A proibição dos cigarros eletrônicos no Brasil: sucesso ou fracasso? / The ban of eletronic cigarettes in Brazil: success or failure?

Resumo O Brasil foi um dos primeiros países do mundo a proibir os Dispositivos Eletrônicos de Fumar (DEFs), tal proibição foi motivada pela inexistência de evidências relativas às alegadas propriedades terapêuticas e da inocuidade destes produtos. Por conta de tal proibição, A Anvisa foi criticada, especialmente de grupos de usuários. Estes grupos argumentam que tal ação proibiu um produto que auxiliaria a cessação ao tabagismo e seria menos tóxico que os cigarros comuns. Assim sendo, surge o questionamento se esta decisão foi acertada ou não. Os dados disponíveis mostram que os DEFs possuem formulações diversas e algumas substâncias tóxicas são liberadas durante sua utilização em níveis significativos. Estudos em animais e em humanos demonstraram potencial efeito tóxico. Os DEFs também demostraram que podem afetar a saúde de fumantes passivos. Quanto a seu uso como ferramenta de cessação, os estudos ainda não são conclusivos. Observou-se também um alto grau de uso entre adolescentes em países que seu uso foi autorizado. Desta forma o Brasil ao proibir estes produtos, impediu que a população consumisse um produto sem comprovação que auxiliasse no tratamento do tabagismo, com indícios de significativa toxidade e altamente atrativo aos jovens.

Abstract Brazil was one of the first countries in the world to ban Electronic Smoking Devices (ESDs). This ban was motivated by the lack of evidence regarding the alleged therapeutic properties and harmlessness of these products. Anvisa was criticized for this move, especially by electronic cigarette's users groups. These groups argue that prohibition prevented people's access to a product that would aid smoking cessation and be less toxic than ordinary cigarettes. Thus, the question arises as to whether this decision was successful. Available data show that ESDs have diverse formulations and some toxic substances are released at significant levels during use. Studies in animals and humans have shown a potential toxic effect, also affecting the health of passive smokers. Studies are still inconclusive regarding its use as a cessation tool. A high level of use among adolescents was observed in countries whose use was authorized. Thus, Brazil's ban prevented the population from consuming a product that has not been proven effective toward smoking cessation, with indications of significant toxicity and highly attractive to young people.

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

RESUMEN Objetivo Identificar factores asociados al cambio de comportamiento en personas fumadoras mayores de 18 años luego de la implementación de políticas provinciales 100% libre de humo en Argentina. Métodos Se realizó un estudio analítico de corte transversal. Se utilizó la técnica de modelos multiniveles trabajando con datos de distintas jerarquías. Se utilizaron fuentes de datos secundarios: Encuesta Nacional de Factores de Riesgo 2005, 2009 y 2013. Resultados En el análisis individual de las variables explicativas, se obtuvo que los pobladores de las provincias que no tienen legislación tuvieron un 40% más de probabilidad de no pensar en dejar de fumar que las personas que viven en provincias con legislación. En las provincias sin legislación, el sexo masculino y la edad mayor de 65 años son las características que aumentan las chances de las personas a no pensar en dejar de fumar, en comparación con las provincias que tiene legislación. Conclusiones Los resultados sugieren que una legislación basada en el artículo 8 del Convenio Marco resultaría efectiva para estimular la cesación tabáquica en Argentina.

ABSTRACT 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.

RESUMO 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.

Smokefree implementation in Colombia: Monitoring, outside funding, and business support / Implementación de los espacios libres de humo en Colombia: vigilancia, financiación externa y apoyo empresarial

Abstract: Objective: To analyze successful national smokefree policy implementation in Colombia, a middle income country. Materials and methods: Key informants at the national and local levels were interviewed and news sources and government ministry resolutions were reviewed. Results: Colombia’s Ministry of Health coordinated local implementation practices, which were strongest in larger cities with supportive leadership. Nongovernmental organizations provided technical assistance and highlighted noncompliance. Organizations outside Colombia funded some of these efforts. The bar owners’ association provided concerted education campaigns. Tobacco interests did not openly challenge implementation. Conclusions: Health organization monitoring, external funding, and hospitality industry support contributed to effective implementation, and could be cultivated in other low and middle income countries.

