'If I hadn't seen this picture, I'd be smoking'-perceptions about innovations in health warnings for cigarette packages in Brazil: a focus group study.

OBJECTIVE: To investigate the perceptions of young people and adults, smokers and non-smokers about the current set of innovations introduced in 2018 into the Brazilian tobacco products' health warnings. METHODS: Twenty focus groups were conducted in five state capitals in Brazil. The participants (n=163) were segmented by smoking status, age (15-17 years, 18-55 years) and social grade (C, D-E classes) to examine cigarette packaging and explore the participants' perceptions of health warnings. RESULTS: Health warnings capture attention, eliciting apprehension, fear, disgust and concern about the negative consequences of cigarette consumption. The 2018 Brazil health warnings are spontaneously recalled by participants, even without the presence of cigarette packages. However, the analysis also reveals the challenges of overcoming communication barriers and distorted interpretations, especially among smokers. The inclusion of direct and provocative stimuli, such as the use of the word 'you', attracts attention and creates more proximity to the recipient of the message. The results also highlight the interest and fear elicited by warnings on toxic constituents and the importance of using contrasting colours in warnings, which differentiate them from the colours of cigarette packs. CONCLUSION: Introducing innovative components in health warnings can catch consumers' attention but considering that the interviewees encountered difficulties interpreting textual warnings about toxic constituents in cigarettes, the study reinforces the importance of adopting direct language and pictures, instead of text, which can visually transmit the warning messages and the use of specific wording that generates proximity between the emitter and receiver.

Brazilian smokers are ready for the ban on flavour additives in tobacco to be implemented.

Brazil became the first country to approve a national policy to ban all flavour additives in all tobacco leaf products in 2012. However, as of February 2022, the policy remained to be implemented. Cross-sectional data come from the International Tobacco Control (ITC) Brazil Wave 3 Survey among adult smokers (N = 1216) in 2016-2017. The majority of smokers supported a ban on menthol (56.0%; 95%CI: 51.7-60.2%) and a ban on all additives (61.7%; 57.5-65.8%), with no significant differences across sociodemographic groups in adjusted logistic regression models. More than half of menthol smokers reported they would either quit or reduce the amount they smoked if menthol cigarettes were banned. Findings suggest that there is support for Brazil's ban on flavour additives, which is a determinant of successful policy implemented. Continued delays will postpone an important measure with demonstrated public health gains.

Cross-validation of four different survey methods used to estimate illicit cigarette consumption in Brazil.

OBJECTIVE: To cross-validate estimates of the size of the illicit cigarette trade based on the results of four different survey methods. METHODS: In 2018/2019, four non-industry-funded, large-scale studies were conducted in selected Brazilian cities: packs discarded in household garbage/PDG (1 city), packs littered in the streets/PLS (5 cities), a phone survey of tobacco users' purchase behaviors/VIGITEL (5 cities), and a face-to-face household survey of tobacco users' purchase behaviors/FTF-household (2 cities). The proportions of illicit cigarettes consumed were based on the price paid by smokers in their last purchase (VIGITEL or FTF-household) and/or direct observation of brand names and health warnings (PDG, PLS or FTF-household). RESULTS: Based on PLS, the share of packs that avoided taxation ranged from 30.4% (95% CI 25.6% to 35.7%) in Rio de Janeiro to 70.1% (95% CI 64.6% to 75.0%) in Campo Grande; and PDG conducted in Rio de Janeiro found an even lower proportion point estimate of illicit cigarette use (26.8%, 95% CI 25.1% to 28.6%). In FTF-household, the share of illicit cigarette consumption based on the self-reported price ranged from 29.1% (95% CI 22.4% to 35.7%) in Rio de Janeiro to 37.5% (95% CI 31.2% to 43.7%) in São Paulo, while estimates based on pack observation ranged from 29.9% (95% CI 23.3% to 36.5%) in Rio de Janeiro to 40.7% (95% CI 34.3% to 47.0%) in São Paulo. For all cities, VIGITEL presented the lowest levels of illicit consumption, and most illicit brands were produced in Paraguay. CONCLUSIONS: Small differences in the estimated levels of illicit trade across methods were found, except for the phone survey. The cross-validation of estimates from independent studies is important to help effectively implement tobacco excise tax policy in Brazil and other low-income and middle-income countries.

