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Estas mismas fuentes indican que est&#225;n expuestos al HAT dos de cada diez ni&#241;os&#47;as&#44; cifra que se eleva hasta siete de cada diez en los&#47;las de raza negra&#46; Aunque se ha observado que la prevalencia de exposici&#243;n al HAT ha disminuido entre los periodos 1999-2000 y 2011-2012&#44; sigue siendo muy alta en la poblaci&#243;n que vive por debajo del umbral de la pobreza y en las personas que habitan en viviendas alquiladas<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En Espa&#241;a&#44; en 2011 se atribuyeron 1028 muertes de personas adultas a la exposici&#243;n al HAT<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">7</span></a>&#46; La prevalencia de exposici&#243;n al HAT disminuy&#243; dr&#225;sticamente tras la implementaci&#243;n de las leyes 28&#47;2005 y 42&#47;2010&#44; tanto en personas adultas como en la infancia&#46; En la poblaci&#243;n espa&#241;ola menor de 15 a&#241;os&#44; la prevalencia de exposici&#243;n disminuy&#243; m&#225;s de un 20&#37; entre 2006 y 2011 &#40;32&#44;8&#37; vs&#46; 11&#44;8&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Diversos estudios sobre inequidades en salud han relacionado los determinantes socioecon&#243;micos con la exposici&#243;n de los&#47;las ni&#241;os&#47;as a los contaminantes ambientales&#44; como el HAT <a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">9</span></a>&#46; Se ha encontrado asociaci&#243;n entre el menor nivel educativo y de ingresos de los progenitores y una mayor exposici&#243;n al HAT<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">10&#44;11</span></a>&#46; Otros factores&#44; como el tama&#241;o del n&#250;cleo familiar&#44; el tipo de familia&#44; la edad de los&#47;las menores&#44; 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y adem&#225;s carecen de autonom&#237;a para evitar la exposici&#243;n al depender para ello de sus padres&#46; Identificar los factores que se asocian con la exposici&#243;n es de gran utilidad para establecer medidas de protecci&#243;n mejor dirigidas&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El objetivo de este trabajo es estimar la prevalencia de exposici&#243;n al HAT de los&#47;las ni&#241;os&#47;as espa&#241;oles&#47;as de 0 a 14 a&#241;os de edad en el periodo de julio de 2011 a junio de 2012 en funci&#243;n de diferentes determinantes socioecon&#243;micos&#44; con especial atenci&#243;n al nivel educativo de los progenitores y la clase social&#44; as&#237; como identificar otras variables relacionadas con la vivienda o ambientales que puedan estar asociadas con la exposici&#243;n de los&#47;las menores a este contaminante ambiental&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todo</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o del estudio</span><p id="par0035" class="elsevierStylePara elsevierViewall">Los datos que se han analizado en este estudio proceden de la Encuesta Nacional de Salud &#40;ENSE&#41; 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el nivel de estudios de los progenitores se seleccionaron los&#47;las menores para los que uno de los progenitores era el&#47;la informante del Cuestionario del Menor &#40;93&#44;9&#37;&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables analizadas</span><p id="par0040" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#41;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Variable dependiente</p></li></ul></p><p id="par0050" class="elsevierStylePara elsevierViewall">Para este an&#225;lisis se utilizaron los datos de exposici&#243;n al HAT recogidos en el m&#243;dulo Determinantes de la Salud&#44; del Cuestionario del Menor&#46; Se recab&#243; informaci&#243;n relativa a la exposici&#243;n del&#47;de la menor al HAT en dos &#225;mbitos&#58; el hogar y los medios de transporte y lugares p&#250;blicos cerrados&#46; Las preguntas formuladas fueron &#171;&#191;Con qu&#233; frecuencia est&#225; expuesto&#47;a el&#47;la ni&#241;o&#47;a al humo del tabaco dentro de su casa&#63; y &#171;&#191;Con qu&#233; frecuencia est&#225; expuesta&#47;o la&#47;el ni&#241;a&#47;o al humo del tabaco en medios de transporte y lugares p&#250;blicos cerrados &#40;como bares&#44; restaurantes&#44; centros comerciales&#44; transporte p&#250;blico&#44; etc&#46;&#41;&#63;&#187;&#46; Las opciones de respuesta eran &#171;Nunca o casi nunca&#187;&#44; &#171;Menos de 1 hora al d&#237;a&#187;&#44; &#171;Entre 1 y 5 horas al d&#237;a&#187;&#44; &#171;M&#225;s de 5 horas al d&#237;a&#187; y &#171;No sabe o no contesta&#187;&#46; La variable &#171;exposici&#243;n&#187; se recodific&#243; como &#171;Nunca o casi