Editorial comment
Smoking in Portugal: Where do we stand today?
Tabagismo em Portugal: em que ponto nos encontramos atualmente?
a CINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Portugal
b Allergy Unit, CUF-Porto Instituto & Hospital, Porto, Portugal
c MEDCIDS-Department of Community Medicine, Information, and Health Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "595" "paginaFinal" => "597" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Ana Margarida Pereira" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Ana Margarida" "apellidos" => "Pereira" "email" => array:1 [ 0 => "ambrpereira@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "CINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Allergy Unit, CUF-Porto Instituto & Hospital, Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "MEDCIDS-Department of Community Medicine, Information, and Health Sciences, Faculty of Medicine, University of Porto, Porto, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Tabagismo em Portugal: em que ponto nos encontramos atualmente?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Smoking is one of the leading causes of preventable illness and death worldwide.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">1,2</span></a> It is a cause of various respiratory, gastrointestinal and urinary cancers, diabetes, cardiovascular disease and chronic obstructive pulmonary disease, and is a determinant of certain infections, including pneumonia, influenza and tuberculosis.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">3</span></a> It is also associated with increased risk of death from renal failure, intestinal ischemia, hypertensive heart disease, other respiratory and gastrointestinal diseases, and other conditions. Smokers have two- to three-fold higher all-cause mortality than those who have never smoked; around 17% of the excess mortality among current smokers appears to be due to diseases that are not currently established as attributable to smoking.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">4</span></a> Furthermore, it is a major cause of attributable loss of disability-adjusted life years, even as exposure is declining.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">2</span></a> In Portugal, it was the second leading risk factor for early death and disability for both sexes combined in 2015.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Several recent systematic reviews have further demonstrated that smoking is associated with increased risk of heart failure,<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">5</span></a> abdominal aortic aneurysms<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">6</span></a> and sudden cardiac death.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">7</span></a> Even smoking a single cigarette a day is associated with increased risk of developing coronary heart disease and stroke: there appears to be no safe level of smoking for cardiovascular disease.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">8</span></a> A meta-analysis of large observational trials showed that smoking cessation reduced the risk of cardiovascular death by 36% among smokers with coronary artery disease, over a mean follow-up of five years. Smoking cessation is the most powerful modifier of cardiovascular risk in smokers.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">According to the World Health Organization, there has been notable progress in reducing the prevalence of smoking, with the overall rate of current smoking among individuals aged over 15 years worldwide declining from 23.5% in 2007 to 20.7% in 2015. However, rates are not declining in all countries; they report that of the 195 countries monitored, 94 are experiencing decline, five have increasing rates, 47 see no significant change and 49 are not conducting sufficient monitoring to identify a trend.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">1</span></a> Data for Portugal showed a trend for a decrease in the overall current smoking prevalence, mainly due to a steady decrease in males.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">10</span></a> However, these reports only focused on overall trends in smoking prevalence, without information or analysis on related socioeconomic factors.</p><p id="par0020" class="elsevierStylePara elsevierViewall">For their study published in the current issue of the <span class="elsevierStyleItalic">Journal</span>, Leite et al. used data from five Portuguese National Health Interview Surveys (NHIS) to show trends in tobacco use and related socioeconomic factors in Portugal from 1987 to 2014.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">11</span></a> Their study updates and broadens the findings of Alves et al.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">12</span></a> and, as reported in other studies<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">13,14</span></a> and countries,<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">1,10</span></a> is further evidence of diverging paths in smoking prevalence: while the prevalence in men is decreasing and reached a minimum in the 2014 NHIS (26.7%), for women smoking prevalence is increasing and reached a maximum (14.6%), based on the available data, in 2014. The prevalence among women may not yet have reached its peak.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The authors also found gender-based divergences in inequalities, with men presenting diminishing inequalities and a trend for stabilization of inequalities in women. The most vulnerable groups, in both men and women, were individuals with low education level, the divorced and the unemployed. Furthermore, in women, those in more qualified occupational groups also had higher odds of smoking, raising concerns about widening of inequalities in the near future.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">11</span></a> Previous studies found that socioeconomic inequalities in smoking contribute to socioeconomic inequalities in mortality,<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">15,16</span></a> with 51-65% of social inequalities in total mortality among men being due to smoking.