Epidemiology of tobacco use and nicotine dependence in truck drivers

ABSTRACT OBJECTIVE To investigate the epidemiology of tobacco use and nicotine dependence in a sample of truck drivers in Brazil. METHODS Between 2015 and 2016, a cross-sectional study was conducted on 624 truck drivers who operate on the BR-050 highway in Brazil. Participants were interviewed about sociodemographic data, occupational characteristics, mental health, behavioral data, and tobacco use. Then, the Fagerstrom test for nicotine dependence (FTND) was used to verify nicotine dependence in smoking truck drivers. Logistic regression and linear regression were also used to verify factors associated with tobacco use in the previous 30 days and nicotine dependence scores, respectively. RESULTS The prevalence of tobacco use among truck drivers was 21.1% (n = 132;95%CI: 18.1-24.5). Of the total number of smokers who responded to the FTND (n = 118; 89.4%), most had high/very high nicotinic dependence (68.6%; 95%CI: 59.8-76.3). Tobacco use was associated with absence of religion (adjusted odds ratio [AOR]: 2.60; 95%CI: 1.35-5.01), employment relationship of the contract (AOR = 1.98; 95%CI: 1.26-3.13); > 12 hours daily working time (AOR = 1.80; 95%CI: 1.09-2.98) and alcohol use in the previous 30 days (AOR = 2.92; 95%CI: 1.86-4.57). Irregular physical activity was associated with higher scores of nicotine dependence (β = 1.87; 95%CI: 0.55-3.19). CONCLUSION The results showed a high prevalence of tobacco use and high/very high nicotine dependence among the truck drivers.

Smoking prevalence and economic crisis in Brazil

ABSTRACT OBJECTIVE To estimate the impact of the 2015-2018 economic crisis on tobacco consumption in Brazil. METHODS This is an interrupted time series analysis conducted with data from 27 cities collected by VIGITEL, using linear regression models to account for first-order autocorrelation. Analyses were conducted based on gender, age group, and education level. RESULTS Smoking rates decreased between 2006 and 2018, decelerating after the crisis onset. Differently than women, men showed an immediate but transient increase in smoking, followed by a decelerated decrease. Those over 65 also showed increased smoking rates immediately after the economic crisis onset, but decline accelerated later on. In turn, we found a trend reversal among those aged 31-44. Rates also decreased among those with lower education levels, but decelerated among those with more years of schooling. CONCLUSION An economic crisis have varied impacts on the smoking habits of different population groups. Tobacco control policies should entail a detailed understanding of smoking epidemiology, especially during an economic crisis.

Prevalencia y variables asociadas al consumo de alcohol y de tabaco en pacientes quemados / Prevalence and variables associated with alcohol and tobacco consumption in burned patients

RESUMEN Fundamento: estudios actuales han demostrado que existe una alta prevalencia de consumo de alcohol y de tabaco en los pacientes quemados. En Cuba las investigaciones publicadas sobre esta temática son escasas. Objetivo: determinar la prevalencia y variables asociadas al consumo de alcohol y de tabaco en pacientes quemados ingresados en el Hospital Universitario Vladimir Ilich Lenin. Métodos: se realizó un estudio desde el enfoque cuantitativo, descriptivo y de corte transversal. El universo estuvo constituido por 73 quemados ingresados en el servicio de Caumatología y Cirugía Reconstructiva del hospital Universitario Vladimir Ilich Lenin, entre enero de 2018 y diciembre de 2019. Se seleccionaron 62 pacientes quemados a través de un muestreo probabilístico. Se utilizó la entrevista semiestructurada, la observación y la revisión documental para la evaluación. Se plantearon como variables las sociodemográficas, modo de producción, agente causal, consumo de alcohol y de tabaco; estado de embriaguez al ingresar y trastorno mental durante la hospitalización. Los resultados se procesaron en los paquetes estadísticos EPIDAT 3.1 y MedCalc. Resultados: predominó el sexo masculino, color de piel blanca, nivel de procedencia rural, estado civil soltero, la tenencia de hijos, modo de producción accidental y el agente causal fuego directo. La mayoría presentó abstinencia al alcohol. Las variables sexo, estado civil, convivencia, modo de producción, agente causal y trastorno mental; se asociaron de forma significativa al consumo de alcohol y de tabaco. Conclusiones: la prevalencia de consumo de alcohol y de tabaco, en general, fue relativamente elevada. Se determinó que las variables sexo, estado civil, convivencia, modo de producción, agente causal y trastorno mental se asocian al consumo de alcohol y de tabaco.

