the collimator with one channel of the vertical neutron camera to define its line of sight. The distance from its primary scintillators to the equatorial plane of LHD plasmas is about 15.5 m. Based on Monte Carlo simulation by a GEANT4 model, the resolution of the DDN energy spectra is 6.6%. When projected onto the neutron rates that are typically obtained in LHD deuterium plasmas (an order of 10 n/s with neutral beam injection), we expect to obtain the DDN and TBN counting rates of about 2.5 · 10 counts/s and 250 counts/s, respectively. This will allow us to analyze the DDN time-of-flight spectra on time scales of 0.1 s and diagnose the TBN emission rates in several seconds with one instrument, for the first time in helical/stellarator plasmas.
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http://dx.doi.org/10.1063/5.0043766DOI Listing
May 2021

COVID-19 lockdown impact on mental health in a large representative sample of Italian adults.

J Affect Disord 2021 09 4;292:398-404. Epub 2021 Jun 4.

Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.

Background: The potential benefits of the COVID-19 lockdown need to be carefully weighed versus the possible impact on people's daily life and negative mental health effects.We aimed to assess the prevalence of depression, anxiety, insomnia and quality of life before and during the COVID-19 lockdown,identifying subgroups at higher risk of mental distress as a consequence of COVID-19 associated restrictions.

Methods: Within the Lost in Italy project, a web-based cross-sectional study was conducted on a representative sample of 6003 Italian adults aged 18-74 recruited from April 27 to May 3, 2020, within the nation-wide stay-at-home order.

Results: The prevalence of depressive symptoms (PHQ-2 ≥ 3) increased from 14.3% before lockdown to 33.2% during lockdown, anxiety symptoms (GAD-2 ≥ 3) from 18.1% to 41.5%, insufficient sleep (≤6 h/day) from 33.7% to 41.1%, unsatisfactory sleep from 17.0% to 38.8% and unsatisfactory quality of life from 13.1% to 42.1%.Overall, 47.7% reported worsened depressive symptoms, 43.6% worsened anxiety symptoms, sleep quantity (31.5%) and quality (35.0%),and 64.1% worsened quality of life.A statistically significant relationship with all mental health outcomes considered was found for women vs. men (multivariate odds ratio,OR between 1.13 and 1.63), for current vs. never smokers (OR between 1.15 and 1.25), and with increasing physical activity (p for trend<0.001 for all the indicators).The use of at least one psychotropic drug increased by 20% compared to pre-lockdown (from 9.5% to 11.4%).

Conclusions: This is the first cross-sectional study conducted in Italy on a representative sample of adults to testify the huge implications of the lockdown on mental health.
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http://dx.doi.org/10.1016/j.jad.2021.05.117DOI Listing
September 2021

Smoking prevalence among healthcare workers in Italy, PASSI surveillance system data, 2014-2018.

Ann Ist Super Sanita 2021 Apr-Jun;57(2):151-160

Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy.

Introduction: Data on smoking among Italian Health Personnel (HP) from PASSI surveillance system from 2014-2018 were analysed.

Materials And Methods: Among 169,678 working-age respondents, smoking prevalence was estimated among 1,253 Medical Doctors (MDs), 4,840 Non-Medical HP (NMHP), 87,749 Non-HP (NHP) and multivariate analysis was conducted.

Results: Current smokers were 23.0% among HP. Smoking prevalence in MDs (16.0%) was significantly lower than those observed in NMHP (25.3%) and NHP (28.6%). A declining trend was detected in all three groups and was more evident among MDs: from 20.8% in 2014 to 11.5% in 2018. Amongst MDs, smoking was significantly associated with male gender (Adjusted Odds Ratio, AdjOR=1.61), younger age (AdjOR=2.00), residing in South (AdjOR=1.71). Among NMHP, smoking prevalence was associated with low economic condition (AdjOR=1.54) and non-university education.

Discussion And Conclusions: To further reduce smoking in HP, it is necessary to develop specific training courses in educational curricula.
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http://dx.doi.org/10.4415/ANN_21_02_07DOI Listing
June 2021

Secondhand smoke exposure assessment in outdoor hospitality venues across 11 European countries.

Environ Res 2021 09 19;200:111355. Epub 2021 May 19.

Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Universitat Pompeu Fabra, Departament de Ciències Experimentals i de la Salut (DCEXS), Doctor Aiguader, 88, 08003, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain. Electronic address:

Objective: Due to partial or poorly enforced restrictions secondhand tobacco smoke (SHS) is still present in outdoor hospitality venues in many European countries. This study aimed to assess SHS concentrations in outdoor hospitality venues across Europe and identify contextual exposure determinants.

Methods: Cross-sectional study. We measured airborne nicotine and evidence of tobacco use in terraces of bars, cafeterias, and pubs from 11 European countries in 2017-2018. Sites were selected considering area-level socioeconomic indicators and half were visited during nighttime. We noted the smell of smoke, presence of smokers, cigarette butts, ashtrays, and number of physical covers. Contextual determinants included national smoke-free policies for the hospitality sector, the Tobacco Control Scale score (2016), and the national smoking prevalence (2017-2018). We computed medians and interquartile ranges (IQR) of nicotine concentrations and used multivariate analyses to characterize the exposure determinants.

