[PAPPS expert group: Lifestyle recommendations]. / Recomendaciones sobre el estilo de vida. Actualización PAPPS 2022.

We present the recommendations of the Preventive Activities and Health Promotion Programme (PAPPS) of the semFYC (Spanish Society of Family and Community Medicine) to promote healthy lifestyles using intervention methodology, and preventive actions against tobacco and alcohol use, healthy eating, physical activity in leisure time, prevention of traffic accidents, and child restraint systems. The recommendations have been updated, and new aspects highlighted, such as the definition of low-risk alcohol consumption, and the references have been updated. For the main recommendations, we include specific tables showing the quality of the evidence and the strength of the recommendation.

Cribado e intervención breve en consumo de alcohol / Screening and brief intervention on alcohol consumption

La morbilidad asociada al consumo de alcohol incluye patología digestiva, psiquiátrica, neurológica, infecciosa, cáncer de diversos tipos, enfermedades cardiovasculares, lesiones intencionales, no intencionales, patología social y problemas familiares. Las evidencias más recientes no indican que el consumo «moderado» sea beneficioso para la salud. Por lo tanto, debe enfatizarse más bien la idea de evitar los consumos de riego y transmitir a los pacientes que lo más beneficioso para la salud sería no consumir alcohol o hacerlo en dosis de bajo riesgo. El instrumento más adecuado de cribado es el AUDIT-C. Las bases de la intervención breve consisten en estrategias cognitivo-conductuales y motivacionales. Hay que dar una información positiva sobre los beneficios de la moderación e informar sobre el peligro de la ingesta de alcohol. En fases precoces de la dependencia se contempla la oferta de tratamiento farmacológico de desintoxicación, deshabituación y seguimiento. Los casos más graves requieren coordinación con los servicios de adicciones. En España se ha podido comprobar que la intervención breve es efectiva y que disminuye el consumo 100 gramos de alcohol a la semana. Las estrategias comunitarias son el marco normativo adecuado para lograr los mejores resultados de la intervención breve. Estas deberán ir encaminadas a reducir la oferta y la disponibilidad para el consumo, mediante la adopción de medidas legislativas, de manera que se limite tanto la accesibilidad económica como la física. Por otra parte, habrá que implementar medidas para disminuir la demanda del alcohol mediante la educación para la salud a determinados grupos de riesgo.(AU)

Morbidity associated with alcohol consumption includes digestive, psychiatric, neurological, infectious disease, cancers of various types, cardiovascular disease, intentional injuries, unintentional injuries, social pathology, and family problems. The most recent evidence does not indicate that “moderate” consumption is beneficial to health. The most recent evidence indicates that “moderate” consumption is not beneficial to health. Therefore, the emphasis should be placed on avoiding risky drinking and advising patients that it would be in their best health interest to avoid alcohol or to drink alcohol at low-risk doses. The AUDIT-C is the most appropriate screening instrument. Cognitive-behavioural and motivational strategies form the basis of brief intervention. Positive information about the benefits of moderation and information about the dangers of alcohol intake should be given. In early stages of dependence, pharmacological treatment for detoxification, withdrawal and follow-up is considered. More serious cases require coordination with addiction services. In Spain, BI has proven effective and to reduce alcohol consumption by 100g/week. Community strategies are the appropriate policy framework to achieve the best results from brief intervention. They should aim to reduce the supply and availability for consumption by adopting legislative measures to limit both economic and physical accessibility. Furthermore, measures should be implemented to reduce the demand for alcohol through health education for specific risk groups.(AU)

[Screening and brief intervention on alcohol consumption]. / Cribado e intervención breve en consumo de alcohol.

Morbidity associated with alcohol consumption includes digestive, psychiatric, neurological, infectious disease, cancers of various types, cardiovascular disease, intentional injuries, unintentional injuries, social pathology, and family problems. The most recent evidence does not indicate that "moderate" consumption is beneficial to health. The most recent evidence indicates that "moderate" consumption is not beneficial to health. Therefore, the emphasis should be placed on avoiding risky drinking and advising patients that it would be in their best health interest to avoid alcohol or to drink alcohol at low-risk doses. The AUDIT-C is the most appropriate screening instrument. Cognitive-behavioural and motivational strategies form the basis of brief intervention. Positive information about the benefits of moderation and information about the dangers of alcohol intake should be given. In early stages of dependence, pharmacological treatment for detoxification, withdrawal and follow-up is considered. More serious cases require coordination with addiction services. In Spain, BI has proven effective and to reduce alcohol consumption by 100g/week. Community strategies are the appropriate policy framework to achieve the best results from brief intervention. They should aim to reduce the supply and availability for consumption by adopting legislative measures to limit both economic and physical accessibility. Furthermore, measures should be implemented to reduce the demand for alcohol through health education for specific risk groups.