ABSTRACT Background: current studies have showed that there is a high prevalence of alcohol and tobacco use in burned patients. In Cuba, published research on this topic is scarce. Objective: to determine the prevalence and associated variables of alcohol and tobacco consumption of burned patients admitted to the Vladimir Ilich Lenin General Teaching Hospital. Methods: a quantitative cross-sectional descriptive study was carried out. The universe consisted of 73 burned patients admitted to the Burn & Reconstructive Surgery service of the Vladimir Ilich Lenin Teaching Hospital, from January 2018 to December 2019. 62 patients were selected by probabilistic sampling. Semi-structured interviews, observation and documentary review were used for the evaluation. Socio-demographic variables, burning production mode and cause, alcohol and tobacco consumption, state of intoxication on admission and mental disorder during hospitalization were considered as variables. The results were processed with the statistical packages EPIDAT 3.1 and MedCalc. Results: the estimate of the prevalence of alcohol and tobacco use, in general, was relatively high. Male sex, white skin color, rural origin, single marital status with children, accidental burning and the direct fire cause predominated. Most of them had alcohol withdrawal symptoms. Significant associations were obtained between alcohol and tobacco use, in general, with the variables sex, marital status, living with other people, mode of burn production, causal agent and mental disorder. Conclusions: the prevalence rate of alcohol and tobacco use, in general, was relatively high. An association was found between alcohol and tobacco consumption and the variables sex, marital status, living with other people, mode of burn production, causal agent and mental disorder.

Smoking among industrial workers in Brazil: association with sociodemographic factors, alcohol consumption, and stress levels / Tabagismo em trabalhadores da indústria no Brasil: associação com fatores sociodemográficos, consumo de bebidas alcoólicas e nível de estresse

ABSTRACT Objective: To determine the prevalence of smoking, as well as its association with sociodemographic factors, alcohol consumption, and stress levels, among industrial workers in Brazil. Methods: This was a nationwide survey, conducted in 24 capitals in Brazil through the application of a pre-tested questionnaire. The response to the question "What is your smoking status?" was the outcome variable. To determine the associations, we performed Poisson regression analyses in which the inputs were blocks of variables: block 1 (age and marital status); block 2 (level of education and gross family income); block 3 (geographic region); and block 4 (alcohol consumption and stress level). All analyses were stratified by gender. Results: The sample consisted of 47,328 workers ≥ 18 years of age, of whom 14,577 (30.8%) were women. The prevalence of smoking was 13.0% (15.2% in men and 7.9% in women). Advancing age, alcohol consumption, and a high stress level were positively associated with smoking. A lower risk of smoking was associated with being married, having a higher level of education, and living in the northeastern region of the country (versus the southern region). Conclusions: The prevalence of smoking was greater in men than in women. Alcohol consumption and high stress levels appear to promote smoking.

RESUMO Objetivo: Determinar a prevalência de tabagismo e sua associação com fatores sociodemográficos, consumo de bebidas alcoólicas e nível de estresse em trabalhadores industriários no Brasil. Métodos: Inquérito nacional realizado em 24 capitais brasileiras através da aplicação de um questionário previamente testado. A variável de desfecho foi obtida através da pergunta: "Com relação ao fumo, qual a sua situação?". Para determinar as associações, foram realizadas análises de regressão de Poisson com entrada de variáveis em blocos: nível 1 (idade e estado civil); nível 2 (escolaridade e renda familiar bruta); nível 3 (região geográfica) e nível 4 (consumo de bebidas alcoólicas e nível de estresse). Todas as análises foram estratificadas por sexo. Resultados: A amostra foi composta por 47.328 trabalhadores com 18 anos ou mais de idade, sendo 14.577 mulheres (30,8%). A prevalência de tabagismo foi de 13,0% (15,2% em homens e 7,9% em mulheres). Aumento da faixa etária, consumo de bebidas alcoólicas e nível de estresse elevado associaram-se positivamente ao tabagismo. Estar casado, ter maior nível de escolaridade e residir na região nordeste do país (quando comparada com a região sul) estiveram associados com menores probabilidades de tabagismo. Conclusões: A prevalência de tabagismo variou entre os sexos, sendo maior entre os homens. O consumo de bebidas alcoólicas e o nível de estresse elevado favoreceram o uso do tabaco.