[Behavioral changes in smokers after implementation of anti-smoking legislation in ArgentinaMudança de comportamento nos fumantes após a implementação da legislação antifumo na Argentina]. / Cambio de comportamiento en personas fumadoras posimplementación de legislación antitabaco en Argentina.

OBJECTIVE: Identify factors related to behavioral changes in smokers over 18 years of age following implementation of provincial policies for 100% smoke-free spaces in Argentina. METHODS: A cross-sectional analytical study was conducted. The multilevel technique was used with data from different hierarchies. Secondary data sources were used: National Risk Factor Surveys 2005, 2009, and 2013. RESULTS: The individual analysis of explanatory variables revealed that residents of provinces that do not have smoke-free legislation were 40% less likely to consider quitting smoking than people who live in provinces with such legislation. In provinces without smoke-free spaces, males over 65 years old are even less likely to think about quitting smoking. CONCLUSIONS: The results suggest that legislation based on Article 8 of the Framework Convention would be effective in promoting tobacco cessation in Argentina.

OBJETIVO: Identificar os fatores associados à mudança de comportamento nos fumantes maiores de 18 anos após a implementação de políticas provinciais de proibição do fumo na Argentina. MÉTODOS: Foi realizado um estudo analítico de corte transversal. Foi usada uma técnica de modelos multiníveis com dados de diferentes hierarquias. As fontes de dados secundários consultadas foram as iterações de 2005, 2009 e 2013 da Pesquisa Nacional de Fatores de Risco. RESULTADOS: Na análise individual das variáveis explicativas, verificou-se que os habitantes das províncias sem legislação antifumo tinham uma probabilidade 40% maior de não considerar parar de fumar quando comparados aos moradores das províncias com legislação antifumo. Em comparação às províncias com legislação antifumo, nas províncias sem esta legislação, ser do sexo masculino e ter idade acima de 65 anos foram as características associadas a uma maior chance de não considerar parar de fumar. CONCLUSÕES: Os resultados do estudo indicam que uma legislação em conformidade com o Artigo 8 da Convenção-Quadro para o Controle do Tabaco da OMS seria efetiva para incentivar as pessoas a pararem de fumar na Argentina.

Assessing the relationship between smoking and abdominal obesity in a National Survey of Adolescents in Brazil.

Abdominal obesity is even a stronger risk factor than overall obesity for noncommunicable chronic diseases. We examined the association between smoking and abdominal obesity among adolescents. Analyses were based on 38,813 subjects aged 15-17 years from the Study of Cardiovascular Risks in Adolescents (ERICA), a Brazilian school-based national survey. Abdominal obesity was defined considering waist circumference (WC) percentiles. Statistical analyses, stratified by sex, considered the sample complex design. Poisson regression with robust variance was used to estimate smoker-to-nonsmoker abdominal obesity prevalence ratio (PR), adjusting by sociodemographic and lifestyle variables. Higher prevalence of abdominal obesity was observed among adolescents who consumed >1 cigarettes/day, comparing to nonsmokers: considering WC >80th percentile, adjusted-PR for boys was 1.27 [95%CI:1.05,1.52] and, for girls, 1.09 [95%CI:1.00,1.19]; using the 90th percentile, adjusted-PR were 2.24 [95%CI:1.70,2.94] and 1.27 [95%CI:1.12,1.46], respectively for male and female adolescents. Our findings suggest a positive association between cigarette consumption and the prevalence of abdominal obesity, for both boys and girls. Although other studies had found this association in adults, our study contributes to this discussion by assessing it in adolescents using a nationwide representative sample of medium and large municipalities.

Cigarette flavors, package shape, and cigarette brand perceptions: an experiment among young Brazilian women.

