A venda de cigarros avulsos no Brasil entre 2008 e 2019: mais um motivo de preocupação? / The sale of single cigarettes in Brazil from 2008 to 2019: one more cause of concern? / La venta de cigarrillos sueltos en Brasil entre 2008 y 2019: ¿Una razón más de preocupación?

Resumo: No Brasil, a venda de cigarros é permitida apenas em embalagens fechadas com 20 unidades. Avaliou-se a evolução ao longo do tempo da proporção de fumantes adultos que adquiriram cigarros industrializados avulsos na última compra. Utilizaram-se os dados da Pesquisa Especial de Tabagismo conduzida em 2008 e da Pesquisa Nacional de Saúde conduzida em 2013 e 2019. Modelo linear generalizado foi usado para calcular as diferenças na proporção de compra de cigarros avulsos entre os anos das pesquisas, ajustadas por variáveis sociodemográficas e de comportamento de fumar. Considerando 2013 como ano de referência, as diferenças relativas entre as proporções foram, respectivamente, -15,3% (valor de p ajustado ≤ 0,05) na comparação com 2008, e +13,3 (valor de p ajustado = 0,08) na comparação com 2019. Cerca de 20% dos jovens adultos fumantes relataram comprar cigarro avulso em 2019 e a diferença na proporção de compra de cigarro avulso entre indivíduos de 18 a 24 anos e aqueles mais velhos provavelmente aumentou entre 2013 e 2019 (valor de p interação ajustado = 0,08). Há motivos de preocupação, pois o fortalecimento da política tributária entre 2008 e 2013 foi acompanhado de um aumento na proporção de compra de cigarros avulsos. Apesar da queda do preço real do maço de cigarros a partir de 2017, um contexto de baixa efetividade de implementação de outras medidas antitabagismo acentuou provavelmente a diferença da proporção de compra de cigarros avulsos entre jovens e adultos. A presença permanente do cigarro avulso como modalidade de aquisição contribui para que subgrupos populacionais mais vulneráveis do ponto de vista econômico se tornem e/ou permaneçam dependentes do comportamento de fumar.

Abstract: In Brazil, the sale of cigarettes is only allowed in closed packages with 20 units. The evolution over time of the proportion of adult smokers who purchased single manufactured cigarettes in their last purchase was evaluated. Data from the Global Adult Tobacco Survey conducted in 2008 and the Brazilian National Health Survey conducted in 2013 and 2019 were used. A generalized linear model was used to calculate the differences in the proportion of single cigarette purchases between the survey years, adjusted for sociodemographic and smoking behavior variables. Considering 2013 as the reference year, the relative differences in the proportions were, respectively, -15.3% (adjusted p-value ≤ 0.05) when compared to 2008, and +13.3 (adjusted p-value = 0.08) when compared to 2019. Approximately 20% of young adult smokers reported buying single cigarettes in 2019 and the difference in the proportion of single cigarette purchases between individuals aged 18 to 24 and those older likely increased from 2013 to 2019 (adjusted interaction p-value = 0.08). There are reasons for concern, as the strengthening of tax policy from 2008 to 2013 was accompanied by an increase in the proportion of purchases of single cigarettes. Despite the decrease in the real price of cigarette packs from 2017, a context of low effectiveness of implementation of other anti-smoking measures likely accentuated the difference in the proportion of purchase of single cigarettes between young people and adults. The continued presence of single cigarettes as a mode of acquisition contributes to economically vulnerable population subgroups becoming and/or remaining dependent on smoking behavior.