Update on the approach to smoking in patients with respiratory diseases / Atualização na abordagem do tabagismo em pacientes com doenças respiratórias

ABSTRACT Smoking is the leading cause of respiratory disease (RD). The harmful effects of smoking on the respiratory system begin in utero and influence immune responses throughout childhood and adult life. In comparison with "healthy" smokers, smokers with RD have peculiarities that can impede smoking cessation, such as a higher level of nicotine dependence; nicotine withdrawal; higher levels of exhaled carbon monoxide; low motivation and low self-efficacy; greater concern about weight gain; and a high prevalence of anxiety and depression. In addition, they require more intensive, prolonged treatment. It is always necessary to educate such individuals about the fact that quitting smoking is the only measure that will reduce the progression of RD and improve their quality of life, regardless of the duration and severity of the disease. Physicians should always offer smoking cessation treatment. Outpatient or inpatient smoking cessation treatment should be multidisciplinary, based on behavioral interventions and pharmacotherapy. It will thus be more effective and cost-effective, doubling the chances of success.

RESUMO O tabagismo é o maior responsável pelas doenças respiratórias (DR). Os efeitos nocivos do tabaco sobre o aparelho respiratório se iniciam ainda intraútero e influenciam as respostas imunológicas ao longo da infância e vida adulta. Os tabagistas com DR possuem peculiaridades que podem dificultar a cessação tabágica, tais como maior grau de dependência e de abstinência de nicotina; níveis mais elevados de monóxido de carbono exalado; motivação e autoeficácia baixas; maior preocupação com ganho ponderal; e elevada prevalência de ansiedade e depressão. Além disso, requerem tratamento mais intensivo e prolongado. É necessário esclarecer sempre o paciente sobre o fato de que parar de fumar será a única medida que irá reduzir a progressão das DR e melhorar sua qualidade de vida, independentemente do tempo e da gravidade da doença. Os médicos devem sempre oferecer o tratamento de cessação tabágica. O tratamento ambulatorial ou hospitalar deve ser multidisciplinar, baseado em intervenções comportamentais e farmacoterapia, sendo eficaz e custo-efetivo, dobrando as chances de sucesso.

Epidemiology of smoking in the rural area of a medium-sized city in Southern Brazil / Epidemiologia do tabagismo em zona rural de um município de médio porte no Sul do Brasil

ABSTRACT OBJECTIVE To estimate the prevalence of smoking and associated factors among rural residents. METHODS This is a population-based, cross-sectional study of 1,519 individuals carried out in 2016. We randomly selected 24 of the 50 census tracts that make up the eight rural districts of the city of Pelotas, State of Rio Grande do Sul, Brazil. All individuals aged 18 years or more living in the randomly selected households were eligible. Smokers were all those who smoked ≥ 1 cigarette/day for at least one month or declared that they had stopped smoking for less than one month. The independent variables included socioeconomic, demographic, behavioral, and health characteristics. We investigated age of onset, duration of addiction, number of cigarettes smoked/day, pack-years, and types of cigarettes consumed. Poisson regression was performed to calculate the adjusted prevalence ratios (PR) and 95% confidence intervals (95%CI). RESULTS The prevalence of smoking was 16.6% (95%CI 13.6-20.0), and it was twice as high in men in relation to women (PR = 1.99, 95%CI 1.44-2.74), in socioeconomic class D or E in relation to class A or B (PR = 2.23, 95%CI 1.37-3.62), and in those who considered their health poor or very poor in relation those with good or very good health (PR = 2.02, 95%CI 1.33-3.08). It was also higher in persons aged 30-59 years (compared to those aged < 30 years), with 5-8 years of education level (compared to those with ≥ 9 years), and with positive screening for alcohol-related disorder. Prevalence was lower among individuals who were overweight or obese than in those with normal weight. Smoking began on average at 16.9 years, with an average consumption of approximately 14 cigarettes/day and mean pack-years of 22 packs/year. The paper hand-rolled cigarette was the most consumed (57.6%). CONCLUSIONS Approximately one in six adults in rural Pelotas is a current smoker. The findings show the existence of social inequalities related to smoking addiction. Actions to prevent and control smoking should continue to be stimulated, especially in the most vulnerable subgroups.