Resumen: Objetivo: Analizar la implementación exitosa de políticas nacionales de ambientes libres de humo en Colombia, un país de ingresos medios. Material y métodos: Entrevistas con informantes claves a nivel nacional y local, y revisión de artículos en las noticias y resoluciones ministeriales nacionales. Resultados: El Ministerio de Salud de Colombia coordinó las prácticas locales para la implementación, que fueron más fuertes en las ciudades grandes y en las ciudades con líderes políticos que la apoyaron. Organizaciones no gubernamentales proporcionaron asistencia técnica y destacaron el incumplimiento. Organizaciones fuera de Colombia financiaron algunos de estos esfuerzos. La asociación de propietarios de bares proporcionó campañas de educación concertadas. Intereses tabacaleros no desafiaron abiertamente la implementación. Conclusiones. La vigilancia de las organizaciones no gubernamentales, la financiación externa y el apoyo de la industria de la hospitalidad contribuyeron a una implementación eficaz. Tales factores pueden ser cultivados en países de ingresos bajos y medios.

The impact of anti-smoking laws on high school students in Ankara, Turkey / O impacto das leis antifumo em alunos do ensino médio em Ancara, Turquia

ABSTRACT OBJECTIVE: To determine the factors affecting the smoking habits of high school students, their thoughts about changes resulting from anti-smoking laws, and how they are affected by those laws. METHODS: In this cross-sectional study, 11th-grade students at eight high schools in Ankara, Turkey, were invited to complete a questionnaire. RESULTS: A total of 1,199 students completed the questionnaire satisfactorily. The mean age of the respondents was 17.0  0.6 years; 56.1% were female, of whom 15.3% were smokers; and 43.9% were male, of whom 43.7% were smokers (p < 0.001). The independent risk factors for smoking were male gender, attending a vocational school, having a sibling who smokes, having a friend who smokes, and poor academic performance. Of the respondents, 74.7% were aware of the content of anti-smoking laws; 81.8% approved of the restrictions and fines; and 8.1% had quit smoking because of those laws. According to the respondents, the interventions that were most effective were the (television) broadcast of films about the hazards of smoking and the ban on cigarette sales to minors. The prevalence of smoking was highest (31.5%) among students attending vocational high schools but lowest (7.5%) among those attending medical vocational high schools. Although 57.1% of the smokers were aware of the existence of a smoking cessation helpline, only 3.7% had called, none of whom had made any attempt to quit smoking. CONCLUSIONS: Although most of the students evaluated were aware of the harmful effects of smoking and approved of the anti-smoking laws, only a minority of those who smoked sought professional help to quit.