Resumen: En Brasil, la venta de cigarrillos está permitida solo en paquetes cerrados que llevan veinte unidades cada. Se evaluó la evolución a lo largo del tiempo de la proporción de fumadores adultos que adquirieron cigarrillos industrializados sueltos en la última compra. Se utilizaron los datos de la Encuesta Especial de Tabaquismo realizada en 2008 y de la Encuesta Nacional de Salud realizada en 2013 y 2019. Se utilizó un modelo lineal generalizado para calcular las diferencias en la proporción de compra de cigarrillos sueltos entre los años de las encuestas, ajustada por variables sociodemográficas y de comportamiento de fumar. Considerando 2013 como año de referencia, las diferencias relativas entre las proporciones fueron, respectivamente, -15,3% (valor de p ajustado ≤ 0,05) en comparación con 2008, y +13,3 (valor de p ajustado = 0,08) en comparación con 2019. Cerca del 20% de los fumadores jóvenes adultos informaron haber comprado cigarrillos sueltos en 2019, y es probable que la diferencia en la proporción de la compra de cigarrillos sueltos entre indivíduos de 18 y 24 años y aquellos más adultos haya aumentado entre 2013 y 2019 (valor de p de interacción ajustado = 0,08). Hay motivos de preocupación, ya que el fortalecimiento de la política fiscal entre 2008 y 2013 estuvo acompañado de un aumento en la proporción de compra de cigarrillos sueltos. Aunque el precio real del paquete de cigarrillos a partir de 2017, un contexto de baja efectividad en la implementación de otras medidas contra el tabaquismo probablemente acentuó la diferencia en la proporción de compra de cigarrillos sueltos entre jóvenes y adultos. La presencia continua de cigarrillos sueltos como modalidad de adquisición contribuye a que los subgrupos de la población económicamente más vulnerables se vuelvan y/o permanezcan dependientes del comportamiento de fumar.

Genetic variability in the neurobiology of nicotine dependence: effects on smoking behavior / A variabilidade genética na neurobiologia da adição à nicotina: reflexos no comportamento tabágico

Abstract Background Smoking dependence is a chronic disease and a public health problem. The neurobiology of nicotine addiction can explain smoking behavior. This system has genetic variability that has been associated with vulnerability to dependence. Genetic variability in the neurobiology of smoking can help to understand why individuals exposed to drugs may or may not become addicted. Objective This study aims to address genetic variability in the neurobiology of smoking addiction with a focus on polymorphic genes related to the nicotinic response and the dopaminergic reward pathway. Method This work involved a search of the main scientific research on genetic variability in the neurobiology of smoking and its effects on smoking behavior. One hundred and five studies were selected, most of which highlighted polymorphisms in the genes of nicotinic receptors, dopamine receptors, and nicotine metabolism. Results The majority of studies have focused on genes related to the activation of the dopaminergic reward system by nicotine. Combinations between different polymorphisms were also highlighted, showing that interactions can determine a genetic profile of predisposition to smoking addiction. Additionally, gender and ethnicity were identified as relevant factors. Conclusion Knowledge of the genetic bases involved in the individual response to smoking can enable a better understanding of inter-individual differences in smoking behavior, and contribute to improving the treatment of addiction.

Resumo Introdução A dependência nicotínica é uma doença crônica e um problema de saúde pública. O comportamento tabágico pode ser explicado pela neurobiologia da adição, cujas variações genéticas têm sido associadas à dependência. A variabilidade genética na neurobiologia do tabagismo pode ajudar a entender por que indivíduos expostos a drogas podem ou não se tornar viciados. Objetivo Este estudo tem como objetivo abordar a variabilidade genética na neurobiologia do tabagismo com foco em genes polimórficos relacionados à resposta nicotínica e à via de recompensa dopaminérgica. Método Uma pesquisa foi realizada nas principais bases de dados científicos sobre a variabilidade genética na neurobiologia do tabagismo e seus efeitos no comportamento do tabagismo. 105 estudos foram selecionados, em sua maioria destacando polimorfismos nos genes de receptores nicotínicos, receptores de dopamina e de metabolismo da nicotina. Resultados A maioria dos estudos concentrou-se em genes relacionados à ativação do sistema de recompensa dopaminérgico pela nicotina. Determinadas combinações entre genótipos de diferentes polimorfismos também se destacaram, mostrando que interações gênicas podem determinar um perfil genético de predisposição ao tabagismo. Além disso, gênero e etnia foram identificados como fatores relevantes. Conclusão O conhecimento das bases genéticas envolvidas na resposta individual ao tabagismo pode permitir uma melhor compreensão das diferenças interindividuais no comportamento tabágico e contribuir para melhoria dos tratamentos disponíveis para a dependência.

