Smoking and Lung Cancer Research Center

Athens, Greece

Smoking and Lung Cancer Research Center

Athens, Greece

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Papadopoulos G.,National and Kapodistrian University of Athens | Papadopoulos G.,Smoking and Lung Cancer Research Center | Vardavas C.I.,Smoking and Lung Cancer Research Center | Limperi M.,National and Kapodistrian University of Athens | And 3 more authors.
BMC Pulmonary Medicine | Year: 2011

Background: Chronic obstructive pulmonary disease (COPD) remains a major public health problem that affects the quality of life of patients, however smoking cessation may emeliorate the functional effects of COPD and alter patient quality of life.Objective-design: The aim of this study was to validate the Clinical COPD Questionnaire (CCQ) into Greek and with such to evaluate the quality of life in patients with different stages of COPD, as also assess their quality of life before and after smoking cessation.Results: The internal validity of questionnaire was high (Cronbach's a = 0.92). The reliability of equivalent types in 16 stabilized patients also was high (ICC = 0.99). In general the domains within the CCQ were strongly correlated with each other, while each domain in separate was strongly correlated with the overall CCQ score (r2= 0.953, r2= 0.915 and r2= 0.842 in regards to the functional, symptomatic and mental domain, respectively). The CCQ scores were also correlated with FEV1,(r2= -0.252, p < 0.001), FEV1/FVC, (r2= -0.135, p < 0.001) as also with the quality of life questionnaire SF-12 (r2= -0.384, p < 0.001). Smoking cessation also lead to a significant reduction in CCQ score and increase in the SF-12 score.Conclusions: The self administered CCQ indicates satisfactory validity, reliability and responsiveness and may be used in clinical practice to assess patient quality of life. Moreover the CCQ indicated the health related quality of life gains attributable to smoking cessation among COPD patients, projecting smoking cessation as a key target in COPD patient management. © 2011 Papadopoulos et al; licensee BioMed Central Ltd.


Alpert H.R.,Center for Global Tobacco Control | Vardavas C.I.,Center for Global Tobacco Control | Vardavas C.I.,Smoking and Lung Cancer Research Center | Chaloupka F.J.,University of Illinois at Chicago | And 6 more authors.
Tobacco Control | Year: 2014

Objectives Greece is in an economic crisis compounded by the costs caused by smoking. The present investigation estimates the economic and public health benefits ensuing from the recent cigarette excise tax increase in 2011 and projects the potential benefits from an additional €2.00 per pack cigarette tax increase. Methods The effects of the recent cigarette excise tax increase were calculated on outcome measures: total price per pack, including specific excise, ad valorem tax, and value-added tax consumption; tax revenue; and per capita consumption of cigarettes. Additionally, smoking-attributable mortality, years of potential life lost, and productivity losses were estimated. Projected effects of an additional €2.00 per pack tax increase on consumption and tax revenue were also assessed. Results The cigarette excise tax increase in 2011 created €558 million in new tax revenue. Cigarette consumption reached a recent low of 24.9 billion sticks sold or 2197 sticks per person in 2011, indicating a 16% decrease in per capita cigarette consumption from the previous year. An additional €2.00 per pack increase in Greek cigarette taxes is projected to result in reduced cigarette sales by an additional 20% and lead to an increase in total cigarette tax revenues by nearly €1.2 billion and the prevention of 192 000 premature deaths. Conclusions Nations such as Greece, should employ taxation as a crucial measure to promote public health and economic development in such dire times. International economic organisations should aggressively pursue programmes and policies that champion the economic benefits of tobacco taxation.


Vardavas C.I.,Center for Global Tobacco Control | Vardavas C.I.,Smoking and Lung Cancer Research Center | Anagnostopoulos N.,Smoking and Lung Cancer Research Center | Anagnostopoulos N.,National and Kapodistrian University of Athens | And 7 more authors.
Chest | Year: 2012

