Valeska Carvalho Figueiredo

Assessing the impact of cigarette package health warning labels: a cross-country comparison in Brazil, Uruguay and Mexico

OBJECTIVE To assess the impact of different health warning labels (HWL). MATERIAL AND METHODS Data from the International Tobacco Control Survey (ITC Survey) were analyzed from adult smokers in Brazil, Uruguay and Mexico, each of which used a different HWL strategy (pictures of human suffering and diseased organs; abstract pictorial representations of risk; and text-only messages, respectively). Main outcomes were HWL salience and cognitive impact. RESULTS HWLs in Uruguay (which was the only country with a HWL on the front of the package) had higher salience than either Brazilian or Mexican packs. People at higher levels of educational attainment in Mexico were more likely to read the text-only HWLs whereas education was unassociated with salience in Brazil or Uruguay. Brazilian HWLs had greater cognitive impacts than HWLs in either Uruguay or Mexico. HWLs in Uruguay generated lower cognitive impacts than the text-only HWLs in Mexico. In Brazil, cognitive impacts were strongest among smokers with low educational attainment. CONCLUSIONS This study suggests that HWLs have the most impact when they are prominent (i.e., front and back of the package) and include emotionally engaging imagery that illustrates negative bodily impacts or human suffering due to smoking.

Cotinine Concentration in Smokers from Different Countries: Relationship with Amount Smoked and Cigarette Type

This four-country study examined salivary cotinine as a marker for nicotine intake and addiction among smokers in relation to numbers and types of cigarettes smoked. Smoking characteristics of cigarette smokers in Brazil, China, Mexico, and Poland were identified using a standard questionnaire. Cotinine concentration was measured using a saliva sample from each participant; its relationship with numbers and types of cigarettes smoked was quantified by applying regression techniques. The main outcome measure was salivary cotinine level measured by gas chromatography. In all four countries, cotinine concentration increased linearly with cigarettes smoked up to 20 per day [11.3 ng/mL (95% confidence interval, 10.5-12.2)] and then stabilized as the number of cigarettes exceeded 20 [6.8 ng/mL per cigarette (95% confidence interval, 6.3-7.4) for up to 40 cigarettes]. On average, smokers of regular cigarettes consumed more cigarettes and had higher cotinine levels than light cigarette smokers. Cotinine concentration per cigarette smoked did not differ between regular and light cigarette smokers. Results suggest a saturation point for daily nicotine intake and minimal or no reduction in nicotine intake by smoking light cigarettes. (Cancer Epidemiol Biomarkers Prev 2006;15(10):1799–804)

A snapshot of the striking decrease in cigarette smoking prevalence in Brazil between 1989 and 2008.

OBJECTIVE To evaluate the differences in cigarette smoking prevalence rates in Brazil between 1989 and 2008. METHODOLOGY We calculated absolute and relative differences in smoking prevalences, overall and stratified by gender, age, place of residence, educational level and birth cohort. Data were obtained from random samples from two National Household Surveys (1989,n=39,969; 2008,n=38,461). GLM models were specified to obtain estimates and assess whether differences in proportions of smokers differed by categories of the stratification variables. RESULTS Adjusted absolute and relative differences in smoking prevalence rates between 1989 and 2008 were, respectively, -12.4% and -41.0%. Individuals aged 15-34 years and those with 9 or more years of education presented larger relative declines than their counterparts (p(s)≤0.001). After stratification by birth cohort, men presented larger reductions than women, only in the absolute scale (p(s)≤0.001), with the exception of the youngest birth cohort (i.e.,1965-1974). CONCLUSIONS In Brazil, several tobacco control measures have been adopted since 1986, in particular increasing taxation of tobacco products and strong health warnings, which may have contributed to the marked decline in smoking prevalence. It is important to understand the evolution of the tobacco epidemic to propose new actions to prevent initiation and encourage cessation among those who started/continued smoking.

Changes in cigarette consumption patterns among Brazilian smokers between 1989 and 2008

The assessment of temporal differences in cigarette consumption may help in understanding whether a smoking population is becoming more resistant to quitting over time. We calculated absolute differences in average cigarette consumption, stratified by birth cohort and age group. Data were obtained from random samples from two Brazilian national household surveys (1989, N = 12,782; 2008, N = 6,675). A linear regression model was used to adjust estimates by gender, educational level, and place of residence. Birth cohort analysis found that average daily cigarette consumption increased for individuals born after 1964 and decreased for those born before 1955 (adjusted p-values < 0.001). Age-specific analysis found that the remaining smoking population aged 64 years-old or less decreased cigarette consumption between 1989 and 2008 (adjusted p-values < 0.001). Brazils anti-tobacco policy changes and rapid economic growth may be principally related to temporal changes in cigarette consumption for most age groups, rather than to a change in the relationship between age and cigarette consumption.

Auto-avaliação de saúde e limitações físicas decorrentes de problemas de saúde

OBJECTIVE: To evaluate self-rated health and physical disabilities due to health problems. METHODS: Population-based cross-sectional study carried out in 18 Brazilian cities between 2002 and 2005. There were interviewed 26,424 residents (aged 15 years or more) of households selected by a two-stage probabilistic sampling. Percentages and confidence intervals were calculated considering the study design effects. RESULTS: Poorer self-rated health status and physical disabilities were found among women, those aged 50 years old or more and those with lower education. In addition, higher percentages of fair or poor self-rated health were found in cities in Northern and Northeastern Brazil compared to those in Southern and Southeastern Brazil. CONCLUSIONS: Poorer health conditions in the North/Northeast compared to the South/Southeast regions reflect factors related to social inequalities, mainly lower education.OBJETIVO: Avaliar a autopercepcao de saude e a presenca de limitacoes fisicas devido a problemas de saude. METODOS: Estudo transversal de base populacional realizado entre 2002 e 2005, em 18 capitais de estados do Brasil. Entrevistaram-se 26.424 moradores de 15 anos ou mais de idade em domicilios selecionados por amostra probabilistica em dois estagios. Calcularam-se percentuais e intervalos de confianca considerando-se os efeitos do desenho do estudo. RESULTADOS: Os resultados mostraram que as piores condicoes de saude sao referidas por mulheres, individuos com 50 anos ou mais e com menor grau de escolaridade. Os percentuais relacionados a percepcao de saude regular ou ruim foram maiores nas cidades das regioes Norte e Nordeste quando comparados aos das cidades das regioes Sul e Sudeste. CONCLUSOES: As piores condicoes de saude das regioes Norte/Nordeste comparadas as das regioes Sul/Sudeste revelam um conjunto de fatores relacionados as desigualdades sociais, entre os quais o menor grau de escolaridade.