Recognition models of cigarette smoking behavior by real-time indoor PM2.5 concentrations in public places / 环境与职业医学

Background Public places are frequently polluted by cigarette smoking, and there is a lack of accurate, real-time, and intelligent monitoring technology to identify smoking behavior. It is necessary to develop a tool to identify cigarette smoking behavior in public places for more efficient control of cigarette smoking and better indoor air quality. Objective To construct a model for recognizing cigarette smoking behavior based on real-time indoor concentrations of PM2.5 in public places. Methods Real-time indoor PM2.5 concentrations were measured for at least 7 continuous days in 10 arbitrarily selected places (6 public service providers and and 4 office or other places) from Oct. to Nov. 2022 in Pudong New Area, Shanghai. Indoor nicotine concentrations were monitored with passive samplers simultaneously. Outdoor PM2.5 concentration data were obtained from three municipal environmental monitoring stations which were nearest to each monitoring point during the same period. Mann-Whitney U test was used to compare indoor and outdoor means of PM2.5 concentrations, and Spearman rank correlation was used to analyze indoor PM2.5 and nicotine concentrations. An interactive plot and a random forest model was applied to examine the association between video observation validated indoor smoking behavior and real-time indoor PM2.5 concentrations in an Internet cafe. Results The average indoor PM2.5 concentration in the places providing public services [(97.5±149.3) µg·m−3] was significantly higher than that in office and other places [(19.8±12.2) µg·m−3] (P=0.011). The indoor/outdoor ratio (I/O ratio) of PM2.5 concentration in the public service providers ranged from 1.1 to 19.0. Furthermore, the indoor PM2.5 concentrations in the 10 public places were significantly correlated with the nicotine concentrations (rs=0.969, P<0.001). Among them, the top 3 highly polluted places were Internet cafes, chess and card rooms, and KTV. The results of random forest modeling showed that, for synchronous real-time PM2.5 concentration, the area under the curve (AUC) was 0.66, while for PM2.5 concentration at a lag of 4 min after the incidence of smoking behavior, the AUC increased to 0.72. Conclusion The indoor PM2.5 concentrations in public places are highly correlated with smoking behavior. Based on real-time indoor PM2.5 monitoring, a preliminary recognition model for smoking behavior is constructed with acceptable accuracy, indicating its potential values applied in smoking control and management in public places.

Fatores individuais e contextuais associados ao tabagismo em adultos jovens brasileiros / Individual and contextual factors associated with smoking among young Brazilian adults

Resumo Aos jovens é atribuída especial atenção no que tange ao tabagismo por se tratar de um período da vida em que o uso dessa e outras substâncias geralmente inicia e se consolida. Não há estudos sobre fatores de risco associados aos adultos jovens, com amostra representativa do Brasil e que consideram aspectos individuais e contextuais. O objetivo foi identificar fatores associados ao tabagismo em adultos jovens brasileiros de 18 a 24 anos, considerando a influência conjunta de fatores individuais e contextual avaliado por meio do Índice de Desenvolvimento Humano Municipal (IDHM). Estudo transversal, de base populacional, que utilizou dados da Pesquisa Nacional de Saúde de 2019. Por meio do modelo multinível de Poisson com variâncias robustas para estimação da Razão de Prevalência, foram analisadas variáveis individuais, e como variável contextual, o IDHM em cada Unidade Federativa. Além de fatores individuais, o IDHM também se mostrou associado ao tabagismo dos jovens, com aumento da prevalência de consumo de tabaco entre os jovens à medida que se aumenta o IDHM do estado (p<0,001), indicando que residir em UF com melhores condições socioeconômicas segundo o IDHM está associado a maior probabilidade de o jovem fumar se comparados com aqueles que residem nos demais estados.