nunca&#187; frente a &#171;Exposici&#243;n diaria&#187; &#40;si se contestaba que el&#47;la menor estaba expuesto&#47;a a diario al HAT&#44; con independencia de las horas que lo estuviera&#41;&#46; A partir de las variables &#171;exposici&#243;n en el hogar&#187; y &#171;exposici&#243;n en medios de transporte y lugares p&#250;blicos cerrados&#187; se cre&#243; la variable &#171;exposici&#243;n total&#187;&#59; as&#237;&#44; se define como expuesto aquel&#47;aquella ni&#241;o&#47;a que estuvo expuesto&#47;a en cualquiera de los &#225;mbitos en estudio&#46;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#41;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Variables independientes</p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">Las variables independientes se seleccionaron entre los determinantes socioecon&#243;micos y ambientales recogidos en los Cuestionarios del Hogar&#44; del Adulto y del Menor&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Sexo de la persona menor&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Edad del&#47;de la menor&#44; que se recodific&#243; en funci&#243;n de los niveles de escolarizaci&#243;n&#58; 0-5 a&#241;os &#40;guarder&#237;a y educaci&#243;n infantil&#41;&#44; 6-9 a&#241;os &#40;primer ciclo de educaci&#243;n primaria&#41; y 10-14 a&#241;os &#40;&#250;ltimo ciclo de educaci&#243;n primaria y educaci&#243;n secundaria obligatoria&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Pa&#237;s de nacimiento del&#47;de la menor&#44; con dos categor&#237;as&#58; Espa&#241;a y otro pa&#237;s&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Nivel educativo del padre o de la madre informante&#44; que se recodific&#243; como nivel de estudios inferior &#40;educaci&#243;n secundaria de primera etapa o estudios inferiores&#41;&#44; medio &#40;bachiller o formaci&#243;n profesional&#41; y alto &#40;universitarios u otros estudios superiores&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Clase social&#44; basada en la clasificaci&#243;n de la Sociedad Espa&#241;ola de Epidemiolog&#237;a<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">15</span></a> a partir de la ocupaci&#243;n de la persona de referencia &#40;la que m&#225;s ingresos aporta al hogar&#41; del Cuestionario del Menor&#46; Se recodific&#243; en dos categor&#237;as&#58; I-III &#40;m&#225;s altas&#41; y IV-VI &#40;m&#225;s bajas&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Composici&#243;n del hogar&#44; recodificada como pareja con hijos&#47;as&#44; progenitor&#47;a solo&#47;a con hijos&#47;as y otra composici&#243;n&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Problemas de la vivienda&#58; escasez de zonas verdes&#44; contaminaci&#243;n del aire por industrias y contaminaci&#243;n del aire por otras causas&#44; con tres categor&#237;as de respuesta&#58; mucho&#44; algo o nada&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Tama&#241;o de la vivienda&#44; que se recodific&#243; como peque&#241;a &#40;menos de 80 m<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">2</span></a>&#41;&#44; mediana &#40;81-120 m<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">2</span></a>&#41; y grande &#40;m&#225;s de 120 m<span class="elsevierStyleSup">2</span>&#41;&#46;</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis estad&#237;stico</span><p id="par0105" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo para calcular las prevalencias de cada categor&#237;a de exposici&#243;n &#40;en el hogar&#44; en medios de transporte y lugares p&#250;blicos cerrados&#44; y total&#41;&#46; Se ajustaron modelos de regresi&#243;n log&#237;stica para determinar qu&#233; variables estaban asociadas con la exposici&#243;n al HAT en el hogar y total &#40;variables dicot&#243;micas&#41;&#46; Las variables introducidas en los modelos fueron aquellas que se identificaron como significativas al realizar el an&#225;lisis bivariante&#46; El valor de las <span class="elsevierStyleItalic">odds ratio</span> de prevalencia &#40;ORP&#41; de exposici&#243;n se ajust&#243; por todas las variables que permanecieron en el modelo&#46; Las variables se introdujeron manualmente y se mantuvieron en el modelo tambi&#233;n aquellas que&#44; aun no siendo significativas&#44; produc&#237;an un cambio de ORP de las principales mayor del 10&#37; cuando entraban en el modelo&#46; Se presentan las ORP acompa&#241;adas de sus intervalos de confianza del 95&#37; &#40;IC95&#37;&#41;&#46; El an&#225;lisis estad&#237;stico se llev&#243; a cabo con el programa IBM SPSS Statistics 22&#46;0&#46; Para corregir los efectos del dise&#241;o del estudio y la falta de respuesta se aplic&#243; el