Lorna Bittencourt

Pictorial health warnings on cigarette packs and the impact on women

OBJECTIVE To analyze the association between the pictorial graphic health warnings on cigarette packs and their impact on intention to quit smoking among women. METHODS Population-based cross-sectional study among 265 women daily smokers in the State of Paraná in 2010. The sample size was calculated using cluster sampling. Participants were asked whether they had seen any pictorial graphic health warnings in the past 30 days, whether these warnings made them think about quitting, and intensity of these thoughts. The data was analyzed using logistic regression and the independent variables included age, educational attainment, whether they had children, whether they had attempted to quit smoking in the past 12 months, age of smoking initiation, number of cigarettes smoked per day, their town of residence, and how soon after waking do they smoke their first cigarette. RESULTS Participants (91.7%) reported seeing the pictorial graphic health warnings in the past 30 days. Women with elementary education or below and women with some/complete high school education were more likely to think about quitting smoking after seeing the pictorial graphic health warningsthan women with higher education (OR = 4.85; p = 0.0028 and OR = 2.91; p = 0.05), respectively). Women who attempted to quit smoking in the past 12 months were more likely to think about quitting than women who had not (OR = 2.49; p = 0.001). Quit attempts within the last 12 months were associated with intensity of these thoughts (OR = 2.2; p = 0.03). CONCLUSIONS Results show an association between pictorial graphic health warnings and intent to quit smoking among women with warnings having a greater impact among women with less education and who had attempted to quit smoking within the past year. Tobacco control strategies should be implemented across all groups of women regardless of their educational attainment.ABSTRACT OBJECTIVE: To analyze the association between the pictorial graphic health warnings on cigarette packs and their impact on intention to quit smoking among women. METHODS: Population-based cross-sectional study among 265 women daily smokers in the State of Parana in 2010. The sample size was calculated using cluster sampling. Participants were asked whether they had seen any pictorial graphic health warnings in the past 30 days, whether these warnings made them think about quitting, and intensity of these thoughts. The data was analyzed using logistic regression and the independent variables included age, educational attainment, whether they had children, whether they had attempted to quit smoking in the past 12 months, age of smoking initiation, number of cigarettes smoked per day, their town of residence, and how soon after waking do they smoke their first cigarette. RESULTS: Participants (91.7%) reported seeing the pictorial graphic health warnings in the past 30 days. Women with elementary education or below and women with some/complete high school education were more likely to think about quitting smoking after seeing the pictorial graphic health warningsthan women with higher education (OR = 4.85; p = 0.0028 and OR = 2.91; p = 0.05), respectively). Women who attempted to quit smoking in the past 12 months were more likely to think about quitting than women who had not (OR = 2.49; p = 0.001). Quit attempts within the last 12 months were associated with intensity of these thoughts (OR = 2.2; p = 0.03).

(Prevalence of tobacco use and associated factors among women in Parana State, Brazil)

This study aimed to estimate the prevalence of tobacco use and to describe the demographic profile of female smokers in Paraná State, Brazil. The study used a cross-sectional population-based design with cluster sampling (n = 2,153) of women 18 years or older in seven cities. Prevalence of smoking was 13.4%, ranging from 10% in Cascavel to 19% in Irati. According to multivariate analysis, city of residence, marital status, and schooling were significantly associated with tobacco use. Women in Irati (OR = 2.08; 95%CI: 1.22-3.54) were more likely to smoke than those in Cambé. Married women and widows were less likely to smoke (OR = 0.47; 95%CI: 0.30-0.73 and OR = 0.43; 95%CI: 0.22-0.87) than single women. Women living with a partner (but not married) were more likely to smoke than single women (OR = 2.49; 95%CI: 1.12-5.53), and women with university degrees were less likely to smoke than those with eight years of school or less (OR = 0.41; 95%CI: 0.22-0.87). The results confirm the need for tobacco control programs that take gender and regional differences into account.

Cervical Cancer Screening among Underscreened and Unscreened Brazilian Women: Training Community Health Workers to be Agents of Change

Abstract:Background: Despite the availability of cervical cancer screening programs in Brazil, some women do not participate in these programs owing to structural and/or interpersonal/intrapersonal barriers, resulting in high cervical cancer incidence and mortality. Integrating community health workers (CHWs) into the delivery of cervical cancer screening interventions is potentially a feasible strategy to address these barriers.Objectives: This study aimed to implement and evaluate a CHW training to deliver a brief intervention to promote cervical cancer screening among underscreened and unscreened women in Brazil.Methods: The curriculum addressed cervical cancer and screening, behavioral intervention strategies, and protection of human subjects in research. Pretest and post-test questionnaires assessed changes in CHW objective and perceived knowledge as well as perceived skills and confidence (N = 15).Results: There was a significant increase in objective and perceived knowledge about cervical cancer, behavior change strategies, and protection of human subjects in research between pretest and post-test, but not in self-perception about skills and confidence to motivate women to engage in cervical cancer screening.Conclusions: Improvements in CHW knowledge about cervical cancer screening and behavior change represents a step forward toward successful interventions, but adaptations are needed to boost their self-confidence and perceived skills with regard to their ability to promote behavior change at the community level.

