Determinantes de saúde mental e abuso de substâncias psicoativas associadas ao tabagismo. Estudo de caso controle / Determinants of mental health and abuse of psychoactive substances associated with tobacco use. A case-control study

Resumo O objetivo deste estudo foi estimar a força de associação entre tabagistas com variáveis referentes à saúde mental, à funcionalidade familiar e ao uso de outras substâncias psicoativas. Estudo caso-controle, observacional, desenvolvido nos meses de março a novembro de 2016. O campo de estudo foi um município no Centro-Oeste do país e constituiu-se por uma população de 646 indivíduos, sendo 323 casos. No modelo, o grupo caso compreendeu indivíduos com algum grau de dependência ao tabaco. O grupo controle envolveu indivíduos que não foram expostos ao tabaco. Em relação ao tempo de tabagismo, a média de exposição do grupo caso foi de 25,65 anos. No modelo de análise múltipla de regressão logística associaram-se positivamente cor de pele não branca (p = 0,002); anos de estudo ≤ 8 (p < 0,001); ter filhos (p < 0,001); trabalho informal (p = 0,024); não possuir plano de saúde (p < 0,001); elevada disfunção familiar (p = 0,007); AUDIT ≥ 8 (p < 0,001); depressão (p < 0,001); já ter usado droga ilícita na vida (p < 0,001); morar com outras pessoas (p = 0,003) e não possuir religião (p = 0,001). Este estudo reforça a vulnerabilidade dos fumantes investigados, ao associar variáveis correlacionadas ao âmbito da saúde mental, e inova ao discutir a influência das relações familiares na dependência nicotínica.

Abstract This study aimed to estimate the strength of association among smokers with variables regarding mental health, family functionality, and use of other psychoactive substances. This is a case-control observational study developed from March to November 2016. The study was conducted in a Brazilian Midwest municipality with 646 subjects, of which 323 were cases. In the model, the case group comprised subjects with a certain degree of tobacco dependence. The control group included subjects that were not exposed to tobacco. Concerning tobacco use time, the mean exposure of the case group was 25.65 years. In the multiple logistic regression analysis model the following were positively associated: non-white skin color (p = 0.002); years of study ≤ 8 (p < 0.001); having children (p < 0.001); informal work (p = 0.024); not having a health plan (p < 0.001); high family dysfunction (p = 0.007); AUDIT ≥ 8 (p < 0.001); depression (p < 0.001); having illicit drug in lifetime (p < 0.001); living with other people (p = 0.003) and no religion (p = 0.001). This study reinforces the vulnerability of smokers, associating variables correlated to the field of mental health, and innovates by discussing the influence of family relationships on nicotinic dependence.

Nursing approach to tobacco users in primary health care / Abordaje del enfermero a los fumadores en atención primaria de salud / Abordagem do enfermeiro aos usuários tabagistas na Atenção Primária à Saúde

ABSTRACT Objective: to understand the experience of nurses in the approach to tobacco users in primary health care services. Method: Qualitative, phenomenological research with 15 nurses who were interviewed between January and March 2017. Their speeches were analyzed and classified into categories. Results: the approach by nurses to tobacco users is performed in an individual and unsystematic manner and in operative groups in accordance with the principles of the cognitive-behavioral therapy. This is a complex approach due to issues related to users themselves and to human, material, and structural resources. The expectations of nurses include supporting smoking cessation and expanding the tobacco use prevention work in educational environments. Final considerations: this study points out that nurses need to use the nursing care systematization in coordination with the recommendations of policies aimed at tobacco use control to perform their role in the promotion, control, and reduction of health complications in tobacco users.

RESUMEN Objetivo: Comprender la experiencia del enfermero en el abordaje a los fumadores en atención primaria de salud. Método: Investigación cualitativa y fenomenológica con 15 enfermeros entrevistadas entre enero y marzo de 2017. Testimonios analizados y organizados en categorías. Resultados: El acercamiento de las enfermeras al fumador se realiza de forma individual y asistemática y en grupos operativos siguiendo los principios de la terapia cognitivo-conductual. Este enfoque es complejo debido a cuestiones relacionadas con el fumador y con los recursos humanos, materiales y estructurales. Las expectativas de las enfermeras incluyen apoyar la cesación tabáquica y expandir el trabajo de prevención del tabaquismo en entornos educativos. Consideraciones finales: Se señala la necesidad de que las enfermeras adecuen la sistematización de la atención de enfermería articulada a las recomendaciones de las políticas de control del tabaquismo, cumpliendo su rol en la promoción, control y reducción de los problemas de salud de los fumadores.

