Vardavas, Constantine

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Vardavas, Constantine

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Vardavas

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Constantine

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Vardavas, Constantine

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Ashtrays and Signage as Determinants of a Smoke-Free Legislation’s Success
(Public Library of Science, 2013) Vardavas, Constantine; Agaku, Israel; Patelarou, Evridiki; Anagnostopoulos, Nektarios; Nakou, Chrysanthi; Dramba, Vassiliki; Giourgouli, Gianna; Argyropoulou, Paraskevi; Antoniadis, Antonis; Gourgoulianis, Konstantinos; Ourda, Despoina; Lazuras, Lambros; Bertic, Monique; Lionis, Christos; Connolly, Gregrory; Behrakis, Panagiotis
Introduction: Successful smoke-free legislation is dependent on political will, enforcement and societal support. We report the success and pitfalls of a non-enforced nationwide smoke-free legislation in Greece, as well as ways in which compliance and enforcement-related factors, including ashtrays and signage, may impact indoor secondhand smoke (SHS) concentrations. Methods: A follow-up study of venues (n = 150, at baseline, n = 75 at 2-year follow-up) in Greece assessed indoor particulate matter with a diameter less than 2.5 micrometers (PM2.5) concentrations attributable to SHS smoke every six months for two years (n = 455 venue/measurements). Results: Following the implementation of the 2010 smoke-free legislation, mean PM2.5 concentrations attributable to SHS fell from 175.3 µg/m3 pre-ban to 84.52 µg/m3 immediately post-ban, increasing over subsequent waves (103.8 µg/m3 and 158.2 µg/m3 respectively). Controlling for potential influential factors such as ventilation, time of day, day of week, city and venue type, all post-ban measurements were still lower than during the pre-ban period (Wave 2 beta: −118.7, Wave 3 beta: −87.6, and Wave 4 beta: −69.9). Outdoor or indoor signage banning smoking was not found to affect SHS concentrations (beta: −10.9, p = 0.667 and beta: −18.1, p = 0.464 respectively). However, ashtray or ashtray equivalents were strong determinants of the existence of indoor SHS (beta: +67 µg/m3, p = 0.017). Conclusions: While the public may be supportive of smoke-free legislation, adherence may decline rapidly if enforcement is limited or nonexistent. Moreover, enforcement agencies should also focus on the comprehensive removal of ashtray equivalents that could act as cues for smoking within a venue.
From the classroom to Facebook: a modern approach for smoking education in adolescents
(BioMed Central, 2014) Kousoulis, Antonis A; Kympouropoulos, Stylianos P; Pouli, Dimitra K; Economopoulos, Konstantinos P.; Vardavas, Constantine
5-year trends in the intention to quit smoking amidst the economic crisis and after recently implemented tobacco control measures in Greece
(BioMed Central, 2014) Schoretsaniti, Sotiria; Filippidis, Filippos T; Vardavas, Constantine; Dimitrakaki, Christine; Behrakis, Panagiotis; Connolly, Gregory N; Tountas, Yannis
Prevalence and determinants of SHS exposure in public and private areas after the 2010 smoke-free legislation in Greece
(BioMed Central, 2014) Schoretsaniti, Sotiria; Filippidis, Filippos T; Vardavas, Constantine; Tzavara, Chara; Dimitrakaki, Christine; Behrakis, Panagiotis; Connolly, Gregory N; Tountas, Yannis
Disparities and Trends in Indoor Exposure to Secondhand Smoke among U.S. Adolescents: 2000-2009
(Public Library of Science, 2013) Agaku, Israel T.; Vardavas, Constantine
Introduction: Secondhand smoke (SHS) exposure causes disease and death among nonsmokers. With a plethora of smoke-free legislation implemented and a steady decrease in cigarette consumption noted over the past decade in the U.S., this study assessed trends in indoor SHS exposure among U.S. adolescents in grades 6–12 during 2000–2009. Methods: Data were obtained from the 2000–2009 National Youth Tobacco Survey – a national survey of U.S. middle and high school students. SHS exposure within an indoor area within the past seven days was self-reported. Trends in indoor SHS exposure during 2000–2009 were assessed overall and by socio-demographic characteristics, using the Wald's test in a binary logistic regression. Within-group comparisons were performed using chi-squared statistics (p<0.05). Results: The proportion of U.S. middle and high school students who were exposed to indoor SHS declined from 65.5% in 2000 to 40.5% in 2009 (p<0.05 for linear trend). Significant declines were also observed across all population subgroups. Between 2000 and 2009, prevalence of indoor SHS exposure declined significantly among both middle (58.5% to 34.3%) and high school (71.5% to 45.4%) students. Prevalence of indoor SHS exposure was significantly higher among girls (44.0% in 2009) compared to boys (37.2% in 2009) during each survey year. Similarly, prevalence of indoor SHS exposure during 2000–2009 was highest among non-Hispanic whites (44.2% in 2009) and lowest among non-Hispanic Asians (30.2% in 2009). During each survey year, prevalence was highest among the oldest age group (≥18 years) and lowest among the youngest (9–11 years). Also, prevalence was significantly higher among current cigarette smokers (83.8% in 2009) compared to nonsmokers (34.0% in 2009). Conclusion: Significant declines in indoor SHS exposure among U.S. middle and high school students occurred during 2000–2009. While the results are encouraging, additional efforts are needed to further reduce youth indoor SHS exposure.
