Perceived Importance of Public Health Risks in Greece: A Nationwide Survey of the Adult Population.

The current study is the first to examine the perceptions of the Greek public towards selected health risks and prioritize perceived risk importance and the needs to be addressed for public health promotion. Participants were asked to consider the individual importance of selected risks and the top three most important risks. Data collection took place on February 2020 in a representative sample of the adult Greek population. Differences between groups were assessed with Chi-square tests. Logistic regression models were used to identify perceptions based on participants' characteristics. Analysis was conducted in Stata 14, and 1976 adults participated in the survey: 48% male and 52% female. Road accidents, cancer and air pollution and environmental protection were considered the top three most important public health risks. Differences were observed between sexes; females were more concerned regarding the importance of the examined public health risks, and between age groups, younger ages considered STDs and contraception more important than older ages. Finally, non-smokers considered exercise and smoking to be more important than smokers. This is the first study to present and grade the public's perceptions on the importance of public health risks in Greece. Our study's prioritization of health risks could aid health authorities in improving and promoting the overall public health in Greece.

Driving Behavior That Limits Concentration: A Nationwide Survey in Greece.

Human behavior is implicated in most road accidents. The current study examined drivers' behavior that interferes with decision making and reaction time to an incidence. Adults (≥17 years-old) participated in a questionnaire-based survey for driver's behavior. Dataset was weighed according to sex, age and education based on the 2011 census. Differences between groups were assessed with Chi-squared tests while logistic regression models were used to identify drivers' characteristics for specific behaviors. A total 1601 adults participated in the survey-48% males and 52% females. Texting, Global Positioning System (GPS) setting and smoking were observed more by professional drivers and drivers of an urban area, while smoking was also dependent on social class. Drink driving was observed more by males (20% vs. 5% females), while after adjusting for age, the odds of drink driving in males were 5 times higher than females (p < 0.001). A different effect of age depending on the driver's sex and vice versa was observed regarding phone calls. Drivers' behavior with distractive potential differed by age, sex, social class and area of residence. Male drivers were more likely to perform drink driving, while professional drivers were more likely to use cell phone for calls and texting, set the GPS and smoke while driving.

A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist.

Following the recent electronic cigarette (e-cigarette) illness outbreak, the current review aimed to collect all related clinical cases for study and analysis and provide a critical synopsis of the proposed injury mechanism. Adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines, e-cigarette-related clinical cases were identified via Google Scholar and PubMed databases. Additionally, references of published case reports and previous review papers were manually searched, revealing 159 publications presenting e-cigarette-related case reports and 19 reports by the Centers for Disease Control and Prevention. 238 individual cases were identified; 53% traumatic injuries due to e-cigarette explosion or self-combustion, 24% respiratory cases, and 12% poisonings. Additional cases pertained to oral, cardiovascular, immunologic, hematologic, allergic reactions, infant complications, and altered medication levels. Case reports were mainly published between 2016-2019 (78%). The oldest case, a lipoid pneumonia, was published in 2012. The current review showed that e-cigarette-related health effects extend beyond the acute lung injury syndrome, including traumatic, thermal injuries and acute intoxications. Physicians should be aware of the distinct clinical presentations and be trained to respond and treat effectively. Regulators and public health authorities should address the regulatory gap regarding electronic nicotine delivery systems (ENDS) and novel tobacco products.

A pilot study of the Tobacco Treatment Guidelines for High-Risk Groups (TOB-G) for pregnant and postpartum women.

INTRODUCTION: Maternal smoking constitutes a significant risk to the fetus and is associated with multiple adverse pregnancy outcomes. Despite this, an estimated 6-19% of women in Europe smoke during pregnancy. We conducted a pilot study to examine the feasibility and effectiveness of the clinical practice recommendations of the 2017 Tobacco Cessation Guidelines for High-Risk Groups (TOB-G) for pregnant and postpartum women in an outpatient obstetrics setting. METHODS: The guideline recommendations were tested on a sample of 67 pregnant women recruited from obstetrics outpatient visits. Pregnant women who smoked received three behavioural counselling sessions through a combination of face-toface and telephone consultations by a midwife trained in the TOBG tobacco treatment recommendations. Smoking status was assessed at 1 month and at 6 months follow-up via self-report. RESULTS: Seventy-one per cent of pregnant smokers screened agreed to participate in the counselling intervention. Pregnant women participants (mean age, M=31.73 years, SD±6.09) smoked for an average of 12.2 (SD±6.55) years. Women reported smoking an average of 4.82 (SD±4.14) cigarettes per day with 51% reporting smoking within 30 minutes of waking, an indicator of higher levels of nicotine addiction. Rates of smoking abstinence among pregnant women undergoing the counselling intervention were 43.9% and 45.6% at the 1 month and at 6 months follow-up, respectively. Replacing those participants with missing data as smokers, the quit rates were 26.9% and 38.8% at the 1 month and 6 months follow-up, respectively. CONCLUSIONS: The counselling intervention delivered to pregnant women who smoke was feasible to implement in a manner that was consistent with the TOB-G guideline recommendations in an outpatient obstetrics setting. Future work should focus on increasing uptake of evidence-based tobacco treatment recommendations in outpatient obstetrics settings.