RESUMO Objetivo: compreender a experiência do enfermeiro na abordagem aos usuários tabagistas na Atenção Primária à Saúde. Método: pesquisa qualitativa, fenomenológica, com 15 enfermeiros entrevistados entre janeiro e março de 2017. Os depoimentos foram analisados e organizados em categorias. Resultados: a abordagem dos enfermeiros ao usuário tabagista é realizada de modo individual e assistemático e em grupos operativos seguindo os princípios da terapia cognitivo-comportamental. Essa abordagem é complexa por causa de questões relativas ao próprio usuário e aos recursos humanos, materiais e estruturais. As expectativas dos enfermeiros incluem apoiar a cessação do tabagismo e expandir o trabalho de prevenção do uso do tabaco em espaços educativos. Considerações finais: aponta-se a necessidade de o enfermeiro apropriar-se da sistematização da assistência de enfermagem articulada às recomendações das políticas voltadas para o controle do tabagismo, com vistas a cumprir seu papel na promoção, no controle e na diminuição dos agravos à saúde dos usuários tabagistas.

Evaluación emocional y actitudinal de advertencias sanitarias de tabaco en adultos y jóvenes de Argentina / Emotional and attitudinal evaluation of tobacco health warnings among youngsters and adults in Argentina

Resumen Objetivo Evaluar el impacto emocional y las respuestas cognitivas y actitudinales de las advertencias sanitarias, para evitar el consumo del tabaco. Material y métodos Se evaluaron 27 advertencias sanitarias de control del tabaco, procedentes de Argentina y de otros países, en 151 adolescentes y 168 adultos. Se aplicó un instrumento estandarizado para medir valencia y activación emocional y un cuestionario estructurado para la medición cognitivo-actitudinal. Se analizaron las correlaciones según edad y sexo, nivel de instrucción, condición de fumador, etapa de cambio en fumadores y susceptibilidad en adolescentes no fumadores. Resultados Se observó alta correlación entre las valoraciones cognitivo-actitudinales y las emocionales. Las advertencias basadas en imágenes cruentas y de sufrimiento generaron más respuestas actitudinales asociadas con el abandono y la prevención del consumo del tabaco. Conclusiones Se recomienda el uso de advertencias con altos niveles de activación emocional tanto para adultos como para adolescentes.

Abstract Objective To evaluate variables of tobacco health warnings associated with their emotional impact, the perception of smoking risks and the perceived effectiveness to avoid tobacco use. Materials and methods Teenagers (151) and adults (168) evaluated 27 tobacco health warnings selected from the sets used on tobacco packages in Argentina and in other countries. A standardized affective rating-scale system and a structured questionnaire measured respectively the emotional impact (hedonic valence and emotional arousal), and the cognitive-behavioral attributions. The correlation between emotional and cognitive-behavioral evaluations was analyzed by age, sex, education level, smoker status, stage of quitting and susceptibility of non-smokers teenagers. Results Strong significant correlations between cognitive-behavioral and emotional assessments were observed. The warnings depicting graphic images of tobacco-related injuries and suffering were considered more valuable for tobacco control, helping quitting and preventing initiation. Conclusions Using graphic images with high emotional arousal is recommended for both adults and teenagers.

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.

Association between body image dissatisfaction and depressive symptoms in adolescents

Objective: To determine the association between body image dissatisfaction (BID) and depressive symptoms in adolescents from a school in Lima, Peru. Methods: A cross-sectional study was performed through a census of 875 high-school students, aged 13 to 17 years, from a school in Lima. Participants completed a survey containing the Body Shape Questionnaire (BSQ) and the Patient Health Questionnaire-9 (PHQ-9). Data regarding demographics, alcohol and tobacco use, self-esteem, and family history of depression were also obtained. To identify associated factors, Poisson regression with robust variance was used. Prevalence ratios with 95% confidence intervals were calculated. Results: Of the 875 adolescents, 55.8% were male. The mean age was 14.1±1.5 years. Depressive symptoms were observed in 19.9% of participants. An association between BID and depressive symptoms was found. Alcohol and tobacco use were also associated with the outcome of interest. Conclusions: Teens who had BID were 3.7 times more likely to report depressive symptoms. Additionally, those who used tobacco or alcohol were 1.5 and 1.4 times more likely to have depressive symptoms, respectively. Further studies targeting other populations and using longitudinal designs are recommended.