Background: Debate exists over the scientific evidence for claims that electronic cigarettes (e-cigarettes) have no health-related ramifications. This study aimed to assess whether using an e-cigarette for 5 min has an impact on the pulmonary function tests and fraction of exhaled nitric oxide (FENO) of healthy adult smokers. Methods: Thirty healthy smokers (aged 19-56 years, 14 men) participated in this laboratory-based experimental vs control group study. Ab lib use of an e-cigarette for 5 min with the cartridge included (experimental group, n = 30) or removed from the device (control group, n = 10) was assessed. Results: Using an e-cigarette for 5 min led to an immediate decrease in F ENO within the experimental group by 2.14 ppb (P = .005) but not in the control group (P = .859). Total respiratory impedance at 5 Hz in the experimental group was found to also increase by 0.033 kPa/(L/s) (P < .001), and flow respiratory resistance at 5 Hz, 10 Hz, and 20 Hz also statistically increased. Regression analyses controlling for baseline measurements indicated a statistically significant decrease in FENO and an increase in impedance by 0.04 kPa/(L/s)(P = .003), respiratory resistance at 5 Hz by 0.04 kPa/(L/s)(P = .003), at 10 Hz by 0.034 kPa/(L/s)(P = .008), at 20 Hz by 0.043 kPa/(L/s) (P = .007), and overall peripheral airway resistance (β, 0.042 kPa/[L/s]; P = .024), after using an e-cigarette. Conclusions: e-Cigarettes assessed in the context of this study were found to have immediate adverse physiologic effects after short-term use that are similar to some of the effects seen with tobacco smoking; however, the long-term health effects of e-cigarette use are unknown but potentially adverse and worthy of further investigation. © 2012 American College of Chest Physicians.


Schoretsaniti S.,National and Kapodistrian University of Athens | Filippidis F.T.,National and Kapodistrian University of Athens | Vardavas C.I.,Harvard University | Vardavas C.I.,Smoking and Lung Cancer Research Center | And 7 more authors.
Addictive Behaviors | Year: 2014

Objectives: The objective of the present study was to explore the trends in the intention to quit smoking among adults in Greece between 2006 and 2011, a period characterized by financial instability and newly endorsed tobacco control initiatives. Methods: Trend analysis of 3 representative national and cross-sectional surveys, 'Hellas Health I' (2006), "Hellas Health III" (2010) and Hellas Health IV (2011). Results: Since 2006, the intention to quit smoking has significantly increased among both genders (33.3% [in 2006] to 42.4% [in 2011], p=0.002), among respondents aged >. 54. years (26.9% [in 2006] to 45.1% [in 2011], p=0.019) and among residents of rural areas (26.4% [in 2006] to 46.7% [in 2011], p=0.001). Both highest (32.1% [in 2006] to 49.4% [in 2011], p=0.036) and lowest (31.7% to 46.0%, p=0.021) socioeconomic (SE) strata showed an increase in the proportion of smokers who intend to quit. However, in 2011, quit attempts were more frequent (35.3%, p=0.009) in smokers of high socioeconomic status. Moreover, smoking prevalence has significantly decreased (43.1% [in 2006] to 38.1% [in 2011], p=0.023), mainly among men (52.4% to 45.7%, p=0.037), respondents of low socioeconomic status (38.9% to 29.4%, p=0.008) and residents of urban areas (45.2% to 37.9%, p=0.005). Conclusions: Over the past 5. years and possibly as a combined result of the implemented tobacco control policies and austerity measures, the intention to quit smoking has increased among all SE strata, however actual quit attempts were higher among those less disadvantaged. Further effort should be made to support quit attempts, especially among vulnerable populations. © 2013 Elsevier Ltd.


Avlonitou E.,Henry Dunant Hospital | Kapsimalis F.,Henry Dunant Hospital | Varouchakis G.,Henry Dunant Hospital | Vardavas C.I.,Smoking and Lung Cancer Research Center | And 2 more authors.
Sleep and Breathing | Year: 2012

Purpose: The aim of the study was to asses quality of life and symptoms of obstructive sleep apnea syndrome (OSAS) patients after adhering to 6 months of continuous positive airway pressure (CPAP) treatment. Methods: A group of 50 patients (41 men and 9 women) were diagnosed by polysomnography and treated with CPAP therapy for 6 months. Their symptoms and healthrelated quality of life were assessed by administering a validated and translated version of the sleep apnea quality of life index (SAQLI). Sleepiness was measured using the Epworth Sleepiness Scale (ESS) and through electronic monitoring of CPAP usage per night of sleep. Results Mean CPAP usage was 4.5±0.5 h per night. Comparisons between quality of life indexes before and after CPAP treatment showed an improvement in the total SAQLI score (3.8±0.9 vs. 5.8±0.8 after CPAP, p<0.01), in daily functioning (4.2±1.4 vs. 6.0±0.9, p<0.01), social interactions (4.8±1.3 vs.6.3±0.7, p<0.01), emotional functioning (4.4±1.4 vs. 5.7±1.0, p<0.01), symptoms (1.6±0.8 vs. 5.8±1.2, p<0.01), and in the ESS (13.7±6.5 vs. 3.9±3.8, p<0.01). Regarding the patients' symptoms, improvement was noticed for "sleepiness while watching a spectacle" (96%), "reading" (95%), "carrying on a conversation"(95%), "driving" (92.9%), "restless sleep" (87.8%), and "urinating more than once per night" (84.8%). Smaller improvements were observed for the reported "dry mouth-throat upon awakening" (36.1%),"excessive fatigue"(54.5%), and "decreased energy" (55.3%). Conclusion We conclude that OSAS patients who adhere to nighttime CPAP therapy show significant improvement of their quality of life, daytime sleepiness, and other symptoms after 6 months of treatment with CPAP. © Springer-Verlag 2011.


