Abstract Objective The TackSHS project aims to comprehensively elucidate the impact that exposure to secondhand smoke (SHS) from cigarettes and second-hand aerosols (SHA) from electronic cigarettes have on the respiratory health of the European population according to socioeconomic characteristics and other determinants. Method The TackSHS project involves a series of coordinated studies carried out by 11 academic and public health organisations from six European countries. The project will investigate: a) the determinants of SHS and SHA exposure assessed at the individual level (surveys on representative general population samples) and in common environments (environmental sampling in specific settings); b) the overall disease burden, mortality and morbidity attributable to such exposure; and c) its economic impact in terms of direct health care costs. The project will also examine specific acute respiratory health changes in healthy individuals and patients with respiratory diseases exposed to SHS and SHA. In addition, the project will examine the effectiveness of a novel intervention to reduce SHS exposure in households where smoking is permitted. All these studies are inter-related and involve collaborative coordination among the participant organisations. Conclusion The comprehensive, integrated approach of the TackSHS project will enable a significant step forward from the current status quo in the understanding of the impact of SHS and SHA exposure on health and provide the basis for health policy recommendations to help European countries to further reduce the harm caused by SHS and SHA exposure.

Resumen Objetivo El proyecto TackSHS pretende caracterizar el impacto global de la exposición al humo ambiental de tabaco (HAT) y al aerosol de los cigarrillos electrónicos (ACE) en la salud respiratoria de la población europea según variables socioeconómicas y otros determinantes. Método El proyecto TackSHS consiste en una serie de estudios coordinados y gestionados por 11 organizaciones académicas y de salud pública de seis países europeos. El proyecto estudiará: a) los determinantes de la exposición al HAT y al ACE a nivel individual (encuestas en muestras representativas de la población general) y en espacios comunes (muestras ambientales en lugares específicos); b) su carga general de enfermedad y la morbimortalidad atribuible a tal exposición; y c) su impacto económico en términos de costes sanitarios directos e indirectos. Además, el proyecto investigará cambios específicos a corto plazo en la salud respiratoria en personas sanas y en pacientes con enfermedades respiratorias expuestos al HAT y al ACE. También examinará la efectividad de una intervención novedosa para reducir la exposición al HAT en hogares donde se permite fumar. Todos estos estudios están interrelacionados y conllevan una coordinación colaborativa entre las instituciones participantes. Conclusión El enfoque integral del proyecto TackSHS permitirá un avance significativo en la evidencia sobre la comprensión del impacto de la exposición al HAT y al ACE en la salud, y proporcionará una base para desarrollar recomendaciones políticas sanitarias para ayudar a los países europeos a reducir los daños causados por la exposición al HAT y al ACE.

Abstract Objective The TackSHS project aims to comprehensively elucidate the impact that exposure to secondhand smoke (SHS) from cigarettes and second-hand aerosols (SHA) from electronic cigarettes have on the respiratory health of the European population according to socioeconomic characteristics and other determinants. Method The TackSHS project involves a series of coordinated studies carried out by 11 academic and public health organisations from six European countries. The project will investigate: a) the determinants of SHS and SHA exposure assessed at the individual level (surveys on representative general population samples) and in common environments (environmental sampling in specific settings); b) the overall disease burden, mortality and morbidity attributable to such exposure; and c) its economic impact in terms of direct health care costs. The project will also examine specific acute respiratory health changes in healthy individuals and patients with respiratory diseases exposed to SHS and SHA. In addition, the project will examine the effectiveness of a novel intervention to reduce SHS exposure in households where smoking is permitted. All these studies are inter-related and involve collaborative coordination among the participant organisations. Conclusion The comprehensive, integrated approach of the TackSHS project will enable a significant step forward from the current status quo in the understanding of the impact of SHS and SHA exposure on health and provide the basis for health policy recommendations to help European countries to further reduce the harm caused by SHS and SHA exposure.

Resumen Objetivo El proyecto TackSHS pretende caracterizar el impacto global de la exposición al humo ambiental de tabaco (HAT) y al aerosol de los cigarrillos electrónicos (ACE) en la salud respiratoria de la población europea según variables socioeconómicas y otros determinantes. Método El proyecto TackSHS consiste en una serie de estudios coordinados y gestionados por 11 organizaciones académicas y de salud pública de seis países europeos. El proyecto estudiará: a) los determinantes de la exposición al HAT y al ACE a nivel individual (encuestas en muestras representativas de la población general) y en espacios comunes (muestras ambientales en lugares específicos); b) su carga general de enfermedad y la morbimortalidad atribuible a tal exposición; y c) su impacto económico en términos de costes sanitarios directos e indirectos. Además, el proyecto investigará cambios específicos a corto plazo en la salud respiratoria en personas sanas y en pacientes con enfermedades respiratorias expuestos al HAT y al ACE. También examinará la efectividad de una intervención novedosa para reducir la exposición al HAT en hogares donde se permite fumar. Todos estos estudios están interrelacionados y conllevan una coordinación colaborativa entre las instituciones participantes. Conclusión El enfoque integral del proyecto TackSHS permitirá un avance significativo en la evidencia sobre la comprensión del impacto de la exposición al HAT y al ACE en la salud, y proporcionará una base para desarrollar recomendaciones políticas sanitarias para ayudar a los países europeos a reducir los daños causados por la exposición al HAT y al ACE.

