Skip to main content
NCBI home page
Tobacco Induced Diseases logoLink to Tobacco Induced Diseases
. 2024 Oct 11;22:10.18332/tid/192118. doi: 10.18332/tid/192118

Assessment of exposure to secondhand tobacco smoke in Spain: A scoping review

Ana Blanco-Ferreiro 1, Ana Teijeiro 1, Leonor Varela-Lema 1,2,3, Julia Rey-Brandariz 1,3,✉, Cristina Candal-Pedreira 1,3, Lucía Martin-Gisbert 1,2, Guadalupe García 1, Iñaki Galán 4, Esteve Fernández 5,6,7,8, Nerea Mourino 1, Mónica Pérez-Ríos 1,2,3
PMCID: PMC11468508  PMID: 39398343

Abstract

INTRODUCTION

There is no consensus on the questions that should be included in questionnaires to properly ascertain exposure to secondhand tobacco smoke (SHS). The objective of this study is to analyze the questions included in studies which have assessed SHS exposure in Spain.

METHODS

A scoping review was performed, using PubMed, Embase and Web of Science databases, selecting original articles published in English and Spanish, across the period 2012–2021. We extracted data from each study regarding its design, target population, sample size or geographical scope; we also collected data regarding how studies dealt with exposure to SHS including assessment and intensity of SHS, exposure setting, geographical scope, and the verbatim questions used.

RESULTS

Finally, 75 studies were identified. In the 23 studies carried out in children, verbatim questions were included in 8 studies, and the setting most studied was the home. SHS exposure was assessed during pregnancy and postnatally by 8 studies, the verbatim questions used were described in 2 studies, being exposure ascertained at home and workplace. In the adult population, 14 of 44 studies described the verbatim questions; the setting most studied was the home. Verbatim questions varied among studies.

CONCLUSIONS

Questionnaire-based assessment of SHS exposure is highly heterogeneous, hindering comparability between studies. Therefore, it is necessary to set a standard questionnaire to assess exposure to SHS.

Keywords: secondhand smoke, questionnaire, Spain, scoping review, observational studies

INTRODUCTION

The harmful health effects of secondhand tobacco smoke (SHS) were first released in the 1960s1,2. In 1986, SHS was the main issue of the Surgeon General’s Report entitled ‘The Health Consequences of Involuntary Smoking’3, which stated that exposure to SHS was a risk factor for different causes of disease, such as lung cancer, coronary disease in adults, and numerous adverse effects in children, ranging from premature births to sudden infant death syndrome. The Report concluded that there is no safe level of exposure to SHS4.

Since then, many epidemiological studies have been performed to obtain detailed information on how many people are exposed to SHS, exposure settings, and the frequency and intensity of such exposure. Studies that use questionnaires to ascertain self-reported SHS exposure, whether as a risk factor or as a variable to be described, are common. Questionnaires allow for obtaining detailed retrospective and updated information at a reasonable cost. That said, however, account must be taken of their limitations, stemming not only from exposure recall bias, but also from individual susceptibility to SHS, or more particularly, from the influence that the different wording of questioning can have on the specific exposure assessed.

Currently, there is no consensus regarding the questions which should be used to assess SHS exposure at the population level5. Studies published in the late 1980s concluded that questionnaire-based assessment of SHS exposure underestimated real exposure, since the exposure settings covered were scarce6. One study conducted in 2012, oriented to identifying the questionnaires used in Europe to determine SHS exposure, concluded that there had been wide variability in the questions targeted at estimating SHS exposure7. Since then, interest in assessing the prevalence of population exposure to SHS has steadily increased, while regulations are being implemented to protect the population from SHS exposure. Therefore, questions addressed to assess SHS exposure are used more frequently in health surveys and epidemiological studies.

Hence, the aim of this study was to identify and describe the questions included in the research studies that have assessed SHS exposure in Spain from 2012 to 2021.

METHODS

We performed a scoping review in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines8 and we also followed the recommendations provided by Levac et al.9 for advancing scoping review methodology. A search was carried out in PubMed, Embase and Web of Science databases including the following MeSH terms and free terms: tobacco smoke pollution, environmental tobacco smoke, passive smok*, second-hand smoke, secondhand smoke, involuntary smoking, case-control, cohort, prospective, cross-sectional, before–after, Spain and Spanish. The search was limited to original articles published from January 2012 through December 2021. No language restriction was applied, but only studies published in English or Spanish were included. Reviews, letters, comments, clinical cases or case studies, and conference abstracts were excluded. The search strategies used for each database can be found in Supplementary file Table 1.

We selected questionnaire-based research studies that assessed SHS regardless epidemiological design. The target population was classified as children (under 18 years of age) and adults, though studies which simultaneously covered pregnant women and children are shown as a separate category.

Two researchers (ABF and AT) individually reviewed the titles and abstracts of the records identified to select potentially relevant studies. Discrepancies were reviewed by a third reviewer (MPR). The full text of selected articles was then read to ascertain whether they fulfilled the selection criteria. Once studies that met the selection criteria had been identified, the full texts were reviewed by four researchers (ABF, AT, JRB, CCP), with any discrepancies being settled by group discussion and consensus.

Data of interest were recorded on purpose-designed tables, with the following variables being extracted: SHS exposure (designated or not designated as the main study objective); study design (cross-sectional – distinguishing before-after studies, cohort, or case-control); target population (adults, children, pregnant women and children); sample size; questionnaire administration (self-administered – mail or online, face-to-face, telephone, or other); validation of reported exposure (none, cotinine, nicotine, or other); and study scope (local, regional, national – including multicenter studies, or supranational). In each study, we identified the variables related with SHS exposure and extracted data on: the setting covered, both indoors and outdoors (home, workplace-teaching institution, leisure settings, public or private transport, or other); assessment of exposure (presence of smokers, tobacco smell, perception of being ‘exposed’, frequency of exposure, or other). We also collected data on the intensity of exposure, differentiating between the number of cigarettes smoked in their presence, number of smokers, number of places where smoking took place, or other. The verbatim questions on SHS exposure were extracted when available in the selected articles.

RESULTS

The search yielded 575 articles of which 199 were duplicates. After reading the titles and abstracts, 190 articles were read in full text, of which 75 fulfilled the eligibility criteria and were included. Of the 75 articles, 23 assessed exposure to SHS in children, 8 assessed it in pregnant women and children, and 44 assessed it in adults (Figure 1).

Figure 1.

Figure 1

Open in a new tab

Flowchart of the process of selecting articles included in the study (search in PubMed, Embase and Web of Science, 2012–2021)

Studies conducted among children

Out of the 23 studies that assessed SHS exposure in children, 6 provided results from the same cohort study (INMA), though assessment of exposure differed among them. In terms of the study design, 14 were cross-sectional studies and 9 were cohort studies. In the cross-sectional studies, the most common geographical scope was regional, accounting for 8 out of 23 studies (Table 1 and Supplementary file Table 2).

Table 1.