Results: Nicotine was present in 93.6% of the 220 sites explored. Overall concentrations were 0.85 (IQR:0.30-3.74) μg/m and increased during nighttime (1.45 IQR:0.65-4.79 μg/m), in enclosed venues (2.97 IQR:0.80-5.80 μg/m), in venues with more than two smokers (2.79 IQR:1.03-6.30 μg/m), in venues in countries with total indoor smoking bans (1.20 IQR:0.47-4.85 μg/m), and in venues in countries with higher smoking prevalence (1.32 IQR:0.49-5.34 μg/m). In multivariate analyses, nicotine concentrations were also positively associated with the observed number of cigarette butts. In venues with more than two smokers, SHS levels did not significantly vary with the venues' degree of enclosure.

Conclusions: Our results suggest that current restrictions in outdoor hospitality venues across Europe have a limited protective effect and justify the adoption of total smoking bans in outdoor areas of hospitality venues.
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http://dx.doi.org/10.1016/j.envres.2021.111355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8417816PMC
September 2021

Thermal neutron cross sections of amino acids from average contributions of functional groups.

J Phys Condens Matter 2021 May 31;33(28). Epub 2021 May 31.

Università degli Studi di Roma 'Tor Vergata', Dipartimento di Fisica and NAST Centre, Via della Ricerca Scientifica 1, Roma 00133, Italy.

The experimental thermal neutron cross sections of the 20 proteinogenic amino acids have been measured over the incident-neutron energy range spanning from 1 meV to 10 keV and data have been interpreted using the multi-phonon expansion based on first-principles calculations. The scattering cross section, dominated by the incoherent inelastic contribution from the hydrogen atoms, can be rationalised in terms of the average contributions of different functional groups, thus neglecting their correlation. These results can be used for modelling the total neutron cross sections of complex organic systems like proteins, muscles, or human tissues from a limited number of starting input functions. This simplification is of crucial importance for fine-tuning of transport simulations used in medical applications, including boron neutron capture therapy as well as secondary neutrons-emission induced during proton therapy. Moreover, the parametrized neutron cross sections allow a better treatment of neutron scattering experiments, providing detailed sample self-attenuation corrections for a variety of biological and soft-matter systems.
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http://dx.doi.org/10.1088/1361-648X/abfc13DOI Listing
May 2021

Impact of COVID-19 lockdown on smoking consumption in a large representative sample of Italian adults.

Tob Control 2021 Mar 29. Epub 2021 Mar 29.

Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy.

Objectives: Italy is one of the first countries that imposed a nationwide stay-at-home order during the COVID-19 outbreak, inevitably resulting in changes in lifestyles and addictive behaviours. The aim of this work is to investigate the impact of lockdown restrictions on smoking habits using data collected within the Lost in Italy project.

Methods: A web-based cross-sectional study was conducted on a representative sample of 6003 Italian adults aged 18-74 years. Study subjects were recruited from 27 April to 3 May 2020 and were asked to report changes in smoking habits before the lockdown and at the time of interview.

Results: During the lockdown, 5.5% of the overall sample quit or reduced smoking, but 9.0% of the sample started, relapsed smoking or increased their smoking intensity. In total, the lockdown increased cigarette consumption by 9.1%. An improvement in smoking habits was associated with younger age, occasional smoking and unemployment, whereas a worsening was mainly associated with mental distress. In particular, an increase in cigarette consumption during lockdown was more frequently reported among those with worsening quality of life (OR: 2.05; 95% CI: 1.49 to 2.80), reduction in sleep quantity (OR: 2.29; 95% CI: 1.71 to 3.07) and increased anxiety (OR: 1.83; 95% CI: 1.38 to 2.43) and depressive symptoms (OR: 2.04; 95% CI: 1.54 to 2.71).

Conclusions: COVID-19 lockdown had a huge impact on smoking consumption of the Italian general population. The main concern is for smokers who increase their cigarette consumption due to an increased mental distress. Providing greater resources for cessation services capable of reducing mental health symptoms in smokers is urgently needed.
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http://dx.doi.org/10.1136/tobaccocontrol-2020-056440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008911PMC
March 2021

The Role of Novel (Tobacco) Products on Tobacco Control in Italy.

Int J Environ Res Public Health 2021 02 16;18(4). Epub 2021 Feb 16.

Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy.