OBJECTIVE: In 2012, a new Brazilian regulation prohibited the use of flavor additives in tobacco products. To better understand the potential impact of this regulation, this study examines how flavor descriptors on cigarette packaging influence brand perceptions among young Brazilian women. METHODS: An online cross-sectional experiment was conducted with Brazilian women aged 16-26 (N = 640: 182 smokers and 458 nonsmokers) who rated 10 cigarette packages from one of three conditions: 1) branded packs; 2) packs with the same size, shape, and verbal descriptions as in condition 1, but without brand imagery (i.e., "plain pack"); and 3) packs from condition 2 but without brand descriptors (i.e., "plain pack, no descriptors"). Mixed-effects linear regression models were utilized to determine what associations that pack features (i.e., experimental condition; flavor descriptor vs. not; slim pack vs. not) had with participant ratings of nine characteristics, including appeal, taste, smoothness, and attributes of people who smoke the brand. RESULTS: Flavored branded packs were rated as more appealing, better tasting, and smoother than flavored plain packs with descriptors. Compared to flavored plain packs with descriptors, the same packs without descriptors were rated less positively on eight of the nine characteristics. Compared to nonsusceptible nonsmokers, susceptible nonsmokers rated flavored packs more positively on eight of the nine characteristics. Slim packs were rated more positively than regular packs on eight of the nine characteristics. CONCLUSIONS: Slim packs and brands highlighting tobacco flavors appear to increase positive perceptions of tobacco products. Banning tobacco flavorings and slim packs may reduce the appeal of smoking for young Brazilian women, as well as for other vulnerable populations.

The Study of Cardiovascular Risk in Adolescents--ERICA: rationale, design and sample characteristics of a national survey examining cardiovascular risk factor profile in Brazilian adolescents.

BACKGROUND: The Study of Cardiovascular Risk in Adolescents (Portuguese acronym, "ERICA") is a multicenter, school-based country-wide cross-sectional study funded by the Brazilian Ministry of Health, which aims at estimating the prevalence of cardiovascular risk factors, including those included in the definition of the metabolic syndrome, in a random sample of adolescents aged 12 to 17 years in Brazilian cities with more than 100,000 inhabitants. Approximately 85,000 students were assessed in public and private schools. Brazil is a continental country with a heterogeneous population of 190 million living in its five main geographic regions (North, Northeast, Midwest, South and Southeast). ERICA is a pioneering study that will assess the prevalence rates of cardiovascular risk factors in Brazilian adolescents using a sample with national and regional representativeness. This paper describes the rationale, design and procedures of ERICA. METHODS/DESIGN: Participants answered a self-administered questionnaire using an electronic device, in order to obtain information on demographic and lifestyle characteristics, including physical activity, smoking, alcohol intake, sleeping hours, common mental disorders and reproductive and oral health. Dietary intake was assessed using a 24-hour dietary recall. Anthropometric measures (weight, height and waist circumference) and blood pressure were also be measured. Blood was collected from a subsample of approximately 44,000 adolescents for measurements of fasting glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, glycated hemoglobin and fasting insulin. DISCUSSION: The study findings will be instrumental to the development of public policies aiming at the prevention of obesity, atherosclerotic diseases and diabetes in an adolescent population.

How smokers may react to cigarette taxes and price increases in Brazil: data from a national survey.

BACKGROUND: Despite being the third largest tobacco producer in the world, Brazil has developed a comprehensive tobacco control policy that includes a broad restriction on both advertising and smoking in indoor public places, compulsory pictorial warning labels, and a menthol cigarette ban. However, tax and pricing policies have been developed slowly and only very recently were stronger measures implemented. This study investigated the expected responses of smokers to hypothetical price increases in Brazil. METHODS: We analyzed smokers' responses to hypothetical future price increases according to sociodemographic characteristics and smoking conditions in a multistage sample of Brazilian current cigarette smokers aged≥14 years (n=500). Logistic regression analysis was used to examine the relationship between possible responses and different predictors. RESULTS: In most subgroups investigated, smokers most frequently said they would react to a hypothetical price increase by taking up alternatives that might have a positive impact on health, i.e., they would "try to stop smoking" (52.3%) or "smoke fewer cigarettes" (46.8%). However, a considerable percentage responded that they would use alternatives that would reduce the effect of price increases, such as the same brand with lower cost (48.1%). After controlling for sex age group (14-19, 20-39, 40-59, and ≥60 years), schooling level (≥9 versus ≤9 years), number of cigarettes per day (>20 versus ≤20), and stage of change for smoking cessation (precontemplation, contemplation, and preparation), lower levels of dependence were positively associated with the response "I would try to stop smoking" (odds ratio [OR], 2.19). Young age was associated with "I would decrease the number of cigarettes" (OR, 3.44). A low schooling level was strongly associated with all responses. CONCLUSIONS: Taxes and prices increases have great potential to stimulate cessation or reduction of cigarette consumption further among two important vulnerable populations of smokers in Brazil: young smokers and those of low educational level. The results from the present study also suggest that seeking illegal products may reduce the impact of increased taxes, but does not eliminate it.