General characteristics of the studies included (N=75)

Authors Year of publication Year of realization Design Population Settings
Ortega-García et al.10 2012 2009–2010 Cohort Children Home-Teaching institution-Leisure
Esplugues et al.11 2013 2003–2008 Overall
Fuentes-Leonarte et al.12 2015 2003–2008 Home-Teaching institution-Leisure
Mariana Fernández et al.13 2015 2000–2002
2005–2006		 Home
Aurrekoetxea et al.14 2016 2003–2008 Home-Teaching institution-Transport
Robinson et al.15 2016 2003–2008 Home-Teaching institution
García-Villarino et al.16 2021 2004–2007 Home-Teaching institution-Leisure
Bermudez-Barrezueta et al.17 2021 2015–2016 Overall
Maitre et al.18 2021 2013–2016 Home
Martín-Pujol et al.19 2013 2006 Cross-sectional Home-Teaching institution-Leisure-Transport
Suárez-López-de-Vergara et al.20 2013 2007–2008 Home
Padrón et al.21 2014 2008–2009 Home
Padrón et al.22 2016 2011–2012 Home
Alicea-Alvarez et al.23 2016 2015 Home
Arechavala et al.24 2018 2012 Home
López et al.25 2018 2016 Home-Teaching institution-Leisure-Transport
Arechavala et al.26 2019 2015–2016 Home
Contienente et al.27 2019 2015 Home-Teaching institution-Leisure-Transport
Díez-Izquierdo et al.28 2019 2017 Home
Lletjós et al.29 2020 2016 Home-Teaching institution-Leisure-Transport
Henderson et al.30 2020 2020 Teaching institution
Continente et al.31 2021 2016 Home
Gonzalez-Barcala et al.32 2017 2006–2007 Overall
Almendros et al.33 2018 2015–2016 Cross-sectional Pregnant women and children Home
Hernández-Martínez et al.34 2012 2004–2009 Cohort Home-Workplace/Teaching institution
McBride et al.35 2012 2006–2010 Home-Workplace/Teaching institution-Leisure
Casas et al.36 2013 2004–2006 Home
Ribot et al.37 2014 2005–2008 Home-Workplace/Teaching institution
Hernández-Martínez et al.38 2017 2005–2009 Home-Workplace/Teaching institution
Roigé-Castellví et al.39 2020 2005–2014 Home-Workplace/Teaching institution
Iniguez et al.40 2016 2003–2008 Home-Workplace-Leisure
Ruano-Ravina et al.41 2014 2011–2013 Case-control Adults Home
Torres-Durán et al.42 2014 2011–2013 Home
Almirall et al.43 2014 1999–2000 Home
Torres-Durán et al.44 2015 2011–2013 Home
Torres-Durán et al.45 2017 2011–2016 Home-Workplace/Teaching institution
González-Romero et al.46 2018 2015 Home
Molina-Montes et al.47 2020 2007 Overall
Torres-Durán et al.48 2021 2011–2019 Home
Torres-Durán et al.49 2015 2011–2013 Overall
Sunyer et al.50 2012 2004–2008 Cohort Home-Workplace-Leisure
Larrañaga et al.51 2013 2003–2008 Home-Workplace/Teaching institution-Leisure
Ortega-García et al.52 2016 2008–2013 Home
Lidón-Moyano et al.53 2017 2013–2014 Home-Workplace/Teaching institution-Leisure-Transport
Pérez-de-Arcelus et al.54 2017 2011 Home-Workplace/Teaching institution
Román-Gálvez et al.55 2018 2013–2015 Home
Flexeder et al.56 2019 1990–1994
1998–2001		 Overall
Olivieri et al.57 2019 1998–2003
2010–2014		 Home-Workplace/Teaching institution
Íñiguez et al.58 2012 2004–2006 Home-Workplace/Teaching institution
Ruano-Ravina et al.59 2020 2018–2019 Overall
Villaverde-Royo et al.60 2012 2009–2011 Cross-sectional Overall
Clemente-Jiménez et al.61 2012 2008 Home-Workplace/Teaching institution-Leisure-Transport
Martínez Sánchez et al.62 2012 2004–2005 Home-Leisure
Ortega-García et al.63 2012 2008 Home-Workplace/Teaching institution-
Leisure-Transport
Jimenez-Muro et al.64 2012 2009–2010 Home-Workplace/Teaching institution
Aurrekoetxea et al.65 2013 2004–2008 Home-Workplace/Teaching institution-Leisure
Mateos-Vílchez et al.66 2014 2007–2012 Home-Workplace/Teaching institution-Leisure
Sureda et al.67 2014 2004–2005
2011–2012		 Home-Workplace/Teaching institutionLeisure-Transport
Aurrekoetxea et al.68 2014 2004–2008 Home-Workplace/Teaching institution-Leisure
Pérez-Ríos et al.69 2014 2005–2011 Home-Workplace/Teaching institution-Leisure
Galán et al.70 2014 2010 Leisure
Sureda et al.71 2015 2011–2012 Home-Workplace/Teaching institution-Leisure-Transport
Ballbè et al.72 2015 2010–2011 Home-Workplace/Teaching institution
Ballbè et al.73 2015 2011–2012 Home-Workplace/Teaching institution-Transport
Fernández et al.74 2017 2006–2011 Home-Workplace/Teaching institution-Leisure-Transport
Martínez et al.75 2017 2014–2015 Teaching institution
Viñolas et al.76 2017 2007–2012 Home-Workplace/Teaching institution
Martínez Sánchez et al.77 2018 2011–2012 Home
Sureda et al.78 2018 2016 Leisure
Fu et al.79 2018 2013 Leisure
Míguez et al.80 2020 2012–2015 Home
Lidón-Moyano et al.81 2021 2013–2014 Home-Workplace/Teaching institution-Leisure-Transport
Rebollar-Álvarez et al.82 2021 2020 Home
Henderson et al.83 2021 2017–2018 Teaching institution-Leisure-Transport
Nogueira et al.84 2021 2017–2018 Workplace/Teaching institutionLeisure-Transport
Open in a new tab

In 17 studies, SHS exposure-related aspects was the main objective (Table 2). The settings most commonly assessed were the home (19 of 23), followed by teaching institution (10 of 23) (Figure 2). Nine of the 23 articles included determined objective exposure markers, mainly cotinine. Verbatim questions were included in 8 of the 23 articles, including different questions to ascertain SHS exposure for the same setting (Table 1 and Supplementary file Table 2). Studies included different SHS exposure indicators, with the presence of smokers being the most commonly used to assess SHS exposure in the home setting (8 of 19), workplace-teaching institution (2 of 9) and transport (3 of 5); and the perception of being exposed to assess SHS exposure in leisure (3 of 8). The intensity of SHS exposure was assessed (3 of 23) by ‘number of hours exposed’ and ‘number of smokers’ (Table 3).

Table 2.

Characteristics of included studies related to the assessment of exposure to secondhand tobacco smoke. The number of studies assessing each characteristic by type of population is shown (N=75)

Characteristics Children (N=23) Pregnant women and children (N=8) Adults (N=44)
Secondhand smoke main objective
Yes 17 5 26
No 6 3 18
Sample size
<500 7 5 13
500–1000 1 1 8
>1000 15 2 23
Validation self-reported exposure
Cotinine 6 2 13
Nicotine 2 0 4
Other 0 1a 3a
No 15 5 27
Geographical scope
Local 6 6 15
Regional 8 1 20
National 7 0 4
Supra-national 2 1 5
Number of settings
Global 3 1 5
1 8 1 15
2 3 5 6
3 2 1 7
>3 7 0 11
Verbatim questions
Yes 8 2 14
No 15 6 30
Open in a new tab
a

Other: benzene, particulate matter (PM2.5).

