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The initiative was motivated by mounting evidence that smoking in this population group had increased in many countries.(1,2) Even in societies where smoking has decreased, the reduction is less pronounced among women. (1,4) It is known that the tobacco industry makes an effort to increase the numbers of women who are nicotine-dependent. Data regarding 151 countries revealed that, in general, the prevalence of smoking is higher in adolescent boys than in adolescent girls (12% vs. 7%); however, in various countries, the prevalence of smoking is similar for both genders.(1) IntroductionSmoking by women has been a growing concern, drawing the attention of health care institutions in an attempt to alert society and health care workers to the negative impact that smoking has on women's health. (1,2) For the 2010 "World No Tobacco Day", which was created by the World Health Organization (WHO) in 1987, the WHO chose the theme "Gender and tobacco with an emphasis on marketing to women". The primary objective was to encourage policies to combat the marketing strategies employed by the tobacco industry and to curb the epidemic of smoking among women. AbstractSmoking among women has drawn increasing attention because of the increase (or less pronounced decrease) in its prevalence when compared with that observed for men, as well as because of the specific effects that smoking has on women's health. For the 2010 "World No Tobacco Day", the World Health Organization chose the theme "Gender and tobacco with an emphasis on marketing to women", with the aim of encouraging policies to combat marketing strategies employed by the tobacco industry and to curb the epidemic of smoking among women. In this article, we discuss the characteristics of smoking among women, addressing factors such as smoking prevalence, nicotine dependence, the role of the tobacco industry, health risks, approaches to smoking cessation, treatment strategies, and prevention measures. Keywords:Smoking; Women's health; Tobacco industry. ResumoO tabagismo entre as mulheres tem cada vez mais merecido destaque devido ao aumento (ou da redução menos acentuada) de sua prevalência em comparação com aquela dos homens, bem como devido a especificidades dos efeitos do tabagismo na saúde da mulher. Em 2010, a Organização Mundial da Saúde elegeu para o "Dia Mundial sem Tabaco" o tema "Gênero e tabaco com ênfase na propaganda voltada para a mulher", com o objetivo de estimular políticas de combate às estratégias de marketing da indústria do tabaco e conter a epidemia de tabagismo entre as mulheres. O presente artigo discorre sobre as características do tabagismo na mulher, abordando fatores como prevalência, dependência, a atuação da indústria, riscos à saúde, abordagens à cessação do tabagismo e estratégias de tratamento e prevenção.Descritores: Tabagismo; Saúde da mulher; Indústria do tabaco.

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OBJECTIVE: Smoking prevalence is frequently estimated on the basis of self-reported smoking status. That can lead to an underestimation of smoking rates. The aim of this study was to evaluate the difference between self-reported smoking status and that determined through the use of objective measures of smoking at a pulmonary outpatient clinic. METHODS: This was a cross-sectional study involving 144 individuals: 51 asthma patients, 53 COPD patients, 20 current smokers, and 20 never-smokers. Smoking status was determined on the basis of self-reports obtained in interviews, as well as through tests of exhaled carbon monoxide (eCO) and urinary cotinine. RESULTS: All of the asthma patients and COPD patients declared they were not current smokers. In the COPD and asthma patients, the median urinary cotinine concentration was 167 ng/mL (range, 2-5,348 ng/mL) and 47 ng/mL (range, 5-2,735 ng/mL), respectively (p < 0.0001), whereas the median eCO level was 8 ppm (range, 0-31 ppm) and 5 ppm (range, 2-45 ppm), respectively (p < 0.05). In 40 (38%) of the patients with asthma or COPD (n = 104), there was disagreement between the self-reported smoking status and that determined on the basis of the urinary cotinine concentration, a concentration > 200 ng/mL being considered indicative of current smoking. In 48 (46%) of those 104 patients, the self-reported non-smoking status was refuted by an eCO level > 6 ppm, which is also considered indicative of current smoking. In 30 (29%) of the patients with asthma or COPD, the urinary cotinine concentration and the eCO level both belied the patient claims of not being current smokers. CONCLUSIONS: Our findings suggest that high proportions of smoking pulmonary patients with lung disease falsely declare themselves to be nonsmokers. The accurate classification of smoking status is pivotal to the treatment of lung diseases. Objective measures of smoking could be helpful in improving clinical management and counseling.

