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aumenta el riesgo de enfermedad coronaria&#44; de infecciones de v&#237;as respiratorias&#44; de enfermedad pulmonar obstructiva cr&#243;nica&#44; de c&#225;ncer de pulm&#243;n y de muerte s&#250;bita del lactante&#44; entre otros efectos sobre la salud<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Por ello&#44; en los &#250;ltimos a&#241;os diversos pa&#237;ses han desarrollado medidas legislativas para proteger a la poblaci&#243;n de los efectos del HAT&#46; En Espa&#241;a&#44; la Ley 28&#47;2005 de medidas sanitarias frente al tabaquismo&#44; en vigor desde enero de 2006&#44; prohib&#237;a el consumo de tabaco en lugares p&#250;blicos y de trabajo&#44; permitiendo restricciones parciales en los locales de hosteler&#237;a<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; Numerosos estudios evaluativos realizados en pa&#237;ses que implantaron prohibiciones totales han demostrado una disminuci&#243;n de la prevalencia de la exposici&#243;n al HAT en la poblaci&#243;n&#44; as&#237; como una disminuci&#243;n en los ingresos por infarto agudo de miocardio y una mejora de los s&#237;ntomas respiratorios en los trabajadores de la hosteler&#237;a<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;9</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La exposici&#243;n al HAT en nuestro medio supone un importante problema de salud p&#250;blica&#44; al que se atribuyeron entre 1&#46;228 y 3&#46;237 muertes en 2002<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a>&#46; Estudios anteriores a la Ley 28&#47;2005 estimaron que m&#225;s del 60&#37; de la poblaci&#243;n estaba expuesta en Barcelona y en su &#225;rea metropolitana<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#8211;14</span></a>&#46; Asimismo&#44; otros estudios realizados en diversas regiones de Espa&#241;a observaban resultados similares<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46; Tras la ley&#44; dos estudios que midieron con marcadores objetivos la exposici&#243;n en los locales de hosteler&#237;a y en los trabajadores de estos locales&#44; antes y despu&#233;s de la ley&#44; demostraron que la exposici&#243;n al HAT s&#243;lo se hab&#237;a reducido en aquellos donde se hab&#237;a prohibido fumar por completo<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a>&#46; Respecto a la prevalencia de la exposici&#243;n&#44; s&#243;lo dos estudios<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a> han evaluado hasta la fecha el impacto de la ley con datos de prevalencia de exposici&#243;n antes y despu&#233;s&#44; el primero en la Comunidad de Madrid y el segundo de &#225;mbito estatal&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El objetivo de nuestro estudio fue analizar el impacto de la Ley 28&#47;2005 en la prevalencia de la exposici&#243;n al HAT en los principales &#225;mbitos de exposici&#243;n &#40;hogar&#44; trabajo y tiempo libre&#41;&#44; as&#237; como su relaci&#243;n con diversas variables sociodemogr&#225;ficas&#44; en la poblaci&#243;n no fumadora de Barcelona&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se trata de un estudio evaluativo antes-despu&#233;s mediante comparaci&#243;n de dos encuestas transversales&#46; Las fuentes de informaci&#243;n fueron las Encuestas de Salud de Barcelona de los a&#241;os 2000 &#40;ESB 2000&#41;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> y 2006 &#40;ESB 2006&#41;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#44; con un tama&#241;o muestral de 10&#46;000 y 6108 individuos&#44; respectivamente&#46; La recogida de datos se realiz&#243; mediante entrevista a domicilio por parte de personal entrenado&#44; en el periodo comprendido entre marzo de 2000 y febrero de 2001 para la ESB 2000&#44; y entre diciembre de 2005 y noviembre de 2006 para la ESB 2006&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se excluyeron las personas menores de 18 a&#241;os y aquellas que requer&#237;an de un informador indirecto para contestar el cuestionario&#44; quedando una muestra final de 8&#46;237 individuos para la ESB 2000 y de 5120 para la ESB 2006&#46; La informaci&#243;n sobre exposici&#243;n al HAT en el trabajo se recogi&#243; en el a&#241;o 2000 mediante el n&#250;mero de horas al d&#237;a con compa&#241;eros fumadores&#46; Se consideraron expuestos aquellos individuos que declaraban pasar como m&#237;nimo 1 hora al d&#237;a con compa&#241;eros fumadores en su lugar de trabajo&#46; En 2006 se pregunt&#243; si hab&#237;a alg&#250;n compa&#241;ero que fumase cerca suyo en el lugar de trabajo&#44; y se consider&#243; expuesto a quien respond&#237;a que s&#237;&#46; La informaci&#243;n sobre exposici&#243;n en el hogar se recogi&#243; en ambas encuestas mediante la pregunta de si alg&#250;n miembro de la familia fumaba en casa&#44; 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El consumo de tabaco se categoriz&#243; en &#171;fumadores&#187; &#40;que inclu&#237;a fumadores diarios y ocasionales&#41; y &#171;no fumadores&#187; &#40;que inclu&#237;a nunca fumadores y ex fumadores&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Para el an&#225;lisis de la exposici&#243;n al HAT se excluy&#243; a la poblaci&#243;n fumadora&#44; y en el caso de la exposici&#243;n en el trabajo tambi&#233;n a las personas mayores de 64 a&#241;os&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo de las variables incluidas en el estudio calculando las frecuencias&#44; sus intervalos de confianza y la variaci&#243;n porcentual entre 2000 y 2006&#46; La comparaci&#243;n entre los datos obtenidos de la ESB 2000 y de la ESB 2006 se realiz&#243; mediante la prueba de independencia de ji al cuadrado&#46; Asimismo&#44; mediante regresi&#243;n log&#237;stica se calcul&#243; la <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; de la exposici&#243;n al HAT despu&#233;s de la implementaci&#243;n de la ley&#44; en el hogar y en el trabajo&#44; ajustada por variables sociodemogr&#225;ficas respecto a la exposici&#243;n previa a la ley&#46; Para el procesamiento y el an&#225;lisis de los datos se utiliz&#243; el paquete estad&#237;stico STATA 10&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas de la poblaci&#243;n en estudio se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; No se observaron diferencias significativas relativas a la proporci&#243;n de hombres y mujeres encuestados en 2000 y 2006&#44; aunque s&#237; se hallaron diferencias entre los no fumadores&#46; Se observaron diferencias en la proporci&#243;n de grupos de edad m&#225;s j&#243;venes&#44; tanto en la poblaci&#243;n general como en los no fumadores&#44; con una disminuci&#243;n de la representaci&#243;n de las personas de 18 a 29 a&#241;os de edad y un aumento de las de 30 a 44 a&#241;os&#46; Asimismo&#44; se observ&#243; un aumento de las clases sociales m&#225;s favorecidas &#40;I y II&#41;&#44; y una disminuci&#243;n de la clase media &#40;III&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> muestra que la exposici&#243;n al HAT en el hogar se redujo significativamente en la poblaci&#243;n no fumadora&#44; en especial entre las personas de 30 a 44 a&#241;os de edad y en las de las clases sociales I y II&#44; con disminuciones superiores al 35&#37; en ambos casos&#46; Se observ&#243; una mayor disminuci&#243;n en los hombres que en las mujeres&#44; con un gradiente de exposici&#243;n por clase social&#46; No obstante&#44; no se observaron cambios significativos en los mayores de 64 a&#241;os&#46; La disminuci&#243;n en