Figure 2.

Figure 2

Open in a new tab

Secondhand smoke exposure settings assessed in the studies (N=75)

Table 3.

Indicators of exposure to secondhand tobacco smoke assessed in the included studies and number of studies analyzing them by exposure setting (N=75)

Exposure indicators Home Workplace and Teaching institution Leisure Transport
Children (N=19) Pregnant women and children (N=7) Adults (N=33) Children (N=9) Pregnant women and children (N=6) Adults (N=24) Children (N=8) Pregnant women and children (N=2) Adults (N=21) Children (N=5) Pregnant women and children (N=0) Adults (N=10)
Presence of smokers 13 0 18 2 0 8 1 0 3 3 0 4
Tobacco smell 1 2 0 1 2 0 1 0 2 0 0 0
Perception of being ‘exposed’ 1 0 4 1 0 7 3 0 2 1 0 0
Smoking area (indoor vs outdoor) 4 0 3 1 0 2 0 0 4 0 0 1
Number of times per week 2 0 3 1 0 0 2 0 4 0 0 0
Not assessed 2 4 9 2 3 1 1 1 7 0 0 5
Assess more than one 5 0 4 1 0 1 1 0 2 0 0 0
Open in a new tab

The period for which recall was elicited was variable: at home, parents or guardians were asked about generic exposures or exposures in the previous two weeks; and in teaching institution, parents or guardians were asked about exposure in the preceding week (Table 1 and Supplementary file Table 2).

Studies on pregnant women and children

The search identified 8 cohort studies that assessed exposure to SHS in pregnant women and their children, with 3 of these providing results on the DEFENSAS study (Table 1 and Supplementary file Table 2). The main stated objective of 5 of the 8 articles was to study SHS exposure (Table 2). The SHS exposure was most commonly assessed in the home setting (7 of 8), followed by the workplace and teaching institution (5 of 8) (Figure 2). SHS exposure was assessed during pregnancy (prenatal exposure) in 7 studies, and postnatally in one. Exposure to SHS was established by reference to ‘tobacco smell’ in 2 out of the 8 studies that assessed exposure to SHS at home and in 2 out of the 5 studies that assessed SHS at the workplace. Intensity of exposure was assessed by ‘number of hours’ by one study (Table 3).

Studies on the adult population

Of the 44 studies that assessed SHS exposure in adults, 5 were based on the INMA cohort study. Regarding the study design, 25 out of the 44 studies in adults were cross-sectional, 9 were cohort studies, and 10 were case-control studies (Table 1 and Supplementary file Table 2). Of the 44 studies, 26 stated that their main objective was to study SHS exposure. The articles referred mainly to studies conducted at a local (15 of 44) and regional level (20 of 44). Objective exposure markers were ascertained in 17 of 44 studies measuring cotinine or nicotine (Table 2). The most commonly studied setting was home (33 of 44), followed by the workplace and teaching institution (24 of 44), and leisure (20 of 44) (Figure 2). Five studies assessed exposure in workplaces, as well as asking subjects about exposure in outdoor settings (Table 1 and Supplementary file Table 2). Assessment of SHS in the home focused mainly on recall of exposure during the previous week. The time window in the workplace/place of study was more variable and ranged from the preceding week to more than 1 year or an indefinite period. Exposure in the home was mainly achieved by asking about the presence of smokers (18 of 33). Intensity of SHS exposure was assessed on the basis of number of times per week exposed to SHS in 9 of 44 studies (Table 3).

DISCUSSION

The results of our study show a wide variability in how exposure to SHS is assessed in research studies conducted in Spain. Exposure to SHS was more frequently assessed in the home setting, followed by the workplace and teaching institution, leisure, and, less frequently, transport. Despite being considered of utmost importance to assess all possible settings85, assessment of SHS exposure in other settings, such as outdoor areas, is anecdotal. The inclusion of the verbatim questions used to elicit exposure is unusual. Our analysis reveals that there is a wide variability in the way SHS exposure is assessed86,87, i.e. the questions are investigation group- or study-dependent.

A previous study concluded that questionnaires underestimated the real prevalence of exposure. The study indicated that this may be because the assessment of exposure is limited to two places: the home and the workplace88. Our study indicates that in the most recent studies, the number of settings in which exposure is assessed by questionnaires has increased, and that it is now more common to include other settings, such as leisure settings. Nonetheless, assessment of exposure in settings such as transport or in outdoor areas is still very infrequent. Since there is no clearly safe SHS exposure threshold, assessing exposure in all settings where exposure may take place seems essential. This would also help address another relevant aspect, namely, that of defining who should consider himself or herself exposed to SHS. An exposed person should be anyone who reports exposure, regardless of its setting, duration or intensity. In light of this, prudence is called for studies to assess the duration and/or intensity of exposure; this could avoid the over-reporting associated with accidental or anecdotal exposures. Assessment of accidental exposures to low SHS concentrations could be influenced by the susceptibility of the person who reports exposure, thereby giving rise to differential reporting bias.

It should also be noted that although there are studies that assess SHS worldwide, such as the Global Adult Tobacco Survey (GATS), the questions included in these studies supported by organizations such as WHO, are not replicated nor is the definition of exposure in studies at the national or local level. It is imperative to advance in the standardization of questions aimed at determining exposure and to reach a global agreement to define who is exposed to SHS.

Another aspect to be highlighted is the researchers’ tendency to systematically omit the questions that they use to assess exposure. This is an important limitation, since if questions are not included, it would be impossible to critically assess the results of studies and contextualize them, given the current lack of standardized set of questions. If question omission is of the researcher’s own volition or caused by journals’ editorial review processes (which tend to put short explanations before detail), then it becomes a more complicated topic that cannot be addressed. In those studies that do provide the questionnaires, there is a surprisingly wide variation in the formulation of questions.

An additional point to highlight is the objective assessment of exposure to SHS. In 25 studies, exposure to SHS was assessed with biomarkers, principally cotinine. Nevertheless, determination of cotinine was performed sometimes to differentiate smokers from non-smokers, not to assess different levels of exposure to SHS. While some studies show agreement between both measures65,68, others display discrepancies58. It should be taken into account that such validation in studies at a population level has no logical basis because the period of time covered by the subject’s recollection of when exposure occurred as shown in the questionnaire and the exposure time window covered by the biomarker are usually different. Exposure biomarkers such as cotinine are detectable in human biological samples with a high degree of precision and allow for approximation of the exposure dose, and despite their half-life, are relatively constant throughout the day89. However, conducting a study to determine cotinine in a representative population sample would have some limitations. The first – and extremely important – limitation resides in the difficulty and cost of conducting such a study. Furthermore, there are discrepancies regarding which cut-off point to apply, something that, for instance, varies considerably in children90, being also inadequate to assess past exposures. Furthermore, the advances in the techniques of analysis used to quantify cotinine might also amount to a limitation, since current techniques are very sensitive, and therefore, detect very low cotinine concentrations which would be linked to non-meaningful exposures. It should also be stressed here that neither cotinine nor any other biomarker can provide information regarding the place of exposure if no information about the place of exposure is also collected. For this purpose, questionnaire-based data-collection is indispensable.