factor de elevaci&#243;n del menor como variable de ponderaci&#243;n en el an&#225;lisis estad&#237;stico&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Para analizar la posible colinealidad en las variables independientes introducidas en el modelo de regresi&#243;n se calcularon los factores de inflaci&#243;n de la varianza mediante el paquete &#8220;car&#8221; del programa R &#40;versi&#243;n 3&#46;3&#46;0&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0115" class="elsevierStylePara elsevierViewall">La prevalencia de exposici&#243;n total al HAT en menores de 15 a&#241;os fue del 11&#44;8&#37;&#59; el 11&#44;5&#37; estaban expuestos en el hogar y el 0&#44;8&#37; en medios de transporte y lugares p&#250;blicos cerrados&#46; Esta prevalencia se increment&#243; al aumentar la edad del&#47;de la menor y al disminuir el nivel educativo del padre o de la madre y la clase social&#46; Tambi&#233;n se observaron diferencias en funci&#243;n de la composici&#243;n del hogar&#58; en aquellos con composiciones distintas a &#171;pareja con hijos&#47;as&#187;&#44; la prevalencia de exposici&#243;n al HAT de los&#47;las menores era mayor&#46; En cuanto a las variables relacionadas con la vivienda&#44; la prevalencia de exposici&#243;n aumentaba al disminuir el tama&#241;o de esta&#44; y de manera menos consistente&#44; con la escasez de zonas verdes pr&#243;ximas&#46; En el caso de la exposici&#243;n en medios de transporte y lugares p&#250;blicos cerrados&#44; la prevalencia de exposici&#243;n no supera el 2&#37;&#46; Los resultados de la exposici&#243;n en el hogar son similares a los de la exposici&#243;n total &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">La exposici&#243;n al HAT era m&#225;s frecuente &#40;2&#44;3 veces&#41; en los&#47;las menores de 10-14 a&#241;os que en los&#47;las de 0-5 a&#241;os&#44; en los&#47;las menores con progenitores con menor nivel educativo &#40;2&#44;7&#41; que en los&#47;las de nivel educativo alto&#44; y entre los&#47;las menores pertenecientes a las clases sociales m&#225;s bajas que en los&#47;las de las m&#225;s altas &#40;1&#44;9&#41;&#46; La prevalencia de exposici&#243;n result&#243; 1&#44;8 veces mayor en los hogares monoparentales que en las familias compuestas por una pareja con hijos&#47;as&#44; y 1&#44;7 veces m&#225;s frecuente en las viviendas peque&#241;as&#46; No se aprecia asociaci&#243;n entre exposici&#243;n al HAT&#44; tanto total como en funci&#243;n del &#225;mbito de exposici&#243;n&#44; el sexo de la persona menor y la escasez de zonas verdes &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">A partir del ajuste del modelo de regresi&#243;n se observa que la prevalencia de exposici&#243;n era mayor en los&#47;las ni&#241;os&#47;as de m&#225;s edad&#58; los&#47;las menores de 10-14 a&#241;os presentan 2&#44;4 veces m&#225;s probabilidad de estar expuestos&#47;as que los&#47;las de 0-5 a&#241;os&#46; Igualmente&#44; aquellos&#47;as con progenitores de menor nivel educativo presentan 2 veces m&#225;s probabilidad de exposici&#243;n que los&#47;las de mayor nivel&#59; los&#47;las pertenecientes a las clases sociales m&#225;s bajas&#44; 1&#44;4 veces m&#225;s probabilidad&#59; y entre los&#47;las que resid&#237;an en hogares con composiciones distintas a &#171;pareja con hijos&#47;as&#187; o &#171;un&#47;una progenitor&#47;a con hijo&#47;a&#187; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0130" class="elsevierStylePara elsevierViewall">Los resultados de este estudio muestran que la exposici&#243;n al HAT en los&#47;las menores espa&#241;oles&#47;as es m&#225;s frecuente entre los&#47;las que presentan una peor situaci&#243;n socioecon&#243;mica&#44; destacando el efecto del menor nivel de estudios de los progenitores y la pertenencia a clases sociales m&#225;s bajas&#46; Adem&#225;s&#44; otros factores&#44; como una mayor edad de los&#47;las menores y residir en una vivienda de menor tama&#241;o&#44; tambi&#233;n se relacionan con una mayor exposici&#243;n&#46; En este estudio se han identificado los hogares como el principal lugar donde los&#47;las menores est&#225;n expuestos&#47;as al HAT&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Algunos trabajos realizados en Espa&#241;a han identificado la posible relaci&#243;n entre la exposici&#243;n al HAT en menores y determinantes socioecon&#243;micos&#44; principalmente el nivel educativo de los progenitores y la clase social<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">16&#44;17</span></a>&#46; Esos resultados son congruentes con lo encontrado en este estudio&#44; que cuenta con una muestra representativa de la poblaci&#243;n en edad