The objective of this article is to describe the process of approval of the Italian smoking ban, enacted in 2005. The method is to conduct a review of proposed and approved legislation 20002005, and of articles published in Italian newspapers, 1998-2008. Enabling factors in the process were: the leadership of two consecutive Health Ministers, both physicians, who introduced the bill four times between 2000-2002; the repeated presentation and final approval of the bill as an amendment within a bill on public administration which enabled timely approval of the ban; and the stringent air quality standards in the 2003 regulation that made building smoking rooms impracticable and prohibitively expensive. Limiting factors in the process were: the 6-month delay in approving the regulation on smoking rooms; the 1.5-year delay in approving the regulation establishing owners' responsibility for enforcing the ban in hospitality premises and the legal action in August 2005, which shifted responsibility for enforcement to police. Eighty-three percent of the 808 articles published on smoking in 1998-2008 were released between 2000-2005, during the policy process. While the press devoted considerable attention to the issues raised by the hospitality sector, the long legislative process of the bill and its regulations also stimulated coverage on tobacco control issues.

L'obiettivo dell'articolo è descrivere l'iter per l'approvazione della legge 3/2003, articolo 51. Il metodo usato è stato la ricostruzione del'iter parlamentare della legge nel 2000-2005, e della rassegna stampa in Italia sul fumo, 1998-2008. Tra i risultati ottenuti, la strategia per l'approvazione del disegno di legge (DDL) anti-fumo presenta alcuni punti di forza: la leadership di due medici-ministri della sanità (Veronesi e Sirchia) che hanno presentato 4 DDL nel 2000-2002; l'aumento di 4 volte delle sanzioni per i divieti già vigenti nel 2001; l'inserimento nel 2002 per 3 volte del divieto come articolo all'interno di una legge-quadro, per far approvare velocemente il bando; gli standard restrittivi della qualità dell'aria dei sistemi di ventilazione previsti nei locali fumatori dal regolamento attuativo DPCM 23/12/2003. I punti negativi dell'iter sono stati: il ritardo nell'approvazione dei requisiti per le aree fumatori e dei responsabili dei controlli; l'annullamento del TAR del Lazio nell'agosto 2005 della responsabilità degli esercenti nel controllare l'osservanza del divieto. Risultano pubblicati oltre 800 articoli sul fumo nel 1998-2008, di cui l'83% durante l'iter di approvazione della legge. Anche se la stampa ha dedicato molta attenzione alle rivendicazioni dei ristoratori, il lungo iter parlamentare ha favorito la pubblicazione di articoli sulla prevenzione del tabagismo.

The objective of this paper is to investigate mortality among 1247 male asbestos-cement workers employed in an asbestos-cement plant located in Naples. The cohort included 1247 men hired between 1950 and 1986. The follow-up began on January 1st 1965. The vital status and causes of death were ascertained up to December 31 2005. Cause-specific mortality rates of the Campania Region population were used as reference. Relative risks were estimated using Standardized Mortality Ratios (SMRs), and the confidence intervals were calculated at a 95% level (95% CI). A significant increase in mortality was observed for respiratory disease (81 deaths; SMR = 187; 95% CI = 149-233), particularly for pneumoconiosis (42 deaths; SMR = 13 313; 95% CI = 9595-17 996) of which 41 deaths for asbestosis (SMR = 43 385; 95% CI = 31 134-58 857), for pleural cancer (24 deaths; SMR = 2617; 95% CI = 1677-3893), for lung cancer (84 deaths; SMR=153; 95% CI = 122-189) and for peritoneal cancer (9 deaths; SMR = 1985; 95% CI = 908-3769). Non-significant increases were also observed for rectum cancer (6 deaths; SMR = 157; 95% CI = 58-342). In conclusion, consistently with other mortality studies on asbestos-cement workers performed in different countries, an increased mortality from asbestosis, lung cancer, pleural and peritoneal mesothelioma was detected in the present cohort.

Obiettivo del presente studio è descrivere la mortalità di una coorte di 1247 lavoratori della Eternit di Bagnoli (NA). è stato condotto uno studio di coorte, ristretto agli uomini, che ha incluso 1247 soggetti assunti a partire dal 1950 sino al 1986, con follow up iniziato nel 1965. Lo stato in vita e le cause di morte sono state accertate al 31/12/2005. La mortalità osservata è stata confrontata con quella attesa in base ai tassi di riferimento della popolazione campana. Sono stati calcolati i rapporti di mortalità standardizzati (SMR) per il periodo 1965-2005 ed i corrispondenti intervalli di confidenza al 95% (IC 95%). Un incremento significativo della mortalità è stato osservato per le malattie respiratorie (81 deceduti; SMR = 187; IC 95% = 149-233), in particolare per le pneumoconiosi (42 deceduti; SMR = 13313; IC 95% = 9595-17996; dei quali 41 deceduti per asbestosi; SMR = 43385; IC 95% = 31134-58857), per tumore maligno della pleura (24 decessi; SMR = 2617; IC 95% = 1677-3893), per tumore del polmone (84 decessi; SMR = 153; IC 95% = 122-189) e per tumore maligno del peritoneo (9 decessi; SMR = 1985; IC 95% = 908-3769). Un incremento non statisticamente significativo è stato osservato per il tumore del retto (6 decessi; SMR = 157; IC 95% = 58-342). In conclusione, i risultati del presente studio, coerentemente con l'insieme dell'evidenza epidemiologica relativa agli effetti sulla salute dell'esposizione a cemento-amianto, mostrano un'aumentata mortalità per asbestosi, cancro polmonare, mesotelioma pleurico e peritoneale.