la exposici&#243;n al HAT en el lugar de trabajo en la poblaci&#243;n no fumadora fue mayor que la observada en el hogar&#44; con diferencias significativas en todas las categor&#237;as analizadas&#46; Asimismo&#44; la disminuci&#243;n fue mayor en las personas de m&#225;s edad y de clases sociales m&#225;s favorecidas &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">En 2006&#44; el 53&#44;2&#37; de los hombres y el 41&#44;6&#37; de las mujeres no fumadores declararon estar expuestos al HAT durante su tiempo libre&#46; La prevalencia de exposici&#243;n m&#225;s alta &#40;83&#44;5&#37;&#41; la reportaron los j&#243;venes de 18 a 29 a&#241;os de edad&#46; La exposici&#243;n al HAT sigue un gradiente inverso&#44; pues disminuye a edades m&#225;s avanzadas&#44; tanto en el fin de semana como en los d&#237;as laborables&#46; Durante el fin de semana&#44; la exposici&#243;n al HAT fue m&#225;s alta en las clases sociales m&#225;s favorecidas &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; En cuanto a la duraci&#243;n de la exposici&#243;n&#44; el 17&#44;6&#37; de los no fumadores permanec&#237;a expuesto de 1 a 4 horas durante el fin de semana&#44; frente al 6&#44;8&#37; en los d&#237;as laborables&#46; La exposici&#243;n de m&#225;s de 4 horas fue del 5&#44;4&#37; durante el fin de semana y del 1&#44;6&#37; en los d&#237;as laborables &#40;datos no mostrados en las tablas&#41;&#46; Destacaba especialmente la duraci&#243;n de la exposici&#243;n al HAT entre los m&#225;s j&#243;venes durante el fin de semana&#44; ya que el 44&#44;9&#37; estaba expuesto entre 1 y 4 horas y el 19&#44;3&#37; m&#225;s de 4 horas&#46; Asimismo&#44; se observ&#243; que los hombres segu&#237;an mostrando un mayor tiempo de exposici&#243;n que las mujeres&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Tras ajustar por sexo&#44; edad y clase social&#44; se observ&#243; que la exposici&#243;n en 2006 disminuy&#243; respecto a 2000 tanto en el hogar &#40;OR &#61; 0&#44;7&#59; intervalo de confianza del 95&#37; &#91;IC95&#37;&#93;&#58; 0&#44;6-0&#44;8&#41; como en el trabajo &#40;OR &#61; 0&#44;2&#59; IC95&#37;&#58; 0&#44;2-0&#44;3&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0085" class="elsevierStylePara elsevierViewall">Los resultados de este estudio muestran una disminuci&#243;n generalizada de la exposici&#243;n al HAT en la poblaci&#243;n no fumadora de Barcelona en el per&#237;odo transcurrido entre los a&#241;os 2000 y 2006&#46; Esta disminuci&#243;n&#44; que podr&#237;a atribuirse a la Ley de medidas sanitarias frente al tabaquismo de 2005&#44; fue especialmente importante en los lugares de trabajo y se relacionaba con determinados aspectos sociodemogr&#225;ficos&#44; como la edad y la clase social&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En el lugar de trabajo&#44; la disminuci&#243;n de la exposici&#243;n al HAT fue generalizada&#44; y adem&#225;s presentaba un gradiente por clase social&#46; Los resultados de nuestro estudio concuerdan con los de estudios realizados en otros pa&#237;ses&#44; como Irlanda&#44; donde se observ&#243; una reducci&#243;n en la prevalencia de la exposici&#243;n del 77&#44;4&#37; tras la implementaci&#243;n de su ley<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#46; Asimismo&#44; en otro estudio realizado en Espa&#241;a que midi&#243; la exposici&#243;n en poblaci&#243;n general tambi&#233;n se observ&#243; una disminuci&#243;n similar en los lugares de trabajo &#40;77&#44;8&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46; Los j&#243;venes y las clases menos favorecidas fueron los que menor disminuci&#243;n experimentaron en su lugar de trabajo&#44; lo que podr&#237;a estar relacionado con una menor protecci&#243;n frente al HAT en los puestos m&#225;s precarios y con una mayor presencia de estos subgrupos de poblaci&#243;n en el sector hostelero&#44; en el cual&#44; tras la ley&#44; se segu&#237;a permitiendo fumar de manera total o parcial en m&#225;s del 80&#37; de los locales<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#8211;26</span></a>&#44; y en &#233;stos la concentraci&#243;n de HAT segu&#237;a siendo muy alta<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Respecto a la exposici&#243;n en el hogar&#44; y en contra de lo que algunos detractores de las normativas suger&#237;an&#44; diversos estudios en otros pa&#237;ses europeos demostraron que tras la implementaci&#243;n de leyes que prohib&#237;an el consumo de tabaco en el trabajo&#44; la exposici&#243;n al HAT no aumentaba en el hogar<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;18&#44;28</span></a>&#46; En este aspecto&#44; los resultados de nuestro estudio revelaron una disminuci&#243;n significativa&#44; del 21&#44;0&#37;&#44; en la prevalencia de exposici&#243;n en el hogar&#44; en concordancia con lo hallado en un estudio previo realizado en Irlanda<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#46; No obstante&#44; cabe destacar que ha habido una disminuci&#243;n notablemente menor en las mujeres&#46; Esto podr&#237;a estar relacionado con una mayor prevalencia de hombres fumadores en comparaci&#243;n con mujeres fumadoras en las personas de mayor edad<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">En relaci&#243;n al tiempo libre&#44; la prevalencia de exposici&#243;n al HAT en los no fumadores continuaba siendo muy alta tras la ley&#44; con cerca de la mitad de la poblaci&#243;n no fumadora expuesta durante su tiempo libre&#46; Esta exposici&#243;n fue similar a la encontrada en otro estudio realizado en nuestro pa&#237;s en 2006 &#40;50&#44;4&#37; en hombres y 44&#44;4&#37; en mujeres en d&#237;as no laborables&#41;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46; Asimismo&#44; cabe destacar que la prevalencia de exposici&#243;n al HAT fue mucho mayor en el grupo de j&#243;venes&#44; de los cuales m&#225;s del 80&#37; declaraba estar expuesto&#46; Estas altas prevalencias de exposici&#243;n podr&#237;an estar relacionadas con la exposici&#243;n en locales de hosteler&#237;a&#44; como bares y discotecas&#46; De igual manera&#44; se observa una mayor prevalencia de exposici&#243;n en los hombres&#44; concordante con otros estudios<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#44; que puede estar relacionada con la mayor frecuentaci&#243;n por parte de &#233;stos de determinados locales de ocio<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Entre las limitaciones de este estudio cabe destacar las propias de los estudios basados en la recogida de informaci&#243;n mediante cuestionario&#44; como el posible sesgo de memoria&#46; No obstante&#44; se recog&#237;a la exposici&#243;n reciente&#44; por lo que no es esperable que afectara a las respuestas de los participantes&#46; Por otro lado&#44; entre las posibles amenazas a la validez interna cabe mencionar que no se trataba de un cuestionario validado para medir la exposici&#243;n al HAT&#44; as&#237; como la ausencia de medici&#243;n de un marcador objetivo del HAT&#46; Asimismo&#44; algunos estudios sugieren que la exposici&#243;n autodeclarada infraestima la exposici&#243;n real<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">32&#44;33</span></a>&#46; Sin embargo&#44; otros estudios que han comparado las respuestas obtenidas de cuestionarios con marcadores objetivos de exposici&#243;n han demostrado una buena fiabilidad de los cuestionarios para estimar la exposici&#243;n al HAT<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34&#44;35</span></a>&#46; Otra posible