Assessing the impact of cigarette package health warning labels: a cross-country comparison in Brazil, Uruguay and Mexico / Impacto de advertencias sanitarias del empaquetado de cigarros: un an lisis comparativo en Brasil, Uruguay y M‚xico

Objective. To assess the impact of different health warning labels (HWL). Material and Methods. Data from the International Tobacco Control Survey (ITC Survey) were analyzed from adult smokers in Brazil, Uruguay and Mexico, each of which used a different HWL strategy (pictures of human suffering and diseased organs; ABSTRACT pictorial representations of risk; and text-only messages, respectively). Main outcomes were HWL salience and cognitive impact. Results. HWLs in Uruguay (which was the only country with a HWL on the front of the package) had higher salience than either Brazilian or Mexican packs. People at higher levels of educational attainment in Mexico were more likely to read the text-only HWLs whereas education was unassociated with salience in Brazil or Uruguay. Brazilian HWLs had greater cognitive impacts than HWLs in either Uruguay or Mexico. HWLs in Uruguay generated lower cognitive impacts than the text-only HWLs in Mexico. In Brazil, cognitive impacts were strongest among smokers with low educational attainment. Conclusions. This study suggests that HWLs have the most impact when they are prominent (i.e., front and back of the package) and include emotionally engaging imagery that illustrates negative bodily impacts or human suffering due to smoking (AU)

Objetivo. Evaluar el impacto de diferentes advertencias sanitarias (AS). Material y m‚todos. Se analizaron datos de la Encuesta Internacional para el Control del Tabaco (ITC Survey), un estudio de fumadores adultos en Brasil, Uruguay y M‚xico, tres pa¡ses con distintas AS (con im genes de sufrimiento humano y ¢rganos enfermos; con im genes abstractas del riesgo; mensajes de solo texto, respectivamente). Se analiz¢ prominencia e impacto cognitivo de las AS. Resultados. Las AS de Uruguay (que era el £nico pa¡s con AS en la parte frontal del paquete) tuvieron una mayor prominencia que en Brasil o M‚xico. En M‚xico, la gente que ten¡a un nivel de educaci¢n mayor eran mas propensos a leer mensajes de advertencia, mientras que educaci¢n no se asoci¢ con prominencia en Brasil o Uruguay. Las AS de Brasil tuvieron un mayor impacto cognitivo y conductual que las AS de Uruguay o M‚xico. Las AS de Uruguay generaron un menor impacto cognitivo y conductual que las AS de s¢lo texto en M‚xico. En Brasil, los impactos cognitivos fueron los m s fuertes entre fumadores con un bajo nivel educacional. Conclusiones. Este estudio sugiere que las AS tienen el mayor impacto cuando son prominentes (por ej. en el frente y la parte trasera del paquete) e incluyen im genes emocionalmente llamativas que muestran impactos negativos en el cuerpo o sufrimiento humano debido al fumar (AU)

Assessing the impact of cigarette package health warning labels: a cross-country comparison in Brazil, Uruguay and Mexico.

OBJECTIVE: To assess the impact of different health warning labels (HWL). MATERIAL AND METHODS: Data from the International Tobacco Control Survey (ITC Survey) were analyzed from adult smokers in Brazil, Uruguay and Mexico, each of which used a different HWL strategy (pictures of human suffering and diseased organs; abstract pictorial representations of risk; and text-only messages, respectively). Main outcomes were HWL salience and cognitive impact. RESULTS: HWLs in Uruguay (which was the only country with a HWL on the front of the package) had higher salience than either Brazilian or Mexican packs. People at higher levels of educational attainment in Mexico were more likely to read the text-only HWLs whereas education was unassociated with salience in Brazil or Uruguay. Brazilian HWLs had greater cognitive impacts than HWLs in either Uruguay or Mexico. HWLs in Uruguay generated lower cognitive impacts than the text-only HWLs in Mexico. In Brazil, cognitive impacts were strongest among smokers with low educational attainment. CONCLUSIONS: This study suggests that HWLs have the most impact when they are prominent (i.e., front and back of the package) and include emotionally engaging imagery that illustrates negative bodily impacts or human suffering due to smoking.

