Living frisbees: riesgos de patologías mentales en niños y niñas expuestos a thc durante su gestación / Living frisbees: risks of mental pathologies in boys and girls exposed to thc during their pregnancy

La Cannabis sativa es una planta que contiene componentes psicoactivos (principalmente tetrahidrocannabinol) y actualmente corresponde a la droga ilícita más consumida a nivel mundial. Además, desde el área de la salud mental, ha habido un creciente interés en evaluar la relación entre el consumo de marihuana y el desarrollo de trastornos mentales. En este contexto, considerando tanto este creciente aumento en su consumo a nivel mundial y el interés por conocer si está involucrada en la patogénesis de patologías de la esfera psiquiátrica, es clave analizar qué posibles riesgos de desarrollar patologías mentales presentan aquellos niños expuestos al tetrahidrocannabinol durante la gestación. A partir de esta situación, el objetivo de este FRISBEEs es determinar si los niños/as expuestos a THC durante su gestación tienen un mayor riesgo de patologías mentales, en comparación a aquellos niños no expuestos durante su gestación. Los materiales y métodos utilizados para responder esta pregunta fueron obtenidos a partir de una búsqueda bibliográfica en dos bases de datos, donde se analizó la evidencia disponible, y se seleccionó el estudio primario titulado "Maternal tobacco, cannabis and alcohol use during pregnancy and risk of adolescent psychotic symptoms in offspring", ya que era el que más se aproximaba a poder responder nuestra pregunta clínica. Este se analizó de forma crítica, llegando al resultado de que el estudio no fue concluyente en establecer una asociación entre el uso de cannabis y síntomas psicóticos. Como conclusión, dado que no se pudo llegar a establecer una asociación entre el uso de cannabis y el desarrollo de patologías mentales, se debería realizar más investigación sobre el tema dado la magnitud del consumo de cannabis a nivel mundial, para así poder llegar a conclusiones clínicas basadas en la evidencia y poder dar recomendaciones clínicas a las pacientes embarazadas.

Cannabis sativa is a plant that contains psychoactive components (mainly tetrahydrocannabinol) and currently corresponds to the most widely consumed illicit drug worldwide. In addition, from the area of mental health, there has been a growing interest in evaluating the relationship between marijuana use and the development of mental disorders. In this context, considering both this growing increase in its consumption worldwide and the interest in knowing if it is involved in the pathogenesis of pathologies in the psychiatric sphere, it is essential to analyze what possible risks of developing mental pathologies present those children exposed to tetrahydrocannabinol during gestation. Based on this situation, the objective of this FRISBEEs is to determine whether children exposed to THC during their pregnancy have a greater risk of mental pathologies, compared to those children not exposed during their pregnancy. The materials and methods used to answer this question were obtained from a bibliographic search in two databases, where the available evidence was analyzed, and the primary study entitled "Maternal tobacco, cannabis and alcohol use during pregnancy and risk of adolescent psychotic symptoms in offspring ", as he was the closest to answering our clinical question. This was critically analyzed, reaching the result that the study was not conclusive in establishing an association between the use of cannabis and psychotic symptoms. In conclusion, given that it was not possible to establish an association between the use of cannabis and the development of mental pathologies, more research should be carried out on the subject given the magnitude of cannabis use worldwide, in order to reach conclusions. evidence-based clinics and to be able to give clinical recommendations to pregnant patients

Interaction of smoking and being bullied on suicidal behaviors: a school-based cross-sectional survey in China

BACKGROUND@#Suicidal behaviors are seriously social issues among adolescents in the world. Exposed to smoking and being bullied are risk factors of suicidal behaviors. The present study was aimed to examine the interaction of smoking and being bullied on suicidal behaviors among Chinese adolescents.@*METHODS@#A total of 18,900 students were involved in the questionnaire study, in four cities of China from November 2017 to January 2018. Suicidal behaviors, smoking, and being bullied were measured by self-reported validated instruments. Chi-square tests and logistic regression were used to analyze the associations of suicidal ideation (SI)/suicidal plan (SP)/suicidal attempt (SA), smoking, and being bullied.@*RESULTS@#The prevalence of smoking, being bullied, SI/SP/SA, were 3.1%, 20.6%, 26.4%, 13.2%, and 5.2% respectively. Interaction analysis indicated that being bullied was associated with a greater increase in the likelihood of suicidal behaviors for adolescents with smoking than for those without smoking.@*CONCLUSIONS@#These finding suggest that smoking exacerbates the association between being bullied and suicidal behaviors. Future research should explore how and why smoking appears to more bully-victims than for those without smoking and how to mitigate it.

Intenção de amamentar entre gestantes: associação com trabalho, fumo e experiência prévia de amamentação / Intention to breastfeed among pregnant women: association with work, smoking, and previous breastfeeding experience

Resumo O objetivo do presente estudo foi estimar a prevalência de intenção de amamentar (IA) por tempo insuficiente (inferior a 6 meses) ou prolongado (24 meses ou mais) e investigar sua associação com variáveis demográficas, socioeconômicas, comportamentais relacionadas à saúde, antecedentes obstétricos e experiência prévia com amamentação entre gestantes. Estudo transversal com gestantes em acompanhamento pré-natal em 17 unidades da Estratégia Saúde da Família, em Colombo (PR). Análises de regressão logística multinomial brutas e ajustadas foram empregadas para identificar associações entre IA e variáveis de exposição. Dentre as gestantes participantes da pesquisa (n = 316), 99,1% relataram IA. O tempo médio de IA foi de 13,5 meses. A IA por tempo insuficiente e prolongado foi referida por 9,8% e 22,0% das gestantes, respectivamente. Apresentaram maiores chances de IA por tempo insuficiente aquelas que não possuíam companheiro (OR 3,23, IC95% 1,31; 7,94), que exerciam trabalho remunerado (OR 5,56, IC95% 2,10; 14,71) e que eram fumantes (OR 7,79, IC95% 2,35; 25,81). A IA prolongada foi mais frequente entre as gestantes com experiência prévia em amamentação prolongada (OR 3,05, IC95% de 1,02; 9,03). Por fim, identifica-se que os fatores associados à IA subsidiam ações voltadas para os grupos vulneráveis com vistas à promoção da prática do aleitamento materno.