pedi&#225;trica en diferentes estratos de edad&#46; La existencia de desigualdades en salud es evidente&#46; A pesar de existir en nuestro pa&#237;s legislaci&#243;n que proh&#237;be el consumo de tabaco en lugares p&#250;blicos&#44; la prevalencia de exposici&#243;n de los&#47;las menores es alta y ocurre fundamentalmente en el &#225;mbito privado &#40;hogares y coches particulares&#41;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">18</span></a>&#46; En este sentido&#44; los resultados del presente estudio muestran que los valores de exposici&#243;n total de los&#47;las menores son pr&#225;cticamente iguales a los de exposici&#243;n en el hogar&#44; y es en este entorno donde se concentra actualmente el riesgo&#44; con muy escasa influencia de la exposici&#243;n en otros &#225;mbitos&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">A pesar de que los estudios concluyen que en la poblaci&#243;n adulta&#44; simult&#225;neamente a la disminuci&#243;n de la exposici&#243;n al HAT en lugares p&#250;blicos tras la aplicaci&#243;n de las leyes 28&#47;2005 y 42&#47;2010&#44; se observ&#243; un descenso en la exposici&#243;n en otros &#225;mbitos&#44; como los hogares<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">19&#44;20</span></a>&#44; la prevalencia de exposici&#243;n de los&#47;las menores en Espa&#241;a a&#250;n es alta&#44; aunque menor que en otros pa&#237;ses desarrollados<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">21&#44;22</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La influencia de diferentes factores socioecon&#243;micos ya se hab&#237;a identificado previamente&#44; tanto en Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">23</span></a> como en otros pa&#237;ses de nuestro entorno<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">24</span></a>&#46; As&#237;&#44; se hab&#237;a descrito que un bajo nivel de ingresos &#40;variable muy relacionada con la clase social&#41; estaba relacionado con la exposici&#243;n al HAT<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">25&#44;26</span></a>&#46; Por otro lado&#44; se hab&#237;a identificado a los&#47;las ni&#241;os&#47;as que viven en entornos socioecon&#243;micos m&#225;s desfavorecidos como los&#47;las que presentan mayor riesgo de exposici&#243;n a determinados contaminantes y otros problemas ambientales como la escasez de acceso a zonas verdes<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">27&#44;28</span></a>&#46; En este trabajo se encontr&#243;&#44; en el an&#225;lisis inicial&#44; una mayor prevalencia de exposici&#243;n al HAT cuanto mayor era la escasez de zonas verdes&#44; pero la asociaci&#243;n no result&#243; estad&#237;sticamente significativa tras el ajuste por otras variables&#46; Otros factores de la vivienda recogidos en el Cuestionario del Hogar de la ENSE&#44; como la contaminaci&#243;n del aire por industrias y por otras causas&#44; tampoco mostraron asociaci&#243;n&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">A medida que aumenta la edad del&#47;de la menor&#44; aumenta la prevalencia de exposici&#243;n al HAT&#46; Este hecho&#44; tambi&#233;n identificado en otros estudios<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">29&#44;30</span></a>&#44; se entiende como una relajaci&#243;n de la protecci&#243;n que las personas adultas dan al menor a medida que crece&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Este estudio presenta algunas limitaciones&#46; Una de ellas es que la ENSE solo recoge el consumo de tabaco de la persona informante&#44; y no de todos los miembros del hogar&#44; y por tanto no es posible analizar informaci&#243;n sobre el n&#250;mero de fumadores&#47;as en el domicilio y su relaci&#243;n con el&#47;la menor&#44; variable que se ha relacionado en diferentes estudios con una mayor exposici&#243;n al HAT en la infancia<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">31</span></a>&#46; Adem&#225;s&#44; debemos considerar que la informaci&#243;n es declarada por los progenitores&#44; por lo que puede haber un sesgo de informaci&#243;n o de deseabilidad social&#44; en cuanto que pueden ocultarse o no declararse determinadas exposiciones&#46; Aunque diferentes estudios avalan la autodeclaraci&#243;n de exposici&#243;n al HAT<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">32</span></a>&#44; otros identifican una infradeclaraci&#243;n en la exposici&#243;n de los&#47;las menores al HAT por parte de sus progenitores<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">33</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Unas de las principales fortalezas de este trabajo son el tama&#241;o muestral