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Purpose To estimate the prevalence of secondhand smoke (SHS) exposure among never-smoking adolescents and identify key factors associated with such exposure. Methods Data were obtained from nationally representative Global Youth Tobacco Surveys conducted in 168 countries during 1999-2008. SHS exposure was ascertained in relation to the location - exposure inside home, outside home, and both inside and outside home, respectively. Independent variables included parental and/or peer smoking, knowledge about smoke harm, attitudes toward smoking ban, age, sex, and World Health Organization region. Simple and multiple logistic regression analyses were conducted. Results Of 356,414 never-smoking adolescents included in the study, 30.4%, 44.2%, and 23.2% were exposed to SHS inside home, outside home, and both, respectively. Parental smoking, peer smoking, knowledge about smoke harm, and positive attitudes toward smoke ban were significantly associated with increased odds of SHS exposure. Approximately 14% of adolescents had both smoking parents and peers. Compared with never-smoking adolescents who did not have both smoking parents and peers, those who had both smoking parents and peers had 19 (adjusted odds ratio [aOR], 19.0; 95% confidence interval [CI], 16.86-21.41), eight (aOR, 7.71; 95% CI, 7.05-8.43), and 23 times (aOR, 23.16; 95% CI, 20.74-25.87) higher odds of exposure to SHS inside, outside, and both inside and outcome home, respectively. Conclusions Approximately one third and two fifths of never-smoking adolescents were exposed to SHS inside or outside home, and smoking parents and/or peers are the key factors. Study findings highlight the need to develop and implement comprehensive smoke-free policies consistent with the World Health Organization Framework Convention on Tobacco Control.

Tobacco use continues to be the leading cause of preventable death in the world. The disproportionate increase in tobacco use in low- and middle-income countries needs immediate attention. Many smokers begin smoking as adolescents and are most likely to become permanent smokers. Moreover, youth are highly targeted by tobacco industry strategies. However, a gap exists in literature to understand worldwide youth tobacco use and control. The purpose of this study is to 1) identify factors that influence never-smoking youths‟ smoking susceptibility, 2) explore characteristics that influence youth exposure to environmental tobacco smoke (ETS) and 3) to delineate key determinants of youth support for smoke-free policies (SFPs). Data related to worldwide youth tobacco use was obtained from the Global Youth Tobacco Survey for the years 1999-2008. Simple and multiple logistic regression analyses were conducted, after the sample was weighted for design effect, nonresponse patterns and poststratification. Unadjusted and adjusted odds ratios along with 95% confidence intervals were reported. Around 14% of never-smoking youth were susceptible to smoking worldwide. Around 40% and 50% youth were exposed to ETS inside and outside the home respectively, and 78% supported SPFs globally. Parental and peer smoking was strongly associated with smoking susceptibility in never-smoking youth [AOR 2.63, 95% CI 2.43 to 2.84], and youth exposure to ETS inside [AOR 5.09, 95% CI 4.84 to 5.35] and outside [AOR 2.51, 95% CI 2.39 to 2.63] the home, while anti-smoking school education was negatively associated. Youth having knowledge about smoking harm [AOR 2.37, 95% CI 2.22 to 2.54] supported SFPs, while youth exposed to tobacco industry promotion [AOR 0.83, 95% CI 0.78 to 0.89] did not support. The study highlighted a number of modifiable factors that can be used for augmenting global tobacco control in youth. Well-executed anti-smoking campaigns, parental and peer education, inclusion of anti-tobacco education in school curricula, comprehensive SFPs, and comprehensive ban on tobacco industry strategies are important approaches to prevent tobacco use and advance global tobacco control in youth.

Introdução - As leis de restrição ao fumo têm sido amplamente difundidas pelo mundo principalmente na última década. Estudos prévios e meta análises têm demonstrado uma redução nas taxas de infarto do miocárdio após a vigência dessas leis. Entretanto, para a população latino-americana, as informações ainda são escassas. Na primeira fase deste estudo foi demonstrada a implementação bem sucedida da lei anti fumo na cidade de São Paulo, com uma redução expressiva nos níveis de monóxido de carbono em restaurantes, bares e casas noturnas. Objetivo - Avaliar se a implementação da lei anti fumo na cidade de São Paulo em 2009 foi associada a uma redução nas taxas de mortalidade e internação hospitalar por infarto do miocárdio e acidente vascular cerebral. Métodos - Foi realizado um estudo de séries temporais mensais entre janeiro de 2005 e dezembro de 2010. Os dados foram provenientes do DATASUS, o principal sistema de informação pública de saúde disponível no Brasil e do Sistema de Informação sobre Mortalidade (SIM). A análise foi realizada utilizando o método Auto-regressivo, Integrado e de Médias Móveis com variáveis exógenas (ARIMAX), modelado por variáveis ambientais e poluentes atmosféricos para avaliar as taxas de mortalidade e internação hospitalar antes da lei e prever os eventos após a lei. Também foi realizada análise utilizando o método de Análise de Séries Temporais Interrompida (ITSA), em conjunto com o ARIMAX, para comparar o período anterior à lei, o momento em que entrou em vigor e o período após a lei. Resultados - Foi observada uma redução nas taxas de internação hospitalar (-5.4% nos primeiros 3 meses após a lei) e mortalidade (-11.9% nos primeiros 17 meses após a lei) por infarto do miocárdio com o método ARIMAX e uma redução na taxa de internação hospitalar (-7,4% entre o 7º e o 12º mês após a lei) e mortalidade (-5,3% nos primeiros 17 meses após a lei) por acidente vascular cerebral, com a mesma metodologia. Conclusão - As taxas de internação hospitalar e mortalidade por infarto do miocárdio e acidente vascular cerebral foram reduzidas após o início da vigência da lei anti fumo / Background - Smoking restriction laws have spread worldwide during the last decade. Previous studies and meta-analyses have shown a decline in the community rates of myocardial infarction and/or heart attack after enactment of these laws. However, data are scarce about the Latin American population. In the first phase of this study, we reported the successful implementation of the law in São Paulo city, with a decrease in carbon monoxide rates in places like restaurants, bars, and nightclubs. Objective - To evaluate whether the 2009 implementation of a smoking ban law in São Paulo city was associated with a reduction in rates of mortality and hospital admissions for myocardial infarction and stroke. Methods - We performed a time series study of monthly rates of mortality and hospital admissions for acute myocardial infarction and stroke from January 2005 to December 2010. The data were derived from DATASUS, the primary public health information system available in Brazil and from Mortality Information System (SIM). Adjustments and analyses were performed using the Autoregressive Integrated Moving Average with exogenous variables (ARIMAX) method modeled by environmental variables and atmospheric pollutants to evaluate the mortality and hospital admission rate before the law and forecast events after the law. We also used Interrupted Time Series Analysis (ITSA) in conjunction with ARIMAX to compare the period before the law, the moment of implementation of the law, and the period after the law. Results - We observed a reduction in hospital admission rate (-5.4% in the first 3 months after the law) and mortality rate (-11.9% in the first 17 months after the law) for myocardial infarction with ARIMAX method. We observed a reduction in hospital admission rate (-7,4% between the 7th and the 12th month after the law) and mortality rate (-5,3% in the first 17 months after the law) for stroke with ARIMAX method. Conclusions - Hospital admission rate and mortality rate for myocardial infarction and stroke were reduced after the smoking ban law was implemented