RESUMO OBJETIVO Estimar a prevalência de tabagismo e fatores associados entre moradores de zona rural. MÉTODOS Estudo transversal de base populacional realizado com 1.519 indivíduos, em 2016. Foram aleatoriamente selecionados 24 dos 50 setores censitários que compõem os oito distritos rurais do município de Pelotas, RS. Indivíduos ≥ 18 anos residentes nos domicílios aleatoriamente selecionados eram elegíveis. Foram considerados tabagistas aqueles que fumavam ≥ 1 cigarro/dia há pelo menos um mês ou que declararam haver parado de fumar há menos de um mês. As variáveis independentes incluíram características socioeconômicas, demográficas, comportamentais e de saúde. Foram investigados: idade de início, duração da adição, número de cigarros fumados/dia, carga tabágica e tipos de cigarros consumidos. Foi realizada regressão de Poisson para cálculo das razões de prevalências (RP) ajustadas e intervalos de confiança de 95% (IC95%). RESULTADOS A prevalência de tabagismo foi 16,6% (IC95% 13,6-20,0), sendo duas vezes maior nos homens do que nas mulheres (RP = 1,99; IC95% 1,44-2,74), na classe econômica D ou E do que na A ou B (RP = 2,23; IC95% 1,37-3,62) e naqueles que consideraram sua saúde ruim ou muito ruim, comparados àqueles que a consideraram muito boa ou boa (RP = 2,02; IC95% 1,33-3,08). Também foi superior em pessoas com 30-59 anos (comparadas àquelas com < 30 anos), com 5-8 anos de escolaridade (comparados às pessoas com ≥ 9 anos), e com rastreio positivo para transtorno relacionado ao consumo de álcool. A prevalência foi menor entre indivíduos com sobrepeso ou obesidade, em comparação aos eutróficos. O tabagismo iniciou em média aos 16,9 anos, com consumo médio de cerca de 14 cigarros/dia e carga tabágica média de 22 maços/ano. O cigarro de papel enrolado à mão foi o mais consumido (57,6%). CONCLUSÕES Aproximadamente um em cada seis adultos da zona rural de Pelotas é fumante atual. Os achados evidenciam a existência de desigualdades sociais relacionadas à adição tabágica. Ações de prevenção e controle do tabagismo devem continuar sendo estimuladas, sobretudo nos subgrupos mais vulneráveis.

School health promotion and use of drugs among students in Southern Brazil / Promoção de saúde escolar e uso de drogas em escolares no Sul do Brasil

ABSTRACT OBJECTIVE: To analyze the relationship between the health promotion conditions in schools and the consumption of alcohol and other drugs by students. METHODS: This is a cross-sectional study with a probabilistic sample of 3,464 students aged 12 to 17 from all schools of the cities of Lajeado and Sapiranga, state of Rio Grande do Sul, Brazil, and 53 managers from the same schools; the data was collected in 2012. Reports of the use of tobacco, alcohol, and illicit drugs in 2012 were used as outcomes, and the health promotion score in the school environment was used as the exposure of interest. We submitted the data to multilevel analysis. RESULTS: The prevalence of the annual use of tobacco was 9.8% (95%CI 8.8-10.8), alcohol was 46.2% (95%CI 44.5-47.8), and other drugs was 10.9% (95%CI 9.9-12.0). In the crude analysis, only the use of tobacco was associated with less health promoting schools (OR = 1.89, 95%CI 1.16-3.09) when compared to those with better conditions. This association lost statistical significance in the adjusted analysis (OR = 1.27, 95%CI 0.74-2.19). CONCLUSIONS: The effects of the school environment on the use of drugs, especially tobacco and alcohol, are manifested mainly by the individual and family conditions of the adolescents.