Abstract The objective of this study was to estimate the prevalence of intention to breastfeed (IB) for an insufficient (under 6 months) or prolonged (24 months and longer) amount of time and to investigate its association with demographic and socioeconomic status, health behaviors, obstetric history, and previous breastfeeding experience among pregnant women. This is a cross-sectional study made with pregnant women under prenatal care in 17 units of the Family Health Strategy, in Colombo (PR). Crude and adjusted multinomial logistic regression analyses were used to identify associations between IB and exposure variables. Among pregnant women participating in the survey (n = 316), 99.1% reported IB. The average IB time was 13.5 months. The IB for insufficient and prolonged time was referred to by 9.8% and 22.0% of participants respectively. Those who presented the greatest changes of IB for insufficient time were women who: did not have a partner (OR 3.23, 95% CI 1.31; 7.94), who performed paid work (OR 5.56, 95% CI 2.10; 14.71), and smokers (OR 7.79, 95% CI 2.35; 25.81). Prolonged IB was more frequent among pregnant women with previous experience in prolonged breastfeeding (OR 3.05, 95% CI 1.02; 9.03). Factors associated to IA were found to support actions directed to vulnerable groups aiming the promotion of breastfeeding practices.

Association between cigarette use and adolescents' behavior

ABSTRACT OBJECTIVE To determine the prevalence of cigarette use among adolescents and to identify associated health risk behaviors. METHODS This is a cross-sectional study with a representative sample, composed of 1059 adolescents between 13 and 19 years old, enrolled in primary and secondary public schools of Olinda, Pernambuco, in 2014. Information was obtained through self-administered questionnaires (validated version of YRBS 2007). Cigarette experimentation was defined as smoking at least once in life. Adolescents who smoked at least one day within 30 days prior to the survey were considered current smokers. Most students were female and 16 years old or older. RESULTS Almost 30% used it in life and about 10% smoked within the 30 days before the survey. Suicidal ideation (PR = 1.51, 95%CI 1.25-1.82), alcohol use (PR = 1.41, 95%CI 1.03-1.92), marijuana (PR = 1.64, 95%CI 1.37-1.96), excessive alcohol consumption (PR = 1.57, 95%CI 1.15-2.16) and sexual experience (PR = 1.78, 95%CI 1.43-2.21) have increased the risk of using cigarettes. Feelings of sadness (PR = 1.70, 95%CI 1.22-2.36), alcohol use (PR=2.40, 95%CI 1.12-5.12), excessive alcohol consumption (PR = 2.5, 95% CI 1.24-5.38), marijuana (PR = 2.31, 95%CI.57-3.39) and cocaine (PR = 1.99, 95%CI.32-3.01) increased the risk of cigarette use within the 30 days before the survey. CONCLUSIONS Cigarette use among adolescents from Olinda was high, being considered higher than the national prevalence. Possible factors associated with cigarette use were drug use (alcohol, marijuana, and cocaine) and behaviors related to sexual experience, feelings of sadness and suicidal ideation.

Sociodemographic factors associated with smoking risk perception in adolescents in São Paulo, Brazil

Objective: We examined the sociodemographic factors associated with smoking risk perceptions (SRP) in youth living in two very different neighborhoods in the city of São Paulo, Brazil: a middle-class central area (Vila Mariana) and a poor outer-city area (Capão Redondo). Methods: A cross-sectional survey was conducted with 180 public school-attending youth (all aged 12 years) and their parents. SRP was evaluated through self-reports. Weighted multinomial logistic regression was used to examine factors associated with SRP. Results: Smoking was considered a high-risk behavior by 70.9% of adolescents. There were significant differences in SRP associated with socioeconomic status (SES) and maternal smoking status. Having a non-smoking mother was positively associated with perceiving smoking as having low to moderate risk versus no risk (OR=3.91 [95%CI 1.27-12.02]). Attending school in Capão Redondo was associated with perceiving smoking as having high risk compared to no risk (OR=3.00 [95%CI 1.11-8.12]), and low SES was negatively associated with perceiving at least some risk in smoking versus perceiving no risk in this behavior. Conclusions: Youth whose mothers smoke appear to have lower SRP than those whose mothers do not smoke. Living in a poor outer-city area was associated with higher SRP.

E-cigarette use and its association with smoking reduction and cessation intentions among Mexican smokers / Uso de cigarros electrónicos y su asociación con la reducción en el consumo de cigarros convencionales y la intención de dejar de fumar entre fumadores mexicanos

Abstract: Objective: Evaluate the patterns of e-cigarette use and their association with smoking behavior. Materials and methods: We analyzed data from a population-based representative cohort of adult smokers who participated in the International Tobacco Control Policy Evaluation Surveys in Mexico. The analytic sample (n=760) was restricted to participants who were followed up from wave 6 (2012) to wave 7 (2014-2015). GEE models regressed e-cigarette use at follow-up and changes in cigarettes per day (CPD) between waves, on baseline sociodemographic variables, smoking status (daily, non-daily, quit), e-cigarette trial, and quit intentions. Results: Smokers who were younger, had a higher income, and had tried e-cigarettes at baseline were more likely to be current e-cigarette users at follow-up. E-cigarette use at follow-up was not associated with a change in CPD over time. Conclusions: E-cigarette use does not appear to have promoted smoking cessation or reduction in this sample of Mexican smokers.

Resumen: Objetivo: Evaluar los patrones de uso de cigarros electrónicos y su asociación con el uso de tabaco. Material y métodos: Se usaron datos de una cohorte de fumadores adultos mexicanos de la Encuesta Internacional de Evaluación de Políticas del Control del Tabaco (n=760) con seguimiento de la ronda 6 (2012) a la 7 (2014-2015). Se usaron modelos GEE para evaluar el uso de cigarros electrónicos y el cambio en el número de cigarros por día (CPD) en variables de la basal sobre características sociodemográficas, consumo del cigarro (diario, no diario, haber dejado de fumar), prueba de cigarros electrónicos e intención de dejar de fumar. Resultados: Fumadores jóvenes, con ingresos altos y que probaron cigarros electrónicos en la medición basal tenían más posibilidad de usar cigarros electrónicos. No se encontró relación entre uso de cigarros electrónicos y cambio en CPD. Conclusiones: Los cigarros electrónicos no parecen promover el abandono ni la reducción del consumo de cigarros en esta muestra de fumadores mexicanos.