limitaci&#243;n estar&#237;a relacionada con el periodo de recogida de los datos tras la ley&#44; que fue justo despu&#233;s de su implementaci&#243;n&#44; por lo que s&#243;lo permiten evaluar su impacto a corto plazo&#46; Adem&#225;s&#44; el periodo de recogida de los datos podr&#237;a haber influido en las respuestas sobre la exposici&#243;n durante el tiempo libre&#44; ya que la fecha l&#237;mite para la habilitaci&#243;n de zonas para fumadores en los locales de hosteler&#237;a fue el 1 de septiembre de 2006&#44; 2 meses antes del final del trabajo de campo&#44; en noviembre de 2006&#46; En cualquier caso&#44; solamente el 3&#37; del total de los locales habilit&#243; zonas separadas en Barcelona<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#44; por lo que no es probable que las respuestas se vieran influenciadas de manera significativa por este motivo&#46; Entre las fortalezas del estudio cabe destacar la representatividad poblacional de las dos muestras estudiadas&#44; la disponibilidad de variables sociodemogr&#225;ficas asociadas a la exposici&#243;n&#44; y la disposici&#243;n de preguntas comparables de exposici&#243;n al HAT antes y despu&#233;s de la ley&#46; Si bien las preguntas relativas a la exposici&#243;n en el trabajo no eran exactamente iguales en ambas encuestas&#44; lo cual puede limitar su comparabilidad&#44; la pregunta de 2006 era m&#225;s restrictiva &#40;S&#237;&#47;No&#41;&#44; lo que supondr&#237;a un mayor control a la hora de medir la exposici&#243;n en este &#225;mbito&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Este estudio sugiere que la Ley 28&#47;2005 tuvo como consecuencia una disminuci&#243;n generalizada de la exposici&#243;n al HAT en casa y en el trabajo en la poblaci&#243;n no fumadora de Barcelona&#46; Aun as&#237;&#44; destaca el hecho de que&#44; tras la ley&#44; un porcentaje muy alto de la poblaci&#243;n segu&#237;a expuesta al HAT en su tiempo libre&#46; Este dato parece asociado al hecho de que se segu&#237;a permitiendo fumar en la mayor&#237;a de los locales del sector de la hosteler&#237;a&#44; sin olvidar otros posibles &#225;mbitos de exposici&#243;n&#44; como las paradas de autob&#250;s o de otros transportes p&#250;blicos&#46; En este sentido&#44; los resultados de una revisi&#243;n sistem&#225;tica internacional realizada en 2010&#44; que inclu&#237;a la revisi&#243;n de 50 estudios sobre prohibiciones legislativas del tabaquismo<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a>&#44; pone de manifiesto la necesidad de normativas que proh&#237;ban fumar en todos los locales de hosteler&#237;a&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">La modificaci&#243;n de la Ley 28&#47;2005&#44; de reciente entrada en vigor en enero de 2011<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a>&#44; representa sin duda un gran avance en el control del tabaquismo en nuestro pa&#237;s&#44; pues permite no s&#243;lo mejorar la situaci&#243;n de los trabajadores de la hosteler&#237;a que continuaban expuestos diariamente al HAT&#44; sino tambi&#233;n la de la poblaci&#243;n general que ahora puede disfrutar de su tiempo libre en locales de ocio sin necesidad de exponerse al HAT y a sus efectos&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Financiaci&#243;n</span><p id="par0120" class="elsevierStylePara elsevierViewall">Ninguna&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflictos de intereses</span><p id="par0125" class="elsevierStylePara elsevierViewall">M&#46;J&#46; L&#243;pez pertenece al Comit&#233; Editorial de GACETA SANITARIA&#46; Ella no ha participado en el proceso editorial del manuscrito&#46;</p></span></span>"
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          "palabras" => array:6 [
            0 => "Humo ambiental del tabaco"
            1 => "Tabaquismo pasivo"
            2 => "Ley 28&#47;2005"
            3 => "Prevalencia"
            4 => "Encuesta"
            5 => "Evaluaci&#243;n"
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          "clase" => "keyword"
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          "palabras" => array:6 [
            0 => "Second-hand smoke"
            1 => "Passive smoking"
            2 => "28&#47;2005 Spanish smoking law"
            3 => "Prevalence"
            4 => "Survey"
            5 => "Evaluation"
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluar el impacto de la Ley 28&#47;2005 de medidas sanitarias frente al tabaquismo en la prevalencia de la exposici&#243;n al humo ambiental del tabaco &#40;HAT&#41; en Barcelona&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio de evaluaci&#243;n antes-despu&#233;s mediante comparaci&#243;n de dos encuestas transversales&#46; Las fuentes de datos fueron las Encuestas de Salud de Barcelona de 2000 y 2006&#46; Se analiz&#243; la prevalencia de exposici&#243;n al HAT en poblaci&#243;n adulta no fumadora seg&#250;n el &#225;mbito de exposici&#243;n &#40;hogar&#44; trabajo y tiempo libre&#41; y las variables sociodemogr&#225;ficas&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La exposici&#243;n al HAT en no fumadores en el hogar y el trabajo disminuy&#243; significativamente &#40;p &#60;0&#44;01&#41; entre 2000 y 2006&#46; Las <span class="elsevierStyleItalic">odds ratio</span> para 2006&#44; respecto a 2000&#44; ajustadas por sexo&#44; edad y clase social&#44; fueron de 0&#44;7 &#40;intervalo de confianza del 95&#37; &#91;IC95&#37;&#93;&#58; 0&#44;6-0&#44;8&#41; para la exposici&#243;n en el hogar y 0&#44;2 &#40;IC95&#37;&#58; 0&#44;2-0&#44;3&#41; para la exposici&#243;n en el trabajo&#46; En ambos casos la reducci&#243;n fue mayor en las personas de clase social favorecida&#46; Tras la implementaci&#243;n de la ley&#44; casi el 50&#37; de la poblaci&#243;n segu&#237;a expuesta al HAT en el tiempo libre&#44; y los m&#225;s j&#243;venes eran los m&#225;s expuestos &#40;83&#44;5&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de exposici&#243;n al HAT en los no fumadores en Barcelona disminuy&#243; significativamente tras la Ley 28&#47;2005&#44; tanto en el &#225;mbito laboral como en el hogar&#46; Aun as&#237;&#44; casi la mitad de la poblaci&#243;n segu&#237;a expuesta durante su tiempo libre&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To assess the impact of the 28&#47;2005 Spanish smoking law on exposure to second-hand smoke &#40;SHS&#41; in Barcelona&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We performed a pre-post evaluation study&#46; Two cross-sectional surveys were compared&#46; Data were obtained from the Barcelona Health Surveys of 2000 and 2006&#46; The prevalence of SHS exposure among non-smoking adults was analyzed by setting &#40;home&#44; workplace and leisure time&#41; and sociodemographic variables&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">SHS exposure in non-smokers significantly decreased between 2000 and 2006 &#40;p &#60;0&#46;01&#41;&#46; Odds ratios adjusted by sex&#44; age and social class were 0&#46;7 &#40;95&#37; CI&#58; 0&#46;6-0&#46;8&#41; for home and 0&#46;2 &#40;95&#37; CI&#58; 0&#46;2-0&#46;3&#41; for workplace exposure in 2006 compared with 2000&#46; In both settings&#44; the decrease in exposure was greater in the higher social classes&#46; After the implementation of the law&#44; almost 50&#37; of the population remained exposed to SHS during leisure time&#44; younger people being the most exposed &#40;83&#46;5&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">After the implementation of the law&#44; the prevalence of SHS exposure in non-smokers in Barcelona decreased significantly in workplaces and in the home&#46; Nevertheless&#44; nearly half of the population remained exposed to SHS during leisure time&#46;</p>"