Los productos de tabaco calentado: nuevo reto en el control del tabaco / Tobacco heated products: a new challenge in tobacco control

Con las ventas de cigarrillos disminuyendo, la industria del tabaco se ha encomendado a la venta de los productos de tabaco calentado (PTC), cuyas ventas están aumentando. Hemos visto con preocupación informaciones que indican erróneamente que el tabaco calentado se asocia a un menor riesgo de cáncer y otras enfermedades que los cigarrillos convencionales, citando a la Food and Drug Administration (FDA) de los Estados Unidos como fuente. Es cierto que la FDA ha autorizado la venta de un PTC, pero niega que esta aprobación suponga un apoyo al producto o indique que este sea inocuo. Philip Morris pidió a la FDA que su PTC fuera aprobado como un producto de tabaco de «riesgo modificado», pero la Agencia negó que el riesgo para la salud de las personas usuarias fuese menor que el de los cigarrillos convencionales, a pesar de emitir menos cantidad de algunos tóxicos. España y la Unión Europea deberían acabar con los privilegios regulatorios de los que disfrutan los PTC. Identificamos por lo menos cinco aspectos que deben mejorarse: 1) el cumplimiento de la prohibición de su uso donde está prohibido fumar; 2) el control de la prohibición de publicidad, promoción y patrocinio de los PTC; 3) que los PTC lleven el mismo tipo de etiquetado que los cigarrillos; 4) limitar que los PTC tengan aromas característicos; y 5) tratar los PTC fiscalmente igual que los cigarrillos. (AU)

As cigarette sales decline, the tobacco industry has turned to the sale of heated tobacco products (HTP), which are on the rise. We are concerned with reports erroneously indicating that heated tobacco is associated with a lower risk of cancer and other diseases than conventional cigarettes, citing as a source the Food and Drug Administration (FDA) of the United States. The FDA has indeed authorized the sale of an HTP, but denies that this approval is an endorsement of the product or that it is safe. Philip Morris asked the FDA to approve this product as a “modified risk” tobacco product. However, the Agency denied that the risk to users' health was less than conventional cigarettes, despite emitting less amount of some toxicants. Spain and the European Union should end the regulatory privileges that HTPs have until now. We identified at least five aspects to improve: 1) compliance with the prohibition of HTPs use where smoking is prohibited; 2) control of the prohibition of advertising, promotion, and sponsorship of HTPs; 3) that HTPs carry the same type of labeling as cigarettes; 4) limit that HTPs have characteristic aromas; and 5) treat HTPs fiscally at the same level as cigarettes. (AU)

[Tobacco heated products: a new challenge in tobacco control]. / Los productos de tabaco calentado: nuevo reto en el control del tabaco.

As cigarette sales decline, the tobacco industry has turned to the sale of heated tobacco products (HTP), which are on the rise. We are concerned with reports erroneously indicating that heated tobacco is associated with a lower risk of cancer and other diseases than conventional cigarettes, citing as a source the Food and Drug Administration (FDA) of the United States. The FDA has indeed authorized the sale of an HTP, but denies that this approval is an endorsement of the product or that it is safe. Philip Morris asked the FDA to approve this product as a "modified risk" tobacco product. However, the Agency denied that the risk to users' health was less than conventional cigarettes, despite emitting less amount of some toxicants. Spain and the European Union should end the regulatory privileges that HTPs have until now. We identified at least five aspects to improve: 1) compliance with the prohibition of HTPs use where smoking is prohibited; 2) control of the prohibition of advertising, promotion, and sponsorship of HTPs; 3) that HTPs carry the same type of labeling as cigarettes; 4) limit that HTPs have characteristic aromas; and 5) treat HTPs fiscally at the same level as cigarettes.

¿Sigue España ofreciendo brindis al sol en cuestión de obesidad infantil? / Does Spain still offer a toast to the sun on the issue of childhood obesity?

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Cambio de paradigma en la relación alcohol y salud: cuanto menos, mejor / Paradigm shift in the relationship between alcohol and health: the less, the better

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Catorce años de ley de control del tabaco en España. Situación actual y propuestas / Fourteen years of tobacco control law in Spain. Current situation and proposals

España ha avanzado en políticas de control del tabaquismo, destacando la prohibición del consumo de tabaco en espacios públicos cerrados. Se observa un descenso continuado en la proporción de fumadores. La exposición al humo ambiental de tabaco ha disminuido en lugares de ocio, con reducción de niveles de nicotina ambiental y partículas mayor del 90%, sin impacto negativo en el hogar. Hay reducciones en los ingresos hospitalarios y en la mortalidad por infarto cardiaco, descenso de las hospitalizaciones por enfermedad pulmonar crónica y asma y disminución del riesgo de prematuridad y bajo peso neonatal. Hay que avanzar en: empaquetado genérico, campañas de publicidad para prevenir el consumo, igualar el precio de los diferentes productos del tabaco, regular cigarrillos electrónicos en lugares públicos, considerar nuevos espacios libres de humo en lugares donde pueden estar expuestos los menores y otros colectivos vulnerables, ampliar ayuda para cesación y fomentar formación de los profesionales

Spain has made progress in tobacco control policies, highlighting the prohibition of tobacco consumption in closed public spaces. A continued decrease in the proportion of smokers is observed. Exposure to environmental tobacco smoke has decreased in entertainment venues, with a reduction of environmental nicotine and particulate levels over 90%, without negative impact at home. There are reductions in hospital admissions and in mortality from heart attack, decrease in hospitalizations for chronic lung disease and asthma, and decrease in the risk of prematurity and low birth weight. We must advance in: plain packaging, advertising campaigns to prevent consumption, equalize the price of different tobacco products, regulate electronic cigarettes in public places, consider new smoke-free spaces where minors and other vulnerable groups may be exposed, expand aid for cessation and promote health professionals training

[Fourteen years of tobacco control law in Spain. Current situation and proposals]. / Catorce años de ley de control del tabaco en España. Situación actual y propuestas.