Motivations for smoking in hospitalized patients

SUMMARY OBJECTIVE: To investigate the profile of motivations for smoking among inpatients at a hospital in southern Brazil. METHODS: A survey study involving hospitalized smokers. The Modified Reasons for Smoking Scale (MRFSS) and its domains were analyzed according to gender and dependence degree. RESULTS: The sample consisted of 85 adults (mean age 53 years), low schooling/family income, and well-adjusted in terms of gender (male= 52.9%) and clinical (48%) or surgical (47%) specialty. Most were in Action as the motivational stage (68%), with elevated smoking exposure (median = 39 years/packs) and dependence degree of nicotine (56.4%). The highest domains of the MRFSS were: Smoking Pleasure (4.34 ± 1.2), Relaxation/Tension Reduction (4.24 ± 1.2) and Dependence (3.8±1.4). Significantly, women presented higher scores, in domain Relaxation/Tension Reduction (4.7±0.9). In those with elevated nicotine dependence, higher scores were observed in the Automatism/Habit and Stimulation domains. CONCLUSIONS: Smoking Pleasure and Relaxation/Tension Reduction, especially in women and Automatism, in those more dependents, are factors that should be more highlighted in future strategies for smoking cessation in inpatients.

RESUMO OBJETIVO: Investigar o perfil de motivações para o tabagismo entre pacientes internados em um hospital do sul do Brasil. MÉTODOS: Estudo tipo survey que incluiu pacientes tabagistas hospitalizados. Utilizou-se a Escala de Razões para Fumar Modificada (ERPFM) e seus domínios, analisados em função do sexo e do grau de dependência. RESULTADOS: A amostra foi composta por 85 adultos (média de 53 anos), com baixa escolaridade/renda familiar e equilibrada quanto ao sexo (masculino= 52,9%) e por especialidade clínica (48%) ou cirúrgica (47%). A maioria estava em estágio motivacional Ação (68%), com carga tabágica (mediana= 39 anos/maços) e grau de dependência à nicotina elevados (56,4%). Os domínios de maior escore da ERPFM foram: Prazer de Fumar (4,34 ± 1,2), Relaxamento/Redução da Tensão (4,24 ± 1,2) e Dependência (3,8 ± 1,4). De forma significativa, com maior pontuação, as mulheres apresentaram o domínio Relaxamento/Redução da Tensão (4,7 ± 0,9). Naqueles com maior grau de dependência, observou-se com significância, escores mais elevados nos domínios Automatismo/Hábito e Estimulação. CONCLUSÕES: Prazer de Fumar e Relaxamento/Redução da Tensão, especialmente em mulheres e Automatismo, naqueles mais dependentes, são fatores que devem ser mais valorizados em futuras estratégias de cessação de tabagismo em hospitalizados.

Evaluación de la dependencia física y psicológica al tabaco en fumadores mexicanos adultos, Encodat 2016 / Evaluation of physical and psychological dependence in Mexican adult smokers, Encodat 2016

Resumen: Objetivo: Evaluar la dependencia física y psicológica de los fumadores mexicanos y su asociación con factores físicos, psicológicos y sociales. Material y métodos: A partir de la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2016 (n=7 331), se analizó la escala de dependencia física a la nicotina de Fagerström (FTND) y la escala corta de dependencia psicológica al tabaco (TAPDSc). Se realizaron análisis bivariados y regresiones logísticas ordinales generalizadas para evaluar los factores asociados. Resultados: 82.3% de fumadores diarios y 98.8% de ocasionales reportaron dependencia física leve, mientras que 47.9 y 37.9%, respectivamente, presentaron dependencia psicológica moderada. La edad de inicio temprana de consumo de tabaco, uso de drogas, consumo alto de alcohol y malestar emocional se asociaron con niveles altos de dependencia psicológica en todos los fumadores. Conclusión: El uso exclusivo de FNTD no permite evaluar adecuadamente a los fumadores mexicanos. La dependencia física y psicológica al tabaco debe ser diagnosticada con escalas independientes y validadas en esta población.

Abstract: Objective: To evaluate the physical and psychological dependence to tobacco of Mexican smokers and its association with physical, psychological and social factors. Materials and methods: The 2016 National Alcohol and Tobacco Drug Consumption Survey (n=7 331) was analyzed using the Fagerström nicotine physical dependence scale (FTND) and the short scale of psychological dependence on tobacco (TAPDSc). Bivariate analyzes and generalized ordinal logistic regressions were performed to evaluate the associated factors. Results: 82.3% of daily smokers and 98.8% of occasional smokers reported mild physical dependence, while 47.9 and 37.9% respectively reported moderate psychological dependence. The age of initiation of tobacco use, drug use, high alcohol consumption and high emotional distress were associated with high levels of psychological dependence in all smokers. Conclusion: The exclusive use of FTND does not allow to adequately evaluate Mexican smokers. The physical and psychological dependence on tobacco should be assessed with independent and validated scales in this population.

Association of violence in schools' vicinity and smoking in schools' premises with tobacco use among Brazilian adolescents / Associação entre violência no entorno da escola e tabagismo no ambiente escolar e o uso de tabaco por adolescentes brasileiros / Asociación de la violencia en las inmediaciones de la escuela y fumar en dependencias escolares con el consumo de tabaco entre adolescentes brasileños

Abstract: This study aims to quantify the overall importance of schools in explaining the individual variance of tobacco use and to test the association between characteristics of the school environment and its vicinity with the experimentation and current use of cigarettes. We analyzed data from 102,072 Brazilian adolescents interviewed in the 2015 National School Health Survey (PeNSE). Multilevel logistic regression models were performed to estimate the between-schools variance and to test the association between school-level variables and the use of tobacco. Violence in the vicinity of the school and presence of teachers or students smoking on school premises were the school-level characteristics. The analyses were adjusted by individual covariates and stratified by gender. Around 12.5% of the individual variance in ever smoking was explained by between-school variation among girls (9.2% among boys). The figures were even higher for current smoking (14.9% girls; 12.2% boys) and current use of other tobacco products (27.7% girls; 17.8% boys). In general, the use of tobacco was associated with the existence of violence in the vicinity of the schools and was higher among students whose schools reported that students and teachers (teachers only for use of other tobacco products among girls) smoke on school premises. Tobacco use on school premises and the safety of the neighborhood where the school is located are associated with some smoking behaviors among adolescents. Such findings reinforce the necessity to effectively consider interventions in the school environment and neighborhood to fight smoking among adolescents.