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Poblaci&#243;n total</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">No fumadores</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">ESB 2000 N &#61; 8237</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">ESB 2006 N &#61; 5120</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">ESB 2000 N &#61; 5828</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">ESB 2006 N &#61; 3714</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="11" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hombres&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;791&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#44;0 &#40;44&#44;9-47&#44;1&#41;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;405&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#44;0 &#40;45&#44;6-48&#44;3&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;285&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;409&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#44;3 &#40;40&#44;1-42&#44;6&#41;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;619&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#44;6 &#40;42&#44;0- 45&#44;2&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujeres&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;446&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#44;0 &#40;52&#44;9-55&#44;1&#41;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;715&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#44;0 &#40;51&#44;7- 54&#44;4&#41;&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;419&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#44;7 &#40;57&#44;4- 59&#44;9&#41;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;095&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#44;4 &#40;54&#44;8- 58&#44;0&#41;&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="11" 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="11" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Edad &#40;a&#241;os&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>18-29&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;775&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#44;6 &#40;20&#44;7-22&#44;4&#41;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">910&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;8 &#40;16&#44;7- 18&#44;8&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;01&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;025&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;6 &#40;16&#44;6- 18&#44;6&#41;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">550&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;8 &#40;13&#44;7- 16&#44;0&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>30-44&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;039&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#44;8 &#40;23&#44;8- 25&#44;7&#41;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;438&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;1 &#40;26&#44;9-29&#44;3&#41;&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;180&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;3 &#40;19&#44;2- 21&#44;3&#41;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">898&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#44;2 &#40;22&#44;8-25&#44;6&#41;&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>45-64&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;448&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
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                  \t\t\t\t">304&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">34&#44;2 &#40;31&#44;0-37&#44;3&#41;&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"><span class="elsevierStyleHsp" style=""></span>IV y V&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">598&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Exposici&#243;n al humo ambiental del tabaco durante el tiempo libre en poblaci&#243;n no fumadora de Barcelona seg&#250;n sexo&#44; edad y clase social&#46; Encuesta de Salud de Barcelona 2006</p>"
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              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara">Regresi&#243;n log&#237;stica ajustada por sexo&#44; edad y clase social&#46;</p>"
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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Comparaci&#243;n de la exposici&#243;n al humo ambiental del tabaco en el hogar y el lugar de trabajo en la poblaci&#243;n no fumadora de Barcelona antes y despu&#233;s de la ley&#46; Encuesta de Salud de Barcelona&#44; 2000-2006</p>"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Changes in exposure of adult non-smokers to secondhand smoke after implementation of smoke-free legislation in Scotland&#58; national cross sectional survey"
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                          "etal" => false
                          "autores" => array:2 [
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                      "titulo" => "Italy and Austria before and after study&#58; second-hand smoke exposure in hospitality premises before and after 2 years from the introduction of the Italian smoking ban"
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                          "etal" => true
                          "autores" => array:3 [
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                            1 => "H&#46; Moshammer"
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                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1111/j.1600-0668.2008.00534.x"
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                        "paginaFinal" => "334"
                        "link" => array:1 [
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                      "doi" => "10.1056/NEJMsa0706740"
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                        "tituloSerie" => "N Engl J Med"
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                        "tituloSerie" => "Occup Environ Med"
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                          "autores" => array:3 [
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                            2 => "M&#46; McCaffrey"
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                    0 => array:2 [
                      "doi" => "10.1164/rccm.200608-1085OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
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                        "volumen" => "175"
                        "paginaInicial" => "840"
                        "paginaFinal" => "845"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Association of anti-smoking legislation with rates of hospital admission for cardiovascular and respiratory conditions"
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Original
Impacto de la Ley 28/2005 de medidas sanitarias frente al tabaquismo en la prevalencia de la exposición al humo ambiental del tabaco en Barcelona
Impact of the 28/2005 Spanish smoking law on second-hand smoke exposure in Barcelona
Sandra Manzanares-Layaa,b, María J. Lópeza,c,d,
Autor para correspondencia
mjlopez@aspb.cat

Autora para correspondencia.