Abstract Young people receive special attention regarding smoking as it is a period of life in which the use of this and other substances generally starts and is consolidated. There are no studies on risk factors associated with young adults with a representative sample from Brazil that take into consideration individual and contextual aspects. The objective was to identify factors associated with smoking among young Brazilian adults aged 18 to 24 years, considering the combined influence of individual and contextual factors assessed through the Municipal Human Development Index (MHDI). It involved a cross-sectional, population-based study that used data from the 2019 National Health Survey. Using the Poisson multilevel model with robust variance for estimating the Prevalence Ratio, individual variables were analyzed, and the MHDI as a contextual variable in each Federative Unit. In addition to individual factors, the MHDI was also associated with smoking among young people, with an increase in the prevalence of tobacco consumption among young people as the state's MHDI increases (p<0.001), indicating that living in a state with better conditions according to the MHDI, socioeconomic status is associated with a higher probability of young people smoking when compared to those residing in other states.

Study on the relationship between smoking behavior and health literacy among grade 4-6 primary students in Shandong province / 中华流行病学杂志

Objective@#To investigate the associations between smoking and literacy on health among 4-6 grade primary school students.@*Methods@#A questionnaire survey was conducted to research on health literacy and smoking among 4-6 grade pupils in Shandong province, through a multi-stage stratified cluster random sampling method. Sociodemographic characteristics, health literacy level and smoking rate were collected from respondents. Binary logistic regression analysis was used to evaluate the association of smoking and health literacy.@*Results@#A total of 9 240 questionnaires were distributed, with the rate of valid response as 99.7%. The current smoking rate of the students was 2.6%, on higher in boys (3.1%) than in girls (2.0%). 60.8% of 4-6 grade students were found to have adequate health literacy level. Levels of literacy health in both boy and girl school students appeared 56.7% and 64.9%, respectively. Results indicated that health literacy in smokers (14.4%) was lower than that in non-smokers (62.0%). Results from the binary logistic regression analysis showed that the independent influencing factors would include grade, father’s education level, economic situation of the family, self-assessment on the school record and literacy on health (P<0.01). After controlling the other independent variables, the smoking rate was 8.62 (1/0.116) times in students with low literacy level on health, than those with high literacy level.@*Conclusions@#Literacy on health was significantly associated with smoking in the 4-6 grade pupils of Shandong province.

Comportamiento del tabaquismo en los adolescentes del Reparto Fructuoso Rodríguez, Cárdenas / Behavior of smoking in teenagers of the Fructuoso Rodriguez Neighborhood. Cardenas

Introducción: la Organización Mundial de la Salud reporta al tabaquismo como la principal causa prevenible de enfermedad, discapacidad y muerte prematura, y ha señalado que mueren aproximadamente 14 000 personas al día, por alguna de las enfermedades atribuibles a este. Objetivo: caracterizar el comportamiento del tabaquismo en adolescentes. Materiales y métodos: la investigación fue observacional, descriptiva, transversal, en un universo de 51 adolescentes de los consultorios 24, 25 y 26 del Policlínico Universitario “Héroes del Moncada”, de Cárdenas, que cumplieron los siguientes criterios de inclusión: tener edad comprendida entre 10 y 19 años, ser fumador activo, independientemente del tiempo con el hábito, la cantidad de cigarrillos que fume, y con consentimiento asistido por los padres de participar en el estudio durante el período de enero a junio de 2013. Resultados: el 11,4 % de los adolescentes son fumadores, y del sexo masculino 78,4 %. Predominó el grupo de 17 a 19 años, con un 58,8 %. El 92,2 % comenzó a fumar a los 12 años, el 56,9 % lo hace diariamente, y compran personalmente el cigarro en las tiendas el 43,8 %. Todos fuman públicamente, y en casa lo hace el 62,7 %. Conclusiones: predominaron los fumadores varones entre 17 y 19 años de edad. La mayoría de los adolescentes fuman diariamente en lugares públicos, compran personalmente los cigarros en las tiendas y comenzaron a fumar con más de 12 años de edad.

