Small-area models to assess the geographic distribution of second-hand smoke exposure by sex and age in Spain
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Departamento de Medicina Preventiva e Saúde Pública, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
Unidade de Epidemioloxía, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, Spain
Servizo de Difusión e Información, Instituto Galego de Estatística, Xunta de Galicia, Santiago de Compostela, Spain
CIBER Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
Carla Guerra-Tort   

Departamento de Medicina Preventiva e Saúde Pública, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
Publication date: 2023-04-25
Tob. Prev. Cessation 2023;9(Supplement):A123
It is estimated that tobacco causes more than 8 million deaths each year, of whom about 1.2 million occur due to exposure to second-hand smoke (SHS) 1. Complete and accurate data on SHS exposure at a regional level would enable health authorities to plan context-dependent control interventions. However, due to limitations associated with sample size, national health surveys (NHS) do not allow for reliable prevalence estimates by sex and age group at a subnational level. Small-area estimation (SAE) methods could be a valid alternative to have meaningful prevalence at a subnational level 2-6. The aim of this study is to apply a SAEmodel-based methodology to obtain reliable estimations of SHS exposure by sex and age group in the Autonomous Regions of Spain.

Material and Methods:
The units of analysis were 180 areas defined on the basis of Spain’s territorial division into Autonomous Regions, as well as sex and age group (15-34, 35-54, 55-64, 65-74, 75 years and over). In each area, we estimated the prevalence of exposed (Ex) and non-exposed (NEx) to SHS in 2017, as well as their coefficients of variation (CV), applying a weighted ratio estimator (direct estimator) and a multinomial logistic model with random area effects 7. The data source used for the SAE model was the Spanish NHS 2017.

The range of Ex prevalence was 1-35% in men and 2-36% in women. The group aged 15-34 years was the most exposed to SHS, with an associated prevalence of 23%. When SHS exposure was estimated using the small-area model, the precision of direct estimates greatly improved; the CV of Ex and NEx decreased by an average of 92%.

This study proposes a methodology to obtain reliable estimates of SHS exposure in groups not covered in the design of a population health survey. The model applied is a good alternative to improve the precision of estimates at a detailed level, at a much lower cost than that involved in conducting large-scale surveys. Having such estimates directly after completion of a health survey would help characterize the prevalence of any risk factor with greater precision.

This work has not been presented in any other conference or disseminated.

The authors declare that they have no conflicts of interest.
This work was supported by the competitive research grants: Carlos III Health Institute, Ministry of Science and Innovation of Spain (proposal number PI22/00727). The sponsors did not participate in the study in any way.
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