y la representatividad de la muestra&#46; La informaci&#243;n recogida en la ENSE ha permitido realizar an&#225;lisis con las variables socioecon&#243;micas m&#225;s relevantes descritas en la literatura de manera conjunta con otras variables potencialmente confusoras &#40;edad del&#47;de la menor&#44; composici&#243;n del hogar&#44; tama&#241;o de la vivienda&#44; escasez de zonas verdes y contaminaci&#243;n del aire&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">El HAT es uno de los contaminantes ambientales m&#225;s extendidos&#44; causante de una enorme carga de morbimortalidad&#44; con afectaci&#243;n m&#225;s insidiosa para la infancia y b&#225;sicamente evitable&#46; Teniendo en cuenta las consideraciones anteriores&#44; resulta prioritario proteger a las poblaciones m&#225;s vulnerables frente a este riesgo&#46; El hecho de que persistan desigualdades en salud en la exposici&#243;n al HAT en la poblaci&#243;n infantil espa&#241;ola sugiere la necesidad de focalizar las medidas de prevenci&#243;n y protecci&#243;n en los entornos y los grupos de poblaci&#243;n con mayor riesgo&#58; los hogares con una situaci&#243;n socioecon&#243;mica m&#225;s precaria&#46; Orientar hacia ellos las medidas de protecci&#243;n y promoci&#243;n de la salud es indispensable&#44; pero dif&#237;cil&#46; Por ello&#44; aunque los programas orientados a prevenir la exposici&#243;n al HAT deben ser universales&#44; es decir&#44; dirigidos a toda la poblaci&#243;n&#44; deben tener en cuenta la necesidad de llegar a aquella m&#225;s expuesta&#46; Los programas de educaci&#243;n o de concienciaci&#243;n poblacional sobre el riesgo que supone para la salud la exposici&#243;n al HAT realizados en guarder&#237;as o escuelas&#44; orientados tanto al alumnado como a los padres y las madres&#44; o en centros de salud&#44; podr&#237;an tener un efecto positivo&#46; Adem&#225;s&#44; se debe tener en cuenta la importancia de promover medidas orientadas al &#225;mbito privado &#40;viviendas libres de tabaco o prohibici&#243;n de fumar en los veh&#237;culos propios&#41;&#46; A pesar de que estas medidas se basan en la voluntariedad de la poblaci&#243;n&#44; diferentes estudios han observado que&#44; tras la implantaci&#243;n de leyes de control del tabaquismo&#44; aumentaron las restricciones voluntarias de consumo de tabaco en el &#225;mbito privado<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">34</span></a>&#44; por lo que trasladar a la poblaci&#243;n estas iniciativas podr&#237;a ser beneficioso&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Editor responsable del art&#237;culo</span><p id="par0180" class="elsevierStylePara elsevierViewall">Juanjo Alguacil&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Declaraci&#243;n de transparencia</span><p id="par0185" class="elsevierStylePara elsevierViewall">La autora principal &#40;garante responsable del manuscrito&#41; afirma que este manuscrito es un reporte honesto&#44; preciso y transparente del estudio que se remite a <span class="elsevierStyleSmallCaps">Gaceta Sanitaria&#44;</span> que no se han omitido aspectos importantes del estudio&#44; y que las discrepancias del estudio seg&#250;n lo previsto &#40;y&#44; si son relevantes&#44; registradas&#41; se han explicado&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Contribuciones de autor&#237;a</span><p id="par0190" class="elsevierStylePara elsevierViewall">I&#46; Fern&#225;ndez &#193;lvarez y A&#46; Montes Mart&#237;nez participaron en el dise&#241;o del trabajo y el an&#225;lisis de los datos&#46; La interpretaci&#243;n de los resultados y la redacci&#243;n del manuscrito las realizaron I&#46; Fern&#225;ndez &#193;lvarez&#44; M&#46; P&#233;rez R&#237;os y A&#46; Montes Mart&#237;nez&#46; Todas las personas firmantes participaron en la revisi&#243;n y la aprobaci&#243;n de la versi&#243;n final para su publicaci&#243;n&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Financiaci&#243;n</span><p id="par0195" class="elsevierStylePara elsevierViewall">Ninguna&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflictos de intereses</span><p id="par0200" class="elsevierStylePara elsevierViewall">Ninguno&#46;</p></span></span>"
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            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusion"
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          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1244295"
          "titulo" => "Keywords"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introducci&#243;n"