In Italy, electronic cigarettes have spread since 2010 and heated tobacco products (HTP) since 2016. We investigated their public health consequences on conventional cigarette smoking, taking advantage of a series of cross-sectional studies annually conducted between 2001 and 2019 in Italy. Every year, the sample, including around 3000 individuals, was representative of the general Italian population aged ≥15 years. In Italy, smoking prevalence steadily declined from 29.1% in 2001 to 20.6% in 2013, then increased to 22.0% in 2019. In 2017-2019, current electronic cigarette users were 2.1% and in 2019 current HTP users were 1.1%. Among 498 ever electronic cigarette users, 23.2% started or re-started smoking and 15.7% quit smoking after electronic cigarette use; of 49 ever HTP users, 19.1% started or re-started smoking combusted cigarettes and 14.6% quit smoking after HTP use. The availability of novel products in Italy resulted in a halt of the decreasing trend in smoking prevalence. For the first time, we observed an increase of Italians inhaling nicotine, concurrently with the spread of novel (tobacco) products. More importantly, the use of novel products appears to increase-rather than decrease-the likelihood of smoking conventional cigarettes. Considering this evidence, we see no argument to justify the huge fiscal and regulatory benefits these products continue to have, at least in Italy.
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http://dx.doi.org/10.3390/ijerph18041895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920305PMC
February 2021

Morbidity Attributable to Second-Hand Smoke in European Children.

Arch Bronconeumol (Engl Ed) 2021 Jan 27. Epub 2021 Jan 27.

Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy.

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http://dx.doi.org/10.1016/j.arbres.2021.01.003DOI Listing
January 2021

Detector Response to D-D Neutrons and Stability Measurements with 4H Silicon Carbide Detectors.

Materials (Basel) 2021 Jan 26;14(3). Epub 2021 Jan 26.

Dipartimento di Fisica "G. Occhialini", Università di Milano-Bicocca, 20126 Milano, Italy.

The use of wide-band-gap solid-state neutron detectors is expanding in environments where a compact size and high radiation hardness are needed, such as spallation neutron sources and next-generation fusion machines. Silicon carbide is a very promising material for use as a neutron detector in these fields because of its high resistance to radiation, fast response time, stability and good energy resolution. In this paper, measurements were performed with neutrons from the ISIS spallation source with two different silicon carbide detectors together with stability measurements performed in a laboratory under alpha-particle irradiation for one week. Some consideration to the impact of the casing of the detector on the detector's counting rate is given. In addition, the detector response to Deuterium-Deuterium (D-D) fusion neutrons is described by comparing neutron measurements at the Frascati Neutron Generator with a GEANT4 simulation. The good stability measurements and the assessment of the detector response function indicate that such a detector can be used as both a neutron counter and spectrometer for 2-4 MeV neutrons. Furthermore, the absence of polarization effects during neutron and alpha irradiation makes silicon carbide an interesting alternative to diamond detectors for fast neutron detection.
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http://dx.doi.org/10.3390/ma14030568DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7866174PMC
January 2021

USE AND AWARENESS OF HEATED TOBACCO PRODUCTS IN EUROPE.

J Epidemiol 2021 Jan 16. Epub 2021 Jan 16.

Institut Català d'Oncologia, L'Hospitalet de Llobregat.

Background Heated tobacco products (HTP) are new forms of tobacco consumption with limited information available on their use among the general population. Our objective is to analyse the prevalence and associations of use of HTP across 11 countries in Europe.Methods Within the TackSHS Project, in 2017-2018 we conducted a cross-sectional study with information on HTP use in the following countries: Bulgaria, England, France, Germany, Greece, Italy, Latvia, Poland, Portugal, Romania and Spain. In each country, face-to-face interviews were performed on a representative sample of around 1,000 subjects aged ≥15 years, for a total of 10,839 subjects.Results Overall, 27.8% of study participants were aware of HTPs, 1.8% were ever HTP users (ranging from 0.6% in Spain to 8.3% in Greece), and 0.1% were current users. Men were more frequently HTP ever users than women (adjusted odds ratio, aOR=1.47; 95% confidence interval, CI: 1.11-1.95). Ever HTP use was inversely related to age (p for trend<0.001) and more frequent in ex-smokers (compared with never smokers, aOR=4.32, 95% CI: 2.69-6.95) and current smokers (aOR=8.35, 95% CI: 5.67-12.28), and in electronic cigarette past users (compared with never users, aOR=5.48, 95% CI: 3.46-8.68) and current users (aOR=5.92, 95% CI: 3.73-9.40).Conclusions In 2017-2018, HTP use was still limited in Europe among the general population, however the dual use of these products, their high use among younger generations and the interest of non-smokers in these products are worrying and indicate the need for close monitoring in terms of prevalence and the characteristics of users.
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http://dx.doi.org/10.2188/jea.JE20200248DOI Listing
January 2021

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.

Prev Med 2021 04 31;145:106412. Epub 2020 Dec 31.

Oncologic network, prevention and research institute (ISPRO), Florence, Italy.

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.
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http://dx.doi.org/10.1016/j.ypmed.2020.106412DOI Listing
April 2021

The "Polonium In Vivo" Study: Polonium-210 in Bronchial Lavages of Patients with Suspected Lung Cancer.

Biomedicines 2020 Dec 23;9(1). Epub 2020 Dec 23.

Oncologic Network, Prevention and Research Institute (ISPRO), 50139 Florence, Italy.