Auto-avalia‡Æo de sa£de elimita‡äes f¡sicas decorrentes de problemas de sa£de / Self-rated health and physicaldisabilities due to heath problems

OBJETIVO: Avaliar a autopercep‡Æo de sa£de e a presen‡a de limita‡äesf¡sicas devido a problemas de sa£de.MTODOS: Estudo transversal de base populacional realizado entre 2002 e2005, em 18 capitais de estados do Brasil. Entrevistaram-se 26.424 moradoresde 15 anos ou mais de idade em domic¡lios selecionados por amostraprobabil¡stica em dois est gios. Calcularam-se percentuais e intervalos deconfi an‡a considerando-se os efeitos do desenho do estudo.RESULTADOS: Os resultados mostraram que as piores condi‡äes de sa£desÆo referidas por mulheres, indiv¡duos com 50 anos ou mais e com menor graude escolaridade. Os percentuais relacionados … percep‡Æo de sa£de regularou ruim foram maiores nas cidades das regiäes Norte e Nordeste quandocomparados aos das cidades das regiäes Sul e Sudeste.CONCLUSåES: As piores condi‡äes de sa£de das regiäes Norte/Nordestecomparadas as das regiäes Sul/Sudeste revelam um conjunto de fatoresrelacionados …s desigualdades sociais, entre os quais o menor grau deescolaridade.(AU)

OBJECTIVE: To evaluate self-rated health and physical disabilities due tohealth problems.METHODS: Population-based cross-sectional study carried out in 18Brazilian cities between 2002 and 2005. There were interviewed 26,424residents (aged 15 years or more) of households selected by a two-stageprobabilistic sampling. Percentages and confi dence intervals were calculatedconsidering the study design effects.RESULTS: Poorer self-rated health status and physical disabilities werefound among women, those aged 50 years old or more and those with lowereducation. In addition, higher percentages of fair or poor self-rated healthwere found in cities in Northern and Northeastern Brazil compared to thosein Southern and Southeastern Brazil.CONCLUSIONS: Poorer health conditions in the North/Northeast comparedto the South/Southeast regions refl ect factors related to social inequalities,mainly lower education.(AU)

Comportamento relativo exposi‡Æo e prote‡Æosolar na popula‡Æo de 15 anos ou mais de15 capitais brasileiras e Distrito Federal, 2002-2003 / Behaviors related to sunlight exposure versusprotection in a random population sample from15 Brazilian State capitals and the Federal District,2002-2003

This article examines region-specific relationsbetween prevalence of protection against sunlightand socio-demographic and behavioralvariables in Brazil. Data were derived froma cross-sectional population-based randomsample. Information on sunlight exposure wasavailable for a total of 16,999 individuals 15years and older. Comparing the North and Southof Brazil, crude differences between women andmen in the use of “sunscreen” and “protectiveheadwear” were +10.9% (95%CI: 7.1; 14.6) and-11.6% (95%CI: -17.0; -6.3) in the North and+21.3% (95%CI: 17.7; 24.9) and -16.0% (95%CI:-20.2; -12.5) in the South. Adjusted differencesby selected variables confirmed that womenuse more sunscreen protection and less headwearprotection as compared to men in both theNorth and South, but the difference was not homogeneousby region (interaction term p value< 0.05).(AU)

Prevalence of pre-gestational and gestational smoking and factors associated with smoking cessation during pregnancy, Brazil, 2011-2012.

Gestational smoking is associated with various adverse maternal and fetal outcomes. Over the last three decades, despite considerable advances in tobacco control policy in Brazil, gestational smoking has caused a considerable number of fetal deaths and disabilities. The aim of this study is to estimate the prevalence of pre-gestational and gestational smoking and to identify the factors associated with smoking cessation up to the 20th gestational week. METHODS: "Birth in Brazil" was a nationwide hospital-based study conducted from February 2011 to October 2012. Smoking prevalence and smoking cessation during pregnancy was estimated through face-to-face interviews with postpartum women during hospitalization for birth care. We performed multivariate logistic regression to verify the factors associated with smoking cessation up to the 5th month of pregnancy. RESULTS: prevalence of pre-gestational smoking of 16.1% (CI 95% 15.3%-16.9%); prevalence of smoking any time during pregnancy of 9.6% (CI 95% 9.0%-10.3%); and prevalence of smoking cessation up to the 5th month of pregnancy of 56.7% (CI 95% 54.0%-59.4%). The factors associated with smoking cessation were residence in the North, Northeast, and Central-West of Brazil, having received at least one prenatal consultation (OR 3.51 CI 95% 1.85-6.67), more years of schooling (15 or more vs less than 7 years of schooling OR 5.54 CI 95% 2.97-10.34), living with a partner (OR 1.35 CI 95% 1.01-1.79), no children prior to the index pregnancy (OR 2.77 CI 95% 2.13-3.61), and absence of alcohol use (1.74 CI 95% 1.39-2.18) or of suspected alcohol abuse (OR 1.62 CI 95% 1.07-2.45). CONCLUSION: The estimated smoking rate during pregnancy in Brazil is still high and is associated with factors of increased maternal social vulnerability, which may contribute to the increased occurrence of unfavorable perinatal outcomes.

