The aim of the present study was to identify risk factors for community-acquired pneumonia (CAP), with special emphasis on modifiable risk factors and those applicable to the general population.A population-based, case-control study was conducted, with a target population of 859,033 inhabitants aged .14 yrs. A total of 1,336 patients with confirmed CAP were matched to control subjects by age, sex and primary centre over 1 yr.In the univariate analysis, outstanding risk factors were passive smoking in never-smokers aged .65 yrs, heavy alcohol intake, contact with pets, households with .10 people, contact with children, interventions on the upper airways and poor dental health. Risky treatments included amiodarone, N-acetylcysteine and oral steroids. Influenza and pneumococcal vaccine, and visiting the dentist were protective factors. Multivariable analysis confirmed cigarette smoking, usual contact with children, sudden changes of temperature at work, inhalation therapy (particularly containing steroids and using plastic pear-spacers), oxygen therapy, asthma and chronic bronchitis as independent risk factors.Interventions for reducing community-acquired pneumonia should integrate health habits and lifestyle factors related to household, work and community, together with individual clinical conditions, comorbidities and oral or inhaled regular treatments. Prevention would include vaccination, dental hygiene and avoidance of upper respiratory colonisation.

The effect of inhaled drugs in community-acquired pneumonia (CAP) is unclear. This case-control study was designed to determine whether inhaled drugs were risk factors for CAP.All incident cases of confirmed CAP that occurred over 1 yr in patients with chronic bronchitis (CB), chronic obstructive pulmonary disease (COPD) or asthma were included, as well as CB, COPD and asthma controls. Risk factors for CAP and inhaled treatment were recorded during a personal interview.An effect of inhaled drugs on the risk of CAP was observed in COPD and asthma patients after adjusting for the effect of other respiratory diseases and their concomitant treatments. In COPD patients, inhaled steroids had a risk OR of 3.26 (95% CI 1.07-9.98) and in asthma patients inhaled anticholinergics had a risk OR of 8.80 (95% CI 1.02-75.7). In CB patients, no association with CAP was observed for any inhaler. These effects were independent of adjusting variables related to severity and other respiratory and non-respiratory risk factors for CAP, including vaccines. Inhaled b 2 -adrenergic agonists did not show a significant effect on the risk of CAP in any of the respiratory diseases.Inhaled steroids may favour CAP in COPD patients, whereas anticholinergics may favour CAP in asthma patients. It is difficult to differentiate the effect of inhaled therapy from the effect of COPD or asthma severity on the risk of CAP, and these relationships may not be causal, but could call attention to inhaled therapy in COPD and asthma patients.

ObjectiveTo assess whether passive smoking exposure at home is a risk factor for community-acquired pneumonia (CAP) in adults.SettingA population-based case-control study was designed in a Mediterranean area with 860 000 inhabitants >14 years of age.Participants1003 participants who had never smoked were recruited.Primary and secondary outcome measuresRisk factors for CAP, including home exposure to passive smoking, were registered. All new cases of CAP in a well-defined population were consecutively recruited during a 12-month period.MethodsA population-based case-control study was designed to assess risk factors for CAP, including home exposure to passive smoking. All new cases of CAP in a well-defined population were consecutively recruited during a 12-month period. The subgroup of never smokers was selected for the present analysis.ResultsThe study sample included 471 patients with CAP and 532 controls who had never smoked. The annual incidence of CAP was estimated to be 1.14 cases×10–3 inhabitants in passive smokers and 0.90×10−3 in non-passive smokers (risk ratio (RR) 1.26; 95% CI 1.02 to 1.55) in the whole sample. In participants ≥65 years of age, this incidence was 2.50×10−3 in passive smokers and 1.69×10−3 in non-passive smokers (RR 1.48, 95% CI 1.08 to 2.03). In this last age group, the percentage of passive smokers in cases and controls was 26% and 18.1%, respectively (p=0.039), with a crude OR of 1.59 (95% CI 1.02 to 2.38) and an adjusted (by age and sex) OR of 1.56 (95% CI 1.00 to 2.45).ConclusionsPassive smoking at home is a risk factor for CAP in older adults (65 years or more).

BackgroundThe likelihood of an adolescent taking up smoking may be influenced by his or her society, school and family. Thus, changes in the immediate environment may alter a young person’s perception of smoking.Methods/DesignThe proposed multi-center, cluster-randomized controlled trial will be stratified by the baseline prevalence of smoking in schools. Municipalities with fewer than 100,000 inhabitants will be randomly assigned to a control or intervention group. One secondary school will be randomly selected from each municipality. These schools will be randomized to two groups: the students of one will receive any existing educational course regarding smoking, while those of the other school will receive a four-year, class-based curriculum intervention (22 classroom lessons) aimed at reinforcing a smoke-free school policy and encouraging smoking cessation in parents, pupils, and teachers. The intervention will also include annual meetings with parents and efforts to empower adolescents to change the smoking-related attitudes and behaviors in their homes, classrooms and communities.We will enroll children aged 12-13 years as they enter secondary school during two consecutive school years (to obtain sufficient enrolled subjects). We will follow them for five years, until two years after they leave secondary school. All external evaluators and analysts will be blinded to school allocation.The aim of this study is to analyze the effectiveness of a complex intervention in reducing the prevalence of smoking in the third year of compulsory secondary education (ESO) and two years after secondary school, when the participants are 14-15 and 17-18 years old, respectively.DiscussionMost interventions aimed at preventing smoking among adolescents yield little to no positive long-term effects. This clinical trial will analyze the effectiveness of a complex intervention aimed at reducing the incidence and prevalence of smoking in this vulnerable age group.Trial registrationCurrent Controlled Trials: NCT01602796.

We examined whether personality traits and parental education are associated with smoking initiation in a sample of Spanish secondary school students. Participants, taken from the ITACA study (842 adolescents aged 14–15 years), completed a questionnaire assessing personality traits of the Five Factor Model, smoking behaviours and parental education. Multinomial logistic regression models controlling for age and sex were used to determine the independent associations and interactions of personality traits and parental education with risk of ever trying smoking, as well as with being a regular smoker in adolescence. Higher conscientiousness was related to a lower chance of trying smoking at least once (OR = 0.57, 95% CIs = 0.46, 0.71) as well as being a regular smoker (OR = 0.39, 95% CIs = 0.27, 0.55). Higher emotional instability (neuroticism) was associated with higher risk of being in either smoking category (OR = 1.33, 95% CIs = 1.10, 1.60 and OR = 1.76, 95% CIs = 1.31, 2.35, respectively). Higher extraversion was also associated with a higher risk of both types of smoking behaviour (OR = 1.38, 95% CIs = 1.12, 1.70 and OR = 2.43 (1.67, 3.55, respectively). Higher parental education was significantly related to lower risk of being a regular smoker (OR = 0.70, 95% CIs = 0.54, 0.89), but not with trying smoking in the past. Finally, we found no evidence of the interactions between adolescents’ personality and parental education in predicting adolescent smoking behaviours. We conclude that personality factors and parental education are important and independent factors associated with smoking behaviour in adolescents.