Few studies have reported on polonium-210, a decay breakdown product of radon-222 and lead-210, in human lungs and there has been no study in patients with suspected lung cancer. The main aim of this "Polonium in vivo" study was to evaluate polonium-210 radioactivity in bronchopulmonary systems of smoker, ex-smoker and never smoker patients with suspected lung cancer. Alpha-spectrometric analyses were performed on bronchial lavage (BL) fluids from two Italian hospitals in 2013-2016. Socio-demographic, smoking, occupational and spirometric characteristics, lung cancer confirmation and histologic type and radon-222 concentration in patients' homes were collected. Seventy BL samples from never ( 13), former ( 35) and current smokers ( 22) were analyzed; polonium-210 was detected in all samples from current and former smokers and in 54% of samples from never smokers ( < 0.001; median values: 1.20, 1.43 and 0.40 mBq, respectively). Polonium-210 levels were significantly higher in COPD versus no COPD patients (median value: 3.60 vs. 0.97 mBq; = 0.007); former and current smokers, without and with COPD, had significantly increased polonium-210 levels ( = 0.012); 96% of confirmed versus 69% of non-confirmed lung cancer patients recorded detectable polonium-210 levels ( = 0.018). A polonium-210 detectable activity was measured in BL samples from all current and former smokers. Polonium-210 in the lungs could be the result of lead-210 entrapment, which, with its half-life of 22 years, could provide a continuous emission of alpha radioactivity, even many years after quitting, thus proposing a possible explanation for the onset of lung cancer, particularly in former smokers.
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http://dx.doi.org/10.3390/biomedicines9010004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822435PMC
December 2020

National burden of cancer in Italy, 1990-2017: a systematic analysis for the global burden of disease study 2017.

Sci Rep 2020 12 16;10(1):22099. Epub 2020 Dec 16.

Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.

We monitored the burden of cancer in Italy and its trends over the last three decades, providing estimates of cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs), for cancer overall and 30 cancer sites using data from the Global Burden of Disease study 2017. An overview of mortality trends between 1990 and 2017 was also provided. In 2017, there were 254,336 new cancer cases in men and 214,994 in women, corresponding to an age-standardized incidence rate (ASIR) of 438 and 330/100,000, respectively. Between 1990 and 2017, incident cancer cases, and, to a lesser extent, ASIRs significantly increased overall and for almost all cancer sites, but ASIRs significantly declined for lung and other tobacco-related neoplasms. In 2017, there were 101,659 cancer deaths in men (age-standardized death rate, ASDR, 158.5/100,000) and 78,918 in women (ASDR 93.9/100,000). Cancer deaths significantly increased between 1990 and 2017 (+ 18%), but ASDR significantly decreased (- 28%). Deaths significantly increased for many cancer sites, but decreased for stomach, esophageal, laryngeal, Hodgkin lymphoma, and testicular cancer. ASDRs significantly decreased for most neoplasms, with the main exceptions of cancer of the pancreas and uterus, and multiple myeloma. In 2017, cancer caused 3,204,000 DALYs. Between 1990 and 2017, DALYs and age-standardized DALY rates significantly declined (-3.4% and -33%, respectively). Age-standardized mortality rates in Italy showed favorable patterns over the last few decades. However, the absolute number of cancer cases and, to a lower extent, of cancer deaths increased likely due to the progressive ageing of the population, this calling for a continuous effort in cancer prevention, early diagnosis, and treatment.
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http://dx.doi.org/10.1038/s41598-020-79176-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744506PMC
December 2020

Secondhand smoke exposure in outdoor children's playgrounds in 11 European countries.

Environ Int 2021 04 20;149:105775. Epub 2020 Nov 20.

Agència de Salut Pública de Barcelona, Barcelona, Spain; Departament de Ciències Experimentals i de la Salut (DCEXS), Universitat Pompeu Fabra, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Barcelona, Spain. Electronic address:

Introduction: Tobacco presence in outdoor children's playgrounds is concerning not only because it leads to secondhand smoke (SHS) exposure, but also cigarette butt pollution and tobacco normalization.

Objectives: This study aimed to assess SHS exposure in children's playgrounds, according to area-level socioeconomic status (SES), smoke-free regulations, national smoking prevalence, and SHS exposure prevalence in playgrounds (2017-2018).

Methods: We monitored vapor-phase nicotine concentration and tobacco-related variables in 20 different playgrounds in 11 European countries (n = 220 measurements) from March 2017 to April 2018. Playgrounds were selected according to area-level SES. Data on the number of people smoking, and cigarette butts inside the playground and on playground surroundings (<1 m away) were recorded. Playground smoking bans, the Tobacco Control Scale (TCS) score, national smoking prevalence and SHS exposure prevalence in playgrounds were used to group countries. To determine nicotine presence, we dichotomized concentrations using the limit of quantification as a cut-off point (0.06 μg/m). Nicotine median concentrations were compared using non-parametric tests, and nicotine presence and tobacco-related observational variables using the Chi-squared test.