Resumo: O estudo tem como objetivos quantificar a importância global da escola na explicação da variância individual no uso de tabaco e testar a associação entre as características do ambiente escolar e o entorno e a experimentação e o uso atual de cigarros. Analisamos os dados de 102.072 adolescentes brasileiros entrevistados na Pesquisa Nacional de Saúde Escolar (PeNSE) de 2015. Foram utilizados modelos de regressão logística multinível para estimar a variância entre escolas e testar a associação entre variáveis escolares e o tabagismo. As características da escola foram a violência no entorno e a presença de professores e alunos fumando no ambiente escolar. As análises foram ajustadas para covariáveis individuais e estratificadas por sexo. Cerca de 12,5% da variância individual no tabagismo pregresso ou atual foram explicados pela variação entre escolas, no sexo feminino (9,2% no sexo masculino). As proporções foram ainda mais altas para o tabagismo atual (14,9% no sexo feminino; 12,2% no sexo masculino) e para o uso atual de outros produtos de tabaco (27,7% no sexo feminino; 17,8% no sexo masculino). Em geral, o uso de tabaco mostrou estar associado à existência de violência no entorno da escola, sendo mais frequente entre alunos cujas escolas relatavam que alunos e professores fumavam no ambiente escolar (para professores, apenas para o uso de outros produtos de tabaco, entre alunas). O uso de tabaco no ambiente escolar e a segurança no entorno da escola estão associados a alguns comportamentos relacionados ao tabaco entre adolescentes. Os achados reforçam a necessidade de considerar intervenções no ambiente escolar e no entorno para combater o tabagismo entre adolescentes

Resumen: Este estudio tiene como objetivo cuantificar la importancia global de las escuelas a la hora de explicar la variancia individual del consumo de tabaco, así como probar la asociación entre las características del entorno de la escuela y sus inmediaciones con probar por primera vez y consumir cigarrillos habitualmente. Analizamos los datos de 102.072 brasileños adolescentes, entrevistados en la Encuesta Nacional de Salud Escolar (PeNSE) 2015. Se usaron modelos de regresión logística multinivel para estimar la variancia entre escuelas y para probar la asociación entre las variables de nivel escolar y consumo de tabaco. La violencia en las inmediaciones de la escuela y la presencia de profesores o estudiantes fumando en las instalaciones de la escuela fueron características del nivel escolar. Los análisis fueron ajustados por covariables individuales y estratificadas por género. Alrededor de un 12,5% de la variancia individual entre quienes habían fumado se explicó mediante la variación interescolar entre chicas (9,2% entre chicos). Las cifras fueron incluso superiores para los fumadores en la actualidad (14,9% chicas; 12,2% chicos) y el consumo actual de otros productos derivados del tabaco (27,7% chicas; 17,8% chicos). En general, el consumo de tabaco estuvo asociado con la existencia de violencia en las inmediaciones de las escuelas y fue superior entre estudiantes en cuyas escuelas se informó que estudiantes y profesores (profesores solo por el consumo de otros productos del tabaco entre chicas) fuman en dependencias escolares. El consumo de tabaco y la seguridad del vecindario donde estaba ubicada la escuela están asociados con algunos hábitos de consumo de tabaco entre adolescentes. Tales resultados refuerzan la necesidad de considerar efectivamente intervenciones en el entorno escolar y en el vecindario para luchar contra el tabaquismo entre adolescentes

Prevalência e perfil de fumantes: comparações na população psiquiátrica e na população geral / Prevalence and smokers' profile: comparisons between the psychiatric population and the general population / Prevalencia y perfil de fumadores: comparaciones en la población psiquiátrica y en la población general

Objetivos: identificar prevalência de fumantes entre a população psiquiátrica e a população geral; comparar o perfil pessoal, sociodemográfico e clínico dos fumantes e não fumantes da população psiquiátrica e da população geral; verificar as razões para fumar desses dois grupos populacionais. Método: estudo epidemiológico descritivo-analítico, de corte transversal, com 378 pacientes de três serviços: Ambulatório Saúde Mental, Hospital Psiquiátrico e Unidade Básica Saúde. Realizaram-se entrevistas com três questionários. Aplicaram-se testes qui-quadrado e Kruskal-Wallis. Resultados: dos 378 participantes, 67% eram mulheres e 69% tinham mais de 40 anos. Identificada maior prevalência de fumantes entre homens, jovens, analfabetos, solteiros e recebedores de mais de um benefício do governo. Os fumantes prevaleceram entre os esquizofrênicos, pacientes crônicos, que utilizavam ≥ 3 psicofármacos e com histórico de ≥ 4 internações psiquiátricas e/ou tentativas suicídio. A principal razão alegada para fumar foi a melhora dos afetos negativos. Conclusão: a prevalência de fumantes é maior na população psiquiátrica (especialmente entre os pacientes graves) e entre os homens, jovens, solteiros e com prejuízos socioeconômicos. A principal razão para fumar é o alívio da tensão/relaxamento. O presente estudo fornece, aos enfermeiros e demais profissionais, conhecimento capaz de subsidiar o planejamento de intervenções do tabagismo na população brasileira.

Objectives: to identify the prevalence of smokers between the psychiatric population and the general population; to compare the personal, socio-demographic and clinical profile of smokers and non-smokers in the psychiatric population and the general population; to compare the reasons for smoking of these two population groups. Method: this is a cross-sectional descriptive-analytical epidemiological study with 378 patients from three services: Ambulatory Mental Health, Psychiatric Hospital, and Basic Health Unit. Interviews were conducted with three questionnaires. The Chi-square and Kruskal-Wallis tests were applied. Results: in the total of the 378 participants, 67% were women and 69% were over 40 years old. There was a higher prevalence of smokers among men, young people, illiterates, singles and with more than one government benefit. Smokers prevailed among schizophrenics, chronic patients, who used ≥ 3 psychotropic drugs and had a history of ≥ 4 psychiatric hospitalizations and/or suicide attempts. The main reason for smoking was the improvement of negative feelings. Conclusion: the prevalence of smokers is higher in the psychiatric population (especially among severely ill patients) and among men, young people, unmarried and with socioeconomic losses. The main reason for smoking is tension/relaxation relief. This study provides nurses and other professionals with knowledge capable of subsidizing the planning of smoking interventions in the Brazilian population.

Objetivos: identificar prevalencia de fumadores entre la población psiquiátrica y la población general; comparar el perfil personal, sociodemográfico y clínico de los fumadores y no fumadores de la población psiquiátrica y de la población general; verificar las razones para fumar de esos dos grupos poblacionales. Método: estudio epidemiológico descriptivo-analítico, de corte transversal, con 378 pacientes de tres servicios: Ambulatorio Salud Mental, Hospital Psiquiátrico y Unidad Básica de Salud. Se realizaron entrevistas con tres cuestionarios. Se aplicaron pruebas chi-cuadrado y Kruskal-Wallis. Resultados: de los 378 participantes, 67% eran mujeres y 69% tenían más de 40 años. Identificada mayor prevalencia de fumadores entre hombres, jóvenes, analfabetos, solteros y recibidores de más de un beneficio del gobierno. Los fumadores prevalecieron entre los esquizofrénicos, pacientes crónicos, que utilizaban ≥ 3 psicofármacos y con histórico de ≥ 4 internaciones psiquiátricas y/o tentativas de suicidio. La principal razón alegada para fumar fue la mejoría de los afectos negativos. Conclusión: la prevalencia de fumadores es mayor en la población psiquiátrica (especialmente entre los pacientes graves) y entre los hombres, jóvenes, solteros y con prejuicios socioeconómicos. La principal razón para fumar es el alivio de la tensión/relajamiento. El presente estudio provee, a los enfermeros y demás profesionales, conocimiento capaz de subsidiar la planificación de intervenciones del tabaquismo en la población brasilera.

