Towards a smoke-free hospital: how the smoking status of health professionals influences their knowledge, attitude and clinical activity. Results from a hospital in central Italy.

OBJECTIVES: In Italy, the prevalence of smoking among health professionals is higher than in the general population and this might hamper their role in the promotion of health. This study aimed to investigate how the smoking status of healthcare professionals might influence knowledge, attitudes and clinical practice in a hospital in central Italy in order to enforce effective tobacco control measures. METHODS: Physicians and professionals of the hospital were asked to complete an anonymous questionnaire which yielded epidemiological and environmental information on knowledge, attitude, clinical practice and quality of the hospital environments, in relation to smoking. RESULTS: Overall, among the employees of the hospital, the smoking prevalence was 47%, (42% among physicians and 43% among nurses); 30% admitted smoking in the hospital and three quarters of the smokers would like to quit. Some knowledge, opinions and attitudes differ statistically among the smoking categories. For example, only 35% of the smokers admitted that smoking is more dangerous to health than atmospheric and car pollution compared with 60% of the ex or never smokers (p=0.04). Fewer smokers realize that their behavior is seen as a role model by patients. A greater percentage of smokers state that patients (34%) and visitors (43%) often smoke in hospital and these percentages are significantly higher than those reported by ex or never smokers (p≤0.05). All smokers claim that they never smoke in patient rooms, infirmaries and clinics, whereas over 20% of ex or never smokers report that smoking sometimes occurs in these places (p=0.015). The mean concentration of PM 2.5 in the 25 rooms was 2.4 µg/m3 with a range from 1 to 7 µg/m3. CONCLUSIONS: This study implies that the prevalence of smoking among health professionals may be very high, and might be twice the rate observed in the general population. Generally, smokers report less knowledge compared with ex and never-smokers and it seems that they systematically underestimate the dangers related to smoking both in their knowledge and in their behavior, and try to socially "normalize" smoking. All this and the evidence of cigarette butts in hospital rooms and clinics, notwithstanding the good quality of the air thanks to the modern ventilation system, imply that there is still a long way to go towards a smoke-free hospital.

Electronic cigarettes: an evaluation of exposure to chemicals and fine particulate matter (PM).

The "electronic (e-)cigarette" generates intense scientific debate about its use. Its popularity is increasing worldwide as a method to reduce/quit smoking, and to smoke indoors when restrictions on smoking tobacco are present. WHO recommends caution, until its effectiveness in helping smokers is clarified, and the possible harm evaluated. The aim of this study was to assess the content of the aromatic liquid mixture and its vapour and the Particulate Matter (PM) emissions of an Italian brand of e-cigarette and to compare its PM emissions with a conventional cigarette. Propylene glycol (66%) and glycerine (24%) were main components in the liquid, while the flavouring substances were less than 0.1%. The same substances were detected in the vapour in similar proportions. Fine and ultrafine PM emissions were higher for the conventional versus the e-cigarette (e.g.: PM10=922 vs 52 microg/m3; PM1=80 vs 14 microg/m3). The e-cigarette seems to give some advantages when used instead of the conventional cigarette, but studies are still scanty: it could help smokers to cope with some of the rituals associated with smoking gestures and to reduce or eliminate tobacco consumption avoiding passive smoking. However, the e-cigarette causes exposure to different chemicals compared with conventional cigarettes and thus there is a need for risk evaluation for both e-cigarettes and passive steam exposure in smokers and non smokers.

Lessons learned on the road to a smoke-free Italy.

In the face of strong and protracted opposition by the Tobacco Industry (TI) and its allies, Italy's national smoke-free legislation came into force in 2005 prohibiting smoking in all indoor public places and workplaces including offices, bars, and restaurants. Using internal TI documents made public through US litigation, we reveal the industry's nearly 40-year effort to influence health policy related to secondhand smoke, including attempts to block Italy's national smoke-free legislation. Strategies included manipulating hospitality groups and establishing front organizations, manipulating journalists and media, and manipulating the science and direct lobbying against smoking restrictions. The TI's extensive plan to thwart smoke-free efforts in Italy can be used to inform other countries about the industry's tactics and Italy's experience in overcoming them by ultimately implementing a comprehensive workplace smoke-free law.

[Smoking while driving and its consequences on road safety]. / Le implicazioni sulla sicurezza stradale del fumare durante la guida.

The study was focused on the risk assessment of distraction of smoking habits while driving vehicles. We have compared the results with the data about driving distraction using mobile phone without voice devices. We video-recorded 10 smokers, 4 male and 6 female, smoking while driving a car The average of measured driving distraction of smokers is about 12 seconds. It means to cover a distance of 160 metres with a speed of 50 Km/h. Comparing to the use of mobile phone, the data of driving distraction show a duration of 10.6 seconds, that means to cover a distance of 150 metres at the speed of 50 Km/h. This result suggest that cigarette smoking produces a remarkable risk for road safety, more than the mobile phone use. In addiction to the conditions that produce a considerable driving distraction of smokers, we underline a demonstrated shortage of oxygen, the presence of carbon monoxide and hight concentration offine particulate in the air breathed inside the vehicle. We also consider another aspect related to smoking habits while driving vehicles: the environmental damage. In fact throwing cigarette outside, while the vehicle is moving, is the prevalent reason of setting fire to the edge of the road. This study proposes to make changes in the laws and regulation on road safety in order to fine smokers behaviour during vehicle driving. Furthermore it seems necessary to promote public information about those risks among people.

Serological responses to infection with B. pertussis.

The results of serological assays performed during the Italian controlled efficacy trial of two acellular vaccines and one whole-cell vaccine against pertussis are described and discussed. We examined 312 episodes of suspected pertussis disease confirmed by B. pertussis isolation, and 2862 episodes without any evidence of B. pertussis or B. parapertussis infection. Higher mean log ELISA titres for IgG to pertussis toxin (PT) were found in the acute-phase serum specimens of those children vaccinated with the acellular pertussis vaccines and particularly in the SmithKline Beecham DTaP vaccine group. These apparently anamnestic responses were responsible for the observed differences in ELISA diagnostic sensitivity exhibited by IgG to PT and by IgG to filamentous haemagglutinin (FHA). We observed minimal IgA responses to PT but vigorous IgA responses to FHA in the convalescent-phase serum specimens for the acellular pertussis vaccine groups, which contributed to the sensitivity of the serological series of assays for diagnostic purposes.