Determinantes del mantenimiento del consumo de tabaco: extensión de la Teoría de la Conducta Planificada / Determinants of maintenance snuff consumption: extension of the Theory of Planned Behavior

El objetivo fundamental de este trabajo es explorar la importancia de las emociones positivas y negativas, la norma moral y la conducta pasada en la intención de mantener el consumo del tabaco más allá de la explicación dada por la Teoría de la Conducta Planificada. Se utilizó una muestra final de 202 estudiantes fumadores de la Universidad de Santiago de Compostela, con edades comprendidas entre 18 y 25 años. Los resultados muestran que las variables añadidas aumentan de forma significativa la capacidad explicativa del modelo (ΔR² = 20 %). Esto, junto con la relación que presentan estas variables con la intención conductual [emociones positivas (β = .23); norma moral (β = -.14); conducta pasada (β= .72)], es lo que hace que estas variables adquieran relevancia explicativa en el modelo y nos dote de herramientas necesarias para intervenir y ayudar a mejorar la salud de nuestros jóvenes.

The main objective of this paper is to explore the importance of positive and negative emotions, the moral norm and the past behavior in the intention of keeping the consumption of snuff beyond the explanation given by the Theory of Planned Behavior. A final sample of202 smokers students at the University of Santiago de Compostela, aged between 18 and 25 years was used. The results show that the added variables significantly increase the explanatory power of the model (ΔR² = 20%). This, together with the list presented by these variables with behavioral intention [positive emotions (β = .23); moral norm (β = -.14); past behavior (β = .72)], it is what makes these explanatory variables acquire relevance in the model and we dowry of tools needed to intervene and help improve the health of our young's.

Consumo de tabaco y su relación con el nivel de actividad física habitual y la condición física en adolescentes de la Región de Murcia (España) / Tobacco consumption and its relationship to the level of regular physical activity and physical fitness in adolescents from the region of Murcia (Spain)

El presente estudio investiga la relación del consumo de tabaco con los niveles de actividad física y condición física. Sobre una muestra de 533 adolescentes de la Región de Murcia (España), se aplicó un cuestionario para la obtención de datos relativos al consumo de tabaco, el International Physical Activity Questionnaire para conocer la actividad física y una batería de test para evaluar la condición física. El consumo de tabaco fue significativamente mayor en las mujeres (32,5%) que en los varones (25,7%). Tanto en varones como en mujeres, los niveles de actividad física se relacionaban de forma significativa con el consumo de tabaco (p<0,0005). De igual modo, en los test de condición física, los sujetos que consumían mostraban medias globales inferiores (4,26 varones y 4,54 mujeres) a las de aquellos que no consumían (5,77 varones y 6,71 mujeres). El consumo de tabaco se muestra relacionado con un menor nivel de actividad física y condición física en los adolescentes.

This study looks at the relationship between tobacco consumption and the physical activity and fitness levels of adolescents. In a sample of 533 adolescents, both a questionnaire to obtain information regarding tobacco consumption and the International Physical Activity Questionnaire for information on physical activity were implemented; a battery of tests to assess physical fitness were also applied. Tobacco consumption was significantly higher in females (32.5%) than in males (25.7%). Levels of physical activity in both males and females were significantly associated with tobacco consumption (p<0.0005). Moreover, subjects who consumed tobacco showed lower overall averages in physical fitness tests than those who did not (4.26 vs. 5.77 in males and 4.54 vs. 6.71 in females). Tobacco consumption is therefore shown to be related to lower levels of physical activity and physical fitness in adolescents.

Patients with multiple sclerosis do not necessarily consume more alcohol or tobacco than the general population / Pacientes com esclerose múltipla não necessariamente consomem mais álcool ou tabaco do que a população geral

Purpose Recent papers suggest that patients with multiple sclerosis (MS) are prone to alcohol misuse. This may be due to the combination of a lifelong and disabling disease with a psychiatric profile typical of MS. The objective of the present study was to assess these findings in a culturally different population of patients with MS.Method The present case-control transversal study assessed 168 patients with MS and 168 control subjects from Brazil.Results There were no evidence that patients with MS drank more alcohol or, smoked more than did controls. In fact, control subjects had a significantly higher alcohol consumption. The only trait associated to higher alcohol consumption was anxiety, both for patients and controls.Conclusion Unlike previous reports in the literature, patients with MS in our study did not drink or smoked more than a control population.

Propósito Artigos recentes sugerem que pacientes com esclerose múltipla (EM) tem tendência ao abuso de álcool. Isto poderia se dever à combinação de uma doença crônica e incapacitante e um perfil psiquiátrico típico da EM. O objetivo do presente estudo foi avaliar estes achados em uma população de pacientes com EM culturalmente diferente.Método O presente estudo caso-controle transversal avaliou 168 pacientes com EM e 168 controles, todos brasileiros.Resultados Não houve evidência que pacientes com EM usassem mais álcool ou tabaco do que os controles. Na verdade, os controles apresentavam um consumo significativamente maior de álcool. O único aspecto associado ao maior consumo de álcool foi a ansiedade, tanto para pacientes quanto para controles.Conclusão Ao contrário de outros dados da literatura, pacientes com EM neste nosso estudo não bebem ou fumam mais do que a população controle.