Prevalence of smoking and reasons for continuing to smoke: a population-based study / Prevalência de tabagismo e motivos para continuar a fumar: estudo de base populacional

ABSTRACT Objective: To investigate the prevalence of smoking and the reasons for continuing to smoke among adults in Brazil. Methods: This was a cross-sectional, population-based study including 1,054 individuals ≥ 40 years of age, residents of the city of Florianopolis, Brazil, of whom 183 were smokers. All of the smokers completed the University of São Paulo Reasons for Smoking Scale (USP-RSS). Depressive symptoms were evaluated with the Hospital Anxiety and Depression Scale, and spirometry was performed to screen for COPD. Results: Of the 183 smokers, 105 (57.4%) were female, 138 (75.4%) were White, and 125 (63.8%) were in a low economic class. The mean level of education among the smokers was 9.6 ± 6.1 years. The mean smoking history was 29 ± 15 pack-years, 59% of the men having a ≥ 30 pack-year smoking history. Approximately 20% of the smokers had COPD, and 29% had depressive symptoms, which were more common in the women. The USP-RSS scores were highest for the pleasure of smoking (PS), tension reduction (TR), and physical dependence (PD) domains (3.9 ± 1.1, 3.6 ± 1.2, and 3.5 ± 1.3, respectively). Scores for the PS, TR, and weight control (WC) domains were significantly higher in women. Smokers with a > 20 pack-year smoking history scored significantly higher on the PD, PS, automatism, and close association (CA) domains. Smoking history was associated with the PD, PS, TR, and CA domains. Depressive symptoms were associated with the PD, social smoking, and CA domains (p = 0.001; p = 0.01; p = 0.09, respectively). Female gender and a low level of education were associated with the PS domain (p = 0.04) and TR domain (p < 0.001). Conclusions: The prevalence of smoking in our sample was relatively high (17.4%). The USP-RSS domains PS, TR, and WC explain why individuals continue smoking, as do depressive symptoms.

RESUMO Objetivo: Investigar a prevalência de tabagismo e as razões para continuar a fumar em adultos no Brasil. Métodos: Estudo transversal de base populacional com 1.054 indivíduos com idade ≥ 40 anos residentes em Florianópolis (SC), dos quais 183 eram tabagistas. Todos os fumantes preencheram a Escala Razões para Fumar da Universidade de São Paulo (ERF-USP). Os sintomas de depressão foram avaliados por meio da Hospital Anxiety and Depression Scale, e a presença ou ausência de DPOC foi determinada por meio de espirometria. Resultados: Dos 183 fumantes, 105 (57,4%) eram do sexo feminino, 138 (75,4%) eram brancos e 125 (63,8%) pertenciam a uma classe econômica baixa. A média de escolaridade entre os fumantes foi de 9,6 ± 6,1 anos. A média de carga tabágica foi de 29 ± 15 anos-maço, e 59% dos homens apresentavam carga tabágica ≥ 30 anos-maço. Aproximadamente 20% dos fumantes apresentavam DPOC, e 29% apresentavam sintomas de depressão, mais comuns entre as mulheres. A pontuação obtida na ERF-USP foi maior nos domínios prazer de fumar (PF), redução da tensão (RT) e dependência física (DF): 3,9 ± 1,1; 3,6 ± 1,2 e 3,5 ± 1,3, respectivamente. A pontuação obtida nos domínios PF, RT e controle de peso (CP) foi significativamente maior entre as mulheres. Fumantes com carga tabágica > 20 anos-maço obtiveram pontuação significativamente maior nos domínios DF, PF, automatismo e associação estreita (AE). A carga tabágica relacionou-se com os domínios DF, PF, RT e AE. Sintomas de depressão relacionaram-se com os domínios DF, tabagismo social e AE (p = 0,001; p = 0,01; p = 0,09, respectivamente). Sexo feminino e baixa escolaridade relacionaram-se com os domínios PF (p = 0,04) e RT (p < 0,001). Conclusões: A prevalência de tabagismo em nossa amostra foi relativamente alta (17,4%). Os domínios PF, RT e CP da ERF-USP, bem como os sintomas de depressão, explicam por que os indivíduos continuam a fumar.

Autoestima e o consumo de álcool, de tabaco e de outras substâncias em trabalhadores terceirizados / Self-esteem and consumption of alcohol, tobacco, and other substances in outsourced workers / La autoestima y el consumo de alcohol, tabaco y otras sustancias por trabajadores tercerizados

Objetivo avaliar a autoestima, o consumo de álcool, de tabaco e de outras substâncias em trabalhadores terceirizados de uma universidade pública. Método estudo descritivo-analítico, transversal, quantitativo, desenvolvido com 316 trabalhadores terceirizados de um município do Sudeste do Brasil. Os dados foram coletados por meio de um instrumento de caracterização, da Escala de Autoestima de Rosenberg e do Alcohol, Smoking and Substance Involvement Screening Test. Para a análise de dados, utilizaram-se a estatística descritiva, o teste de qui-quadrado de Pearson, o teste exato de Fisher, odds ratio e regressão logística. Resultados a maioria dos trabalhadores possuía autoestima alta e alguns utilizavam álcool, tabaco, maconha e inalantes. Constatou-se associação significativa entre sexo, faixa etária e turno de trabalho com a autoestima; entre o risco de desenvolver problemas relacionados ao consumo de álcool com sexo, faixa etária, estado civil, crença religiosa e quantidade de filhos; entre a prática de atividade física e o risco de desenvolver problemas relacionados ao consumo de derivados do tabaco. Conclusão este estudo contribui para o aumento do conhecimento devido ao número reduzido de pesquisas envolvendo esta temática e para os enfermeiros terem subsídios para atuação junto a esta população, utilizando-se de estratégias para combater os fatores desencadeadores de desordens psíquicas.