, Francesca Sánchez-Martíneza,c,d, Esteve Fernándeze,f, Manel Nebota,c,d
a Servicio de Evaluación y Métodos de Intervención, Agencia de Salud Pública de Barcelona, Barcelona, España
b Unidad Docente de Medicina Preventiva y Salud Pública, H. MAR-UPF-ASPB, Barcelona, España
c Instituto de Investigación Biosanitaria Sant Pau, Barcelona, España
d CIBER de Epidemiología y Salud Pública (CIBERESP), España
e Institut Català d’Oncologia-IDIBELL, L’Hospitalet de Llobregat, Barcelona, España
f Departamento de Ciencias Clínicas, Facultat de Medicina, Universitat de Barcelona, Barcelona, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tb0005"></elsevierMultimedia></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Contribuciones de autor&#237;a</span><p id="par0020" class="elsevierStylePara elsevierViewall">S&#46; Manzanares realiz&#243; la revisi&#243;n bibliogr&#225;fica&#44; el an&#225;lisis estad&#237;stico y el primer borrador del manuscrito&#46; M&#46;J&#46; L&#243;pez&#44; M&#46; Nebot y F&#46; S&#225;nchez concibieron el estudio&#44; supervisaron el proceso de realizaci&#243;n y contribuyeron a la revisi&#243;n cr&#237;tica del manuscrito&#46; E&#46; Fern&#225;ndez revis&#243; el protocolo del estudio&#44; y contribuy&#243; a la discusi&#243;n de los resultados y la revisi&#243;n del manuscrito&#46; Todos los autores aprobaron la versi&#243;n final del manuscrito&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="par0025" class="elsevierStylePara elsevierViewall">La exposici&#243;n al humo ambiental del tabaco &#40;HAT&#41; aumenta el riesgo de enfermedad coronaria&#44; de infecciones de v&#237;as respiratorias&#44; de enfermedad pulmonar obstructiva cr&#243;nica&#44; de c&#225;ncer de pulm&#243;n y de muerte s&#250;bita del lactante&#44; entre otros efectos sobre la salud<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Por ello&#44; en los &#250;ltimos a&#241;os diversos pa&#237;ses han desarrollado medidas legislativas para proteger a la poblaci&#243;n de los efectos del HAT&#46; En Espa&#241;a&#44; la Ley 28&#47;2005 de medidas sanitarias frente al tabaquismo&#44; en vigor desde enero de 2006&#44; prohib&#237;a el consumo de tabaco en lugares p&#250;blicos y de trabajo&#44; permitiendo restricciones parciales en los locales de hosteler&#237;a<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; Numerosos estudios evaluativos realizados en pa&#237;ses que implantaron prohibiciones totales han demostrado una disminuci&#243;n de la prevalencia de la exposici&#243;n al HAT en la poblaci&#243;n&#44; as&#237; como una disminuci&#243;n en los ingresos por infarto agudo de miocardio y una mejora de los s&#237;ntomas respiratorios en los trabajadores de la hosteler&#237;a<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;9</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La exposici&#243;n al HAT en nuestro medio supone un importante problema de salud p&#250;blica&#44; al que se atribuyeron entre 1&#46;228 y 3&#46;237 muertes en 2002<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a>&#46; Estudios anteriores a la Ley 28&#47;2005 estimaron que m&#225;s del 60&#37; de la poblaci&#243;n estaba expuesta en Barcelona y en su &#225;rea metropolitana<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#8211;14</span></a>&#46; Asimismo&#44; otros estudios realizados en diversas regiones de Espa&#241;a observaban resultados similares<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46; Tras la ley&#44; dos estudios que midieron con marcadores objetivos la exposici&#243;n en los locales de hosteler&#237;a y en los trabajadores de estos locales&#44; antes y despu&#233;s de la ley&#44; demostraron que la exposici&#243;n al HAT s&#243;lo se hab&#237;a reducido en aquellos donde se hab&#237;a prohibido fumar por completo<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a>&#46; Respecto a la prevalencia de la exposici&#243;n&#44; s&#243;lo dos estudios<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a> han evaluado hasta la fecha el impacto de la ley con datos de prevalencia de exposici&#243;n antes y despu&#233;s&#44; el primero en la Comunidad de Madrid y el segundo de &#225;mbito estatal&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El objetivo de nuestro estudio fue analizar el impacto de la Ley 28&#47;2005 en la prevalencia de la exposici&#243;n al HAT en los principales &#225;mbitos de exposici&#243;n &#40;hogar&#44; trabajo y tiempo libre&#41;&#44; as&#237; como su relaci&#243;n con diversas variables sociodemogr&#225;ficas&#44; en la poblaci&#243;n no fumadora de Barcelona&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se trata de un estudio evaluativo antes-despu&#233;s mediante comparaci&#243;n de dos encuestas transversales&#46; Las fuentes de informaci&#243;n fueron las Encuestas de Salud de Barcelona de los a&#241;os 2000 &#40;ESB 2000&#41;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> y 2006 &#40;ESB 2006&#41;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#44; con un tama&#241;o muestral de 10&#46;000 y 6108 individuos&#44; respectivamente&#46; La recogida de datos se realiz&#243; mediante entrevista a domicilio por parte de personal entrenado&#44; en el periodo comprendido entre marzo de 2000 y febrero de 2001 para la ESB 2000&#44; y entre diciembre de 2005 y noviembre de 2006 para la ESB 2006&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se excluyeron las personas menores de 18 a&#241;os y aquellas que requer&#237;an de un informador indirecto para contestar el cuestionario&#44; quedando una muestra final de 8&#46;237 individuos para la ESB 2000 y de 5120 para la ESB 2006&#46; La informaci&#243;n sobre exposici&#243;n al HAT en el trabajo se recogi&#243; en el a&#241;o 2000 mediante el n&#250;mero de horas al d&#237;a con compa&#241;eros fumadores&#46; Se consideraron expuestos aquellos individuos que declaraban pasar como m&#237;nimo 1 hora al d&#237;a con compa&#241;eros fumadores en su lugar de trabajo&#46; En 2006 se pregunt&#243; si hab&#237;a alg&#250;n compa&#241;ero que fumase cerca suyo en el lugar de trabajo&#44; y se consider&#243; expuesto a quien respond&#237;a que s&#237;&#46; La informaci&#243;n sobre exposici&#243;n en el hogar se recogi&#243; en ambas encuestas mediante la pregunta de si alg&#250;n miembro de la familia fumaba en casa&#44; y se consider&#243; expuestos a quienes respond&#237;an que s&#237;&#46; La exposici&#243;n durante el tiempo libre&#44; que s&#243;lo se incluy&#243; en la encuesta de 2006&#44; se recogi&#243; preguntando cu&#225;nto tiempo al d&#237;a se estaba expuesto al HAT&#44; distinguiendo entre los d&#237;as laborables y los fines de semana fuera del lugar de trabajo o del hogar&#46; Se consideraron expuestas aquellas personas que declararon una exposici&#243;n al HAT de m&#225;s de 0 horas&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">La edad de los participantes se