ERICA: prevalência de tabagismo em adolescentes brasileiros

OBJECTIVE To estimate the prevalences of tobacco use, tobacco experimentation, and frequent smoking among Brazilian adolescents. METHODS We evaluated participants of the cross-sectional, nation-wide, school-based Study of Cardiovascular Risks in Adolescents (ERICA), which included 12- to 17-year-old adolescents from municipalities of over 100 thousand inhabitants. The study sample had a clustered, stratified design and was representative of the whole country, its geographical regions, and all 27 state capitals. The information was obtained with self-administered questionnaires. Tobacco experimentation was defined as having tried cigarettes at least once in life. Adolescents who had smoked on at least one day over the previous 30 days were considered current cigarette smokers. Having smoked cigarettes for at least seven consecutive days was an indicator for regular consumption of tobacco. Considering the complex sampling design, prevalences and 95% confidence intervals were estimated according to sociodemographic and socio-environmental characteristics. RESULTS We evaluated 74,589 adolescents. Among these, 18.5% (95%CI 17.7-19.4) had smoked at least once in life, 5.7% (95%CI 5.3-6.2) smoked at the time of the research, and 2.5% (95%CI 2.2-2.8) smoked often. Adolescents aged 15 to 17 years had higher prevalences for all indicators than those aged 12 to 14 years. The prevalences did not differ significantly between sexes. The highest prevalences were found in the South region and the lowest ones, in the Northeast region. Regardless of sex, the prevalences were found to be higher for adolescents who had had paid jobs, who lived with only one parent, and who reported having been in contact with smokers either inside or outside their homes. Female public school adolescents were found to smoke more than the ones from private schools. CONCLUSIONS Tobacco use among adolescents is still a challenge. Intending to reduce the prevalence of tobacco use among young people, especially the ones under socioeconomic vulnerability conditions, Brazil must consolidate and increase effective public health care measures.OBJETIVO Estimar as prevalências de tabagismo, experimentação e fumo frequente em adolescentes brasileiros. MÉTODOS Foram avaliados os participantes do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA), estudo transversal de base escolar e abrangência nacional. Participaram adolescentes de 12 a 17 anos de municípios com mais de 100 mil habitantes. A amostra foi estratificada e conglomerada e tem representatividade nacional, regional e para as 27 capitais. As informações foram obtidas usando-se questionário autopreenchível. Experimentação foi definida como: ter experimentado cigarros alguma vez na vida. Foram considerados fumantes atuais de cigarros aqueles que fumaram pelo menos um dia nos últimos 30 dias. Utilizou-se como indicador de uso frequente de tabaco ter fumado cigarros por pelo menos sete dias seguidos. Considerando-se o desenho complexo da amostra, prevalências e intervalos de confiança de 95% foram estimados segundo características sociodemográficas e socioambientais. RESULTADOS Foram avaliados 74.589 adolescentes; dentre esses, 18,5% (IC95% 17,7-19,4) fumaram pelo menos uma vez na vida, 5,7% (IC95% 5,3-6,2) fumavam no momento da pesquisa e 2,5% (IC95% 2,2-2,8) fumavam com frequência. Adolescentes de 15 a 17 anos tiveram prevalências mais elevadas de todos os indicadores comparados aos de 12 a 14 anos. As prevalências não apresentaram diferenças significativas entre sexos. Maiores prevalências foram observadas na região Sul e menores na região Nordeste. Independentemente de sexo, as prevalências foram maiores para adolescentes que tinham tido trabalho remunerado, nos que não moravam com os dois pais e que referiram ter tido contato com fumante em casa ou fora. Adolescentes do sexo feminino de escolas públicas fumavam mais do que as de escolas privadas. CONCLUSÕES O tabagismo entre adolescentes ainda é um desafio. Visando a redução da prevalência de tabagismo entre jovens, em especial os que se encontram em situação de vulnerabilidade socioeconômica, o Brasil deve consolidar e ampliar medidas de saúde pública efetivas

How smokers may react to cigarette taxes and price increases in Brazil: data from a national survey