ERICA: smoking is associated with more severe asthma in Brazilian adolescents.

OBJECTIVE: To investigate the association between smoking and asthma, and possible associated factors in Brazilian adolescents. METHODS: A cross-sectional, national, school-based study with adolescents aged 12-17 years, participants in the Study of Cardiovascular Risks in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes - ERICA). A total of 66,394 participants answered a self-administered questionnaire with questions about asthma, smoking, lifestyle and sociodemographic variables. Bivariate analysis between Current Asthma (CA) and Severe Asthma (SA) and the other study variables were performed using Chi-squared. Then, the crude and adjusted Prevalence Ratios (PR), and respective 95% Confidence Intervals (95% CI) of current asthma/severe asthma and smoking variables, corrected for sociodemographic and lifestyle variables, were estimated using generalized linear models with Poisson regression, logit link, and robust variance. RESULTS: The prevalence of current asthma and severe asthma were significantly higher in adolescents who were exposed to: experimentation (current asthma: PR=1.78, 95% CI: 1.51-2.09; severe asthma: PR=2.01; 95% CI: 1.35-2.98); current smoking (current asthma: PR=2.08, 95% CI: 1.65-2.64; severe asthma: PR=2.29; 95% CI: 1.38-3.82); regular smoking (current asthma: PR=2.25, 95% CI: 1.64-3.07; severe asthma: PR: 2.41; 95% CI: 1.23-4.73); and passive smoking (current asthma: PR=1.47, 95% CI: 1.27-1.67; severe asthma: PR=1.66; 95% CI: 1.19-2.32); these associations remained significant after adjustment. CONCLUSIONS: Asthma and smoking were significantly associated in Brazilian adolescents, regardless of the sociodemographic and lifestyle factors, notably in those with more severe disease.

[Self-rated health and physical disabilities due to health (corrected) problems]. / Auto-avaliação de saúde e limitações físicas decorrentes de problemas de saúde.

OBJECTIVE: To evaluate self-rated health and physical disabilities due to health problems. METHODS: Population-based cross-sectional study carried out in 18 Brazilian cities between 2002 and 2005. There were interviewed 26,424 residents (aged 15 years or more) of households selected by a two-stage probabilistic sampling. Percentages and confidence intervals were calculated considering the study design effects. RESULTS: Poorer self-rated health status and physical disabilities were found among women, those aged 50 years old or more and those with lower education. In addition, higher percentages of fair or poor self-rated health were found in cities in Northern and Northeastern Brazil compared to those in Southern and Southeastern Brazil. CONCLUSIONS: Poorer health conditions in the North/Northeast compared to the South/Southeast regions reflect factors related to social inequalities, mainly lower education.

[Urban-rural gradient in tobacco consumption and cessation patterns in Brazil]. / Gradiente urbano-rural no padrão de consumo e cessação do tabagismo no Brasil.

The degree of urbanization has been associated with both tobacco consumption and quit rates. The current study aims to examine the importance of the urban-rural context in the determination of tobacco consumption patterns and smoking cessation. Data were used from the supplement of the Special Survey on Smoking (PETab) from the 2008 Brazilian National Household Sample Survey (PNAD). The sample included 14,420 individuals over 15 years of age, of whom 7,003 were current smokers and 7,417 former smokers in the PETab. Smoking prevalence and cessation rates were calculated. Individuals were stratified according to urban and rural residence. Other sociodemographic variables were also analyzed: sex, age bracket, race, and schooling. To explore the difference in smoking prevalence and cessation rate for each stratum in the census situation, the data were adjusted using a Poisson model. Smoking prevalence was higher in places less influenced by the urban environment. Meanwhile, smoking cessation was higher in more urbanized places. Smoking prevalence showed a decrease in consumption as the population's urban characteristics increased (PR = 0.75 for eminently urban vs eminently rural, p = 0.001). Smoking cessation trends showed that the more urban population was more prone to quitting (PR = 1.22 for eminently urban vs eminently rural, p < 0.001). The results point to the need to improve the effectiveness of services for follow-up and encouragement of cessation in rural areas.