estratific&#243; en cuatro grupos &#40;18-29&#44; 30-44&#44; 45-64 y mayores de 64 a&#241;os&#41;&#46; Para definir la clase social se utiliz&#243; la clasificaci&#243;n propuesta por la Sociedad Espa&#241;ola de Epidemiolog&#237;a<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46; Las personas que no especificaron su clase social fueron menos del 4&#37;&#44; y no se incluyeron en los an&#225;lisis&#46; El consumo de tabaco se categoriz&#243; en &#171;fumadores&#187; &#40;que inclu&#237;a fumadores diarios y ocasionales&#41; y &#171;no fumadores&#187; &#40;que inclu&#237;a nunca fumadores y ex fumadores&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Para el an&#225;lisis de la exposici&#243;n al HAT se excluy&#243; a la poblaci&#243;n fumadora&#44; y en el caso de la exposici&#243;n en el trabajo tambi&#233;n a las personas mayores de 64 a&#241;os&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo de las variables incluidas en el estudio calculando las frecuencias&#44; sus intervalos de confianza y la variaci&#243;n porcentual entre 2000 y 2006&#46; La comparaci&#243;n entre los datos obtenidos de la ESB 2000 y de la ESB 2006 se realiz&#243; mediante la prueba de independencia de ji al cuadrado&#46; Asimismo&#44; mediante regresi&#243;n log&#237;stica se calcul&#243; la <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; de la exposici&#243;n al HAT despu&#233;s de la implementaci&#243;n de la ley&#44; en el hogar y en el trabajo&#44; ajustada por variables sociodemogr&#225;ficas respecto a la exposici&#243;n previa a la ley&#46; Para el procesamiento y el an&#225;lisis de los datos se utiliz&#243; el paquete estad&#237;stico STATA 10&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas de la poblaci&#243;n en estudio se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; No se observaron diferencias significativas relativas a la proporci&#243;n de hombres y mujeres encuestados en 2000 y 2006&#44; aunque s&#237; se hallaron diferencias entre los no fumadores&#46; Se observaron diferencias en la proporci&#243;n de grupos de edad m&#225;s j&#243;venes&#44; tanto en la poblaci&#243;n general como en los no fumadores&#44; con una disminuci&#243;n de la representaci&#243;n de las personas de 18 a 29 a&#241;os de edad y un aumento de las de 30 a 44 a&#241;os&#46; Asimismo&#44; se observ&#243; un aumento de las clases sociales m&#225;s favorecidas &#40;I y II&#41;&#44; y una disminuci&#243;n de la clase media &#40;III&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> muestra que la exposici&#243;n al HAT en el hogar se redujo significativamente en la poblaci&#243;n no fumadora&#44; en especial entre las personas de 30 a 44 a&#241;os de edad y en las de las clases sociales I y II&#44; con disminuciones superiores al 35&#37; en ambos casos&#46; Se observ&#243; una mayor disminuci&#243;n en los hombres que en las mujeres&#44; con un gradiente de exposici&#243;n por clase social&#46; No obstante&#44; no se observaron cambios significativos en los mayores de 64 a&#241;os&#46; La disminuci&#243;n en la exposici&#243;n al HAT en el lugar de trabajo en la poblaci&#243;n no fumadora fue mayor que la observada en el hogar&#44; con diferencias significativas en todas las categor&#237;as analizadas&#46; Asimismo&#44; la disminuci&#243;n fue mayor en las personas de m&#225;s edad y de clases sociales m&#225;s favorecidas &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">En 2006&#44; el 53&#44;2&#37; de los hombres y el 41&#44;6&#37; de las mujeres no fumadores declararon estar expuestos al HAT durante su tiempo libre&#46; La prevalencia de exposici&#243;n m&#225;s alta &#40;83&#44;5&#37;&#41; la reportaron los j&#243;venes de 18 a 29 a&#241;os de edad&#46; La exposici&#243;n al HAT sigue un gradiente inverso&#44; pues disminuye a edades m&#225;s avanzadas&#44; tanto en el fin de semana como en los d&#237;as laborables&#46; Durante el fin de semana&#44; la exposici&#243;n al HAT fue m&#225;s alta en las clases sociales m&#225;s favorecidas &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; En cuanto a la duraci&#243;n de la exposici&#243;n&#44; el 17&#44;6&#37; de los no fumadores permanec&#237;a expuesto de 1 a 4 horas durante el fin de semana&#44; frente al 6&#44;8&#37; en los d&#237;as laborables&#46; La exposici&#243;n de m&#225;s de 4 horas fue del 5&#44;4&#37; durante el fin de semana y del 1&#44;6&#37; en los d&#237;as laborables &#40;datos no mostrados en las tablas&#41;&#46; Destacaba especialmente la duraci&#243;n de la exposici&#243;n al HAT entre los m&#225;s j&#243;venes durante el fin de semana&#44; ya que el 44&#44;9&#37; estaba expuesto entre 1 y 4 horas y el 19&#44;3&#37; m&#225;s de 4 horas&#46; Asimismo&#44; se observ&#243; que los hombres segu&#237;an mostrando un mayor tiempo de exposici&#243;n que las mujeres&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Tras ajustar por sexo&#44; edad y clase social&#44; se observ&#243; que la exposici&#243;n en 2006 disminuy&#243; respecto a 2000 tanto en el hogar &#40;OR &#61; 0&#44;7&#59; intervalo de confianza del 95&#37; &#91;IC95&#37;&#93;&#58; 0&#44;6-0&#44;8&#41; como en el trabajo &#40;OR &#61; 0&#44;2&#59; IC95&#37;&#58; 0&#44;2-0&#44;3&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0085" class="elsevierStylePara elsevierViewall">Los resultados de este estudio muestran una disminuci&#243;n generalizada de la exposici&#243;n al HAT en la poblaci&#243;n no fumadora de Barcelona en el per&#237;odo transcurrido entre los a&#241;os 2000 y 2006&#46; Esta disminuci&#243;n&#44; que podr&#237;a atribuirse a la Ley de medidas sanitarias frente al tabaquismo de 2005&#44; fue especialmente importante en los lugares de trabajo y se relacionaba con determinados aspectos sociodemogr&#225;ficos&#44; como la edad y la clase social&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En el lugar de trabajo&#44; la disminuci&#243;n de la exposici&#243;n al HAT fue generalizada&#44; y adem&#225;s presentaba un gradiente por clase social&#46; Los resultados de nuestro estudio concuerdan con los de estudios realizados en otros pa&#237;ses&#44; como Irlanda&#44; donde se observ&#243; una reducci&#243;n en la prevalencia de la exposici&#243;n del 77&#44;4&#37; tras la implementaci&#243;n de su ley<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#46; Asimismo&#44; en otro estudio realizado en Espa&#241;a que midi&#243; la exposici&#243;n en poblaci&#243;n general tambi&#233;n se observ&#243; una disminuci&#243;n similar en los lugares de trabajo &#40;77&#44;8&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46; Los j&#243;venes y las clases menos favorecidas fueron los que menor disminuci&#243;n experimentaron en su lugar de trabajo&#44; lo que podr&#237;a estar relacionado con una menor protecci&#243;n frente al HAT en los puestos m&#225;s precarios y con una mayor presencia de estos subgrupos de poblaci&#243;n en el sector