Nonetheless, assessing exposure to SHS at a population level is complicated because there is great variability in terms of the settings where people are exposed, source of exposure, the SHS concentration, the duration of exposure, the characteristics of the person concerned, and his/her history of exposure. Moreover, the main aim of the study can have a marked influence on the questions to be included. Hence, studies targeted at assessing the impact of SHS exposure on health should prioritize history of exposure over exposure settings, whereas studies targeted at estimating the prevalence of exposure should prioritize exposure settings over history of exposure. Failure to include the correct questions may trigger misclassification of SHS exposure, and lead, among other things, to the poor performance of early interventions based on primary prevention, incorrect evaluation of smoking control policies, or inaccurate estimation of the impact associated with exposure. While identification of the various settings in which exposure can occur, assessment of exposure indicators, measurement of the intensity of exposure, and precise characterization of the history of exposure, would allow for a correct characterization of the exposure and are all essential for assessing SHS exposure accurately.

Giving the difficulty of generating a single set of questions to assess exposure to SHS, it seems important to draw a distinction, a priori, between a study targeted at estimating prevalence of exposure and one targeted at assessing the relationship between SHS exposure and a health outcome. In either case, pinpointing those characteristics specific to the survey respondent which may determine response, such as smoker status or tolerance to smoking, is important to prevent reporting biases. Several initiatives such as the Global Youth Tobacco Survey (GYTS)91,92, recommend that exposure to SHS should be assessed with a breakdown of such exposure in closed spaces. Breaking down exposure in the home, workplace-teaching institution, leisure or transport is indispensable, as is having an indicator of the duration or intensity of such exposure. These last two aspects are crucial when conducting studies targeted at assessing the relationship between exposure and a health outcome, along with an accurate and detailed history of exposure.

Having questions that allow a breakdown of where exposure occurs is also important for the evaluation of the implementation of new tobacco control policies. In Spain, where a modification of the tobacco control law is expected soon, scientific societies are calling for further progress in protecting the population from exposure to SHS by expanding smoke-free spaces. These spaces include hospitality terraces, sports facilities, university campuses, transport stops, swimming pools, beaches, and natural areas.

Limitations

This study has some limitations. One limitation might be not having included studies prior to 2012, but this information was included in two previous reviews, one focused on Europe7 and the other on informal sources on SHS exposure in Spain86. This review focuses on the questions used to assess SHS exposure in Spain. However, there does not seem to be any justification to assume that the variability in the questions used in Spain is not common in other countries. A quantitative synthesis of the results was not possible in this review because of the nature of the results extracted. In addition, as the aim of this review was to analyze the questions used to estimate exposure to SHS, an analysis of the individual potential risks of bias of each of the included studies was not included. This review’s main advantage lies in the fact that it includes studies not only assessing SHS exposure as the main dependent or independent variable, but also studies including SHS exposure as independent secondary variable or variable of adjustment. Furthermore, we included studies conducted on both adults and children, creating a separate category for those that simultaneously assessed pregnant women and children.

CONCLUSIONS

We would like to highlight the importance of obtaining SHS exposure in a more standardized manner through questions. Having a set of recommendations and standardized questions for assessing SHS exposure, would allow for comparable data to be obtained. Furthermore, it would be important to generate specific groups of questions for each epidemiological design or study objective. Currently, it is not known whether differences in exposure are due to real differences or to data-collection differences. In fact, changes in prevalence of exposure to SHS in a period of time could be just an artifact if the way to measure exposure is constantly changing. Lastly, it should be borne in mind that any questionnaire-based measurement process will inevitably be associated with an error which will have to be accepted. In view of these results, a standardized questionnaire for obtaining self-reported exposure to SHS from individuals should be established and it should be used by researchers to assess an individual SHS exposure. This questionnaire should be made up of sets of questions that would enable SHS exposure to be measured in a harmonized manner. Meanwhile, the questions used to assess exposure should be included in scientific articles. This would allow readers to know which settings are assessed, what time frame the exposure refers to or whether other aspects such as intensity or frequency of exposure are assessed. Readers will then be able to make a proper judgement on whether characterization of SHS exposure is relatively more or less appropriate.

Supplementary Material

TID-22-165-s1.pdf (484.6KB, pdf)

Funding Statement

FUNDING Funding support was provided by Instituto de Salud Carlos III (ISCIII) (reference: PI22/00727), and co-finance by the European Union.

CONFLICTS OF INTEREST

The authors have each completed and submitted an ICMJE form for disclosure of potential conflicts of interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. E. Fernández reports that in the past 36 months he received Grant 2021SGR00906 for the Tobacco Control Unit from Ministry of Universities and Research, Government of Catalonia.

ETHICAL APPROVAL AND INFORMED CONSENT

Ethical approval and informed consent were not required for this study.

DATA AVAILABILITY

The data supporting this research are available from the authors on reasonable request.

AUTHORS’ CONTRIBUTIONS

ABF: interpretation of study data. LVL, LMG, GG, NM and MPR: conceptualization. AT, JRB, CCP, LMG, GG, IG and EF: interpretation of study data and critical revision of manuscript. NM: data analysis, critical revision of the manuscript. MPR: funding. ABF and MPR: writing of the original draft and editing of the manuscript. All authors have read and approved the final version of the manuscript.

PROVENANCE AND PEER REVIEW

Not commissioned; externally peer reviewed.

