Um panorama do tabagismo em 16 capitais brasileiras e Distrito Federal: tendências e heterogeneidades

Abstract

This Thesis includes two papers that aim at describing tobacco use trends and heterogeneity in Brazilian regions and capitals. These data, in turn, aim at supporting tobacco control plan and evaluation. Data from two household surveys The Health and Nutrition National Survey (PNSN) and the Non-Communicable Disease and Self-Perceived Domiciliary Survey (InqDANT) - were used in this study. The first paper s objective is to estimate the differences in tobacco use prevalence in Brazilian capitals between 1989 and 2002/2003, and their relationships to tobacco control actions during this period. The percentage of current smokers decreased from 30.2% to 19.4% from 1989 to 2002/2003. The prevalence changed from 37.5% to 23.2% (1.1% /year) in men and from 24.3% to 16.5% (0.6 % /year) in women. The timing of the principal public health actions related to smoking suggests that the declines were the result of the combined effects of cigarette package warning labels, tobacco products advertisement restriction and ban, and restriction of environmental tobacco smoke exposure in public places. The decline in smoking prevalence observed in the present study was one of the highest of the world. On the second paper, we described tobacco use in Brazil and its heterogeneity by region and other characteristics. The study included 24.681 participants selected through a multi-stage sampling strategy of individuals 15 years old or older living in 16 capitals and in the Federal District. The prevalence of smoking was greater in men than in women in all cities. The smoking prevalence ranged from 17.0% to 28.2% in men, and from 10% to 22.9% in women. The highest prevalences in women were found in the South and Southeast regions, a pattern that was not observed in men. Regardless of gender, the highest prevalences of smoking were found in those with lower educational levels and those aged 40- 49 years. Cessation average was approximately 50% in both men and women. These results suggest that tobacco control public policies have been effective, particularly with regard to cessation strategies. However, the high smoking prevalence in the young individuals underscores the importance of reinforcing smoking initiation control measures. The heterogeneity observed in this survey highlights the necessity of tailoring control actions to the different regions. In addition to these two study reports, this Thesis also described possible new studies on tobacco use using InqDANT data. Finally, a description is also presented of important research areas to be developed in Brazil aiming at supporting the National Tobacco Control Program and the Framework Convention on Tobacco Control.