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        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "M&#233;todo"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Dise&#241;o del estudio"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Variables analizadas"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "An&#225;lisis estad&#237;stico"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Resultados"
        ]
        7 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Discusi&#243;n"
        ]
        8 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Editor responsable del art&#237;culo"
        ]
        9 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Declaraci&#243;n de transparencia"
        ]
        10 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Contribuciones de autor&#237;a"
        ]
        11 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Financiaci&#243;n"
        ]
        12 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Conflictos de intereses"
        ]
        13 => array:1 [
          "titulo" => "Bibliograf&#237;a"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-08-08"
    "fechaAceptado" => "2018-12-10"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1244294"
          "palabras" => array:6 [
            0 => "Exposici&#243;n al humo ambiental del tabaco"
            1 => "Ni&#241;os"
            2 => "Ni&#241;as"
            3 => "Prevalencia"
            4 => "Determinantes socioecon&#243;micos"
            5 => "Desigualdades en salud"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1244295"
          "palabras" => array:5 [
            0 => "Environmental tobacco smoke exposure"
            1 => "Children"
            2 => "Prevalence"
            3 => "Socioeconomic determinants"
            4 => "Health inequalities"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Valorar la asociaci&#243;n entre la prevalencia de exposici&#243;n al humo ambiental del tabaco &#40;HAT&#41; en los ni&#241;os y ni&#241;as espa&#241;oles y diferentes determinantes socioecon&#243;micos<span class="elsevierStyleBold">&#46;</span></p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se analiz&#243; informaci&#243;n de 5495 menores de 15 a&#241;os incluidos en la Encuesta Nacional de Salud de Espa&#241;a 2011-2012&#46; Se realizaron an&#225;lisis crudos de las variables de inter&#233;s y se ajust&#243; un modelo de regresi&#243;n log&#237;stica multivariante para evaluar la relaci&#243;n de variables socioecon&#243;micas con la exposici&#243;n al HAT total&#44; en el hogar y en medios de transporte y lugares p&#250;blicos cerrados&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de exposici&#243;n al HAT total en menores de 15 a&#241;os fue del 11&#44;8&#37;&#46; La <span class="elsevierStyleItalic">odds ratio</span> de la prevalencia &#40;ORP&#41; de exposici&#243;n en el hogar result&#243; el doble para los&#47;las mayores de 5 a&#241;os &#40;ORP&#58; 2&#44;19 para 6-9 a&#241;os y 2&#44;28 para 10-14 a&#241;os&#41; que para los&#47;las m&#225;s peque&#241;os&#47;as&#46; Un nivel de estudios de los progenitores inferior y medio se asoci&#243; con mayor exposici&#243;n &#40;ORP&#58; 1&#44;97 y 1&#44;29&#41;&#44; al igual que las clases sociales IV-VI &#40;ORP&#58; 1&#44;42&#41;&#46; Una composici&#243;n del hogar diferente a &#171;pareja con hijos&#47;as&#187; y residir en viviendas m&#225;s peque&#241;as tambi&#233;n se relacion&#243; con una mayor exposici&#243;n&#46; Los resultados de exposici&#243;n total son muy similares a los de exposici&#243;n en el hogar &#40;11&#44;5&#37;&#41; debido a la baja prevalencia de exposici&#243;n en medios de transporte y lugares p&#250;blicos cerrados &#40;0&#44;8&#37;&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En Espa&#241;a&#44; los&#47;las menores de 15 a&#241;os con peor situaci&#243;n socioecon&#243;mica presentan mayor prevalencia de exposici&#243;n al HAT&#46; Estas desigualdades deben considerarse al establecer y desarrollar estrategias de salud p&#250;blica&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "M&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To assess the association between exposure to environmental tobacco smoke &#40;ETS&#41; and different socioeconomic determinants among Spanish children&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We analyzed the data of 5495 children included in the 2011-2012 Spanish National Health Survey&#46; We estimated the prevalence of exposure to ETS and adjusted logistic regression models to identify variables related to exposure to ETS&#58; total exposure and exposure in the home in addition to ETS exposure in enclosed public places&#47;transport&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Total