Background: the World Health Organization reports smoking as the main preventable cause of disease, disability and premature death, and has pointed out that around 14 000 persons per day die due to any of the diseases attributed to it. Aim: characterizing smoking behavior in teenagers. Material and Methods: the research was observational, descriptive, cross-sectional, in a universe of 51 teenagers belonging to the family physician consultations 24, 25 and 26 of the Teaching Policlinic “Heroes del Moncada”, of Cardenas, fulfilling the following inclusion criteria: aged 10-19 years, being active smokers without taking into account the time they have being smoking, the quantity of cigarettes they smoke, and having their relatives´ informed consent for participating in the research in the period from January to June 2013. Outcomes: 11.4 % of the teenagers were smokers, and 78.4 % were male. There it was a predominance of the 17-19 years-old group, for 58.8 %. 92.2 % of them began smoking at the age of 12, 56.9 percent smokes every day, and 43.8 % buys cigarettes in the stores by themselves. All of them smoke in public, and 62.7 % smokes at home. Conclusions: there it is a predominance of male teenagers aged 17-19 years. Most of the teenagers smoke every day in public places, buy personally cigarettes in the stores and began smoking when they were more than 12 years old.

Tobacco consumption and behavior of the smokers in Jiangxi province / 中华流行病学杂志

Objective To explore the behaviors of smokers as well as the tobacco consumption in Jiangxi province.Impact regarding the increases of tobacco retail price on the smoking behaviors among cigarette consumers was also studied.Data was provided for further development on measurements including legislation,taxing and increasing the retail price on tobacco.Methods 805 residents above 15 year-olds were chosen through random clustered sampling,and face to face interviewed,in Shangrao and Yichun of Jiangxi province.A chart was drawn to show the relationship between the change of smoking behavior and the increase of sales price of tobacco.Results The average rate of smoking was 27.08％ (46.62％ for males and 3.05％ for females).16.06％ (35/218) of the smokers had ever tried to quit smoking but failed.The years of smoking ranged from 1 year to 50 years,with 96.33％ of the smokers purchased cigarettes on their own.Price of the cigarette ranged from 15 to 30 RMB per package,and smokers usually spent on average 192 RMB which accounted 13％ of their monthly income,per month.According to the chart,if the cigarette price had a 50％ increase,it would lead to 45％ of the smokers reduce the number of cigarette consumption with another 5％ of the smokers attempt to quit smoking.If cigarette price had an increase by 2 times,50％ of the smokers would attempt to quit smoking.So the chart could be used to estimate the percentage of smokers' behavior change according to the increase of tobacco's sales price.Conclusion The cconomy burden of tobacco consumption among cigarette smokers was huge,suggesting that the Chinese smokers did need to change their smoking behavior.Chinese government should develop tobacco-related legislations and laws and set proper cigarette tax,hopefully this could reduce the number of smokers in a long run.

CYP2A6 gene polymorphisms impact to nicotine metabolism.

Nicotine is a major addictive compound in tobacco cigarette smoke. After being absorbed by the lung nicotine is rapidly metabolized and mainly inactivated to cotinine by hepatic cytochrome P450 2A6 (CYP2A6) enzyme. Genetic polymorphisms in CYP2A6 may play a role in smoking behavior and nicotine dependence. CYP2A6*1A is the wild type of the CYP2A6 gene which is associated with normal or extensive nicotine metabolism. In the CYP2A6 gene, several polymorphic alleles have been reported such as CYP2A6*4, CYP2A6*7, CYP2A6*9, and CYP2A6*10 which are related to decreasing nicotine metabolism activity. The variation of nicotine metabolism activity could alter nicotine plasma levels. Smokers need a certain level of nicotine in their brain and must smoke regularly because of nicotine’s short half-life; this increases the number of smoked cigarettes in extensive metabolizers. Meanwhile, in slow metabolizers, nicotine plasma level may increase and results in nicotine toxicity. This will eventually lower the risk of dependence.

Study on knowledge,attitude and behavior of smoking in college students / 中国基层医药

Objective To explore the current situation of knowledge,attitude and behavior of smoking among the college student.Methods 1855 subjects,who were randomly chosen from colleges,were investigated with the questionnaire and analyzed the recognition and behavior of smoking.Results 1700 valid questionnaire were reclaimed.(effective rate 91.6%).The awareness of harmful components in the cigarette,such as nicotine,Tar cigarettes,had no difference among different grades (P＞0.05),but the recognition about the nitrogen oxides,carbon monoxide and radioactivity in higher grades was higher than that of lowers(P＜0.01,).The rate of smoking was 21.1% in total,there was no significant difference among different grades (P＞0.05).Conclusion Although the level of awareness about the harmful components in the cigarette and its harmness to health was different among different grades.Health education should be enforced in college students.