Objective to evaluate self-esteem, the consumption of alcohol, tobacco and other substances in outsourced workers of a public university. Method a descriptive-analytical, cross-sectional, quantitative study developed with 316 outsourced workers from a municipality in the Southeast of Brazil. Data was collected through a characterization tool, the Rosenberg Self-Esteem Scale and the Alcohol, Smoking and Substance Involvement Screening Test. For data analysis, we used descriptive statistics, Pearson's chi-square test, Fisher's exact test, odds ratio and logistic regression. Results the majority of workers had high self-esteem and some used alcohol, tobacco, marijuana and inhalants. A significant association between gender, age group and work shift with self-esteem; between the risk of developing problems related to alcohol consumption with sex, age group, marital status, religious belief and number of children; between the practice of physical activity and the risk of developing problems related to the consumption of tobacco products was found. Conclusion this study contributes to the increase of knowledge due to the small number of researches involving this subject and to contribute to the nurses to have subsidies to work with this population using strategies to combat the triggers of psychic disorders.

Objetivo evaluar la autoestima, el consumo de alcohol, de tabaco y de otras sustancias por trabajadores tercerizados, en una universidad pública. Método estudio descriptivo analítico, transversal y cuantitativo, desarrollado en 316 trabajadores tercerizados, en un municipio del Sureste de Brasil. Los datos fueron recogidos por medio de un instrumento de caracterización y de la Escala de Autoestima de Rosenberg y del Alcohol, Smoking and Substance Involvement Screening Test. Para el análisis de los datos se utilizó: estadística descriptiva, test de Chi-cuadrado de Pearson, test Exacto de Fisher, odds ratio y regresión logística. Resultados la mayoría de los trabajadores poseía autoestima alta y algunos utilizaban alcohol, tabaco, marihuana e inhalantes. Se constató asociación significativa: 1) entre la autoestima con sexo, intervalo etario y turno de trabajo; 2) entre el riesgo de desarrollar problemas relacionados al consumo de alcohol con sexo, intervalo etario, estado civil, creencia religiosa y cantidad de hijos; 3) entre la práctica de actividad física con el riesgo de desarrollar problemas relacionados al consumo de derivados del tabaco. Conclusión considerando el número reducido de investigaciones sobre esta temática, este estudio contribuye para aumentar el conocimiento y también para que los enfermeros tengan auxilio para la actuación junto a la población, utilizando estrategias para combatir los factores desencadenadores de desórdenes psíquicos.

Trastorno por déficit de atención e hiperactividad más allá de la adolescencia ¿tiempo de pensar diferente? / Attention deficit hyperactivity disorder beyond adolescence. Time to think different?

El trastorno por déficit de atención e hiperactividad (TDAH) es un desorden del neurodesarrollo caracterizado por un patrón de inatención-desorganización e hiperactividad-impulsividad más grave que lo esperado para el nivel de desarrollo de acuerdo con la edad del individuo. Para el diagnóstico es necesario, además, que este comportamiento produzca alteraciones en las distintas áreas de funcionamiento del afectado en comparación con individuos similares de su entorno. Se han publicado extensas revisiones sobre las comorbilidades psiquiátricas asociadas con el TDAH, pero se ha dedicado poca atención a su efecto en la salud general. En este trabajo se revisan algunos de los problemas de medicina general del adulto más frecuentemente asociados con el diagnóstico de TDAH, tales como tabaquismo, adicción, accidentes, trastornos de sueño, obesidad, hipertensión, diabetes, y muerte temprana. Hoy se requiere un seguimiento más cercano de los afectados con TDAH, no solo desde el punto de vista psiquiátrico sino también en lo referente a la atención médica general, para prevenir su impacto sistémico que en la adultez lleva a enfermedades crónicas graves y costosas para los sistemas de salud, los individuos y la sociedad. Estas consecuencias tienen repercusiones médicas muy serias que exceden lo académico y lo emocional y deben ser consideradas por equipos multidisciplinarios.

ADHD is a neurodevelopmental disorder characterized by a pattern of severe inattention-disorganization and/or hyperactivity-impulsivity beyond what is expected for individuals with a comparable development level. These behaviors impair daily life activities of patients in more than one environment and impact their performance and abilities compared with their peers. Extensive reviews have been published about the psychiatric comorbidities associated with ADHD but little attention has been given to the overall impact of ADHD on health. This study reviews some of the most common problems in medical care associated with ADHD like smoking, substance use, accident risk, sleep disorders, obesity, hypertension, diabetes, and early mortality. Today, a close follow-up of patient with ADHD is necessary not only from the psychiatric perspective but also in regard to general medicine issues to prevent the impact on health of those medical co-morbidities. Such conditions can end in severe chronic diseases with consequences and high cost for the individuals, the families and the society far beyond the academic and emotional impact frequently described as associated to ADHD. This condition has serious repercussions on health which need a medical multidisciplinary approach.

El cine induce a los adolescentes a consumir tabaco. es necesario implementar políticas públicas para contrarrestar este fenómeno / Cinema induces adolescents to consume tobacco. it is necessary to implement public policies to counteract this phenomenon

El consumo de tabaco es la primera causa de mortalidad prevenible en el mundo. Para combatir esta epidemia, los países miembros de la Organización Mundial de la Salud han firmado, y la mayoría de ellos ratificado, el Convenio Marco para el Control del Tabaco. El artículo 13 de este tratado regula toda forma de publicidad, promoción y patrocinio del tabaco. Las guías para la implementación de este artículo reconocen que la presencia de tabaco en el cine es una forma de promoción de los productos del tabaco dirigida principalmente a los jóvenes. En esta revisión describimos la relación entre la industria del cine y la del tabaco en los últimos 100 años, los estudios de corte transversal y longitudinales que demuestran cómo la exposición a tabaco en el cine induce a los jóvenes a iniciarse en el tabaquismo, y las políticas públicas recomendadas para evitar la presencia de tabaco en el cine, al menos en las películas para niños y adolescentes.

Tobacco use is the primary preventable cause of death and disability in the world. To combat the tobacco epidemic, most countries have signed and ratified the World Health Organzation’s Framework Convention on Tobacco Control (WHO FCTC). Article 13 of this treaty requires implementation of a comprehensive ban on tobacco advertising, promotion and sponsorship. Implementation guidelines for Article 13 recognize that the depiction of tobacco use in commercially-produced films promotes tobacco use amongst young people. In this article we review the relationship between the tobacco industry and the movie industry over the past 100 years; the cross sectional and longitudinal studies that demonstrate a causal relationship between exposure to movie smoking depictions and youth smoking initiation; and the policy interventions recommended by the WHO to limit youth exposure to tobacco in movies.