Results: Airborne nicotine presence was found in 40.6% of the playgrounds. Median nicotine concentration was <0.06 μg/m (Interquartile range: <0.06-0.125) and higher median concentrations were found in more deprived neighborhoods, non-regulated playgrounds, in countries with lower overall TCS scores, higher national smoking prevalence and higher SHS exposure prevalence in playgrounds. Overall, people were smoking in 19.6% of the playgrounds. More than half of playgrounds had cigarette butts visible inside (56.6%) and in the immediate vicinity (74.4%). Presence of butts inside playgrounds was higher in sites from a low area-level SES, in countries with low TCS scores, and greater smoking prevalence and SHS exposure prevalence (p<0.05).

Conclusions: There is evidence of SHS exposure in children's playgrounds across Europe. These findings confirm the need for smoking bans in playgrounds and better enforcement in those countries with smoking bans in playgrounds.
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http://dx.doi.org/10.1016/j.envint.2020.105775DOI Listing
April 2021

Advance care planning in patients with advanced cancer: A 6-country, cluster-randomised clinical trial.

PLoS Med 2020 11 13;17(11):e1003422. Epub 2020 Nov 13.

University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia.

Background: Advance care planning (ACP) supports individuals to define, discuss, and record goals and preferences for future medical treatment and care. Despite being internationally recommended, randomised clinical trials of ACP in patients with advanced cancer are scarce.

Methods And Findings: To test the implementation of ACP in patients with advanced cancer, we conducted a cluster-randomised trial in 23 hospitals across Belgium, Denmark, Italy, Netherlands, Slovenia, and United Kingdom in 2015-2018. Patients with advanced lung (stage III/IV) or colorectal (stage IV) cancer, WHO performance status 0-3, and at least 3 months life expectancy were eligible. The ACTION Respecting Choices ACP intervention as offered to patients in the intervention arm included scripted ACP conversations between patients, family members, and certified facilitators; standardised leaflets; and standardised advance directives. Control patients received care as usual. Main outcome measures were quality of life (operationalised as European Organisation for Research and Treatment of Cancer [EORTC] emotional functioning) and symptoms. Secondary outcomes were coping, patient satisfaction, shared decision-making, patient involvement in decision-making, inclusion of advance directives (ADs) in hospital files, and use of hospital care. In all, 1,117 patients were included (442 intervention; 675 control), and 809 (72%) completed the 12-week questionnaire. Patients' age ranged from 18 to 91 years, with a mean of 66; 39% were female. The mean number of ACP conversations per patient was 1.3. Fidelity was 86%. Sixteen percent of patients found ACP conversations distressing. Mean change in patients' quality of life did not differ between intervention and control groups (T-score -1.8 versus -0.8, p = 0.59), nor did changes in symptoms, coping, patient satisfaction, and shared decision-making. Specialist palliative care (37% versus 27%, p = 0.002) and AD inclusion in hospital files (10% versus 3%, p < 0.001) were more likely in the intervention group. A key limitation of the study is that recruitment rates were lower in intervention than in control hospitals.

Conclusions: Our results show that quality of life effects were not different between patients who had ACP conversations and those who received usual care. The increased use of specialist palliative care and AD inclusion in hospital files of intervention patients is meaningful and requires further study. Our findings suggest that alternative approaches to support patient-centred end-of-life care in this population are needed.

Trial Registration: ISRCTN registry ISRCTN63110516.
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http://dx.doi.org/10.1371/journal.pmed.1003422DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7665676PMC
November 2020

Burden of disease from exposure to secondhand smoke in children in Europe.

Pediatr Res 2021 07 4;90(1):216-222. Epub 2020 Nov 4.

Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy.

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.

Methods: 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.

Results: 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.

Conclusions: 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.

Impact: 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.
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http://dx.doi.org/10.1038/s41390-020-01223-6DOI Listing
July 2021

Italian pool of asbestos workers cohorts: asbestos related mortality by industrial sector and cumulative exposure.

Ann Ist Super Sanita 2020 Jul-Sep;56(3):292-302

Dipartimento di Biologia e Biotecnologie "Charles Darwin", La Sapienza Università di Roma, Rome, Italy.

Objective: Italy has been a large user of asbestos and asbestos containing materials until the 1992 ban. We present a pooled cohort study on long-term mortality in exposed workers.

Methods: Pool of 43 Italian asbestos cohorts (asbestos cement, rolling stock, shipbuilding, glasswork, harbors, insulation and other industries). SMRs were computed by industrial sector for the 1970-2010 period, for the major causes, using reference rates by age, sex, region and calendar period.

Results: The study included 51 801 subjects (5741 women): 55.9% alive, 42.6% died (cause known for 95%) and 1.5% lost to follow-up. Asbestos exposure was estimated at the plant and period levels. Asbestos related mortality was significantly increased. All industrial sectors showed increased mortality from pleural malignancies, and most also from peritoneal and lung cancer and asbestosis, with exposure related trend. Increased mortality was also observed for ovarian cancer and for bladder cancer.