Background: Despite being the third largest tobacco producer in the world, Brazil has developed a comprehensive tobacco control policy that includes a broad restriction on both advertising and smoking in indoor public places, compulsory pictorial warning labels, and a menthol cigarette ban. However, tax and pricing policies have been developed slowly and only very recently were stronger measures implemented. This study investigated the expected responses of smokers to hypothetical price increases in Brazil.Methods: We analyzed smokers' responses to hypothetical future price increases according to sociodemographic characteristics and smoking conditions in a multistage sample of Brazilian current cigarette smokers aged >= 14 years (n = 500). Logistic regression analysis was used to examine the relationship between possible responses and different predictors.Results: in most subgroups investigated, smokers most frequently said they would react to a hypothetical price increase by taking up alternatives that might have a positive impact on health, i.e., they would try to stop smoking (52.3%) or smoke fewer cigarettes (46.8%). However, a considerable percentage responded that they would use alternatives that would reduce the effect of price increases, such as the same brand with lower cost (48.1%). After controlling for sex age group (14-19, 20-39, 40-59, and >= 60 years), schooling level (>= 9 versus 20 versus <= 20), and stage of change for smoking cessation (precontemplation, contemplation, and preparation), lower levels of dependence were positively associated with the response I would try to stop smoking (odds ratio [OR], 2.19). Young age was associated with I would decrease the number of cigarettes (OR, 3.44). A low schooling level was strongly associated with all responses.Conclusions: Taxes and prices increases have great potential to stimulate cessation or reduction of cigarette consumption further among two important vulnerable populations of smokers in Brazil: young smokers and those of low educational level. the results from the present study also suggest that seeking illegal products may reduce the impact of increased taxes, but does not eliminate it.National Anti-Drug Secretariat (SENAD)Universidade Federal de São Paulo, Dept Psychiat, Natl Inst Alcohol & Drug Policies INPAD, São Paulo, BrazilOswaldo Cruz Fdn Fiocruz, Natl Sch Publ Hlth, Ctr Studies Tobacco & Hlth, Rio de Janeiro, BrazilUT Southwestern Sch Hlth Profess, Dallas, TX USAUT Sch Publ Hlth, Dallas, TX USAUniv Nottingham, Div Epidemiol & Publ Hlth, UK Ctr Tobacco Control Studies, Nottingham NG7 2RD, EnglandUniversidade Federal de São Paulo, Dept Psychiat, Natl Inst Alcohol & Drug Policies INPAD, São Paulo, BrazilNational Anti-Drug Secretariat (SENAD): 017/2003Web of Scienc

Erratum to: The study of cardiovascular risk in adolescents – ERICA: rationale, design and sample characteristics of a national survey examining cardiovascular risk factor profile in Brazilian adolescents

1585

Use of flavored cigarettes in the first few puffs: a step toward smoking initiation and nicotine addiction? Data from a national survey among Brazilian adolescents

Background Little is known about the importance of flavored cigarettes for initiation among youth in Brazil, which has amongst the greatest number of smokers in the world. This study aimed at analyzing the relationship between trying to smoke mainly mentholated and flavored cigarettes and initiation and intensity of smoking among Brazilian students. Methods A cross-sectional school-based survey that included a multistage probability sample of 12-17 years old students was conducted in cities with more than 100,000 inhabitants, who participated in the Study of Cardiovascular Risks Among Adolescents in 2013-2014 (ERICA) (n=70,589). Data was collected using self-administered questionnaires. Logistic models regressed current smoking (last 30 days) and days smoking (6 ore more vs 5 or fewer) on preference for flavored cigarettes, adjusting for gender, age, skin color, type of school (public vs private), family structure (with vs without two parents), having a paid job, time since experimentation, and geographic region. Results Among the 18.5% of adolescents who ever tried cigarettes, 26.4% (95% confidence interval, CI 24.1, 28.9) of males and 28.8% (CI 26.4, 31.4) of females had flavored cigarettes as their first choice brand. Of the 5.7% who smoked in the past 30 days, flavored cigarettes were the first choice in 54.7% of males (CI 49.9, 59.4) and 60.6% (CI 55.6, 65.4) of females. In adjusted models, experimenters who preferred flavored cigarettes were more likely to have smoked in the past 30 days (adjusted Odds Ratio, adjOR = 1.62, CI 1.36; 1.92), and to smoke 6 or more days ( vs 1-5 days) in the past 30 days (adjOR = 1.37, CI 1.01; 1.86) than experimenters who preferred non-flavor cigarettes. Conclusions Preferences for flavored cigarettes among Brazilian adolescents is very high. Banning flavored cigarettes could reducing the palatability of cigarettes for youth and thereby reduce smoking initiation and prevalence