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.

IntroduçãoAs transformações sociais e econômi-cas pelas quais o Brasil vem passando têm causado mudanças relevantes no perfil de morbimortalidade da população. As doenças infecciosas e parasitárias, principais causas de morte no início do século passado, cederam lugar às doenças crônicas não transmissíveis (DCNTs) (CASADO; VIANNA; THULER, 2009). Essa transição epidemiológica tem se refletido na área de saúde pública e o desenvolvimento de estratégias para seu controle tornou-se uma emergência para o Sistema Único de Saúde (SUS).Diante da constatação das mudanças ocorridas nos perfis demográfico, epidemiológico e nutricional da população brasileira e do aumento significativo da prevalência das DCNTs, o Ministério da Saúde (MS), com a intenção de monitorar essa nova realidade brasileira e diminuir a carga das doenças, baseou-se nas orientações da Organização Mundial da Saúde (OMS) e da Organização Pan-Americana de Saúde (Opas) e implan-

Background Fragility hip fractures are associated with increased mortality, especially in men1. As bone mineral density (BMD) determination is the single most important determinant of bone strength, and mass dual-energy X-ray absorptiometry (DXA) testing is not cost-effective, several clinical decision rules have been developed to identify individuals with higher probability of low BMD. However, their validation across different populations has led to heterogeneity in the proposed cut-offs, making its applicability unclear and calling for calibration. Finally, when similar validity can be ensured, the simpler the clinical decision tool the more likely it is to be applied in clinical practice. Objectives To develop and validate a simple clinical screening tool (EPIPOST) able to identify men with higher probability of having low bone mineral density (BMD) who may benefit from DXA testing and to compare its discriminatory ability with two other osteoporosis screening tools in men (OST and MORES), after calibration for our population. Methods As part of EPIPorto population-based study among adults, 147 men aged between 40 and 65 years were assessed. Age, height, weight, body mass index and several body circumferences were recorded by trained observers. DXA whole-body scans were performed for BMD assessment. For the calibration of OST and MORES, new regression parameters were estimated for each risk factor included accounting for their prevalence and also for the prevalence of low BMD in our population. For EPIPOST development, the different anthropometric variables were tested using logistic regression models to predict low BMD. EPIPOST validation was done by the leave-one-out cross-validation method. The overall fit and discriminatory capacity of the different models were assessed by direct comparison of the observed and expected prevalences of low BMD by quartiles of each score, Hosmer-Lemeshow “goodness-of-fit” test and area under the receiver operating characteristic (ROC) curve. Finally, likelihood ratios (LR) were calculated to select the ideal cut-off for each model. Results Calibration maintained the discriminatory capacity of OST and MORES (AUC of 0.73 and 0.75, respectively) and improved the fit. The EPIPOST included only upper arm circumference and showed better discriminatory capacity (AUC 0.76). For predicting low BMD, OST≤2 had a sensitivity of 100% and a specificity of 8.2%; MORES>-2 had a sensitivity of 93.9% and a specificity of 30.6%; EPIPOST>-2 had a sensitivity of 98.0% and a specificity of 18.6%. The LR analysis showed that EPIPOST had higher discriminative ability across different risk levels (LR range of 0.1-18.4, compared to 0.0-2.4 with OST and 0.2-2.8 with MORES). Conclusions Calibration of OST and MORES improved the fitting of both models to our population data and maintained their discriminatory ability to identify men with low BMD. The newly developed tool, EPIPOST, is easier to execute and performed similarly to OST and MORES in terms of overall accuracy while showing a wider ra...