Discussion: The study confirmed the increased risk for cancer of the lung, ovary, pleura and peritoneum but not of the larynx and the digestive tract. A large increase in mortality from asbestosis was observed.
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http://dx.doi.org/10.4415/ANN_20_03_07DOI Listing
September 2021

What is the face of new nicotine users? 2012-2018 e-cigarettes and tobacco use among young students in Italy.

Int J Drug Policy 2020 Sep 16;86:102941. Epub 2020 Sep 16.

Epidemiology and Health Research Lab, Institute of Clinical Physiology, National Research Council of Italy (IFC-CNR), Pisa, Italy. Electronic address:

Background: With increased use of electronic-nicotine delivery devices (e-cigarettes) and non-cigarettes tobacco products (heated tobacco products, shisha, moist snuff/snus) among adolescents, the percentage of Italian students who use nicotine products is at its highest level of the past ten years, even though prevention and anti-smoking policies have produced tangible results in decreasing tobacco smoking prevalence. This cross-sectional study examined trends in exclusive and dual smoking, identified new poly-consumption patterns and profiled old and new nicotine users.

Methods: We used the annual cross-sectional ESPAD® Italia survey which sampled students (aged 15-19), currently used for surveillance and monitoring of at risk population, between 2012 and 2018 (N = 170,974) to describe Italian trends in exclusive cigarette, exclusive vaping, and dual cigarette and vaping use. . For the 2018 sample, patterns of poly-consumption were described, and a multinomial logistic regression (N = 15,732) estimated characteristics associated with exclusive and dual cigarette and vaping use.

Results: The lifetime prevalence of cigarette smokers slightly decreased from 60.9% in 2012 to 56.9% in 2018, whereas the proportion of vaping users substantially increased from 32.9% in 2013 to 52.0% in 2018. Combining cigarette and vaping use, these trends result in an increase in the lifetime prevalence of any use from 60.8% in 2013 to 66.2% in 2018. Three out of every 10 minors have experienced smoking and/or vaping, and younger students were more prone to be dual users. Overall, current vapers were generally less prone to risky behaviours.

Conclusion: In contrast to a slight decrease in cigarette smoking, the prevalence of Italian students approaching old and/or new smoking habits in their lifetime is substantially increasing. The popularity of alternative nicotine-based products, particularly e-cigarettes, has increased among teenagers, resulting in a summation of usage patterns rather than a compensation, and attracting a novel slice of young users. The lack of regulation within current drug policy to limit the access to such licit psychoactive substance use, is urgently needed to avoid a future nicotine addicted population.
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http://dx.doi.org/10.1016/j.drugpo.2020.102941DOI Listing
September 2020

Covid-19 and the role of smoking: the protocol of the multicentric prospective study COSMO-IT (COvid19 and SMOking in ITaly).

Acta Biomed 2020 08 27;91(3):e2020062. Epub 2020 Aug 27.

Ospedale Vito Fazzi, Lecce.

The emergency caused by Covid-19 pandemic raised interest in studying lifestyles and comorbidities as important determinants of poor Covid-19 prognosis. Data on tobacco smoking, alcohol consumption and obesity are still limited, while no data are available on the role of e-cigarettes and heated tobacco products (HTP). To clarify the role of tobacco smoking and other lifestyle habits on COVID-19 severity and progression, we designed a longitudinal observational study titled COvid19 and SMOking in ITaly (COSMO-IT). About 30 Italian hospitals in North, Centre and South of Italy joined the study. Its main aims are: 1) to quantify the role of tobacco smoking and smoking cessation on the severity and progression of COVID-19 in hospitalized patients; 2) to compare smoking prevalence and severity of the disease in relation to smoking in hospitalized COVID-19 patients versus patients treated at home; 3) to quantify the association between other lifestyle factors, such as e-cigarette and HTP use, alcohol and obesity and the risk of unfavourable COVID-19 outcomes. Socio-demographic, lifestyle and medical history information will be gathered for around 3000 hospitalized and 700-1000 home-isolated, laboratory-confirmed, COVID-19 patients. Given the current absence of a vaccine against SARS-COV-2 and the lack of a specific treatment for -COVID-19, prevention strategies are of extreme importance. This project, designed to highly contribute to the international scientific debate on the role of avoidable lifestyle habits on COVID-19 severity, will provide valuable epidemiological data in order to support important recommendations to prevent COVID-19 incidence, progression and mortality.
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http://dx.doi.org/10.23750/abm.v91i3.10373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716969PMC
August 2020

[Smoking in cars and motorcycles in Italy over the last decade].

Epidemiol Prev 2020 Jul-Aug;44(4):280-287

Dipartimento di ambiente e salute, Istituto di ricerche farmacologiche Mario Negri IRCCS, Milano.

Objectives: to estimate the prevalence of smoking while driving a car or a motorcycle, and its determinants, and to analyze the trends of these habits before and after the transposition of the European Directive 40/2014 (Legislative Decree 6/2016) adopted in 2016, which bans smoking in cars in the presence of minors.