REFERENCES

  • 1.Colley JR, Holland WW. Social and environmental factors in respiratory disease. A preliminary report. Arch Environ Health. 1967;14(1):157-161. doi: 10.1080/00039896.1967.10664707 [DOI] [PubMed] [Google Scholar]
  • 2.Cameron P, Kostin JS, Zaks JM, et al. The health of smokers’ and nonsmokers’ children. J Allergy. 1969;43(6):336-341. doi: 10.1016/0021-8707(69)90078-1 [DOI] [PubMed] [Google Scholar]
  • 3.US Office on Smoking and Health . The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. U.S. Centers for Disease Control and Prevention; 2006. Accessed August 6, 2024. https://www.ncbi.nlm.nih.gov/books/NBK44324/ [PubMed] [Google Scholar]
  • 4.Gaffney KF. Infant exposure to environmental tobacco smoke. J Nurs Scholarsh. 2001;33(4):343-347. doi: 10.1111/j.1547-5069.2001.00343.x [DOI] [PubMed] [Google Scholar]
  • 5.Nondahl DM, Cruickshanks KJ, Schubert CR. A questionnaire for assessing environmental tobacco smoke exposure. Environ Res. 2005;97(1):76-82. doi: 10.1016/j.envres.2004.02.005 [DOI] [PubMed] [Google Scholar]
  • 6.Haley NJ, Colosimo SG, Axelrad CM, Harris R, Sepkovic DW. Biochemical validation of self-reported exposure to environmental tobacco smoke. Environ Res. 1989;49(1):127-135. doi: 10.1016/s0013-9351(89)80027-1 [DOI] [PubMed] [Google Scholar]
  • 7.Pérez-Ríos M, Schiaffino A, López MJ, et al. Questionnaire-based second-hand smoke assessment in adults. Eur J Public Health. 2013;23(5):763-767. doi: 10.1093/eurpub/cks069 [DOI] [PubMed] [Google Scholar]
  • 8.Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-473. doi: 10.7326/M18-0850 [DOI] [PubMed] [Google Scholar]
  • 9.Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5:69. doi: 10.1186/1748-5908-5-69 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Ortega-García JA, López-Fernández MT, Llano R, et al. Smoking prevention and cessation programme in cystic fibrosis: integrating an environmental health approach. J Cyst Fibros. 2012;11(1):34-39. doi: 10.1016/j.jcf.2011.09.005 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Esplugues A, Estarlich M, Sunyer J, et al. Prenatal exposure to cooking gas and respiratory health in infants is modified by tobacco smoke exposure and diet in the INMA birth cohort study. Environ Health. 2013;12:100. doi: 10.1186/1476-069X-12-100 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Fuentes-Leonarte V, Estarlich M, Ballester F, et al. Pre- and postnatal exposure to tobacco smoke and respiratory outcomes during the first year. Indoor Air. 2015;25(1):4-12. doi: 10.1111/ina.12128 [DOI] [PubMed] [Google Scholar]
  • 13.Fernández MF, Artacho-Cordón F, Freire C, et al. Trends in children’s exposure to second-hand smoke in the INMA-Granada cohort: an evaluation of the Spanish anti-smoking law. Environ Res. 2015;138:461-468. doi: 10.1016/j.envres.2015.03.002 [DOI] [PubMed] [Google Scholar]
  • 14.Aurrekoetxea JJ, Murcia M, Rebagliato M, et al. Second-hand smoke exposure in 4-year-old children in SpaIn: sources, associated factors and urinary cotinine. Environ Res. 2016;145:116-125. doi: 10.1016/j.envres.2015.11.028 [DOI] [PubMed] [Google Scholar]
  • 15.Robinson O, Martínez D, Aurrekoetxea JJ, et al. The association between passive and active tobacco smoke exposure and child weight status among Spanish children. Obesity (Silver Spring). 2016;24(8):1767-1777. doi: 10.1002/oby.21558 [DOI] [PubMed] [Google Scholar]
  • 16.García-Villarino M, Fernández-Iglesias R, Riaño-Galán I, et al. Prenatal exposure to cigarette smoke and anogenital distance at 4 Years in the INMA-Asturias cohort. Int J Environ Res Public Health. 2021;18(9):4774. doi: 10.3390/ijerph18094774 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Bermúdez Barrezueta L, Miñambres Rodríguez M, Palomares Cardador M, et al. Effect of prenatal and postnatal exposure to tobacco in the development of acute bronchiolitis in the first two years of life. An Pediatr (Engl Ed). 2021;94(6):385-395. doi: 10.1016/j.anpede.2020.05.011 [DOI] [PubMed] [Google Scholar]
  • 18.Maitre L, Julvez J, López-Vicente M, et al. Early-life environmental exposure determinants of child behavior in Europe: a longitudinal, population-based study. Environ Int. 2021;153:106523. doi: 10.1016/j.envint.2021.106523 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Martín-Pujol A, Fernández E, Schiaffino A, et al. Tobacco smoking, exposure to second-hand smoke, and asthma and wheezing in schoolchildren: a cross-sectional study. Acta Paediatr. 2013;102(7):e305-e309. doi: 10.1111/apa.12232 [DOI] [PubMed] [Google Scholar]
  • 20.Suárez López de Vergara RG, Galván Fernández C, Oliva Hernández C, Aguirre-Jaime A, Vázquez Moncholí C; Grupo de Trabajo sobre Tabaquismo de la Infancia y Adolescencia de la Sociedad Española de Neumología Pediátrica . Environmental tobacco smoke exposure in children and its relationship with the severity of asthma. Exposición al humo de tabaco del niño asmático y su asociación con la gravedad del asma. An Pediatr (Barc). 2013;78(1):35-42. doi: 10.1016/j.anpedi.2011.12.008 [DOI] [PubMed] [Google Scholar]
  • 21.Padrón A, Galán I, Rodríguez-Artalejo F. Second-hand smoke exposure and psychological distress in adolescents. A population-based study. Tob Control. 2014;23(4):302-307. doi: 10.1136/tobaccocontrol-2012-050548 [DOI] [PubMed] [Google Scholar]
  • 22.Padrón A, Galán I, García-Esquinas E, Fernández E, Ballbè M, Rodríguez-Artalejo F. Exposure to secondhand smoke in the home and mental health in children: a population-based study. Tob Control. 2016;25(3):307-312. doi: 10.1136/tobaccocontrol-2014-052077 [DOI] [PubMed] [Google Scholar]
  • 23.Alicea-Alvarez N, Foppiano Palacios C, Ortiz M, Huang D, Reeves K. Path to health asthma study: a survey of pediatric asthma in an urban community. J Asthma. 2017;54(3):273-278. doi: 10.1080/02770903.2016.1216564 [DOI] [PubMed] [Google Scholar]
  • 24.Arechavala T, Continente X, Pérez-Ríos M, et al. Second-hand smoke exposure in homes with children: assessment of airborne nicotine in the living room and children’s bedroom. Tob Control. 2018;27(4):399-406. doi: 10.1136/tobaccocontrol-2017-053751 [DOI] [PubMed] [Google Scholar]
  • 25.López MJ, Arechavala T, Continente X, Schiaffino A, Pérez-Ríos M, Fernández E. Social inequalities in secondhand smoke exposure in children in Spain. Tob Induc Dis. 2018;16(April):14. doi: 10.18332/tid/85717 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Arechavala T, Continente X, Pérez-Ríos M, Schiaffino A, Fernández E, López MJ. Sociodemographic factors associated with secondhand smoke exposure and smoking rules in homes with children. Eur J Public Health. 2019;29(5):843-849. doi: 10.1093/eurpub/ckz054 [DOI] [PubMed] [Google Scholar]