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">15</span></a> These unfavorable trends could be reversed with effective tobacco control policies, especially if groups that are more vulnerable to inequalities are targeted.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">17</span></a> However, in every European country, at least some of these tobacco control measures have not yet been fully implemented,<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a> leaving considerable room for the development of more comprehensive and equity-oriented strategies of tobacco control.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">17</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Monitoring the prevalence of tobacco use is crucial to efforts to control the global tobacco epidemic. Reliable prevalence data provide the information on the magnitude of the tobacco epidemic and its influencing factors that is required to plan and adopt tobacco control interventions and assess their impact.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">1</span></a> Moreover, having a full picture of patterns and trends in tobacco use, especially when accounting for diverging paths according to different demographic or socioeconomic characteristics, helps enable interventions to be tailored to best meet the needs of different population subgroups.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">1</span></a> A previous overview of systematic reviews found that, when designing and implementing tobacco control programs, governments should prioritize regulations that ban smoking and increase tobacco product prices,<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">19</span></a> the latter intervention demonstrating the greatest potential to reduce socioeconomic inequalities in smoking.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">20</span></a> However, although no information was provided regarding the effects of these policies according to the characteristics of different subgroups, other studies have found that there are subgroups with diverging responses to smoking cessation interventions.<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">21,22</span></a> In accordance with the current emphasis on personalized care, these differences should also be considered when planning population-based tobacco control policies, favoring the implementation of interventions that have the greatest proven effectiveness in the most vulnerable target subgroups. Nevertheless, the striking lack of research demonstrating the real effectiveness of applying specific interventions to specific subgroups undermines the current application of these interventions and, at both country and continent level, more general policies have consistently been preferred.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">23</span></a> However, the effects of these general strategies on smoking prevalence are not fully known and different studies have reported conflicting results.<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">23,24</span></a> Future research should clarify these issues, identifying the most cost-effective interventions and designing implementation strategies that optimize the effect on smoking cessation, especially in the most vulnerable subgroups.</p><p id="par0035" class="elsevierStylePara elsevierViewall">While smoking has detrimental effects on various organs and systems, its importance as a major risk factor for cardiovascular disease cannot be overemphasized. The data from Leite et al.,<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">11</span></a> highlighting the trends in prevalence and inequalities in daily smoking, can be used to support more appropriate population-based interventions targeting smoking cessation in Portugal. However, further research is still needed to find the most effective strategies.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib0125" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "WHO report on the global tobacco epidemic, 2017. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 12 | 5 | 17 |
| 2024 Outubro | 52 | 30 | 82 |
| 2024 Setembro | 47 | 20 | 67 |
| 2024 Agosto | 55 | 22 | 77 |
| 2024 Julho | 44 | 32 | 76 |
| 2024 Junho | 42 | 17 | 59 |
| 2024 Maio | 27 | 12 | 39 |
| 2024 Abril | 35 | 31 | 66 |
| 2024 Maro | 36 | 22 | 58 |
| 2024 Fevereiro | 30 | 30 | 60 |
| 2024 Janeiro | 29 | 32 | 61 |
| 2023 Dezembro | 24 | 25 | 49 |
| 2023 Novembro | 27 | 27 | 54 |
| 2023 Outubro | 19 | 15 | 34 |
| 2023 Setembro | 18 | 20 | 38 |
| 2023 Agosto | 27 | 15 | 42 |
| 2023 Julho | 33 | 12 | 45 |
| 2023 Junho | 35 | 15 | 50 |
| 2023 Maio | 40 | 26 | 66 |
| 2023 Abril | 22 | 2 | 24 |
| 2023 Maro | 55 | 17 | 72 |
| 2023 Fevereiro | 43 | 20 | 63 |
| 2023 Janeiro | 10 | 14 | 24 |
| 2022 Dezembro | 33 | 23 | 56 |
| 2022 Novembro | 66 | 29 | 95 |
| 2022 Outubro | 40 | 26 | 66 |
| 2022 Setembro | 22 | 34 | 56 |
| 2022 Agosto | 25 | 31 | 56 |
| 2022 Julho | 27 | 43 | 70 |
| 2022 Junho | 21 | 33 | 54 |
| 2022 Maio | 14 | 46 | 60 |
| 2022 Abril | 35 | 35 | 70 |
| 2022 Maro | 27 | 48 | 75 |
| 2022 Fevereiro | 23 | 29 | 52 |
| 2022 Janeiro | 16 | 24 | 40 |
| 2021 Dezembro | 28 | 27 | 55 |
| 2021 Novembro | 26 | 39 | 65 |
| 2021 Outubro | 24 | 41 | 65 |
| 2021 Setembro | 24 | 30 | 54 |
| 2021 Agosto | 28 | 29 | 57 |
| 2021 Julho | 40 | 24 | 64 |
| 2021 Junho | 41 | 23 | 64 |
| 2021 Maio | 30 | 31 | 61 |
| 2021 Abril | 29 | 23 | 52 |
| 2021 Maro | 58 | 20 | 78 |
| 2021 Fevereiro | 46 | 20 | 66 |
| 2021 Janeiro | 41 | 12 | 53 |
| 2020 Dezembro | 42 | 3 | 45 |
| 2020 Novembro | 13 | 13 | 26 |
| 2020 Outubro | 25 | 17 | 42 |
| 2020 Setembro | 21 | 12 | 33 |
| 2020 Agosto | 11 | 14 | 25 |
| 2020 Julho | 21 | 14 | 35 |
| 2020 Junho | 15 | 10 | 25 |
| 2020 Maio | 26 | 7 | 33 |
| 2020 Abril | 25 | 9 | 34 |
| 2020 Maro | 41 | 15 | 56 |
| 2020 Fevereiro | 63 | 39 | 102 |
| 2020 Janeiro | 51 | 11 | 62 |
| 2019 Dezembro | 100 | 21 | 121 |
| 2019 Novembro | 121 | 27 | 148 |
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