exposure to ETS among children aged 15 and younger was 11&#46;8&#37;&#44; 11&#46;5&#37; of whom were exposed at home and 0&#46;8&#37; in enclosed public places&#47;transport&#46; The prevalence odds ratio &#40;POR&#41; of exposure at home increased with age &#40;6-9 years&#58; 2&#46;19&#59; 10-14 years&#58; 2&#46;28&#41;&#44; in children with parents of low or medium education levels &#40;1&#46;97 and 1&#46;29&#41;&#44; of social class IV-VI &#40;1&#46;42&#41;&#44; among those living in a household with a composition other than a &#8220;couple with children&#8221; &#40;1&#46;43&#41;&#44; and in smaller-sized homes &#40;1&#46;39&#41;&#46; Total exposure results were similar to home exposure results&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The prevalence of ETS is higher among children younger than 15 years with a more difficult economic situation&#46; These inequalities must be considered in the establishment and development of public health policies&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Method"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusion"
          ]
        ]
      ]
    ]
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        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabla "
            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">IC95&#37;&#58; intervalo de confianza del 95&#37;&#46;</p>"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables independientes</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tipo de exposici&#243;n</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Exposici&#243;n total</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ORP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Edad</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>0-5 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#95;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#95;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>6-9 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;66-3&#44;06&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inferior&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;97&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;30-2&#44;98&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Alto&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#95;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Medio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;10-2&#44;14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Alto&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Clase social</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSmallCaps">Y</span>I-III&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#95;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleSmallCaps">Y</span>IV-VI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">54&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;96&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;57-2&#44;44&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;67-2&#44;86&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;54-2&#44;38&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Composici&#243;n del hogar</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pareja con hijo&#47;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Progenitor&#47;a solo&#47;a con hijo&#47;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;34-2&#44;40&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otra&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;22-2&#44;12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;61-3&#44;47&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;21-2&#44;10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Escasez de zonas verdes</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mucho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;28&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;95-1&#44;71&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;63&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;17-5&#44;90&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  """
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inferior&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleSmallCaps">Y</span>I-III&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Var&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Cada uno de los dos modelos &#40;exposici&#243;n en el hogar y exposici&#243;n total&#41; est&#225; ajustado por todas las variables que permanecen en &#233;l&#46;</p>"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">La coherencia de los IC95&#37; sugiere que no existe colinealidad&#44; lo cual fue confirmado mediante el c&#225;lculo del factor de inflaci&#243;n de la varianza&#46;</p>"