Psychometric Validation of the Short Form of the Smoking Consequences Questionnaire (S-SCQ) for Brazil / Validação Psicométrica do Short Form of the Smoking Consequences Questionnaire (S-SCQ) a um contexto brasileiro

Abstract Smoking accounts for 24% of deaths in the general population and is also the factor that explains the biggest amount of years of life lost. It is important to understand the expectations regarding smoking behavior. The present study aimed to validate the Short Form of the Smoking Consequences Questionnaire (S-SCQ) for a Brazilian version. The Researchers did the process of semantic adaptation to language and national context. The S-SCQ was applied in a sample of 129 people. The next step was to perform psychometric analyses for the set of 21 items. Exploratory Factor Analysis, with pairwise treatment for missing cases, was used to achieve construct validity. To carry out Factor Analysis, the method of Principal Component Analysis (PCA) was used initially. Afterwards, Principal Axis Factoring (PAF) using Varimax rotation with Kaiser normalization was applied. The reliability of the total scale (21 items) showed a Cronbach alpha index of 0.851 and a 0.870 Lambda2 of Gutmann. Quite satisfactory rates were also observed in the subscales. Similarly, the item-overall correlation values also confirmed the scale's good reliability indices.

Resumo Fumar representa 24% das mortes na população geral, sendo o fator que explica o maior número de anos de vida perdidos. É importante compreender as expectativas relacionadas ao comportamento de fumar. O presente estudo teve por objetivo validar o instrumento Short Form of the Smoking Consequences Questionnaire (S-SCQ) para uma versão brasileira. Após o processo de adaptação semântica para o idioma e o contexto nacional, o S-SCQ foi aplicado numa amostra de 129 pessoas. No passo seguinte, foram realizadas análises psicométricas para o conjunto de 21 itens. Os dados foram submetidos à prova de validade de construto por meio de Análise Fatorial Exploratória, com tratamento "pairwise" para casos omissos. Para proceder a Análise Fatorial se utilizou inicialmente o método da Análise dos Componentes Principais (ACP). Após, foi feita a Fatoração dos Eixos Principais (FEP) utilizando rotação Varimax com normalização de Kaiser. A fidedignidade da escala total (com 21 itens) apresentou índice alfa de Cronbach 0,851 e Lambda 2 de Gutmann 0,870. Índices bastante satisfatórios foram observados também nas subescalas. No mesmo sentido, os valores de correlação item-total também confirmaram os bons índices de fidedignidade da escala.

Problemas de comportamento internalizantes e externalizantes e uso de substâncias na adolescência / Internalizing and externalizing behavior problems and substance use in adolescence / Problemas de comportamiento internalizantes y externalizantes y consumo de sustancias en la adolescencia

Este estudo investigou a relação entre problemas de comportamento externalizantes (PCE), internalizantes (PCI) e desses concomitantemente (PCEI) no início da adolescência (11 anos) e o consumo de substâncias (bebidas alcoólicas, tabaco e drogas ilícitas) aos 15 anos, utilizando dados da coorte de nascimentos de Pelotas, Rio Grande do Sul, Brasil, de 1993. Os problemas de comportamento foram avaliados pelo Strengths and Difficulties Questionnaire (SDQ) aplicado às mães quando os filhos tinham 15 anos. O consumo de substâncias foi avaliado por meio de questionário sigiloso autoaplicado ao adolescente. A associação entre problemas de comportamento e uso de substâncias foi analisada por meio de regressão de Poisson com ajuste robusto da variância. Após ajuste para fatores de confusão, os adolescentes com PCE tiveram maior risco para consumo abusivo de álcool (RR = 1,74; IC95%: 1,21; 2,50) e para experimentação (RR = 1,78; IC95%: 1,42; 2,23) e uso de tabaco nos últimos 30 dias (RR = 2,38; IC95%: 1,64; 3,45). Os adolescentes com PCI tiveram maior risco de experimentar tabaco (RR = 1,54; IC95%: 1,22; 1,93) e de utilizá-lo nos últimos 30 dias (RR = 1,92; IC95%: 1,31; 2,83). Os adolescentes com PCEI apresentaram maior risco para experimentação (RR = 2,24; IC95%: 1,57; 3,21) e consumo de tabaco nos últimos 30 dias (RR = 3,01; IC95%: 1,63; 5,56), e menor risco de experimentação de álcool aos 15 anos (RR = 0,72; IC95%: 0,55; 0,94). Ações de saúde pública que atuem na redução dos problemas de comportamento no início da adolescência poderão diminuir o consumo de tabaco e de bebidas alcoólicas aos 15 anos.

This study investigated the relationship between externalizing behavior problems (EBP), internalizing behavior problems (IBP), and combined externalizing/internalizing behavior problems (EIBP) in early adolescence (11 years) and substance use (alcohol, tobacco, and illegal drugs) at 15 years, using data from the 1993 Pelotas (Brazil) birth cohort. Behavior problems were assessed with the Strengths and Difficulties Questionnaire (SDQ), applied to mothers when their children were 15 years old. Substance use was assessed with a self-applied confidential questionnaire for the adolescent. The association between behavior problems and substance use was analyzed with Poisson regression with robust adjustment of variance. After adjusting for confounding, adolescents with EBP showed higher risk of alcohol abuse (RR = 1.74, 95%CI: 1.21; 2.50) and experimentation (RR = 1.78, 95%CI: 1.42; 2,23) and tobacco use in the previous 30 days (RR = 2.38, 95%CI: 1.64; 3.45). Adolescents with IBP showed greater risk of having tried tobacco (RR = 1.54, 95%CI: 1.22; 1.93) and of having used tobacco products in the previous 30 days (RR = 1.92, 95%CI: 1.31; 2.83). Adolescents with EIBP showed greater risk of trying (RR = 2.24, 95%CI: 1.57; 3.21) and consuming tobacco products in the previous days (RR = 3.01, 95%CI: 1.63; 5.56), and lower risk of having tried alcohol at 15 years of age (RR = 0.72, 95%CI: 0.55; 0.94). Public health measures aimed at reducing behavior problems in early adolescence can help reduce tobacco and alcohol consumption at 15 years.