Introdução - As leis de restrição ao fumo têm sido amplamente difundidas pelo mundo principalmente na última década. Estudos prévios e meta análises têm demonstrado uma redução nas taxas de infarto do miocárdio após a vigência dessas leis. Entretanto, para a população latino-americana, as informações ainda são escassas. Na primeira fase deste estudo foi demonstrada a implementação bem sucedida da lei anti fumo na cidade de São Paulo, com uma redução expressiva nos níveis de monóxido de carbono em restaurantes, bares e casas noturnas. Objetivo - Avaliar se a implementação da lei anti fumo na cidade de São Paulo em 2009 foi associada a uma redução nas taxas de mortalidade e internação hospitalar por infarto do miocárdio e acidente vascular cerebral. Métodos - Foi realizado um estudo de séries temporais mensais entre janeiro de 2005 e dezembro de 2010. Os dados foram provenientes do DATASUS, o principal sistema de informação pública de saúde disponível no Brasil e do Sistema de Informação sobre Mortalidade (SIM). A análise foi realizada utilizando o método Auto-regressivo, Integrado e de Médias Móveis com variáveis exógenas (ARIMAX), modelado por variáveis ambientais e poluentes atmosféricos para avaliar as taxas de mortalidade e internação hospitalar antes da lei e prever os eventos após a lei. Também foi realizada análise utilizando o método de Análise de Séries Temporais Interrompida (ITSA), em conjunto com o ARIMAX, para comparar o período anterior à lei, o momento em que entrou em vigor e o período após a lei. Resultados - Foi observada uma redução nas taxas de internação hospitalar (-5.4% nos primeiros 3 meses após a lei) e mortalidade (-11.9% nos primeiros 17 meses após a lei) por infarto do miocárdio com o método ARIMAX e uma redução na taxa de internação hospitalar (-7,4% entre o 7º e o 12º mês após a lei) e mortalidade (-5,3% nos primeiros 17 meses após a lei) por acidente vascular cerebral, com a mesma metodologia. Conclusão - As taxas de internação hospitalar e mortalidade por infarto do miocárdio e acidente vascular cerebral foram reduzidas após o início da vigência da lei anti fumo / Background - Smoking restriction laws have spread worldwide during the last decade. Previous studies and meta-analyses have shown a decline in the community rates of myocardial infarction and/or heart attack after enactment of these laws. However, data are scarce about the Latin American population. In the first phase of this study, we reported the successful implementation of the law in São Paulo city, with a decrease in carbon monoxide rates in places like restaurants, bars, and nightclubs. Objective - To evaluate whether the 2009 implementation of a smoking ban law in São Paulo city was associated with a reduction in rates of mortality and hospital admissions for myocardial infarction and stroke. Methods - We performed a time series study of monthly rates of mortality and hospital admissions for acute myocardial infarction and stroke from January 2005 to December 2010. The data were derived from DATASUS, the primary public health information system available in Brazil and from Mortality Information System (SIM). Adjustments and analyses were performed using the Autoregressive Integrated Moving Average with exogenous variables (ARIMAX) method modeled by environmental variables and atmospheric pollutants to evaluate the mortality and hospital admission rate before the law and forecast events after the law. We also used Interrupted Time Series Analysis (ITSA) in conjunction with ARIMAX to compare the period before the law, the moment of implementation of the law, and the period after the law. Results - We observed a reduction in hospital admission rate (-5.4% in the first 3 months after the law) and mortality rate (-11.9% in the first 17 months after the law) for myocardial infarction with ARIMAX method. We observed a reduction in hospital admission rate (-7,4% between the 7th and the 12th month after the law) and mortality rate (-5,3% in the first 17 months after the law) for stroke with ARIMAX method. Conclusions - Hospital admission rate and mortality rate for myocardial infarction and stroke were reduced after the smoking ban law was implemented