Training Community Health Workers to promote breast cancer screening in Brazil

Although it has been show that early detection through mammograms is the most effective way to reduce breast cancer mortality, breast cancer is the leading cause of cancer deaths among women worldwide with survival rates being even lower in low- and middle-income countries as compared to high-income countries. Despite the availability of breast cancer screening programs in Brazil through the public health system, some women do not participate in these programs due to structural and/or inter/intrapersonal barriers. The Community Health Worker (CHW) model is a promising approach to reach these women who have not been reached through other efforts. This paper describes a participatory approach for capacity building of CHWs to promote breast cancer screening among low-income women 50 years of age and older in a southern city in Brazil as a combined effort between two academic institutions, the municipal health care system, and a local non-profit organization. The capacity building program consisted of an 8-hour training focusing on knowledge (e.g., breast cancer and screening) and skills (e.g., communication skills, basic principles of behavior change) to promote breast cancer screening among community members. Pre- and post-test questionnaires assessed changes in breast cancer knowledge and self-perceived knowledge and confidence (N=44). There was a significant increase in objective knowledge regarding breast cancer overall, risk factors, and behavior change strategies between pre- and post-test. There was also a significant increase in self-perceived knowledge and confidence, items related to knowledge about breast cancer, breast cancer early detection methods, and the ability to solve problems between pre- and post-test as well as a significant increase in their confidence to motivate women to get a mammogram. Overall, this study demonstrates the importance of welldeveloped capacity building programs to promote breast cancer screening among health care professionals, especially those with limited educational attainment, such as CHWs.

Seleção e capacitação para o tratamento do tabagismo no Sistema Único de Saúde: perspectivas de gestores e profissionais de saúde no estado do Paraná, Brasil

OBJETIVO:descrever a perspectiva de gestores e profissionais de saude sobre a selecao e capacitacao dos profissionais de saude para o Programa de Tratamento do Tabagismo do Sistema Unico de Saude.METODOS:estudo descritivo realizado em sete cidades do estado do Parana, Brasil, em 2012; a amostra incluiu 84 gestores e 118 profissionais de saude.RESULTADOS:dos 202 gestores e profissionais, a maioria (98%) indicou que todo profissional que tenha demonstrado interesse ou tenha perfil adequado e selecionado para a capacitacao; 81,2% dos entrevistados indicaram a capacitacao como excelente ou boa, 51% deles estao satisfeitos com a oferta da capacitacao, enquanto 64,4% mostraram-se insatisfeitos com o numero de profissionais capacitados e 42,1% consideraram o numero de profissionais capacitados adequado a demanda dos pacientes.CONCLUSAO:os entrevistados estavam satisfeitos com a capacitacao do Programa; contudo, algumas sugestoes foram referidas para melhorar a capacitacao e a comunicacao entre os profissionaisObjective: to identify the perspectives of health care managers and professionals regarding health care professional selection and training for the Unified Health System (SUS) Tobacco Cessation Program. Methods: this was a descriptive study conducted in seven municipalities in the state of Parana, Brazil, in 2012. The sample included 84 service managers and 118 health care professionals. Results: the majority of the 202 participants (98%) indicated that health care professionals who demonstrate interest and request participation or have appropriate profile are selected. 81.2% of them indicated that the training is excellent or good, 51% were satisfied with the training available, 64.4% were not satisfied with the number of professionals trained, and 42.1% considered the number of professionals trained met patient demand. Conclusion: the participants are satisfied with the training. However, some suggestions were raised to improve both training and communication among professionals.