RESUMO OBJETIVO: Determinar os fatores que afetam os hábitos de fumar de estudantes do ensino médio, seus pensamentos sobre as mudanças resultantes das leis antifumo e como eles são afetados por essas leis. MÉTODOS: Neste estudo transversal, alunos do 11º ano de oito escolas de ensino médio em Ancara, Turquia, foram convidados para preencher um questionário. RESULTADOS: Preencheram o questionário 1.199 estudantes de forma satisfatória. A média de idade dos participantes foi de 17,0  0,6 anos; 56,1% eram mulheres; das quais 15,3% eram fumantes; e 43,9% eram homens, dos quais 43,7% eram fumantes (p < 0,001). Os fatores de risco independentes para o tabagismo foram ser homem, frequentar escola técnica, ter um irmão/irmã que fuma, ter um amigo que fuma e ter baixo desempenho acadêmico. Dos participantes, 74,7% conheciam o conteúdo das leis antifumo; 8,1% aprovavam as restrições e multas, e 8,1% haviam cessado o tabagismo devido a essas leis. Na opinião dos participantes, as intervenções mais efetivas foram a exibição de curtas na TV sobre os malefícios do tabagismo e a proibição da venda de cigarros a menores. A prevalência do tabagismo foi maior (31,5%) nos estudantes de escolas técnicas, mas menor (7,5%) nos estudantes de escolas técnicas médicas. Embora 57,1% dos fumantes soubessem da existência de um serviço telefônico de ajuda para a cessação tabágica, somente 3,7% haviam ligado para esse serviço, mas nenhum tentou parar de fumar. CONCLUSÕES: Embora a maioria dos alunos avaliados conhecesse os efeitos deletérios do tabagismo e aprovasse as leis antifumo, apenas uma minoria dos fumantes procurou ajuda profissional para a cessação tabágica.

Public opinion about smoking and smoke free legislation in a district of North India.

Context: A growing number of cities, districts, counties and states across the globe are going smoke-free. While an Indian national law namely Cigarettes and Other Tobacco Products Act (COTPA) exists since 2003 and aims at protecting all the people in our country; people still smoke in public places. Aim: This study assessed knowledge and perceptions about smoking, SHS and their support for Smoke-free laws among people residing in Mohali district, Punjab. Materials and Methods: This cross-sectional study was conducted in Mohali district of Punjab, India. A sample size of 1600 people was obtained. Probability Proportional to Size technique was used for selecting the number of individuals to be interviewed from each block and also from urban and rural population. Statistical Analysis Used: We estimated proportions and tested for significant differences by residence, smoking status, literacy level and employment level by means of the chi-square statistics. Statistical software SPSS for Windows version 20 was used for analysing data . Results: The overall prevalence of current smoking among study participants was 25%. Around 96% were aware of the fact that smoking is harmful to health, 45% viewed second-hand smoke to be equally harmful as active smoking, 84.2% knew that smoking is prohibited in public places and 88.3% wanted the government to take strict actions to control the menace of public smoking. Multivariate logistic regression analysis showed that people aged 20 years and above, unemployed, urban, literate and non-smokers had significantly better perception towards harms of smoking. The knowledge about smoke free provisions of COTPA was significantly better among males, employed individuals, urban residents, and literate people. Conclusions: There was high knowledge about deleterious multi-dimensional effects of smoking among residents and a high support for implementation of COTPA. Efforts should be taken to make Mohali a "smoke-free district".

The opinion of patients with mental disorder about tobacco and its prohibition in psychiatric hospitalization / Opinião dos portadores de transtorno mental sobre o fumo e sua proibição na internação psiquiátrica / Opinión de los portadores de trastorno mental sobre el tabaco y su prohibición en la hospitalización psiquiátrica

Objective: To identify the opinion of patients with mental disorder about tobacco and its prohibition during psychiatric hospitalization. Method: An exploratory study with 96 patients smokers with mental disorders hospitalized in a psychiatric ward of a general hospital. The interviews were conducted individually, using an instrument designed for this study. The content from the interviews was recorded, transcribed and submitted to a thematic content analysis. Results: The patients with mental disorder were identified as perceiving smoking during the psychiatric hospitalization as a help to support the difficulties in socialization and in the lack of activities. The permission for smoking is seen as a signal of respect to their needs. The subjects mentioned to not accept the total smoking prohibition. Conclusion: Tobacco helps to face difficulties and conflicts in the psychiatric hospitalization. There is resistance regarding the possibility to totally withdraw the smoking permission during hospitalization.