O grau de urbanização tem sido associado ao consumo de produtos do tabaco, bem como a interrupção do hábito de fumar. Dito isso, o objetivo deste trabalho é examinar a importância do contexto urbano-rural na determinação do padrão de consumo de derivados do tabaco e da cessação do hábito de fumar. Utilizou-se dados do módulo suplementar Pesquisa Especial de Tabagismo (PETab) do inquérito Pesquisa Nacional por Amostra de Domicílios (PNAD) de 2008. Foram analisados 14.420 indivíduos maiores de 15 anos, sendo 7.003 tabagistas atuais e 7.417 ex-tabagistas na PETab. Foram calculados a prevalência e o índice de cessação de tabagismo. Houve uma estratificação espacial desses indivíduos por moradores de ambientes urbanos e rurais. Outras variáveis sociodemográficas também foram analisadas: sexo, faixa etária, raça e escolaridade. Para explorar a diferença na prevalência e na cessação de tabagismo para cada estrato da situação censitária, os dados foram ajustados usando-se um modelo de Poisson. Há uma prevalência de tabagismo maior para os locais menos influenciados pelo ambiente urbano. Por outro lado, a cessação do tabagismo é maior nos locais mais urbanizados. Observa-se que para a prevalência de tabagismo há redução no consumo na medida em que aumenta a característica urbana da população (RP = 0,75 para eminentemente urbana vs. eminentemente rural, p = 0,001). Para a cessação do tabagismo, observa-se que a população mais urbana é a mais propensa à interrupção do consumo (RP = 1,22 para eminentemente urbana vs. eminentemente rural, p < 0,001). Os resultados apontam para a necessidade de aperfeiçoar a efetividade dos serviços de acompanhamento e estímulo à cessação para o ambiente rural.

El grado de urbanización ha estado asociado al consumo de productos derivados del tabaco, así como a la interrupción del hábito de fumar. Así pues, el objetivo de este trabajo ha sido examinar la importancia del contexto urbano-rural para determinar el patrón de consumo de derivados del tabaco, así como el fin del hábito de fumar. Se utilizaron datos del módulo complementario de la Encuesta Especial sobre Tabaquismo (PETab por sus siglas en portugués) de la Encuesta Nacional por Muestras de Domicilios (PNAD) de 2008. Se analizaron a 14.420 individuos mayores de 15 años, siendo 7.003 tabaquistas actuales y 7.417 ex-tabaquistas en la PETab. Se calculó la prevalencia y el índice en el cese de tabaquismo. Hubo una estratificación espacial de esos individuos como residentes en ambientes urbanos y rurales. Se analizaron también otras variables sociodemográficas: sexo, franja de edad, raza y escolaridad. Para explorar las diferencias entre la prevalencia, y el fin del tabaquismo en cada estrato dentro de su situación censal, los datos se ajustaron usando el modelo de Poisson. Existe una prevalencia de tabaquismo mayor en los lugares menos influenciados por el ambiente urbano. Por otro lado, la eliminación del tabaquismo es mayor en los lugares más urbanizados. Se observa que para la prevalencia del tabaquismo existe una reducción en el consumo, a medida que aumenta la característica urbana de la población (RP = 0,75 para eminentemente urbana vs. eminentemente rural, p = 0,001). Para el fin del tabaquismo, se observa que la población más urbana es la más propensa a la interrupción del consumo (RP = 1,22 para eminentemente urbana vs. eminentemente rural, p < 0,001). Los resultados apuntan la necesidad de perfeccionar la efectividad de los servicios de acompañamiento y estímulo al fin del tabaquismo en el ambiente rural.

Tobacco Control Policies in Brazil: a 30-year assessment. / A Política de Controle do Tabaco no Brasil: um balanço de 30 anos.