Este estudio investigó la relación entre los problemas de comportamiento externalizantes (PCE), internalizantes (PCI), y los que se producían concomitantemente (PCEI), al comienzo de la adolescencia (11 años) y el consumo de sustancias como: bebidas alcohólicas, tabaco y drogas ilícitas a los 15 años, utilizando datos de la cohorte de nacimientos de Pelotas, Brasil, de 1993. Los problemas de comportamiento fueron evaluados por el Strengths and Difficulties Questionnaire (SDQ), aplicado a las madres cuando los hijos tenían 15 años. El consumo de sustancias se evaluó mediante un cuestionario anónimo, realizado por el propio adolescente. La asociación entre problemas de comportamiento y el uso de sustancias se analizó mediante la regresión de Poisson, con un ajuste robusto de variancia. Tras el ajuste para los factores de confusión, los adolescentes con PCE tuvieron un riesgo mayor de consumo abusivo de alcohol (RR = 1,74; IC95%: 1,21; 2,50) y de probar estas sustancias (RR = 1,78; IC95%: 1,42; 2,23), además del consumo de tabaco en los últimos 30 días (RR = 2,38; IC95%: 1,64; 3,45). Los adolescentes con PCI tuvieron un mayor riesgo de probar el tabaco (RR = 1,54; IC95%: 1,22; 1,93) y de consumirlo durante los últimos 30 días (RR = 1,92; IC95%: 1,31; 2,83). Los adolescentes con PCEI presentaron un mayor riesgo de probar estas sustancias (RR = 2,24; IC95%: 1,57; 3,21) y consumir tabaco durante los últimos 30 días (RR = 3,01; IC95%: 1,63; 5,56), y menor riesgo de probar el alcohol a los 15 años (RR = 0,72; IC95%: 0,55; 0,94). Se requieren acciones de salud pública que actúen en la reducción de los problemas de comportamiento al principio de la adolescencia, puesto que podrían disminuir el consumo de tabaco y bebidas alcohólicas a los 15 años.

Smoking among adolescents is associated with their own characteristics and with parental smoking: cross-sectional study

ABSTRACT BACKGROUND: This study aimed to analyze the association between smoking during adolescence and the characteristics of smoking and alcohol consumption among their parents. DESIGN AND SETTING: Cross-sectional study in Londrina (PR), Brazil. METHODS: The subjects comprised 1,231 adolescents aged 14-17 years. The adolescents and their parents answered a self-report questionnaire that asked for sociodemographic information and data on smoking and alcohol consumption. Multiple logistic regression models were used to analyze associations between smoking among adolescents and their characteristics (age, sex, period of the day for attending school, alcohol consumption and socioeconomic level) and their parents' characteristics (smoking, alcohol consumption, age and education level), adjusted according to the adolescents' characteristics (sex, age and socioeconomic level). RESULTS: The prevalence of smoking among adolescents was 3.4% (95% confidence interval, CI: 2.4-4.4). Adolescents whose mothers or fathers were smokers were 2.0 and 2.5 times more likely to be smokers, respectively. The prevalence of smoking among adolescents with a smoking mother was 7.1% (95% CI: 2.6-10.7) and a smoking father, 5.4% (95% CI: 1.6-8.5). There were significant associations between smoking adolescents and age [5.2% (95% CI: 3.3-6.6)], studying at night [9.6% (95% CI: 4.0-15.5)] and alcohol consumption [69.0% (95% CI: 55.0-83.0)]. It was observed that the number of alcoholic beverage doses consumed was higher among smoking adolescents (P = 0.001). CONCLUSION: Adolescent smoking was associated with smoking by their parents, regardless of the gender of the parents or adolescents. Age, alcohol consumption and studying at night are characteristics of adolescents that can contribute towards smoking.

Tabaquismo en pacientes con diagnóstico psiquiátrico / Smoking in patients with psychiatric diagnosis

Resumen El tabaquismo es un problema altamente prevalente en la población de pacientes con diagnóstico psiquiátrico. El uso de tabaco dentro de ellos se asocia a mortalidad, gravedad de los síntomas psiquiátricos e interacción con los medicamentos. La presencia de síntomas psiquiátricos aumenta la posibilidad de usar tabaco, pero a la vez los equipos de salud mental han incentivado históricamente el uso de esta sustancia. Por otra parte, el uso de tabaco se asocia a mayor riesgo de síntomas psiquiátricos. Los tratamientos farmacológicos disponibles para cesar el hábito tabáquico han probado ser seguros y efectivos en pacientes con diagnóstico psiquiátrico estables.

Smoking is a highly prevalent problem in the psychiatric population. Tobacco use within them is associated with higher mortality, severity of psychiatric symptoms and also interacts with medications. The presence of psychiatric symptoms increases the possibility of using tobacco, but also the mental health teams have historically encouraged the use of this substance. In addition, tobacco use is associated with a higher risk of psychiatric symptoms. Pharmacological treatments available for smoking cessation have proven to be safe and effective in stable psychiatric patients.

Tabaquismo en el adolescente / Adolescents and smoking

Resumen El tabaquismo en adolescentes produce adicción a la nicotina, daño en el aparato cardiorrespiratorio, siendo además puerta de entrada para el uso de drogas ilícitas. En Estados Unidos, los cigarrillos electrónicos son más frecuentemente utilizados por los jóvenes que el cigarrillo convencional, creyendo que son menos dañinos para la salud, sin embargo, se sabe que estos dispositivos producen combustión y entregan nicotina por vía inhalada por lo que su uso lleva al consumo de cigarrillo tradicional y a la exposición a sustancias cancerígenas. Por todo lo anterior, los esfuerzos del control del tabaco deben estar puestos: en políticas públicas (aumento del impuesto al tabaco, campañas publicitarias masivas, ambientes cerrados libres de humo, restricción de la publicidad), la pesquisa precoz y tratamiento oportuno del adolescente que ya se ha iniciado en el consumo de tabaco a través del ABC-D tal como aparece en las Primeras Guías de Práctica Clínica de Tratamiento del Tabaquismo, Chile, 2017 para esto se necesita que los profesionales de salud reciban entrenamiento. Respecto al humo de segunda mano los pediatras deben derivar a los padres a cesación del tabaco que puede ser telefónica (6003607777, Salud responde MINSAL, este número aparece en las cajetillas de cigarrillos).

Smoking in adolescents produces addiction to nicotine, damage to the cardiorespiratory apparatus, and it is also a gateway to the use of illicit drugs. In the United States, electronic cigarettes are more frequently used by young people than conventional cigarettes, believing that they are less harmful to health, however, it is known that these devices produce combustion and deliver nicotine inhaled so their use leads traditional cigarette consumption and exposure to carcinogenic substances. For all of the above, tobacco control efforts must be: public policies (tobacco tax increases, mass advertising campaigns, smoke-free environments, restriction of advertising), early register and timely treatment of adolescents who have initiated tobacco consumption through the ABC-D as it appears in the First Guidelines of Clinical Practice of Smoking Treatment, Chile 2017, for this it is necessary that the health professionals receive training. Regarding second-hand smoke, pediatricians must refer parents to smoking cessation that can be telephone (6003607777, Salud Responde MINSAL, this number appears on cigarette packets).