A Study on Taxi Drivers' Smoking Behavior, Self-efficacy and Expectation Level of Success in Smoking Cessation

PURPOSE: The purpose of this study is to find taxi drivers' smoking behavior, self-efficacy and expectation level of success in smoking cessation. It will provide useful information for developing nursing interventions in health promotion programs. METHOD: The subjects of this study were 271 taxi drivers in Seoul and its metropolitan area. Data were collected using a self-reported questionnaire asking smoking history, smoking behaviors, health problem, stages of change for smoking cessation, self-efficacy and the expectation level of success in smoking cessation. Data were analyzed through descriptive statistics. Pearson's correlation, Mann-Whitney U test, Kruskal-Wallis test and Cronbach's a. RESULTS: Of the taxi drivers, 83.8% were current smokers. Stages of change were as follows: 45.8% were in the precontemplation stage, 26.2% in the contemplation stage, 13.7% in the maintenance stage, 12.2% in the preparation stage and 1.5% in the action stage. In addition. 20.3% of the subjects reported health problems such as hypertension, heart disease, diabetes mellitus and respiratory disease. The expectation level of success in smoking cessation was positively related with self-efficacy. There were statistically significant differences in the expectation level of success in smoking cessation according to the number of cigarettes per day and nicotine dependency. In addition. there were statistically significant differences in self-efficacy according to the number of cigarettes per day, duration of smoking (years) and nicotine dependency. CONCLUSION: The results of this study suggest that taxi drivers' health problems and smoking rate were serious. Therefore more systematic health promotion programs for smoking cessation should be developed and executed by health care specialists at individual taxi companies.

An Analysis on Attitudes of University Students in the Prediction of Smoking Behavior / 아동간호학회지

Cigarette smoking has been identified as the single most important source of preventable morbidity and mortality. Smoking behavior varies each individual, so individuality & subjectivity of smoking behavior must be specially focused upon to understand smoking behavior. The purpose of this study was to find attitudes of university students in the prediction of smoking behavior. Q-Methodological method was used as a research design and data were collected during the period from Jan. 1, 1997 to Feb. 28, 1998. As the research method, Q-statements were collected through in-depth interviews and a literature review. For the study 33 Q-statements were selected. There were 45 university students as subjects for the research. The 45 university students sorted the 33 statements using the principle of Forced Normal Distribution. The principle of Forced Normal Distribution, which has nine scales to measure the individual opinions, Pc Quanl program was used for analysis and Q-factors were analyzed by using principal component analysis. According to the results of this study, there were four categories of opinion about the smoking behavior in university students. The first type is seeking the habitual dependency: The second type is seeking the stress relief: The third type is seeking the active disapproval: The fourth type is seeking the self control. As a result, The meaning of the smoking behavior is affected by perceived subjective experience, so we need to understand each persons meaning of the smoking behavior and to develop appropriate nursing interventions based on the typology of smoking behavior. Finally, The result of the study will provide basic data for smoking prevention and cessation program.

The Importance of Parental Attitudes and Behavior upon Adolescent Smoking Behavior / 성인간호학회지

The purpose of this study was to find out the relationships between parental attitudes about smoking and parental smoking behavior as factors associated with adolescent's smoking behavior. Data were collected from Nov 20, 1997 to Feb 30, 1998 from 295 male high school students located in the Kyung Gi Do Province. Specific questions for adolescents concerning their parent's attitudes about their smoking, parental smoking behavior and the youth smoking behavior were included. Data were analyzed using a SPSS/PC program for the descriptive and chi-square statistics. Results indicated that parental attitudes are significantly associated with adolescents' smoking, both in behavior and amount smoked. Whereas parental behavior showed difference in means of adolescent's smoking behavior and smoking amount. In conclusion, parental attitudes toward adolescent smoking have a significantly greater effect on both the behavior and on the amount smoked than does parental antismoking educational efforts may find it helpful to include this factor.