Design and Study Protocol of the Maternal Smoking Cessation During Pregnancy Study, (M-SCOPE)
(BioMed Central, 2011) Loukopoulou, Andriani N; Vardavas, Constantine; Farmakides, George; Rossolymos, Christos; Chrelias, Charalambos; Tzatzarakis, Manolis N; Tsatsakis, Aristidis; Lymberi, Maria; Connolly, Gregory N; Behrakis, Panagiotis
Background: Maternal smoking is the most significant cause of preventable complications during pregnancy, with smoking cessation during pregnancy shown to increase birth weight and reduce preterm birth among pregnant women who quit smoking. Taking into account the fact that the number of women who smoke in Greece has increased steadily throughout the previous decade and that the prevalence of smoking among Greek females is one of the highest in the world, smoking cessation should be a top priority among Greek health care professionals. Methods/Design: The Maternal Smoking Cessation during Pregnancy Study (M-SCOPE), is a Randomized Control Trial (RCT) that aims to test whether offering Greek pregnant smokers a high intensity intervention increases smoking cessation during the third trimester of pregnancy, when compared to a low intensity intervention. Prospective participants will be pregnant smokers of more than 5 cigarettes per week, recruited up to the second trimester of pregnancy. Urine samples for biomarker analysis of cotinine will be collected at three time points: at baseline, at around the 32nd week of gestation and at six months post partum. The control group/low intensity intervention will include: brief advice for 5 minutes and a short leaflet, while the experimental group/intensive intervention will include: 30 minutes of individualized cognitive-behavioural intervention provided by a trained health professional and a self-help manual especially tailored for smoking cessation during pregnancy, while counselling will be based on the ''5 As.'' After childbirth, the infants' birth weight, gestational age and any other health related complications during pregnancy will be recorded. A six months post-partum a follow up will be performed in order to re-assess the quitters smoking status. Discussion: If offering pregnant smokers a high intensity intervention for smoking cessation increases the rate of smoking cessation in comparison to a usual care low intensity intervention in Greek pregnant smokers, such a scheme if beneficial could be implemented successfully within clinical practice in Greece. Trial Registration ClinicalTrials.gov Identifier NCT01210118
Measuring the Burden of Herpes Zoster and Post Herpetic Neuralgia Within Primary Care in Rural Crete, Greece
(BioMed Central, 2011) Lionis, Christos D; Symvoulakis, Emmanouil K; Papadakaki, Maria G; Anastasiou, Foteini S; Antonopoulou, Maria D; Apostolakis, Charalampos M; Dimitrakopoulos, Stelios A; Fountakis, George I; Grammatikopoulos, Ilias A; Komninos, John D; Kounalakis, Dimitris K; Ladoukaki, Eva S; Makri, Kornilia V; Petraki, Chrysa S; Ploumis, Nikos G; Prokopiadou, Dimitra P; Stefanaki, Ioanna N; Tsakountakis, Nikos A; Tsiligianni, Ioanna G; Tzortzis, Emmanouil N; Vasilaki, Aggeliki A; Vasilopoulos, Theodoros K; Vrentzos, George E; Vardavas, Constantine
Background: Research has indicated that general practitioners (GPs) have good clinical judgment in regards to diagnosing and managing herpes zoster (HZ) within clinical practice in a country with limited resources for primary care and general practice. The objective of the current study was to assess the burden of HZ and post herpetic neuralgia (PHN) within rural general practices in Crete, Greece. Methods: The current study took place within a rural setting in Crete, Greece during the period of November 2007 to November 2009 within the catchment area in which the Cretan Rural Practice-based Research Network is operating. In total 19 GP's from 14 health care units in rural Crete were invited to participate, covering a total turnover patient population of approximately 25, 000 subjects. For the purpose of this study an electronic record database was constructed and used as the main tool for monitoring HZ and PHN incidence. Stress related data was also collected with the use of the Short Anxiety Screening Test (SAST). Results: The crude incidence rate of HZ was 1.4/1000 patients/year throughout the entire network of health centers and satellite practices, while among satellite practices alone it was calculated at 1.3/1000 patients/year. Additionally, the standardised incidence density within satellite practices was calculated at 1.6/1000 patients/year. In regards to the stress associated with HZ and PHN, the latter were found to have lower levels of anxiety, as assessed through the SAST score (17.4 ± 3.9 vs. 21.1 ± 5.7; p = 0.029). Conclusions: The implementation of an electronic surveillance system was feasible so as to measure the burden of HZ and PHN within the rural general practice setting in Crete.