  • 27.Continente X, Arechavala T, Fernàndez E, et al. Burden of respiratory disease attributable to secondhand smoke exposure at home in children in Spain (2015). Prev Med. 2019;123:34-40. doi: 10.1016/j.ypmed.2019.02.028 [DOI] [PubMed] [Google Scholar]
  • 28.Díez-Izquierdo A, Cassanello Peñarroya P, Cartanyà-Hueso À, et al. Prevalence of smoke-free homes and passive exposure to tobacco in pediatric population (children from 3 to 36 months). Prevalencia de hogares libres de humo y exposición pasiva al tabaco en población pediátrica (niños de 3 a 36 meses). Rev Esp Salud Publica. 2019;93:e201907045. Accessed August 6, 2024. https://www.sanidad.gob.es/biblioPublic/publicaciones/recursos_propios/resp/revista_cdrom/VOL93/O_BREVES/RS93C_201907045.pdf [PubMed] [Google Scholar]
  • 29.Lletjós P, Continente X, Arechavala T, et al. Association between exposure to second-hand smoke and health status in children. Asociación entre el humo ambiental de tabaco y el estado de salud en la población infantil. Gac Sanit. 2020;34(4):363-369. doi: 10.1016/j.gaceta.2018.10.006 [DOI] [PubMed] [Google Scholar]
  • 30.Henderson E, Continente X, Fernández E, et al. ; TackSHS project Investigators et al. Secondhand smoke exposure and other signs of tobacco consumption at outdoor entrances of primary schools in 11 European countries. Sci Total Environ. 2020;743:140743. doi: 10.1016/j.scitotenv.2020.140743 [DOI] [PubMed] [Google Scholar]
  • 31.Continente X, Rodríguez A, Pérez-Ríos M, Schiaffino A, Fernández E, López MJ. Factors related to caregivers’ risk perception of secondhand smoke exposure on children’s health. Tob Induc Dis. 2021;19(December):93. doi: 10.18332/tid/143318 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Gonzalez-Barcala FJ, Pertega S, Perez Castro T, et al. Exposure to paracetamol and asthma symptoms. Eur J Public Health. 2013;23(4):706-710. doi: 10.1093/eurpub/cks061 [DOI] [PubMed] [Google Scholar]
  • 33.Román Almendros M, García-Campaña A, Hidalgo-Lacalle M, López-León M. Perfil de las gestantes y grado de exposición al humo del tabaco. Matronas Prof. 2018;19:135-141. [Google Scholar]
  • 34.Hernández-Martínez C, Arija Val V, Escribano Subías J, Canals Sans J. A longitudinal study on the effects of maternal smoking and secondhand smoke exposure during pregnancy on neonatal neurobehavior. Early Hum Dev. 2012;88(6):403-408. doi: 10.1016/j.earlhumdev.2011.10.004 [DOI] [PubMed] [Google Scholar]
  • 35.McBride D, Keil T, Grabenhenrich L, et al. The EuroPrevall birth cohort study on food allergy: baseline characteristics of 12,000 newborns and their families from nine European countries. Pediatr Allergy Immunol. 2012;23(3):230-239. doi: 10.1111/j.1399-3038.2011.01254.x [DOI] [PubMed] [Google Scholar]
  • 36.Casas M, Valvi D, Luque N, et al. Dietary and sociodemographic determinants of bisphenol A urine concentrations in pregnant women and children. Environ Int. 2013;56:10-18. doi: 10.1016/j.envint.2013.02.014 [DOI] [PubMed] [Google Scholar]
  • 37.Ribot B, Isern R, Hernández-Martínez C, Canals J, Aranda N, Arija V. Effects of tobacco habit, second-hand smoking and smoking cessation during pregnancy on newborn’s health. Impacto del tabaquismo, la exposición pasiva al tabaco y el dejar de fumar sobre la salud del recien nacido. Med Clin (Barc). 2014;143(2):57-63. doi: 10.1016/j.medcli.2013.09.040 [DOI] [PubMed] [Google Scholar]
  • 38.Hernández-Martínez C, Voltas Moreso N, Ribot Serra B, Arija Val V, Escribano Macías J, Canals Sans J. Effects of prenatal nicotine exposure on infant language development: a cohort follow up study. Matern Child Health J. 2017;21(4):734-744. doi: 10.1007/s10995-016-2158-y [DOI] [PubMed] [Google Scholar]
  • 39.Roigé-Castellví J, Murphy M, Hernández-Martínez C, et al. The effect of prenatal smoke exposure on child neuropsychological function: a prospective mother-child cohort study. J Reprod Infant Psychol. 2020;38(1):25-37. doi: 10.1080/02646838.2019.1580350 [DOI] [PubMed] [Google Scholar]
  • 40.Iñiguez C, Esplugues A, Sunyer J, et al. ; INMA Project et al. Prenatal exposure to NO2 and ultrasound measures of fetal growth in the Spanish INMA cohort. Environ Health Perspect. 2016;124(2):235-242. doi: 10.1289/ehp.1409423 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Ruano-Ravina A, García-Lavandeira JA, Torres-Durán M, et al. Leisure time activities related to carcinogen exposure and lung cancer risk in never smokers. a case-control study. Environ Res. 2014;132:33-37. doi: 10.1016/j.envres.2014.03.027 [DOI] [PubMed] [Google Scholar]
  • 42.Torres-Durán M, Ruano-Ravina A, Parente-Lamelas I, et al. Lung cancer in never-smokers: a case-control study in a radon-prone area (Galicia, Spain). Eur Respir J. 2014;44(4):994-1001. doi: 10.1183/09031936.00017114 [DOI] [PubMed] [Google Scholar]
  • 43.Almirall J, Serra-Prat M, Bolíbar I, et al. ; Study Group of Community-Acquired Pneumonia in Catalan Countries (PACAP)et al. Passive smoking at home is a risk factor for community-acquired pneumonia in older adults: a population-based case-control study. BMJ Open. 2014;4(6):e005133. doi: 10.1136/bmjopen-2014-005133 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44.Torres-Durán M, Ruano-Ravina A, Parente-Lamelas I, et al. Alpha-1 antitrypsin deficiency and lung cancer risk: a case-control study in never-smokers. J Thorac Oncol. 2015;10(9):1279-1284. doi: 10.1097/JTO.0000000000000609 [DOI] [PubMed] [Google Scholar]
  • 45.Torres-Durán M, Ruano-Ravina A, Kelsey KT, et al. Environmental tobacco smoke exposure and EGFR and ALK alterations in never smokers’ lung cancer. Results from the LCRINS study. Cancer Lett. 2017;411:130-135. doi: 10.1016/j.canlet.2017.09.042 [DOI] [PubMed] [Google Scholar]
  • 46.González Romero MP, Cuevas-Fernández FJ, Marcelino-Rodríguez I, et al. Application of the Smoking Scale for Primary Care (ETAP) in clinical practice. Aplicación de la Escala de Tabaquismo para Atención Primaria (ETAP) en la práctica clínica. Aten Primaria. 2018;50(7):414-421. doi: 10.1016/j.aprim.2017.05.010 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47.Molina-Montes E, Van Hoogstraten L, Gomez-Rubio P, et al. Pancreatic cancer risk in relation to lifetime smoking patterns, tobacco type, and dose-response relationships. Cancer Epidemiol Biomarkers Prev. 2020;29(5):1009-1018. doi: 10.1158/1055-9965.EPI-19-1027 [DOI] [PubMed] [Google Scholar]