Filippidis F.T.,National and Kapodistrian University of Athens | Vardavas C.I.,Center for Global Tobacco Control | Vardavas C.I.,Smoking and Lung Cancer Research Center | Loukopoulou A.,National and Kapodistrian University of Athens | And 4 more authors.
European Journal of Public Health | Year: 2013

Background: Greece has one of the highest rates of adult smoking globally. The objective of the present survey was to explore the epidemiology of tobacco use in Greece after the implementation of recent legislative tobacco control measures and to compare it with previous cross-sectional data from 2006. Methods: The nationwide household survey 'Hellas Health III' was conducted in 2010. A sample of 1000 adults (mean age 47.1 ± 17.1 years) were interviewed. Individuals who had smoked at least once during the past 30 days were classified as smokers. Results were compared with those from the similar 'Hellas Health I' study, which was conducted in 2006. Results: The prevalence of smoking was calculated at 41% (45% among men and 38% in women, P = 0.04). Greek men smoke more cigarettes (23.2 vs. 19.3 per day, P = 0.002), and they become regular smokers earlier in life. In age groups <55 years, most gender inequalities are attenuated. Socio-economic status does not affect tobacco use in Greece. In comparison with 2006, smoking prevalence, especially among young adults, has fallen from 48 to 35% in 2010. Moreover, a substantial reduction in the number of cigarettes smoked among all age groups was noticed. Conclusions: Trends in smoking prevalence and consumption among adults seem favourable in Greece during the past 4 years; a substantial reduction of younger smokers and in the number of cigarettes smoked among all age groups is documented. This constitutes a significant public health achievement and an indicator that young adults are a susceptible population to legislative action. © 2012 The Author 2012. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.


Vardavas C.I.,Center for Global Tobacco Control | Vardavas C.I.,Smoking and Lung Cancer Research Center | Filippidis F.T.,National and Kapodistrian University of Athens | Agaku I.,Center for Global Tobacco Control | And 6 more authors.
Tobacco Induced Diseases | Year: 2012

Background: Increases in tobacco taxation are acknowledged to be one of the most effective tobacco control interventions. This study aimed at determining the mediating role of socioeconomical status (SES) and the earmarking of revenue to healthcare and tobacco control, in influencing population support for the adoption of a 2 Euro tobacco tax increase in Greece, amid the challenging economic environment and current austerity measures. Methods. Data was collected from two national household surveys, the "Hellas Health III" survey, conducted in October 2010 and the "Hellas Tobacco survey" conducted in September 2012. Data was analyzed from 694 and 1066 respondents aged 18 years or more, respectively. Logistic regression models were fitted to measure the adjusted relationship between socio-economic factors for the former, and support for increased taxation on tobacco products for the latter. Results: In 2012 amidst the Greek financial crisis, population support for a flat two euro tax increase reached 72.1%, if earmarked for health care and tobacco control, a percentage high both among non-smokers (76%) and smokers (64%) alike. On the contrary, when not earmarked, only 43.6% of the population was in support of the equivalent increase. Women were more likely to change their mind and support a flat two-euro increase if the revenue was earmarked for health care and tobacco control (aOR = 1.70; 95% C.I: 1.22-2.38, p = 0.002). Furthermore, support for an increase in tobacco taxation was not associated with SES and income. Conclusion: Despite dire austerity measures in Greece, support for an increase in tobacco taxation was high among both smokers and non-smokers, however, only when specifically earmarked towards health care and tobacco control. This should be taken into account not only in Greece, but within all countries facing social and economic reform. © 2012 Vardavas et al.; licensee BioMed Central Ltd.