The article presents a review of Brazilian tobacco control policies from 1986 to 2016, based on contributions from political economics and analyses of public policies. The institutionalization of tobacco control in the country was marked by more general changes in health policies and by specific events related to the theme. Brazil's international leadership role, a robust National Tobacco Control Policy, the role of civil society and the media all contributed to the success of tobacco control in this country. However, challenges remain regarding crop diversification in tobacco farms, illegal trade in cigarettes, pressure from the tobacco industry and the sustainability of the Policy. This study reinforces the importance of bearing in mind the relationship between the domestic and international context, and the articulation between different governmental and non-governmental sectors and players when analyzing complex health policies. Continuity and consolidation of the tobacco control policies depend on the persistence of a broad institutional framework to guide the State's actions in social protection, in accordance with Unified Healthcare System guidelines.

O artigo apresenta um balanço da política brasileira de controle do tabaco de 1986 a 2016, baseando-se em contribuições dos referenciais da economia política e da análise de políticas públicas. A institucionalização do controle do tabaco no país foi marcada por mudanças mais gerais da política de saúde e por eventos específicos relacionados ao tema. A liderança brasileira no cenário internacional, a sólida estruturação da Política Nacional de Controle do Tabaco e o papel da sociedade civil e dos meios de comunicação contribuíram para o sucesso do controle do tabaco no Brasil. No entanto, persistem desafios relacionados à diversificação de produção em áreas plantadas de fumo, ao comércio ilícito, à interferência da indústria do fumo e à sustentabilidade da Política. O estudo reforça a relevância de serem consideradas, na análise de políticas de saúde complexas, as relações entre contexto internacional e nacional e a articulação entre diferentes setores e atores governamentais e não governamentais. A continuidade e a consolidação da política de controle do tabaco dependem da persistência de um marco institucional amplo que norteie a atuação do Estado na proteção social, consoante com as diretrizes do Sistema Único de Saúde.

[Behaviors related to sunlight exposure versus protection in a random population sample from 15 Brazilian State capitals and the Federal District, 2002-2003]. / Comportamento relativo à exposição e proteção solar na população de 15 anos ou mais de 15 capitais brasileiras e Distrito Federal, 2002-2003.

This article examines region-specific relations between prevalence of protection against sunlight and socio-demographic and behavioral variables in Brazil. Data were derived from a cross-sectional population-based random sample. Information on sunlight exposure was available for a total of 16,999 individuals 15 years and older. Comparing the North and South of Brazil, crude differences between women and men in the use of "sunscreen" and "protective headwear" were +10.9% (95%CI: 7.1; 14.6) and -11.6% (95%CI: -17.0; -6.3) in the North and +21.3% (95%CI: 17.7; 24.9) and -16.0% (95%CI: -20.2; -12.5) in the South. Adjusted differences by selected variables confirmed that women use more sunscreen protection and less headwear protection as compared to men in both the North and South, but the difference was not homogeneous by region (interaction term p value < 0.05).

Determinants of salivary cotinine level: a population-based study in Brazil.

OBJECTIVE: A cross-sectional population-based study was conducted to assess, in active smokers, the relationship of number of cigarettes smoked and other characteristics to salivary cotinine concentrations. METHODS: A random sample of active smokers aged 15 years or older was selected using a stepwise cluster sample strategy, in the year 2000 in Rio de Janeiro, Brazil. The study included 401 subjects. Salivary cotinine concentration was determined using gas chromatography with nitrogen-phosphorus detection. A standard questionnaire was used to collect demographic and smoking behavioral data. The relation between the number of cigarettes smoked in the last 24h and cotinine level was examined by means of a nonparametric fitting technique of robust locally weighted regression. RESULTS: Significantly (p<0.05) higher adjusted mean cotinine levels were found in subjects smoking their first cigarette within five minutes after waking up, and in those smoking 1-20 cigarettes in the last 24h who reported inhaling more than (1/2) the time. In those smoking 1-20 cigarettes, the slope was significantly higher for those subjects waiting for more than five minutes before smoking their first cigarette after waking up, and those smoking "light" cigarettes when compared with their counterparts. These heterogeneities became negligible and non-significant when subjects with cotinine >40 ng/mL per cigarette were excluded. CONCLUSIONS: There was found a positive association between self-reporting smoking five minutes after waking up, and inhaling more than (1/2) the time are consistent and higher cotinine levels. These can be markers of dependence and higher nicotine intake. Salivary cotinine proved to be a useful biomarker of recent smoking and can be used in epidemiological studies and smoking cessation programs.