  • 48.Torres-Durán M, Curiel-García MT, Ruano-Ravina A, et al. Small-cell lung cancer in never-smokers. ESMO Open. 2021;6(2):100059. doi: 10.1016/j.esmoop.2021.100059 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49.Torres-Durán M, Ruano-Ravina A, Parente-Lamelas I, et al. Residential radon and lung cancer characteristics in never smokers. Int J Radiat Biol. 2015;91(8):605-610. doi: 10.3109/09553002.2015.1047985 [DOI] [PubMed] [Google Scholar]
  • 50.Sunyer J, Garcia-Esteban R, Castilla AM, et al. ; INMA project et al. Exposure to second-hand smoke and reproductive outcomes depending on maternal asthma. Eur Respir J. 2012;40(2):371-376. doi: 10.1183/09031936.00091411 [DOI] [PubMed] [Google Scholar]
  • 51.Larrañaga I, Santa-Marina L, Begiristain H, et al. Socio-economic inequalities in health, habits and self-care during pregnancy in Spain. Matern Child Health J. 2013;17(7):1315-1324. doi: 10.1007/s10995-012-1134-4 [DOI] [PubMed] [Google Scholar]
  • 52.Ortega-García JA, Perales JE, Cárceles-Álvarez A, et al. Long term follow-up of a tobacco prevention and cessation program in cystic fibrosis patients. Adicciones. 2016;28(2):99-107. doi: 10.20882/adicciones.778 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 53.Lidón-Moyano C, Fu M, Ballbè M, et al. Impact of the Spanish smoking laws on tobacco consumption and secondhand smoke exposure: a longitudinal population study. Addict Behav. 2017;75:30-35. doi: 10.1016/j.addbeh.2017.06.016 [DOI] [PubMed] [Google Scholar]
  • 54.Pérez-de-Arcelus M, Toledo E, Martínez-González MÁ, Martín-Calvo N, Fernández-Montero A, Moreno-Montañés J. Smoking and incidence of glaucoma: the SUN Cohort. Medicine (Baltimore). 2017;96(1):e5761. doi: 10.1097/MD.0000000000005761 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 55.Román-Gálvez RM, Amezcua-Prieto C, Olmedo-Requena R, Lewis-Mikhael Saad AM, Martínez-Galiano JM, Bueno-Cavanillas A. Partner smoking influences whether mothers quit smoking during pregnancy: a prospective cohort study. BJOG. 2018;125(7):820-827. doi: 10.1111/1471-0528.14986 [DOI] [PubMed] [Google Scholar]
  • 56.Flexeder C, Zock JP, Jarvis D, et al. Second-hand smoke exposure in adulthood and lower respiratory health during 20 year follow up in the European Community Respiratory Health Survey. Respir Res. 2019;20(1):33. doi: 10.1186/s12931-019-0996-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 57.Olivieri M, Murgia N, Carsin AE, et al. Effects of smoking bans on passive smoking exposure at work and at home. The European Community respiratory health survey. Indoor Air. 2019;29(4):670-679. doi: 10.1111/ina.12556 [DOI] [PubMed] [Google Scholar]
  • 58.Iñiguez C, Ballester F, Amorós R, Murcia M, Plana A, Rebagliato M. Active and passive smoking during pregnancy and ultrasound measures of fetal growth in a cohort of pregnant women. J Epidemiol Community Health. 2012;66(6):563-570. doi: 10.1136/jech.2010.116756 [DOI] [PubMed] [Google Scholar]
  • 59.Ruano-Ravina A, Cameselle-Lago C, Torres-Durán M, et al. Indoor radon exposure and COPD, synergic association? A multicentric, hospital-based case-control study in a radon-prone area. Arch Bronconeumol. 2021;57(10):630-636. doi: 10.1016/j.arbr.2020.11.020 [DOI] [PubMed] [Google Scholar]
  • 60.Villaverde Royo MV, Marín Izaguerri MP, Requeno Jarabo MN, Val Esco L, Coronas Mateos S, Córdoba-García R. Impact of the smoke-free legislation on the prevalence and referred time exposure to the environmental tobacco smoke in Zaragoza. Impacto de la regulacion de espacios sin humo en la exposicion referida al humo ambiental de tabaco en Zaragoza. Aten Primaria. 2012;44(10):603-610. doi: 10.1016/j.aprim.2012.02.010 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 61.Clemente Jiménez ML, Bartolomé Moreno C, Rubio Aranda E, Martín Cantera C, Puente D, Sobradiel Sierra N; Grupo de Abordaje del Tabaquismo de semFYC y responsables autonómicos de la Semana sin Humo 2008 . Spanish opinions on tobacco smoke-free areas. Actitudes de los españoles frente a los espacios libres de humo de tabaco. Aten Primaria. 2012;44(3):138-144. doi: 10.1016/j.aprim.2011.01.015 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 62.Martínez-Sánchez JM, Fu M, Schiaffino A, et al. Exposición al humo ambiental del tabaco en el hogar y el tiempo libre según el día de la semana (laborable y no laborable) en Barcelona. Adicciones. 2012;24:173-178. doi: 10.20882/adicciones.110 [DOI] [PubMed] [Google Scholar]
  • 63.Ortega-García JA, Gutierrez-Churango JE, Sánchez-Sauco MF, et al. Head circumference at birth and exposure to tobacco, alcohol and illegal drugs during early pregnancy. Childs Nerv Syst. 2012;28(3):433-439. doi: 10.1007/s00381-011-1607-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 64.Jiménez-Muro A, Samper MP, Marqueta A, Rodríguez G, Nerín I. Prevalence of smoking and second-hand smoke exposure: differences between Spanish and immigrant pregnant women. Prevalencia de tabaquismo y exposición al humo ambiental de tabaco en las mujeres embarazadas: diferencias entre españolas e inmigrantes. Gac Sanit. 2012;26(2):138-144. doi: 10.1016/j.gaceta.2011.07.015 [DOI] [PubMed] [Google Scholar]
  • 65.Aurrekoetxea JJ, Murcia M, Rebagliato M, et al. Determinants of self-reported smoking and misclassification during pregnancy, and analysis of optimal cut-off points for urinary cotinine: a cross-sectional study. BMJ Open. 2013;3(1):e002034. doi: 10.1136/bmjopen-2012-002034 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 66.Mateos-Vílchez PM, Aranda-Regules JM, Díaz-Alonso G, et al. Smoking prevalence and associated factors during pregnancy in Andalucía 2007-2012. Prevalencia de tabaquismo durante el embarazo y factores asociados en Andalucía 2007-2012. Rev Esp Salud Publica. 2014;88(3):369-381. doi: 10.4321/S1135-57272014000300007 [DOI] [PubMed] [Google Scholar]
  • 67.Sureda X, Martínez-Sánchez JM, Fu M, et al. Impact of the Spanish smoke-free legislation on adult, non-smoker exposure to secondhand smoke: cross-sectional surveys before (2004) and after (2012) legislation. PLoS One. 2014;9(2):e89430. doi: 10.1371/journal.pone.0089430 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 68.Aurrekoetxea JJ, Murcia M, Rebagliato M, et al. Factors associated with second-hand smoke exposure in non-smoking pregnant women in SpaIn: self-reported exposure and urinary cotinine levels. Sci Total Environ. 2014;470-471:1189-1196. doi: 10.1016/j.scitotenv.2013.10.110 [DOI] [PubMed] [Google Scholar]
  • 69.Pérez-Ríos M, Santiago-Pérez MI, Malvar A, et al. Impact of the Spanish smoking laws on the exposure to environmental tobacco smoke in Galicia (2005-2011). Impacto de las leyes de control del tabaquismo en la exposición al humo ambiental de tabaco en Galicia (2005-2011). Gac Sanit. 2014;28:20-24. doi: 10.1016/j.gaceta.2013.04.010 [DOI] [PubMed] [Google Scholar]