Design: eight different population-based surveys conducted in Italy by Doxa between 2007 and 2018.

Setting And Participants: 21,807 subjects aged >=18 years, representative of the Italian adult population.

Main Outcome Measures: prevalence of smokers who smoke while driving a car, with and without minors, or a motorcycle. Prevalence of non-smokers exposed to second-hand smoke (SHS) in cars, with or without minors. Estimate of multivariate odds ratios (ORs) and 95% confidence intervals (CIs), using multiple logistic regression models adjusted by gender, age, education, geographic area, and year of survey.

Results: the prevalence of smokers who smoked in cars decreased from 69.6% in 2007-2008 to 57.5% in 2016, and to 51.5% in 2017-2018. Those who smoked in cars in presence of minors were 20.9% in 2011-2012 and 11.7% in 2017-2018. The prevalence of smokers who smoked while driving a motorcycle decreased from 15.0% in 2007-2008 to 6.5% in 2017-2018. Smoking while driving a car in presence of minors decreased with increasing age (p=0.004) and education level (p=0.029) and was more frequent in Southern than in Northern Italy (OR 4.40; 95%CI 2.21-8.74). In 2017-2018, 16.2% of non-smokers reported being exposed to SHS in cars. Of these, 42.3% were exposed also in presence of minors.

Conclusions: the tobacco control legislations adopted over the last 15 years, in particular the last one adopted in 2016, have largely contributed in reducing smoking in private vehicles, even in the presence of minors. This notwithstanding, 50% of Italian smokers smoke while driving and more than 15% of non-smokers are exposed to SHS in cars. It is suggested to adopt informative campaigns that inform people about the risks associated with smoking in cars, both for drivers and for passengers, and to increase the fines for those who smoke in cars in the presence of minors or driving a motorcycle.
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http://dx.doi.org/10.19191/EP20.4.P280.058DOI Listing
June 2021

[Smoking initiation in Italian regions, 2014, and Regional Prevention Plans].

Epidemiol Prev 2020 Jul-Aug;44(4):271-279

Ministero della salute, Roma.

Objectives: to evaluate smoking prevalence in adolescents by Italian region from the Health Behaviour Study in School-aged Children (HBSC) of 2014 and to correlate it with the presence, in the 2014-2018 Regional Prevention Plans (PRPs), of school-based smoking prevention interventions.

Setting And Participants: the 2014 HBSC surveillance system provided data on 48,000 adolescents aged 11, 13, and 15 years; Ministry of Health provided data for each PRP on interventions with a tobacco control component and, among them, school-based smoking prevention interventions.

Main Outcome Measures: weekly smoking prevalence; proportion of school-based smoking prevention interventions out of prevention interventions with tobacco control measures.

Results: regions with the highest weekly smoking prevalence were Sardinia and Apulia for all age groups, Abruzzo for 11- and 15-year-old children, Basilicata for 15-year-old children, Bolzano for girls aged 13 years old; Liguria for females, Molise, Calabria, and Veneto for males. In the regions with the highest prevalence of smoking in 2014, in girls aged 11 and 13 years (Sardinia, Apulia, Basilicata, Liguria, Bolzano), a greater proportion of school-based smoking prevention interventions to be developed in the period 2014-2018 have been recorded.

Conclusions: smoking prevalence in Italian adolescents is high, especially in 15-year-old children. Implementing policies recommended by the World Health Organization - Framework Convention on Tobacco Control (higher tobacco taxes, anti-tobacco mass media campaigns, plain tobacco package) could work synergistically with school-based interventions in order to decrease tobacco initiation among adolescents in Italy.
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http://dx.doi.org/10.19191/EP20.4.P271.057DOI Listing
June 2021

Secondhand smoke exposure and other signs of tobacco consumption at outdoor entrances of primary schools in 11 European countries.

Sci Total Environ 2020 Nov 7;743:140743. Epub 2020 Jul 7.

Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023 Barcelona, Spain; Universitat Pompeu Fabra, Departament de Ciències Experimentals i de la Salut (DCEXS), Doctor Aiguader, 88, 08003 Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029 Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain. Electronic address:

Introduction: Although smoking restrictions at child-related settings are progressively being adopted, school outdoor entrances are neglected in most smoke-free policies across Europe.

Objectives: To describe secondhand smoke (SHS) exposure and tobacco-related signs in outdoor entrances of primary schools in Europe according to area-level socioeconomic status (SES), smoke-free policy, national smoking prevalence, and geographical region.

Methods: In this cross-sectional study we monitored vapor-phase nicotine concentrations at 220 school outdoor entrances in 11 European countries (March 2017-October 2018). To account for nicotine presence, we used the laboratory's limit of quantification of 0.06 μg/m as point threshold. We also recorded the presence of smell of smoke, people smoking, cigarette butts, and ashtrays. Half of the schools were in deprived areas. We grouped countries according to their Tobacco Control Scale (TCS) score, smoking prevalence (2017-2018), and United Nations M49 geographical region.