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Modelo de regresi&#243;n log&#237;stica ajustado para las variables de inter&#233;s</p>"
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                0 => array:1 [
                  "referenciaCompleta" => "Organizaci&#243;n Mundial de la Salud &#40;OMS&#41;&#46; Consecuencias del tabaco para la salud&#58; informe de un Comit&#233; de Expertos de la OMS&#46; Ginebra&#59; 1975&#46; Disponible en&#58; <a target="_blank" href="http://apps.who.int/iris/bitstream/handle/10665/40804/WHO_TRS_568_spa.pdf?sequence=1%26isAllowed=y">http&#58;&#47;&#47;apps&#46;who&#46;int&#47;iris&#47;bitstream&#47;handle&#47;10665&#47;40804&#47;WHO&#95;TRS&#95;568&#95;spa&#46;pdf&#63;sequence&#61;1&#38;isAllowed&#61;y</a>"
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                0 => array:1 [
                  "referenciaCompleta" => "Centers for Disease Control&#46; 1986 Surgeon General&#39;s report&#58; the health consequences of involuntary smoking&#46; MMWR Morb Mortal Wkly Rep&#46; 1986&#59;35&#58;769-70&#46;"
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              ]
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              "identificador" => "bib0185"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "California Environmental Protection Agency&#46; Health effects of exposure to environmental tobacco smoke&#46; Tob Control&#46; 1997&#59;6&#58;346-53&#46;"
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              ]
            ]
            3 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Office on Smoking and Health &#40;US&#41;&#46; The health consequences of involuntary exposure to tobacco smoke&#58; a report of the Surgeon General&#46; Atlanta &#40;GA&#41;&#58; Centers for Disease Control and Prevention &#40;US&#41;&#59; 2006&#46; &#40;Consultado el 18&#47;8&#47;2016&#46;&#41; Disponible en&#58; <a target="_blank" href="https://www.surgeongeneral.gov/library/reports/secondhandsmoke/executivesummary.pdf">https&#58;&#47;&#47;www&#46;surgeongeneral&#46;gov&#47;library&#47;reports&#47;secondhandsmoke&#47;executivesummary&#46;pdf</a>"
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                        "volumen" => "95"
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                        "paginaFinal" => "92"
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                  "referenciaCompleta" => "World Health Organization Europe&#46; Environmental and health risks&#58; a review of the influences of social inequialities&#46; 2010&#46; &#40;Consultado el 18&#47;8&#47;2016&#46;&#41; Disponible en&#58; <a target="_blank" href="http://www.euro.who.int/__data/assets/pdf_file/0003/78069/E93670.pdf">http&#58;&#47;&#47;www&#46;euro&#46;who&#46;int&#47;&#95;&#95;data&#47;assets&#47;pdf&#95;file&#47;0003&#47;78069&#47;E93670&#46;pdf</a>"
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                  "referenciaCompleta" => "Ministerio de Sanidad&#44; Seguridad Social e Igualdad&#46; Encuesta Nacional de Salud 2011-2012&#46; Metodolog&#237;a&#46; &#40;Consultado el 18&#47;8&#47;2016&#46;&#41; Disponible en&#58; <a target="_blank" href="http://www.msssi.gob.es/estadEstudios/estadisticas/encuestaNacional/encuestaNac2011/MetodologiaENSE2011_12.pdf">http&#58;&#47;&#47;www&#46;msssi&#46;gob&#46;es&#47;estadEstudios&#47;estadisticas&#47;encuestaNacional&#47;encuestaNac2011&#47;MetodologiaENSE2011&#95;12&#46;pdf</a>"
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                  ]
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                        "paginaFinal" => "468"
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                      "titulo" => "Changes in secondhand smoke exposure after smoke-free legislation &#40;Spain&#44; 2006-2011&#41;"
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                          "etal" => true
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                        "volumen" => "19"
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                    0 => array:2 [
                      "titulo" => "Recent trends in children&#39;s exposure to second-hand smoke in England&#58; cotinine evidence from the Health Survey for England&#58; Children&#39;s exposure to second-hand smoke"
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                        0 => array:2 [
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                        "tituloSerie" => "Addiction&#46;"
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