OBJECTIVE: Water-pipe tobacco smoking is becoming increasingly more common among young people. The objective of this study was to estimate the prevalence of the use of water pipes and other forms of tobacco use, including cigarette smoking, among medical students, as well as to examine the attitudes, beliefs, and knowledge of those students regarding this issue. METHODS: We administered a questionnaire to students enrolled in the University of São Paulo School of Medicine, in São Paulo, Brazil. The respondents were evaluated in their third and sixth years of medical school, between 2008 and 2013. Comparisons were drawn between the two years. RESULTS: We evaluated 586 completed questionnaires. Overall, the prevalence of current cigarette smokers was low, with a decline among males (9.78% vs. 5.26%) and an increase among females (1.43% vs. 2.65%) in the 3rd and 6th year, respectively. All respondents believed that health professionals should advise patients to quit smoking. However, few of the medical students who smoked received physician advice to quit. Experimentation with other forms of tobacco use was more common among males (p<0.0001). Despite their knowledge of its harmful effects, students experimented with water-pipe tobacco smoking in high proportions (47.32% and 46.75% of the third- and sixth-year students, respectively). CONCLUSIONS: The prevalence of experimentation with water-pipe tobacco smoking and other forms of tobacco use is high among aspiring physicians. Our findings highlight the need for better preventive education programs at medical schools, not only to protect the health of aspiring physicians but also to help them meet the challenge posed by this new epidemic.

Heart rate variability (HRV) analysis is a useful method to assess abnormal functioning in the autonomic nervous system and to predict cardiac events in patients with heart failure (HF). HRV measurements with heart rate monitors have been validated with an electrocardiograph in healthy subjects but not in patients with HF. We explored the reproducibility of HRV in two consecutive six-minute walk tests (6MW), 60-minute apart, using a heart rate monitor (PolarS810i) and a portable electrocardiograph (called Holter) in 50 HF patients (mean age 59 years, NYHA II, left ventricular ejection fraction ~35%). The reproducibility for each device was analysed using a paired t-test or the Wilcoxon signed-rank test. Additionally, we assessed the agreement between the two devices based on the HRV indices at rest, during the 6MW and during recovery using concordance correlation coefficients (CCC), 95% confidence intervals and Bland-Altman plots. The test-retest for the HRV analyses was reproducible using Holter and PolarS810i at rest but not during recovery. In the second 6MW, patients showed significant increases in rMSSD and walking distance. The PolarS810i measurements had remarkably high concordance correlation [0.86

OBJECTIVE:To evaluate the effectiveness of nicotine replacement therapy (NRT), bupropion, nortriptyline and combination therapy and describe factors associated with treatment success.INTRODUCTION:Clinical trials clearly demonstrate the efficacy of pharmacotherapy in smoking cessation. However, it is only after its use in real‐life settings that clinical effectiveness and limitations of a treatment are fully known.METHODS:Patients attended a four‐session cognitive‐behavioral program and received medicines free of charge. Abstinence from smoking was assessed at each visit.RESULTS:A total of 868 smokers (68.8% women) were included. Their mean age was 49.6 years; the amount smoked was 25 cigarettes/day and the Fagerström Score was 6.6. Abstinence rates after 6 months and 1 year were 36.5% and 33.6%. In univariate analysis, male gender, age (>50), higher number of cigarettes smoked, cardiovascular comorbidities, longer interval from the last cigarette and combined treatment of nortriptyline plus NRT were predictive of abstinence, while neuropsychiatric comorbidities and the answer “yes” to the question “Do you smoke more often during the first hours after waking” were correlated with failure. In a multivariate model, predictors of abstinence were neuropsychiatric comorbidities, the answer “yes” to the question “Do you smoke more often during the first hours after waking” and combined treatment of nortriptyline plus NRT. Male gender and a longer period from the last cigarette were correlated with lower abstinence rate.CONCLUSION:Satisfactory success rates were obtained in a teaching hospital. Factors such as age, daily cigarette consumption, number of pack‐years and dependency score were not reliable markers of abstinence. The combination nortriptyline+NRT was independently associated with higher abstinence rates.

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