Spain has made progress in tobacco control policies, highlighting the prohibition of tobacco consumption in closed public spaces. A continued decrease in the proportion of smokers is observed. Exposure to environmental tobacco smoke has decreased in entertainment venues, with a reduction of environmental nicotine and particulate levels over 90%, without negative impact at home. There are reductions in hospital admissions and in mortality from heart attack, decrease in hospitalizations for chronic lung disease and asthma, and decrease in the risk of prematurity and low birth weight. We must advance in: plain packaging, advertising campaigns to prevent consumption, equalize the price of different tobacco products, regulate electronic cigarettes in public places, consider new smoke-free spaces where minors and other vulnerable groups may be exposed, expand aid for cessation and promote health professionals training.

[PAPPS expert group. Lifestyle recommendations]. / Grupo de expertos del PAPPS. Recomendaciones sobre el estilo de vida.

Primary and secondary health determinants explain a large part of the morbidity and mortality observed in primary care. The recommendations of the Program of Preventive Activities and Health Promotion (PAPPS) of the semFyC are presented, for the promotion of a healthy lifestyle through intervention methodology and preventive actions in tobacco consumption, alcohol consumption, healthy eating, physical activity in free time and prevention of traffic accidents and child restraint systems. The most common clinical prevention guidelines are outlined. The recommendations are updated, new aspects are pointed out, such as the definition of low-risk alcohol consumption, and the bibliography is updated. For the main recommendations, specific tables are included that show the quality of the evidence and the strength of the recommendation.

Attitudes towards anti-smoking legislation and prevalence of tobacco consumption in Spanish primary healthcare personnel.

INTRODUCTION: Our aim was to ascertain how the anti-smoking legislation of 2005/2010 has affected the behavior of primary healthcare center (PHC) personnel (medical and nonmedical) with respect to their attitudes towards tobacco, its consumption and the legislative changes. METHODS: We conducted a multi-center descriptive study of a randomized conglomerate sample of PHC personnel from each Autonomous Community in Spain. The questionnaire covered tobacco consumption, and knowledge/attitudes towards smoking and legislation. The statistical analysis used SPSS software. RESULTS: The sample consisted of 2040 PHC employees (1578 women, 77.4%). Never smokers, ex-smokers, and smokers represented 46.7%, 37.8%, and 15.5% of the sample, respectively. Tobacco prevalence amongst physicians and nurses was 12.3%. Following the introduction of the antismoking legislation, a decrease in consumption was observed. Most of the participants considered that tobacco consumption affected health, was an addictive illness, and passive smoking had an impact on the health of non-smokers. Whilst 91.6% agreed with the current legislation, only 25% felt that it encouraged cessation. CONCLUSIONS: Spanish primary healthcare professionals have a relatively low prevalence of smoking compared to the general population. It is necessary to implement more legislative measures to improve and maintain this outcome.

Recomendaciones sobre el estilo de vida. Actualizacón PAPPS 2018 / No disponible

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Flexibilidad psicológica y autoabandono del tabaco / Smoking self-quitting and psychological flexibility

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The prevalence of smoking in the general population remains high in spite of the extended acknowledgement of the well-documented health consequences of smoking and potential benefits of quitting. Only a minority of smokers who attempt to quit seeks professional treatment, yet most of the research on smoking cessation focuses on such form of quitting. Research on self-quitting is scarce, although most smokers who successfully quit, do so on their own. Recently, research has evidenced that psychological flexibility, a core concept in Acceptance and Commitment Therapy, is an important variable in predicting successful behavioral change in many clinically relevant areas. The goal of this study was to analyze the relationship between psychological flexibility and successful self-quitting from smoking. 277 participants who had attempted to quit on their own (217 successfully abstinent and 60 still smoking) provided information on their smoking history, quit attempts, nicotine dependence, and demographics, and were assessed with the Acceptance and Action Questionnaire-II. Abstinence status was measured through self-reports of continuous abstinence and confirmed by concentrations of expired carbon monoxide below 8 ppm. Results show a statistically significant difference (t= -8,775; p <.01) for the AAQ-II scores of successful (M= 18.39, SD= 7.76) and unsuccessful self-quitters (M= 27.17; SD= 6.88). Only 26% participants with high level of psychological inflexibility quitted successfully, compared to 94% participants with low levels of psychological inflexibility. These results show clear evidence that psychological flexibility is associated to successful self-quitting, and suggest that this variable could facilitate success in attempts to stop smoking without professional help. Implications and limitations of this study are discussed (AU)