Tobacco cessation program selection and training in the Unified Health System: manager and health care professional perspectives in the state of Paraná, Brazil

OBJETIVO:descrever a perspectiva de gestores e profissionais de saude sobre a selecao e capacitacao dos profissionais de saude para o Programa de Tratamento do Tabagismo do Sistema Unico de Saude.METODOS:estudo descritivo realizado em sete cidades do estado do Parana, Brasil, em 2012; a amostra incluiu 84 gestores e 118 profissionais de saude.RESULTADOS:dos 202 gestores e profissionais, a maioria (98%) indicou que todo profissional que tenha demonstrado interesse ou tenha perfil adequado e selecionado para a capacitacao; 81,2% dos entrevistados indicaram a capacitacao como excelente ou boa, 51% deles estao satisfeitos com a oferta da capacitacao, enquanto 64,4% mostraram-se insatisfeitos com o numero de profissionais capacitados e 42,1% consideraram o numero de profissionais capacitados adequado a demanda dos pacientes.CONCLUSAO:os entrevistados estavam satisfeitos com a capacitacao do Programa; contudo, algumas sugestoes foram referidas para melhorar a capacitacao e a comunicacao entre os profissionaisObjective: to identify the perspectives of health care managers and professionals regarding health care professional selection and training for the Unified Health System (SUS) Tobacco Cessation Program. Methods: this was a descriptive study conducted in seven municipalities in the state of Parana, Brazil, in 2012. The sample included 84 service managers and 118 health care professionals. Results: the majority of the 202 participants (98%) indicated that health care professionals who demonstrate interest and request participation or have appropriate profile are selected. 81.2% of them indicated that the training is excellent or good, 51% were satisfied with the training available, 64.4% were not satisfied with the number of professionals trained, and 42.1% considered the number of professionals trained met patient demand. Conclusion: the participants are satisfied with the training. However, some suggestions were raised to improve both training and communication among professionals.

Selección y capacitación para el tratamiento del tabaquismo en el Sistema Único de Salud: perspectivas de gestores y profesionales de salud en el estado de Paraná, Brasil

OBJETIVO:descrever a perspectiva de gestores e profissionais de saude sobre a selecao e capacitacao dos profissionais de saude para o Programa de Tratamento do Tabagismo do Sistema Unico de Saude.METODOS:estudo descritivo realizado em sete cidades do estado do Parana, Brasil, em 2012; a amostra incluiu 84 gestores e 118 profissionais de saude.RESULTADOS:dos 202 gestores e profissionais, a maioria (98%) indicou que todo profissional que tenha demonstrado interesse ou tenha perfil adequado e selecionado para a capacitacao; 81,2% dos entrevistados indicaram a capacitacao como excelente ou boa, 51% deles estao satisfeitos com a oferta da capacitacao, enquanto 64,4% mostraram-se insatisfeitos com o numero de profissionais capacitados e 42,1% consideraram o numero de profissionais capacitados adequado a demanda dos pacientes.CONCLUSAO:os entrevistados estavam satisfeitos com a capacitacao do Programa; contudo, algumas sugestoes foram referidas para melhorar a capacitacao e a comunicacao entre os profissionaisObjective: to identify the perspectives of health care managers and professionals regarding health care professional selection and training for the Unified Health System (SUS) Tobacco Cessation Program. Methods: this was a descriptive study conducted in seven municipalities in the state of Parana, Brazil, in 2012. The sample included 84 service managers and 118 health care professionals. Results: the majority of the 202 participants (98%) indicated that health care professionals who demonstrate interest and request participation or have appropriate profile are selected. 81.2% of them indicated that the training is excellent or good, 51% were satisfied with the training available, 64.4% were not satisfied with the number of professionals trained, and 42.1% considered the number of professionals trained met patient demand. Conclusion: the participants are satisfied with the training. However, some suggestions were raised to improve both training and communication among professionals.