hostelero&#44; en el cual&#44; tras la ley&#44; se segu&#237;a permitiendo fumar de manera total o parcial en m&#225;s del 80&#37; de los locales<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#8211;26</span></a>&#44; y en &#233;stos la concentraci&#243;n de HAT segu&#237;a siendo muy alta<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Respecto a la exposici&#243;n en el hogar&#44; y en contra de lo que algunos detractores de las normativas suger&#237;an&#44; diversos estudios en otros pa&#237;ses europeos demostraron que tras la implementaci&#243;n de leyes que prohib&#237;an el consumo de tabaco en el trabajo&#44; la exposici&#243;n al HAT no aumentaba en el hogar<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;18&#44;28</span></a>&#46; En este aspecto&#44; los resultados de nuestro estudio revelaron una disminuci&#243;n significativa&#44; del 21&#44;0&#37;&#44; en la prevalencia de exposici&#243;n en el hogar&#44; en concordancia con lo hallado en un estudio previo realizado en Irlanda<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#46; No obstante&#44; cabe destacar que ha habido una disminuci&#243;n notablemente menor en las mujeres&#46; Esto podr&#237;a estar relacionado con una mayor prevalencia de hombres fumadores en comparaci&#243;n con mujeres fumadoras en las personas de mayor edad<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">En relaci&#243;n al tiempo libre&#44; la prevalencia de exposici&#243;n al HAT en los no fumadores continuaba siendo muy alta tras la ley&#44; con cerca de la mitad de la poblaci&#243;n no fumadora expuesta durante su tiempo libre&#46; Esta exposici&#243;n fue similar a la encontrada en otro estudio realizado en nuestro pa&#237;s en 2006 &#40;50&#44;4&#37; en hombres y 44&#44;4&#37; en mujeres en d&#237;as no laborables&#41;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46; Asimismo&#44; cabe destacar que la prevalencia de exposici&#243;n al HAT fue mucho mayor en el grupo de j&#243;venes&#44; de los cuales m&#225;s del 80&#37; declaraba estar expuesto&#46; Estas altas prevalencias de exposici&#243;n podr&#237;an estar relacionadas con la exposici&#243;n en locales de hosteler&#237;a&#44; como bares y discotecas&#46; De igual manera&#44; se observa una mayor prevalencia de exposici&#243;n en los hombres&#44; concordante con otros estudios<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#44; que puede estar relacionada con la mayor frecuentaci&#243;n por parte de &#233;stos de determinados locales de ocio<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Entre las limitaciones de este estudio cabe destacar las propias de los estudios basados en la recogida de informaci&#243;n mediante cuestionario&#44; como el posible sesgo de memoria&#46; No obstante&#44; se recog&#237;a la exposici&#243;n reciente&#44; por lo que no es esperable que afectara a las respuestas de los participantes&#46; Por otro lado&#44; entre las posibles amenazas a la validez interna cabe mencionar que no se trataba de un cuestionario validado para medir la exposici&#243;n al HAT&#44; as&#237; como la ausencia de medici&#243;n de un marcador objetivo del HAT&#46; Asimismo&#44; algunos estudios sugieren que la exposici&#243;n autodeclarada infraestima la exposici&#243;n real<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">32&#44;33</span></a>&#46; Sin embargo&#44; otros estudios que han comparado las respuestas obtenidas de cuestionarios con marcadores objetivos de exposici&#243;n han demostrado una buena fiabilidad de los cuestionarios para estimar la exposici&#243;n al HAT<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34&#44;35</span></a>&#46; Otra posible limitaci&#243;n estar&#237;a relacionada con el periodo de recogida de los datos tras la ley&#44; que fue justo despu&#233;s de su implementaci&#243;n&#44; por lo que s&#243;lo permiten evaluar su impacto a corto plazo&#46; Adem&#225;s&#44; el periodo de recogida de los datos podr&#237;a haber influido en las respuestas sobre la exposici&#243;n durante el tiempo libre&#44; ya que la fecha l&#237;mite para la habilitaci&#243;n de zonas para fumadores en los locales de hosteler&#237;a fue el 1 de septiembre de 2006&#44; 2 meses antes del final del trabajo de campo&#44; en noviembre de 2006&#46; En cualquier caso&#44; solamente el 3&#37; del total de los locales habilit&#243; zonas separadas en Barcelona<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#44; por lo que no es probable que las respuestas se vieran influenciadas de manera significativa por este motivo&#46; Entre las fortalezas del estudio cabe destacar la representatividad poblacional de las dos muestras estudiadas&#44; la disponibilidad de variables sociodemogr&#225;ficas asociadas a la exposici&#243;n&#44; y la disposici&#243;n de preguntas comparables de exposici&#243;n al HAT antes y despu&#233;s de la ley&#46; Si bien las preguntas relativas a la exposici&#243;n en el trabajo no eran exactamente iguales en ambas encuestas&#44; lo cual puede limitar su comparabilidad&#44; la pregunta de 2006 era m&#225;s restrictiva &#40;S&#237;&#47;No&#41;&#44; lo que supondr&#237;a un mayor control a la hora de medir la exposici&#243;n en este &#225;mbito&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Este estudio sugiere que la Ley 28&#47;2005 tuvo como consecuencia una disminuci&#243;n generalizada de la exposici&#243;n al HAT en casa y en el trabajo en la poblaci&#243;n no fumadora de Barcelona&#46; Aun as&#237;&#44; destaca el hecho de que&#44; tras la ley&#44; un porcentaje muy alto de la poblaci&#243;n segu&#237;a expuesta al HAT en su tiempo libre&#46; Este dato parece asociado al hecho de que se segu&#237;a permitiendo fumar en la mayor&#237;a de los locales del sector de la hosteler&#237;a&#44; sin olvidar otros posibles &#225;mbitos de exposici&#243;n&#44; como las paradas de autob&#250;s o de otros transportes p&#250;blicos&#46; En este sentido&#44; los resultados de una revisi&#243;n sistem&#225;tica internacional realizada en 2010&#44; que inclu&#237;a la revisi&#243;n de 50 estudios sobre prohibiciones legislativas del tabaquismo<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a>&#44; pone de manifiesto la necesidad de normativas que proh&#237;ban fumar en todos los locales de hosteler&#237;a&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">La modificaci&#243;n de la Ley 28&#47;2005&#44; de reciente entrada en vigor en enero de 2011<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a>&#44; representa sin duda un gran avance en el control del tabaquismo en nuestro pa&#237;s&#44; pues permite no s&#243;lo mejorar la situaci&#243;n de los trabajadores de la hosteler&#237;a que continuaban expuestos diariamente al HAT&#44; sino tambi&#233;n la de la poblaci&#243;n general que ahora puede disfrutar de su tiempo libre en locales de ocio sin necesidad de exponerse al HAT y a sus efectos&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Financiaci&#243;n</span><p id="par0120" class="elsevierStylePara elsevierViewall">Ninguna&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflictos de intereses</span><p id="par0125" class="elsevierStylePara elsevierViewall">M&#46;J&#46; L&#243;pez pertenece al Comit&#233; Editorial de GACETA SANITARIA&#46; Ella no ha participado en el proceso editorial del manuscrito&#46;</p></span></span>"