Filippidis F.T.,National and Kapodistrian University of Athens | Schoretsaniti S.,National and Kapodistrian University of Athens | Dimitrakaki C.,National and Kapodistrian University of Athens | Vardavas C.I.,Center for Global Tobacco Control | And 5 more authors.
European Journal of Public Health | Year: 2014

Background: Economic crises may have a significant impact on public health. The objective of this study was to assess trends in health-related behaviours and cardiovascular risk factors within Greece before, at the beginning and during the current financial crisis by comparing data from three waves of the Greek cross-sectional household 'Hellas Health' surveys. Methods: Data from three waves were analysed. The first wave was conducted in 2006 (n = 1005), the second in 2008 (n = 1490) and the third in 2011 (n = 1008). Samples were representative of the Greek adult population in terms of age and residency. Smoking status, height, weight and fruit and vegetable consumption were self-reported. Physical activity levels were assessed with the International Physical Activity Questionnaire. Results: The prevalence of smoking in Greece decreased from 42.6 to 38.1% during the crisis period 2008-11 (P = 0.026), but not during 2006-8. The prevalence of high levels of physical activity increased among Greek adults (from 21.9 to 31.7%, P < 0.001) in all socio-economic and demographic groups, with the exception of the highest socio-economic status (SES) group. On the contrary, the consumption of at least five portions of fruit and vegetables per day significantly decreased during the crisis among those of lower SES (from 9.0 to 4.1%, P = 0.006). Prevalence of obesity did not show significant trends. Conclusions: During the economic crisis, fruit and vegetable consumption alarmingly decreased, especially among those of lower SES, whereas trends in smoking prevalence and physical activity levels seem favourable. These results indicate that the economic crisis may unequally impact cardiovascular risk factors among different socio-economic groups. © 2013 The Author.


Vardavas C.I.,University of Crete | Vardavas C.I.,Center for Global Tobacco Control | Vardavas C.I.,Smoking and Lung Cancer Research Center | Girvalaki C.,University of Crete | And 7 more authors.
Tobacco Control | Year: 2013

Background As tobacco advertising bans are enacted in accordance with the Framework Convention on Tobacco Control, it is essential to assess enforcement and how the industry may circumvent such measures. Objective design During this longitudinal study, we compared the characteristics of points-of-sale (POS) advertising within 300 m of all high schools in Heraklion, Greece before (n=101 POS and 44 billboards in 2007) and after (n=106 POS in 2011) an outdoor advertising ban was implemented in 2009. Cigarette advertisements in all retailers near all high schools were assessed. Results Following the ban, tobacco industry billboards around schools were eradicated (from 44 to 0). The proportion of POS that had external advertisements dropped from 98% to 66% (p<0.001), more so in regulated convenience stores (from 97% to 35%, p<0.001) than in kiosks (98% to 92%, p=0.192), which were exempt from the ban. The proportion of convenience stores that had advertisements on the door (79.5% to 20.4%, p<0.001), ads that could be seen from the street (92.3% to 22.4%, p<0.001) or illuminated exterior ads (46.2% to 10.2%, p<0.001) was also significantly reduced. Overall, the average number of exterior advertisements per POS fell from 7.4 to 3.9 (p<0.05). This reduction was noted in regulated convenience stores (4.8±3.0 vs 0.9±2.1, p<0.001) and in unregulated kiosks (9.0±6.7 vs 6.5±4.5, p=0.019). Conclusions The outdoor advertising restriction in Greece has led to a reduced number of tobacco advertisements per POS, and the eradication of billboard advertising. Nevertheless, there is a need to regulate kiosks, which were identified as a key vector for tobacco advertising, and to increase compliance among regulated convenience stores.


PubMed | Academy of Athens and Smoking and Lung Cancer Research Center
Type: | Journal: TheScientificWorldJournal | Year: 2015

The aim of this study was to evaluate the 30-year progress of research on exhaled breath condensate in a disease-based approach.We searched PubMed/Medline, ScienceDirect, and Google Scholar using the following keywords: exhaled breath condensate (EBC), biomarkers, pH, asthma, gastroesophageal reflux (GERD), smoking, COPD, lung cancer, NSCLC, mechanical ventilation, cystic fibrosis, pulmonary arterial hypertension (PAH), idiopathic pulmonary fibrosis, interstitial lung diseases, obstructive sleep apnea (OSA), and drugs.We found 12600 related articles in total in Google Scholar, 1807 in ScienceDirect, and 1081 in PubMed/Medline, published from 1980 to October 2014. 228 original investigation and review articles were eligible.There is rapidly increasing number of innovative articles, covering all the areas of modern respiratory medicine and expanding EBC potential clinical applications to other fields of internal medicine. However, the majority of published papers represent the results of small-scale studies and thus current knowledge must be further evaluated in large cohorts. In regard to the potential clinical use of EBC-analysis, several limitations must be pointed out, including poor reproducibility of biomarkers and absence of large surveys towards determination of reference-normal values. In conclusion, contemporary EBC-analysis is an intriguing achievement, but still in early stage when it comes to its application in clinical practice.

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