Letter to the Editor
Towards a 100% smoke-free Portugal: No more delays
Para um Portugal 100% livre de tabaco: Sem mais demoras
a Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, 6200-506 Covilha, Portugal
b CHCB University Hospital, Quinta do Alvito, 6200-251 Covilha, Portugal
c Portuguese NGOs Tobacco Control Movement, Portugal
d National Institute of Health Dr. Ricardo Jorge, Avenida Padre Cruz, Lisbon, Portugal
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Ravara, N. Miranda, J.M. Calheiros" "autores" => array:3 [ 0 => array:4 [ "nombre" => "S.B." "apellidos" => "Ravara" "email" => array:2 [ 0 => "sbravara@fcsaude.ubi.pt" 1 => "sbravara@gmail.com" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:4 [ "nombre" => "N." "apellidos" => "Miranda" "email" => array:1 [ 0 => "natercia.miranda@insa.min-saude.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 2 => array:4 [ "nombre" => "J.M." "apellidos" => "Calheiros" "email" => array:1 [ 0 => "jcalheiros@fcsaude.ubi.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, 6200-506 Covilha, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "CHCB University Hospital, Quinta do Alvito, 6200-251 Covilha, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Portuguese NGOs Tobacco Control Movement, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "National Institute of Health Dr. Ricardo Jorge, Avenida Padre Cruz, Lisbon, Portugal" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Para um Portugal 100% livre de tabaco: Sem mais demoras" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with the greatest of interest the study by Paradela et al., 2013 assessing self-reported exposure (e) to second-hand smoke (SHS) in private/public enclosed settings.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Although only a regional survey, it is one of the few that has assessed post-ban perception about the change in SHSe. The main findings are:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0010" class="elsevierStylePara elsevierViewall">Exposure to SHS is high, significantly higher in public leisure settings where vulnerable populations such as young people should be protected by law.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0015" class="elsevierStylePara elsevierViewall">Young adults are highly exposed.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0020" class="elsevierStylePara elsevierViewall">Perceived exposure in the home and workplaces is similar to the pre-ban period.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></li></ul></p><p id="par0025" class="elsevierStylePara elsevierViewall">In 2013, a similar survey conducted in Covilhã observed the same trends. Furthermore, several studies have reported: (1) high SHSe in restaurants/casinos/bars/discos/mental health services; (2) patchy compliance with the ban, specially in settings which allow exemptions; (3) poor ban enforcement<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> (non-published research: Calheiros et al., 2010; Ravara et al., 2012; Reis et al., 2011). Moreover, Portuguese children's exposure to SHS is high<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>; one of the highest in the EU (non-published research: Reis et al., Democophes 2012), several studies have reported low motivation to quit, few attempts at giving up, and an increasing prevalence among youth and females.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> These indicators mirror the failure of tobacco control policies enacted by successive governments/legislators. At the moment, the Portuguese government is about to revise the smoke-free policy (SFP). The government has publicly announced its intention to pass a 100% SFP. However, an 8 years moratorium has been proposed for hospitality venues, allowing smoking and ventilation systems, in order to “compensate for the investment made”.</p><p id="par0030" class="elsevierStylePara elsevierViewall">While governments and legislators are elected to promote the health and well-being of all Portuguese citizens, they have mostly protected tobacco industry and other “vested interests”. The consequence of this is a major toll of death, disability, and suffering and it promotes health and social inequalities and threatens the country economy and welfare.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> WHO clearly emphasises that only 100% SFPs protect against SHSe<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and stresses that exemptions, such as the moratorium presented by the current Portuguese government, are common tactics of the tobacco industry to block SFP implementation.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Moreover, an eminent Portuguese constitutionalist has stated that SFP exemptions are unconstitutional: while failing to protect all citizens, they violate the general principle of health protection of Portuguese law.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The Portuguese public health community should publicly denounce the interference of the tobacco industry in policy-making, accordingly to article 5.3 of WHO-FCTC treaty<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>; and demand a 100% smoke-free Portugal without any exemptions or delays; as part of a comprehensive, adequately funded and enforced tobacco control programme.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> This would comply with the Portuguese government's obligation following the WHO-FCTC ratification in 2005.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exposure to environmental tobacco smoke in Chaves after the implementation of the law 37/2007. A cross-sectional study in two healthcare settings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Paradela" 1 => "M. Pérez-Ríos" 2 => "A. Ruano-Ravina" 3 => "J.M. Barros-Dios" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rppneu.2013.02.003" "Revista" => array:6 [ "tituloSerie" => "Rev Port Pneumol" "fecha" => "2013" "volumen" => "19" "paginaInicial" => "168" "paginaFinal" => "174" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23623407" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Compliance and enforcement of a partial smoking ban in Lisbon taxis: an exploratory cross-sectional study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.B. Ravara" 1 => "M. Castelo-Branco" 2 => "P. Aguiar" 3 => "J.M. Calheiros" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2458-13-134" "Revista" => array:5 [ "tituloSerie" => "BMC Public Health" "fecha" => "2013" "volumen" => "13" "paginaInicial" => "134" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23406366" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Protecting children from exposure to environmental tobacco smoke: towards health education" "tituloTraducido" => "A educação para a saúde na protecção das crianças da exposição ao fumo ambiental de tabaco" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Precioso" 1 => "A.C. Araújo" 2 => "J. Machado" 3 => "C. Samorinha" 4 => "E. Becoña" 5 => "S. Ravara" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Educ Soc Cult" "fecha" => "2013" "volumen" => "38" "paginaInicial" => "13" "paginaFinal" => "29" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Direcção Geral Da Saúde. Direcção de Serviços de Informação e Análise. Portugal. Prevenção e Controlo do Tabagismo em números-2013. Programa Nacional para a Prevenção e Controlo do Tabagismo. Retrieved from: <a href="http://www.dgs.pt/estatisticas-de-saude/estatisticas-de-saude/publicacoes/portugal-prevencao-e-controlo-do-tabagismo-em-numeros-2013.aspx">http://www.dgs.pt/estatisticas-de-saude/estatisticas-de-saude/publicacoes/portugal-prevencao-e-controlo-do-tabagismo-em-numeros-2013.aspx</a> [assessed 10.06.14]." ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "WHO Report on the Global Tobacco Epidemic, 2009: implementing smoke-free environments" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "World Health Organization (WHO)" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2009" "editorial" => "WHO" "editorialLocalizacion" => "Geneva" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08732159/0000002000000005/v2_201509041759/S0873215914001019/v2_201509041759/en/main.assets" "Apartado" => array:4 [ "identificador" => "19161" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Cartas ao editor" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08732159/0000002000000005/v2_201509041759/S0873215914001019/v2_201509041759/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215914001019?idApp=UINPBA00004E" ]
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