Advertencias graficas nos macos de cigarro e o impacto entre mulheres

OBJECTIVE To analyze the association between the pictorial graphic health warnings on cigarette packs and their impact on intention to quit smoking among women. METHODS Population-based cross-sectional study among 265 women daily smokers in the State of Paraná in 2010. The sample size was calculated using cluster sampling. Participants were asked whether they had seen any pictorial graphic health warnings in the past 30 days, whether these warnings made them think about quitting, and intensity of these thoughts. The data was analyzed using logistic regression and the independent variables included age, educational attainment, whether they had children, whether they had attempted to quit smoking in the past 12 months, age of smoking initiation, number of cigarettes smoked per day, their town of residence, and how soon after waking do they smoke their first cigarette. RESULTS Participants (91.7%) reported seeing the pictorial graphic health warnings in the past 30 days. Women with elementary education or below and women with some/complete high school education were more likely to think about quitting smoking after seeing the pictorial graphic health warningsthan women with higher education (OR = 4.85; p = 0.0028 and OR = 2.91; p = 0.05), respectively). Women who attempted to quit smoking in the past 12 months were more likely to think about quitting than women who had not (OR = 2.49; p = 0.001). Quit attempts within the last 12 months were associated with intensity of these thoughts (OR = 2.2; p = 0.03). CONCLUSIONS Results show an association between pictorial graphic health warnings and intent to quit smoking among women with warnings having a greater impact among women with less education and who had attempted to quit smoking within the past year. Tobacco control strategies should be implemented across all groups of women regardless of their educational attainment.ABSTRACT OBJECTIVE: To analyze the association between the pictorial graphic health warnings on cigarette packs and their impact on intention to quit smoking among women. METHODS: Population-based cross-sectional study among 265 women daily smokers in the State of Parana in 2010. The sample size was calculated using cluster sampling. Participants were asked whether they had seen any pictorial graphic health warnings in the past 30 days, whether these warnings made them think about quitting, and intensity of these thoughts. The data was analyzed using logistic regression and the independent variables included age, educational attainment, whether they had children, whether they had attempted to quit smoking in the past 12 months, age of smoking initiation, number of cigarettes smoked per day, their town of residence, and how soon after waking do they smoke their first cigarette. RESULTS: Participants (91.7%) reported seeing the pictorial graphic health warnings in the past 30 days. Women with elementary education or below and women with some/complete high school education were more likely to think about quitting smoking after seeing the pictorial graphic health warningsthan women with higher education (OR = 4.85; p = 0.0028 and OR = 2.91; p = 0.05), respectively). Women who attempted to quit smoking in the past 12 months were more likely to think about quitting than women who had not (OR = 2.49; p = 0.001). Quit attempts within the last 12 months were associated with intensity of these thoughts (OR = 2.2; p = 0.03).

Advertencias graficas en los paquetes de cigarro y el impacto entre mujeres

OBJECTIVE To analyze the association between the pictorial graphic health warnings on cigarette packs and their impact on intention to quit smoking among women. METHODS Population-based cross-sectional study among 265 women daily smokers in the State of Paraná in 2010. The sample size was calculated using cluster sampling. Participants were asked whether they had seen any pictorial graphic health warnings in the past 30 days, whether these warnings made them think about quitting, and intensity of these thoughts. The data was analyzed using logistic regression and the independent variables included age, educational attainment, whether they had children, whether they had attempted to quit smoking in the past 12 months, age of smoking initiation, number of cigarettes smoked per day, their town of residence, and how soon after waking do they smoke their first cigarette. RESULTS Participants (91.7%) reported seeing the pictorial graphic health warnings in the past 30 days. Women with elementary education or below and women with some/complete high school education were more likely to think about quitting smoking after seeing the pictorial graphic health warningsthan women with higher education (OR = 4.85; p = 0.0028 and OR = 2.91; p = 0.05), respectively). Women who attempted to quit smoking in the past 12 months were more likely to think about quitting than women who had not (OR = 2.49; p = 0.001). Quit attempts within the last 12 months were associated with intensity of these thoughts (OR = 2.2; p = 0.03). CONCLUSIONS Results show an association between pictorial graphic health warnings and intent to quit smoking among women with warnings having a greater impact among women with less education and who had attempted to quit smoking within the past year. Tobacco control strategies should be implemented across all groups of women regardless of their educational attainment.ABSTRACT OBJECTIVE: To analyze the association between the pictorial graphic health warnings on cigarette packs and their impact on intention to quit smoking among women. METHODS: Population-based cross-sectional study among 265 women daily smokers in the State of Parana in 2010. The sample size was calculated using cluster sampling. Participants were asked whether they had seen any pictorial graphic health warnings in the past 30 days, whether these warnings made them think about quitting, and intensity of these thoughts. The data was analyzed using logistic regression and the independent variables included age, educational attainment, whether they had children, whether they had attempted to quit smoking in the past 12 months, age of smoking initiation, number of cigarettes smoked per day, their town of residence, and how soon after waking do they smoke their first cigarette. RESULTS: Participants (91.7%) reported seeing the pictorial graphic health warnings in the past 30 days. Women with elementary education or below and women with some/complete high school education were more likely to think about quitting smoking after seeing the pictorial graphic health warningsthan women with higher education (OR = 4.85; p = 0.0028 and OR = 2.91; p = 0.05), respectively). Women who attempted to quit smoking in the past 12 months were more likely to think about quitting than women who had not (OR = 2.49; p = 0.001). Quit attempts within the last 12 months were associated with intensity of these thoughts (OR = 2.2; p = 0.03).