Substance use across adolescence: do gender and age matter? / Consumo de substâncias na adolescência: o género e a idade são importantes?

Many of the choices which impact in lifetime health, such as substance use, are made in adolescence. It becomes, therefore, important to know the factors associated to these behaviours in adolescence in different contexts of life. To analyze these factors, an explanatory model was developed using structural equation modeling. Data from 12.881 state school students from Portugal who participated in two waves of the Health Behaviours in School-aged Children (HBSC) / World Health Organization (WHO) survey were analyzed. The model fits well the data [CFI: .985; NNFI: .980; RMSEA: .018 (.017-.020); SRMR: .018]. For each of the dependent factors, the levels of variance ranged from 12% (tobacco use) to 47% (alcohol and illicit drugs use). Alcohol and tobacco present the strongest associations to illicit drugs use. Relationships with family, friends, classmates, and teachers were also associated with substance use, being this association mediated by certain factors, including psychological symptoms, well-being, and school satisfaction. Several non-invariant paths were obtained in gender and age comparisons. The results showed that substance use is associated with several factors and that social factors are mediated by personal factors. Results have also shown that gender and age are important factors on substance use.

Muitas das escolhas com impacto na saúde a longo prazo, como o consumo de substâncias, são feitas na adolescência. Torna-se pois importante conhecer os fatores associados a estes comportamentos em diferentes contextos de vida. Para analisar estes fatores, foi desenvolvido um modelo explicativo através da modelação de equações estruturais. Para este estudo foram analisados dados de 12881 alunos de escolas públicas participantes em duas recolhas do estudo HBSC/OMS. O modelo apresenta uma boa adequação [CFI:.985; NNFI:.980; RMSEA:.018 (.017-.020); SRMR:.018]. Para cada um dos fatores dependentes, os níveis de variância explicada variaram entre 12% (tabaco) e 47% (álcool e drogas ilícitas). Os consumos de álcool e tabaco apresentaram as associações mais fortes com o consumo de drogas ilícitas. As relações com a família, amigos, colegas e professores estão associadas ao consumo de substâncias, sendo esta associação mediada por vários fatores, nomeadamente sintomas psicológicos, bem-estar, e satisfação com a escola. Ligações não-invariantes foram obtidas nas comparações de género e idade. Os resultados mostraram que o consumo de substâncias está associado a vários fatores, e que o impacto dos fatores sociais é mediado por fatores pessoais. Os resultados mostraram ainda que o género e a idade são fatores importantes no consumo de substâncias.

Self-esteem and Life satisfaction: Implications for Adolescents Tobacco use.

Background: Adolescents are the most vulnerable population to initiate tobacco use. Aims: The aim of the study is to explore the level of life satisfaction & self esteem among adolescents with and without tobacco use. Methodology: The sample consisted of 76 tobacco users and 76 non- users in the age range of 16-19 years. Basic data sheet, Fagerstrom Test for Nicotine Dependence, Satisfaction with Life Scale and Rosenberg Self-Esteem Scale were used. Results and Conclusions: Tobacco users has low self esteem, low life satisfaction in comparison to non- users.It has implications in tobacco cessation program and community level tobacco prevention program for adolescents.

Tobacco Use Among Drug Dependent Patients in Treatment Setting.

Tobacco use is widely prevalent in substance using patients in treatment settings. Nearly three times as many individuals with alcohol and drug problems smoke cigarettes compared to the general population. In addition to addressing the primary drug of abuse, it is important to systematically assess characteristics and patterns of tobacco use and treat tobacco dependence in these patients as they are at high risk of mortality from tobacco related illnesses..Consecutive patients presenting to the Tobacco Cessation Clinic of a national level deaddiction centre were assessed in detail using a semi-structured proforma. Most were males(97.3%) and majority (61.8%) of patients belonged to the 21-40 yrs age group. Most were self employed and primary drug of abuse was heroin in 47 (42.3%) and alcohol in 44 (39.6%) subjects. 53 (47.7%)used smoking tobacco only, 16 (14.7%) used only smokeless tobacco and 40 (36%) used a combination of both. Majority of smokable tobacco use was in the form of bidi (69.4%). Majority of the subjects (56.7%) were in the contemplation stage of change whereas 36 (32.7%) of subjects had taken steps towards quitting the use of tobacco products and qualified for the action stage as per RTCQ. The majority of patients qualified for moderate [56 (50.9%) dependence] to high dependence [37 (33.3%)] as per FTND score. This has obvious treatment implications.