Tobacco taxation: the importance of earmarking the revenue to health care and tobacco control
(BioMed Central, 2012) Vardavas, Constantine; Filippidis, Filippos T; Agaku, Israel; Mytaras, Vasileios; Bertic, Monique; Connolly, Gregrory; Tountas, Yannis; Behrakis, Panagiotis
Background: Increases in tobacco taxation are acknowledged to be one of the most effective tobacco control interventions. This study aimed at determining the mediating role of socioeconomical status (SES) and the earmarking of revenue to healthcare and tobacco control, in influencing population support for the adoption of a 2 Euro tobacco tax increase in Greece, amid the challenging economic environment and current austerity measures. Methods: Data was collected from two national household surveys, the “Hellas Health III” survey, conducted in October 2010 and the "Hellas Tobacco survey” conducted in September 2012. Data was analyzed from 694 and 1066 respondents aged 18 years or more, respectively. Logistic regression models were fitted to measure the adjusted relationship between socio-economic factors for the former, and support for increased taxation on tobacco products for the latter. Results: In 2012 amidst the Greek financial crisis, population support for a flat two euro tax increase reached 72.1%, if earmarked for health care and tobacco control, a percentage high both among non-smokers (76%) and smokers (64%) alike. On the contrary, when not earmarked, only 43.6% of the population was in support of the equivalent increase. Women were more likely to change their mind and support a flat two-euro increase if the revenue was earmarked for health care and tobacco control (aOR = 1.70; 95% C.I: 1.22-2.38, p = 0.002). Furthermore, support for an increase in tobacco taxation was not associated with SES and income. Conclusion: Despite dire austerity measures in Greece, support for an increase in tobacco taxation was high among both smokers and non-smokers, however, only when specifically earmarked towards health care and tobacco control. This should be taken into account not only in Greece, but within all countries facing social and economic reform.
The impact of the Cyprus comprehensive smoking ban on air quality and economic business of hospitality venues
(BioMed Central, 2013) Christophi, Costas; Paisi, Martha; Pampaka, Despina; Kehagias, Martha; Vardavas, Constantine; Connolly, Gregrory
Background: Several countries, including Cyprus, have passed smoke-free legislations in recent years. The goal of this study was to assess the indoor levels of particulate matter in hospitality venues in Cyprus before and after the implementation of the law on 1/1/2010, evaluate the role of enforcement, and examine the legislation’s effect on revenue and employment. Methods: Several hospitality venues (n = 35) were sampled between April 2007 and January 2008, and 21 of those were re-sampled after the introduction of the smoking ban, between March and May 2010. Data on enforcement was provided by the Cyprus Police whereas data on revenue and employment within the hospitality industry of Cyprus were obtained from the Cyprus Statistical Service; comparisons were made between the corresponding figures before and after the implementation of the law. Results: The median level of PM\(_{2.5}\) associated with secondhand smoking was 161 μg/m\(^3\) pre-ban and dropped to 3 μg/m\(^3\) post-ban (98% decrease, p < 0.0001). Furthermore, in the year following the ban, the hotel turnover rate increased by 4.1% and the restaurant revenue by 6.4%; employment increased that same year by 7.2% and 1.0%, respectively. Conclusion: Smoke free legislations, when enforced, are highly effective in improving the air quality and reducing the levels of indoor PM\(_{2.5}\). Strict enforcement plays a key role in the successful implementation of smoking bans. Even in nations with high smoking prevalence comprehensive smoking laws can be effectively implemented and have no negative effect on accommodation, food, and beverage services.
Dealing with tobacco use and dependence within primary health care: time for action
(BioMed Central, 2013) Vardavas, Constantine; Symvoulakis, Emmanouil K; Lionis, Christos