Impact of the Tobacco Treatment Guidelines for High Risk Groups (TOB.g): A pilot study among physicians specializing in CVD, Diabetes and COPD.

INTRODUCTION: The 2017 Tobacco Cessation Guidelines for High-risk Groups (TOB-G) is a comprehensive document on best practices for smoking cessation in clinical practice. The purpose of this pilot study was to assess physician satisfaction and changes in tobacco-related knowledge, self-efficacy and attitudes following exposure to training in the TOB-G guidelines for patients with cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), or diabetes. METHODS: A pre-post pilot study was conducted. All participating physicians received an electronic or printed copy of the TOB-G guidelines for patients with CVD, COPD or diabetes. Physicians were also exposed to a one-day training focused on the key clinical practice recommendations from the TOB.g guidelines. Outcome measurement occurred via survey before, immediately following and 6 months after exposure to the training. RESULTS: Fifty physicians participated in the TOB.g training session. High rates of participant satisfaction were documented (exceeded expectations 47.7%; met expectations to a great extent 52.3%). Significant increases in physician knowledge and self-efficacy were documented immediately following and 6 months after exposure to the guideline training session. Exposure to the training was associated with positive changes in some but not all tobacco-related treatment attitudes, however these were no longer significant at the 6-month follow-up. Lower knowledge, confidence and unfavourable attitudes were documented for aspects of treatment related to pharmacotherapy. CONCLUSIONS: Positive changes in previously reported barriers to the delivery of tobacco treatment among physicians were documented following exposure to the TOB.g guidelines and training for patients with CVD, COPD or diabetes.

Tobacco Treatment Guideline for High Risk Groups: A pilot study in patients with Chronic Obstructive Pulmonary Disease.

INTRODUCTION: Smoking cessation is a key clinical intervention for reducing progressive lung destruction and lung function deterioration in patients with Chronic Obstructive Pulmonary Disease (COPD). Specialised Tobacco Cessation Guidelines for High-risk Groups (TOB-G) were developed and published in 2017 that present evidence-based recommendations to support smoking cessation in COPD patients. The purpose of this pilot study was to examine the real world effectiveness of the TOB-G guideline recommendations among a sample of COPD patients. METHODS: A pilot study was conducted among a sample of COPD patients who smoke and were interested in quitting. Participants were recruited from inpatient and outpatient hospital admissions between October and December 2016 in Iasi, Romania. The intervention program was designed based on the recommendations of the TOB-G guidelines for COPD patients. Patients received a total of four contacts: at baseline, 1, 2, and 6 months. The primary outcome measure was biochemically validated point prevalence smoking abstinence measured at 6 months. RESULTS: Fifty patients (74% male; age mean±SD = 60.2±7.8) with diagnosed COPD took part in the pilot study. Self-reported rates of point prevalence smoking abstinence were 30.6%, 44.9% and 64.6% at the 1-, 2-, and 6-month follow-up, respectively. Carbon monoxide testing was completed with 51.6% of the sample at 6 months. The biochemically verified abstinent rate was 33.3% at the 6-month follow-up. CONCLUSIONS: This pilot testing of the TOB-G Clinical Practice Guidelines for COPD patients was associated with high rates of patient smoking abstinence, which are of clinical importance. Further research is needed to evaluate the guidelines large-scale effectiveness in clinical practice.

Relation between individual factors and support for smoking bans in bars in Greece: A cross-sectional study of the 2013 Global Adult Tobacco Survey (GATS).

INTRODUCTION: Smoking rates among the general population and among youth are decreasing in Greece. Low compliance with smoke-free legislation in indoor places in Greece renders non-smokers exposed to secondhand smoke, especially when frequenting bars. The aim of the current study was to identify the factors related to support for smoking bans in bars in Greece. METHODS: A cross-sectional secondary data analysis was conducted on the 2013 Greek Global Adult Tobacco Survey. Multivariate regression was used to analyze individual factors and their relation to support for the smoking ban in bars. The total sample was nationally representative of the Greek population and included 3961 residents over the age of 15 with 2061 supporting a ban in bars. RESULTS: Overall, 50.5% (95% CI: 46.5-54.4) of Greeks supported the smoking ban in bars. Among them, 1,832 (74.9%, 95% CI=70.1-79.1) were non-smokers and 229 (13.7%, 95% CI=10.6-17.5) were smokers. Age over 65 years was significantly related to increased support for the smoking ban in bars compared to those aged 15-24 years (p<0.05). Belief that secondhand smoke causes lung cancer was significantly related (p<0.001) to having increased support for the ban. Increased knowledge of smoking-related harm was significantly related to increased support for the ban in bars (p<0.001). Male non-smokers were significantly less likely to support the ban in bars than females (p<0.05). CONCLUSIONS: Increasing knowledge and awareness of smoking-related harm will enhance smoking ban support and compliance, improving tobacco prevention and cessation, especially among the youth and young adults.