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          "titulo" => "Introducci&#243;n"
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          "titulo" => "M&#233;todos"
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          "titulo" => "Discusi&#243;n"
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          "titulo" => "Financiaci&#243;n"
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          "identificador" => "sec0045"
          "titulo" => "Conflictos de intereses"
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        11 => array:2 [
          "identificador" => "xack995"
          "titulo" => "Agradecimientos"
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        12 => array:1 [
          "titulo" => "Bibliograf&#237;a"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2011-03-08"
    "fechaAceptado" => "2011-06-27"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec12989"
          "palabras" => array:6 [
            0 => "Humo ambiental del tabaco"
            1 => "Tabaquismo pasivo"
            2 => "Ley 28&#47;2005"
            3 => "Prevalencia"
            4 => "Encuesta"
            5 => "Evaluaci&#243;n"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec12990"
          "palabras" => array:6 [
            0 => "Second-hand smoke"
            1 => "Passive smoking"
            2 => "28&#47;2005 Spanish smoking law"
            3 => "Prevalence"
            4 => "Survey"
            5 => "Evaluation"
          ]
        ]
      ]
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    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluar el impacto de la Ley 28&#47;2005 de medidas sanitarias frente al tabaquismo en la prevalencia de la exposici&#243;n al humo ambiental del tabaco &#40;HAT&#41; en Barcelona&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio de evaluaci&#243;n antes-despu&#233;s mediante comparaci&#243;n de dos encuestas transversales&#46; Las fuentes de datos fueron las Encuestas de Salud de Barcelona de 2000 y 2006&#46; Se analiz&#243; la prevalencia de exposici&#243;n al HAT en poblaci&#243;n adulta no fumadora seg&#250;n el &#225;mbito de exposici&#243;n &#40;hogar&#44; trabajo y tiempo libre&#41; y las variables sociodemogr&#225;ficas&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La exposici&#243;n al HAT en no fumadores en el hogar y el trabajo disminuy&#243; significativamente &#40;p &#60;0&#44;01&#41; entre 2000 y 2006&#46; Las <span class="elsevierStyleItalic">odds ratio</span> para 2006&#44; respecto a 2000&#44; ajustadas por sexo&#44; edad y clase social&#44; fueron de 0&#44;7 &#40;intervalo de confianza del 95&#37; &#91;IC95&#37;&#93;&#58; 0&#44;6-0&#44;8&#41; para la exposici&#243;n en el hogar y 0&#44;2 &#40;IC95&#37;&#58; 0&#44;2-0&#44;3&#41; para la exposici&#243;n en el trabajo&#46; En ambos casos la reducci&#243;n fue mayor en las personas de clase social favorecida&#46; Tras la implementaci&#243;n de la ley&#44; casi el 50&#37; de la poblaci&#243;n segu&#237;a expuesta al HAT en el tiempo libre&#44; y los m&#225;s j&#243;venes eran los m&#225;s expuestos &#40;83&#44;5&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de exposici&#243;n al HAT en los no fumadores en Barcelona disminuy&#243; significativamente tras la Ley 28&#47;2005&#44; tanto en el &#225;mbito laboral como en el hogar&#46; Aun as&#237;&#44; casi la mitad de la poblaci&#243;n segu&#237;a expuesta durante su tiempo libre&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To assess the impact of the 28&#47;2005 Spanish smoking law on exposure to second-hand smoke &#40;SHS&#41; in Barcelona&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We performed a pre-post evaluation study&#46; Two cross-sectional surveys were compared&#46; Data were obtained from the Barcelona Health Surveys of 2000 and 2006&#46; The prevalence of SHS exposure among non-smoking adults was analyzed by setting &#40;home&#44; workplace and leisure time&#41; and sociodemographic variables&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">SHS exposure in non-smokers significantly decreased between 2000 and 2006 &#40;p &#60;0&#46;01&#41;&#46; Odds ratios adjusted by sex&#44; age and social class were 0&#46;7 &#40;95&#37; CI&#58; 0&#46;6-0&#46;8&#41; for home and 0&#46;2 &#40;95&#37; CI&#58; 0&#46;2-0&#46;3&#41; for workplace exposure in 2006 compared with 2000&#46; In both settings&#44; the decrease in exposure was greater in the higher social classes&#46; After the implementation of the law&#44; almost 50&#37; of the population remained exposed to SHS during leisure time&#44; younger people being the most exposed &#40;83&#46;5&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">After the implementation of the law&#44; the prevalence of SHS exposure in non-smokers in Barcelona decreased significantly in workplaces and in the home&#46; Nevertheless&#44; nearly half of the population remained exposed to SHS during leisure time&#46;</p>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">ESB&#58; Encuesta de Salud de Barcelona&#59; IC95&#37;&#58; intervalo de confianza del 95&#37;&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Poblaci&#243;n total</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">No fumadores</td><td class="td" title="\n
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                  \t\t\t\t">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t">&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  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">ESB 2000 N &#61; 8237</td><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">ESB 2006 N &#61; 5120</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">ESB 2000 N &#61; 5828</td><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">ESB 2006 N &#61; 3714</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" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;619&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">43&#44;6 &#40;42&#44;0- 45&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">IC95&#37;&#58; intervalo de confianza del 95&#37;&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">Periodo previo a la ley &#40;2000&#41;</td><td class="td" title="\n
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                  \t\t\t\t">Variaci&#243;n porcentual&nbsp;\t\t\t\t\t\t\n
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Gaceta Sanitaria
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?