RESUMO OBJETIVO: Analisar a relação entre condições de promoção de saúde nas escolas e o consumo de álcool e outras drogas pelos escolares. MÉTODOS: Estudo transversal de base escolar, com amostra probabilística de 3.464 escolares de 12 a 17 anos de todas as escolas de Lajeado e Sapiranga, RS, e 53 gestores das mesmas escolas; dados coletados em 2012. Os relatos do uso de 2012 de tabaco, álcool e drogas ilícitas foram tomados como desfechos e o escore de promoção de saúde no ambiente das escolas, como exposição de interesse. Os dados foram submetidos à análise multinível. RESULTADOS: A prevalência do uso anual de tabaco foi 9,8% (IC95% 8,8-10,8), álcool 46,2% (IC95% 44,5-47,8) e outras drogas 10,9% (IC95% 9,9-12,0). Na análise bruta, apenas o uso de tabaco esteve associado a escolas menos promotoras (OR = 1,89; IC95% 1,16-3,09) quando comparado as com melhores condições. Essa associação perdeu significância estatística na análise ajustada (OR = 1,27; IC95% 0,74-2,19). CONCLUSÕES: Os efeitos do ambiente escolar quanto ao uso de drogas, especialmente tabaco e álcool, manifestam-se principalmente pelas condições individuais e familiares dos adolescentes.

Patterns of tobacco consumption among residents of a rural settlement: a cross-sectional study / Padrões de consumo de tabaco em residentes de um assentamento rural: um estudo transversal

ABSTRACT OBJECTIVE Investigate patterns and factors associated with tobacco consumption among residents of a rural settlement. METHODS A cross-sectional study conducted between September and November 2014, with 172 residents of a rural settlement in the Midwest region of Brazil. We analyzed as dependent variables tobacco consumption at some point in life; current tobacco consumption; tobacco abuse; and the high risk of nicotine dependence, with sociodemographic variables associated with tobacco use, and we applied the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) and Self-Reporting Questionnaire (SRQ-20). RESULTS The prevalence of tobacco use in life, current use, tobacco abuse, and high risk of nicotine dependence were 62.2%, 20.9%, 59.8%, and 10.3%, respectively. Advanced age, low education level, evangelical religion, marijuana use, hypnotic or sedative consumption, and male gender were factors associated with smoking patterns in the settlers. CONCLUSIONS There was a high prevalence of smoking patterns, evidencing the need for public policies on tobacco prevention and control in this population.

RESUMO OBJETIVO Investigar os padrões e fatores associados ao consumo de tabaco em residentes de um assentamento rural. MÉTODOS Estudo de corte transversal realizado entre setembro e novembro de 2014, com 172 residentes de assentamento rural, na região Centro-Oeste do Brasil. Foram analisadas como variáveis dependentes o consumo de tabaco alguma vez na vida; o consumo atual de tabaco; abuso de tabaco; e alto risco de dependência nicotínica, com as variáveis sociodemográficas associadas ao consumo de tabaco, com aplicação dos instrumentos Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) e Self-Reporting Questionnaire (SRQ-20). RESULTADOS As prevalências de uso de tabaco na vida, uso atual, abuso de tabaco e alto risco de dependência nicotínica foram de 62,2%, 20,9%, 59,8%, 10,3%, respectivamente. Idade mais elevada, escolaridade baixa, religião evangélica, consumo de maconha, consumo de hipnóticos ou sedativos, sexo masculino foram fatores associados aos padrões de consumo de tabaco nos assentados. CONCLUSÕES Verificaram-se elevadas prevalências nos padrões de consumo de tabaco, evidenciando a necessidade de políticas públicas de saúde de prevenção e controle do tabaco nessa população.