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Objetivo:Construir un modelo teórico que configure la vivencia del apoyo de la red social por las personas en cuidado domiciliario. Método: Estudio de abordaje cualitativa, con la utilización del método Teoría Fundamentada en los Datos. La recopilación y el análisis concomitante de los datos hizo viable la interpretación del significado del fenómeno La vivencia del apoyo de la red social por las personas implicadas en el cuidado domiciliario. Resultados: Se destacó la postura pasiva de la población en la construcción de su bienestar. Reconociendo que debe existir una responsabilidad compartida entre las partes implicadas, población y Estado. Conclusión: Se sugiere que los enfermeros sean estimulados a ampliar el cuidado que realizan en el domicilio para atender las demandas de los cuidadores; y que sean elaborados nuevos estudios con distintas poblaciones, con el fin de validar o complementar el modelo teórico propuesto.
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Objetivo: Identificar a opinião dos portadores de transtorno mental sobre o fumo e sua proibição durante a internação psiquiátrica. Método: Estudo exploratório com 96 portadores de transtorno mental, tabagistas, internados em enfermaria psiquiátrica de hospital geral. As entrevistas foram realizadas individualmente, utilizando-se o instrumento elaborado para este estudo. O conteúdo verbalizado nas entrevistas foi gravado, transcrito e submetido à análise de conteúdo temático. Resultados: Identificou-se que os portadores de transtorno mental veem o tabagismo na internação psiquiátrica como ajuda para suportar a dificuldade de convívio e a falta de atividades. A permissão do tabagismo é vista como sinal de respeito às suas necessidades. Os sujeitos relatam não aceitar a proibição total do tabagismo. Conclusão: O tabagismo ajuda a enfrentar dificuldades e conflitos na internação psiquiátrica. Existe resistência quanto à possibilidade de retirar totalmente a permissão para fumar na internação.


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MPOWER and the Framework Convention on Tobacco Control implementation in the South-East Asia region.

The 11 member states of WHO's South-East Asia Region share common factors of high prevalence of tobacco use, practice of several forms of tobacco use, increasing prevalence of tobacco use among the youth and women, link of tobacco use with poverty, and influence of tobacco advertisements in propagating the use of tobacco, especially among young girls and women. The effects of tobacco use are many-fold, leading to high morbidity and mortality rates as well as loss of gross domestic product (GDP) to respective countries. The WHO Regional Office for South-East Asia has been actively involved in curbing this menace essentially by way of assisting member states in implementing the WHO Framework Convention on Tobacco Control (FCTC). This paper gives an overview of these activities and discusses the opportunities and challenges in implementing the FCTC and possible practical solutions.

Impact of smoke-free law on tobacco consumption in Chandigarh: A community-based study.

Background and Objectives: Tobacco use is a major public health issue today and it is expected that 650 million smokers will die prematurely due to tobacco use. On 15 July 2007, Chandigarh became the first city to go smoke-free. However, there is no data on the impact of smoke-free law. The objective of the present study was therefore to study the pattern and prevalence of tobacco use and to examine the impact of smoke-free law in Chandigarh. Materials and Methods: Total sample comprised of 3000 subjects. Socio-demographic data sheet along with initial two questions from the General questionnaire were administered on each individual. In addition, all the tobacco users underwent administration of the Fagerstrom test for nicotine dependence or the Fagerstrom test for smokeless tobacco (smokeless tobacco users). Results: There were 43.9% tobacco users in the sample of 3000 subjects. Out of these tobacco users, 357 (11.9%) were pure smokers and 370 (12.3%) were using smokeless tobacco and 590 (19.6%) used both. The mean number of cigarettes/bidis smoked per day was 14 (+8.64) and the mean age of starting smoking was 19.41 (SD + 4.5 years).73.2% of population was aware about implementation of smoke-free law and all the participants (100%) reported smoking in public places. 43.4% smokers reported thoughts of quitting nicotine. Interpretation and Conclusion: Although the prevalence of tobacco use in Chandigarh is lower than the national average but the rates are still alarming and need attention. The findings of this study will help in designing tobacco control strategies and understanding the epidemiology of tobacco related health burden.