  • 70.Galán I, Mayo E, López MJ, et al. Validity of self-reported exposure to second-hand smoke in hospitality venues. Environ Res. 2014;133:1-3. doi: 10.1016/j.envres.2014.04.029 [DOI] [PubMed] [Google Scholar]
  • 71.Sureda X, Fernández E, Martínez-Sánchez JM, et al. Secondhand smoke in outdoor settings: smokers’ consumption, non-smokers’ perceptions, and attitudes towards smoke-free legislation in Spain. BMJ Open. 2015;5(4):e007554. doi: 10.1136/bmjopen-2014-007554 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 72.Ballbè M, Sureda X, Martínez-Sánchez JM, et al. Secondhand smoke in psychiatric units: patient and staff misperceptions. Tob Control. 2015;24(e3):e212-e220. doi: 10.1136/tobaccocontrol-2014-051585 [DOI] [PubMed] [Google Scholar]
  • 73.Ballbè M, Martínez-Sánchez JM, Gual A, et al. Association of second-hand smoke exposure at home with psychological distress in the Spanish adult population. Addict Behav. 2015;50:84-88. doi: 10.1016/j.addbeh.2015.06.020 [DOI] [PubMed] [Google Scholar]
  • 74.Fernández E, Fu M, Pérez-Ríos M, Schiaffino A, Sureda X, López MJ. Changes in secondhand smoke exposure after smoke-free legislation (Spain, 2006-2011). Nicotine Tob Res. 2017;19(11):1390-1394. doi: 10.1093/ntr/ntx040 [DOI] [PubMed] [Google Scholar]
  • 75.Martínez C, Méndez C, Sánchez M, Martínez-Sánchez JM. Attitudes of students of a health sciences university towards the extension of smoke-free policies at the university campuses of Barcelona (Spain). Gac Sanit. 2017;31(2):132-138. doi: 10.1016/j.gaceta.2016.08.009 [DOI] [PubMed] [Google Scholar]
  • 76.Viñolas N, Garrido P, Isla D, et al. Lung cancer in never-smoking women: a sub-analysis of the Spanish female-specific database WORLD07. Cancer Invest. 2017;35(5):358-365. doi: 10.1080/07357907.2017.1295461 [DOI] [PubMed] [Google Scholar]
  • 77.Martínez-Sánchez JM, González-Marrón A, Martín-Sánchez JC, et al. Validity of self-reported intensity of exposure to second-hand smoke at home against environmental and personal markers. Gac Sanit. 2018;32(4):393-395. doi: 10.1016/j.gaceta.2017.08.002 [DOI] [PubMed] [Google Scholar]
  • 78.Sureda X, Bilal U, Fernández E, et al. Second-hand smoke exposure in outdoor hospitality venues: smoking visibility and assessment of airborne markers. Environ Res. 2018;165:220-227. doi: 10.1016/j.envres.2018.04.024 [DOI] [PubMed] [Google Scholar]
  • 79.Fu M, Fernández E, Martínez-Sánchez JM, et al. Second-hand smoke exposure in indoor and outdoor areas of cafés and restaurants: need for extending smoking regulation outdoors? Environ Res. 2016;148:421-428. doi: 10.1016/j.envres.2016.04.024 [DOI] [PubMed] [Google Scholar]
  • 80.Míguez MC, Pereira B. Effects of active and/or passive smoking during pregnancy and the postpartum period. Repercusiones del consumo de tabaco activo y/o pasivo en el embarazo y postparto. An Pediatr (Engl Ed). 2020:S1695-4033(20)30288-5. doi: 10.1016/j.anpedi.2020.07.029 [DOI] [PubMed] [Google Scholar]
  • 81.Lidón-Moyano C, Fu M, Pérez-Ortuño R, et al. Third-hand exposure at homes: assessment using salivary cotinine. Environ Res. 2021;196:110393. doi: 10.1016/j.envres.2020.110393 [DOI] [PubMed] [Google Scholar]
  • 82.Rebollar Álvarez A, Nuez Vicente C, Lozano Polo A, et al. Tobacco use in Spain during COVID-19 lockdown: an evaluation through social media. Consumo de tabaco en España durante el estado de alarma por COVID-19: resultados de una evaluación a través de redes sociales. Rev Esp Salud Publica. 2021;95:e202103049. [PubMed] [Google Scholar]
  • 83.Henderson E, Lugo A, Liu X, et al. Secondhand smoke presence in outdoor areas in 12 European countries. Environ Res. 2021;195:110806. doi: 10.1016/j.envres.2021.110806 [DOI] [PubMed] [Google Scholar]
  • 84.Nogueira SO, Fu M, Lugo A, et al. ; TackSHS Project Investigators et al. Non-smokers’ and smokers’ support for smoke-free legislation in 14 indoor and outdoor settings across 12 European countries. Environ Res. 2022;204(Pt C):112224. doi: 10.1016/j.envres.2021.112224 [DOI] [PubMed] [Google Scholar]
  • 85.López MJ, Nebot M, Sallés J, et al. Measurement of exposure to environmental tobacco smoke in education centers, health centers, transport facilities and leisure places. Medición de la exposición al humo ambiental de tabaco en centros de enseñanza, centros sanitarios, medios de transporte y lugares de ocio. Gac Sanit. 2004;18(6):451-457. doi: 10.1016/s0213-9111(04)72032-4 [DOI] [PubMed] [Google Scholar]
  • 86.Nebot M, Manzanares S, López MJ, et al. Estimation of environmental tobacco smoke exposure: review of questionnaires used in Spain. Estimación de la exposición al humo ambiental de tabaco: revisión de cuestionarios utilizados en España. Gac Sanit. 2011;25(4):322-328. doi: 10.1016/j.gaceta.2011.02.013 [DOI] [PubMed] [Google Scholar]
  • 87.Gaffney KF, Molloy SB, Maradiegue AH. Questionnaires for the measurement of infant environmental tobacco smoke exposure: a systematic review. J Nurs Meas. 2003;11(3):225-239. doi: 10.1891/jnum.11.3.225.61275 [DOI] [PubMed] [Google Scholar]
  • 88.Rebagliato M, Bolumar F, Florey Cdu V. Assessment of exposure to environmental tobacco smoke in nonsmoking pregnant women in different environments of daily living. Am J Epidemiol. 1995;142(5):525-530. doi: 10.1093/oxfordjournals.aje.a117670 [DOI] [PubMed] [Google Scholar]
  • 89.Benowitz NL. Cotinine as a biomarker of environmental tobacco smoke exposure. Epidemiol Rev. 1996;18(2):188-204. doi: 10.1093/oxfordjournals.epirev.a017925 [DOI] [PubMed] [Google Scholar]
  • 90.Mourino N, Pérez-Ríos M, Santiago-Pérez MI, Lanphear B, Yolton K, Braun JM. Secondhand tobacco smoke exposure among children under 5 years old: questionnaires versus cotinine biomarkers: a cohort study. BMJ Open. 2021;11(6):e044829. doi: 10.1136/bmjopen-2020-044829 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 91.Noncommunicable Disease Surveillance, Monitoring and Reporting. World Health Organization. June 19, 2023. Accessed August 6, 2024. https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools [Google Scholar]
  • 92.Global Youth Tobacco Survey. Pan American Health Organization. Accessed August 6, 2024. https://www.paho.org/en/gyts [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

TID-22-165-s1.pdf (484.6KB, pdf)

Data Availability Statement

The data supporting this research are available from the authors on reasonable request.

Articles from Tobacco Induced Diseases are provided here courtesy of The International Society for the Prevention of Tobacco Induced Diseases

RESOURCES