Results: There were detectable levels of nicotine in 45.9% of the outdoor entrances, in 29.1% smell of smoke, in 43.2% people smoking, in 75.0% discarded butts, and in 14.6% ashtrays. Median nicotine concentration was below the laboratory's limit of quantification <0.06 μg/m (Interquartile range:<0.06-0.119). We found higher SHS levels in countries with lower TCS scores, higher national smoking prevalence, and in the Southern and Eastern European regions. People smoking were more common in schools from lower area-level SES and in countries with lower TCS scores (p<0.05).

Conclusions: Smoking at school outdoor entrances is a source of SHS exposure in Europe. These findings support the extension of smoking bans with a clear perimeter to the outdoor entrances of schools.
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http://dx.doi.org/10.1016/j.scitotenv.2020.140743DOI Listing
November 2020

COVID-19 lockdown impact on lifestyle habits of Italian adults.

Acta Biomed 2020 07 20;91(9-S):87-89. Epub 2020 Jul 20.

Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.

In March 2020, when the Government imposed nation-wide lockdown measures to contrast the COVID-19 outbreak, the life of Italians suddenly changed. In order to evaluate the impact of lockdown on lifestyle habits and behavioral risk factors of the general adult population in Italy, we set up the Lost in Italy (LOckdown and lifeSTyles IN ITALY) project. Within this project, the online panel of Doxa was used to conduct a web-based cross-sectional study during the first phase of the lockdown, on a large representative sample of adults aged 18-74 years (N=6003). The self-administered questionnaire included information on lifestyle habits and perceived physical and mental health, through the use of validated scales. As we are working within the Lost in Italy project, we got two additional grants to further research on the medium-term impact of lockdown, a topic of great interest and with anticipated large socio-economic and public health implications. In details: we obtained by the AXA Research Fund support to evaluate the impact of COVID-19 lockdown on physical, mental, and social wellbeing of elderly and fragile populations in the Lombardy region, the area most heavily hit by the pandemic in the country. Moreover, as a fruitful integration, we obtained support by the Directorate General for Welfare of the region to assess health services delivery and access to healthcare in the same study population, combining an analysis of administrative databases with an economic analysis. We are confident that the solid background of our partners, the multi-disciplinary competencies they bring, together with appropriate funding and access to rich data sources will allow us to fulfill our research objectives.
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http://dx.doi.org/10.23750/abm.v91i9-S.10122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023096PMC
July 2020

No double-edged sword and no doubt about the relation between smoking and COVID-19 severity.

Eur J Intern Med 2020 07 13;77:33-35. Epub 2020 Jun 13.

Oncologic network, prevention and research Institute (ISPRO), Florence, Italy.

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http://dx.doi.org/10.1016/j.ejim.2020.06.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293499PMC
July 2020

Lung function changes in patients with chronic obstructive pulmonary disease (COPD) and asthma exposed to secondhand smoke in outdoor areas.

J Asthma 2021 09 22;58(9):1169-1175. Epub 2020 May 22.

TobaccoFree Research Institute Ireland, Focas Research Institute, DIT, Dublin, Ireland.

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).

Methods: 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.

Results: 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.

Conclusion: 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.
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http://dx.doi.org/10.1080/02770903.2020.1766062DOI Listing
September 2021

Tobacco smoking and COVID-19 pandemic: old and new issues. A summary of the evidence from the scientific literature.

Acta Biomed 2020 May 11;91(2):106-112. Epub 2020 May 11.

Oncologic network, prevention and research Institute (ISPRO), Florence, Italy .

Introduction: COVID-19 pandemic burst onto the international scene as a new disease not affecting patients uniformly; hence it has risen many questions yet to be clarified. The aim of this study was to outline the main issues that led tobacco smoking being discussed as a potential risk factor associated with COVID-19.

Methods: articles from MEDLINE and pre-prints published from January to April 2020 were identified.

Results: data from China showed that men had more severe outcomes of COVID-19 than women. Since smoking prevalence is very high among Chinese men in comparison to women, it was hypothesized that smoking could be a risk factor for poor prognosis. This was also supported by the higher prevalence of comorbidities, many of which are tobacco-related diseases, in patients with severe COVID-19, who were also more likely to have a smoking history. A meta-analysis confirmed these results reporting an OR=2.25 (95% CI: 1.49-3.39) for developing severe Covid-19 among patients with a smoking history. Some authors, noticing that reported smoking prevalence among hospitalized patients was substantially below smoking prevalence in the corresponding populations, speculated a protective role of nicotine. However, it is likely that low prevalence among hospitalized patients are partially due to many smokers misclassified as nonsmokers. Tobacco smoking seems to cause a dose-dependent upregulation of the angiotensin-converting- enzyme-2 (ACE2), the virus cellular entry receptor, which could explain the higher risk of severe COVID-19 in smokers.

Conclusions: There is need for further independent studies to clarify the role of smoking on COVID-19 incidence, progression and mortality.
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http://dx.doi.org/10.23750/abm.v91i2.9698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569632PMC
May 2020
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