Background: To establish the impact of tobacco smoking on mortality is essential to define and monitor public health interventions in developing countries.

Background Smoking is the largest preventable cause of mortality in Brazil. Education Against Tobacco (EAT) is a network of more than 3500 medical students and physicians across 14 countries who volunteer for school-based smoking prevention programs. EAT educates 50,000 adolescents per year in the classroom setting. A recent quasi-experimental study conducted in Germany showed that EAT had significant short-term smoking cessation effects among adolescents aged 11 to 15 years. Objective The aim is to measure the long-term effectiveness of the most recent version of the EAT curriculum in Brazil. Methods A randomized controlled trial was conducted among 2348 adolescents aged 12 to 21 years (grades 7-11) at public secondary schools in Brazil. The prospective experimental design included measurements at baseline and at 6 and 12 months postintervention. The study groups comprised randomized classes receiving the standardized EAT intervention (90 minutes of mentoring in a classroom setting) and control classes in the same schools (no intervention). Data were collected on smoking status, gender, social aspects, and predictors of smoking. The primary endpoint was the difference in the change in smoking prevalence between the intervention group and the control group at 12-month follow-up. Results From baseline to 12 months, the smoking prevalence increased from 11.0% to 20.9% in the control group and from 14.1% to 15.6% in the intervention group. This difference was statistically significant ( P <.01). The effects were smaller for females (control 12.4% to 18.8% vs intervention 13.1% to 14.6%) than for males (control 9.1% to 23.6% vs intervention 15.3% to 16.8%). Increased quitting rates and prevented onset were responsible for the intervention effects. The differences in change in smoking prevalence from baseline to 12 months between the intervention and control groups were increased in students with low school performance. Conclusions To our knowledge, this is the first randomized trial on school-based tobacco prevention in Brazil that shows significant long-term favorable effects. The EAT program encourages quitting and prevents smoking onset, especially among males and students with low educational background. Trial Registration ClinicalTrials.gov NCT02725021; https://clinicaltrials.gov/ct2/show/NCT02725021 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.7134

Objetivos: Verificar a prevalência da co-infecção tuberculose (TBC)/HIV e a capacidade da anamnese em detectar a infecção pelo HIV em pacientes internados por TBC. Local: Hospital Eduardo de Menezes, Belo Horizonte, MG, referência para TBC e SIDA. Material e métodos: Todos os pacientes internados com TBC na enfermaria de pneumologia foram avaliados prospectivamente no período de 1/1/1997 até 31/1/1998, com anamnese dirigida para fatores de risco para SIDA, TBC, tratamentos anteriores e abandonos de tratamento para TBC, e verificadas as formas clínicas de TBC. Foram excluídos pacientes com doenças marcadoras de SIDA com exceção da TBC, ou com sorologia anti-HIV realizada anteriormente. Foram realizadas sorologias anti-HIV (ELISA) e, quando positivas, confirmadas pelo teste Western-Blot. Os testes do qui-quadrado e de Fisher foram usados para análise estatística. Resultados: Sessenta e cinco pacientes avaliados foram divididos em grupo I (sorologia positiva para HIV, n = 6) e grupo II (sorologia negativa para HIV, n = 59). Não houve diferença significativa entre os dois grupos quanto a fatores de risco para SIDA, TBC, abandonos de tratamento ou tratamentos anteriores para TBC ou formas clínicas de TBC. Conclusões: Devido à alta prevalência da infecção pelo HIV (9,2%) no grupo estudado, estes achados reforçam as orientações do Consenso Brasileiro de Tuberculose no sentido de: 1) a anamnese não consegue detectar uma parcela significativa dos pacientes com co-infecção TBC/HIV; e: 2) a solicitação de sorologia anti-HIV deve ser feita de forma rotineira em todos os pacientes com TBC ativa.

BackgroundSmoking is the largest preventable cause of morbidity and mortality in Brazil. Education Against Tobacco (EAT) is a large network of medical students in 13 countries who volunteer for school-based prevention in the classroom setting. A recent quasi-experimental EAT study conducted in Germany showed significant short-term smoking cessation effects on 11- to 15-year-old adolescents.ObjectiveThe aim of this study is both to describe and to provide the first randomized long-term evaluation of the EAT intervention involving a photoaging app for its effectiveness to reduce the smoking prevalence among 12- to 17-year-old pupils in Brazilian public schools.MethodsA randomized controlled trial will be conducted among approximately 1500 adolescents aged 12 to 17 years in grades 7-11 of public secondary schools in Brazil. The prospective experimental study design includes measurements at baseline and at 6 and 12 months postintervention. The study groups will consist of randomized classes receiving the standardized EAT intervention (90 minutes of mentoring in a classroom setting) and control classes within the same schools (no intervention). The questionnaire measures smoking status, gender, social, and cultural aspects as well as predictors of smoking. Biochemical validation of smoking status is conducted via random carbon monoxide measurements. The primary end point is the difference of the change in smoking prevalence in the intervention group versus the difference in the control group at 12 months of follow-up. The differences in smoking behavior (smoking onset, quitting) between the 2 groups as well as effects on the different genders will be studied as secondary outcomes.ResultsThe recruitment of schools, participating adolescents, and medical students was conducted from August 2016 until January 2017. The planned period of data collection is February 2017 until June 2018. Data analysis will follow in July 2018 and data presentation/publication will follow shortly thereafter.ConclusionsThis is the first evaluative study of a medical student–delivered tobacco prevention program in Brazil and the first randomized trial on the long-term effectiveness of a school-based medical student–delivered tobacco prevention program in general.ClinicalTrialClinicalTrials.gov NCT02725021; https://clinicaltrials.gov/ct2/show/NCT02725021 (archived by WebCite at http://www.webcitation.org/6njy3nNml)

Smoking is the leading cause of respiratory disease (RD). The harmful effects of smoking on the respiratory system begin in utero and influence immune responses throughout childhood and adult life. In comparison with “healthy” smokers, smokers with RD have peculiarities that can impede smoking cessation, such as a higher level of nicotine dependence; nicotine withdrawal; higher levels of exhaled carbon monoxide; low motivation and low self-efficacy; greater concern about weight gain; and a high prevalence of anxiety and depression. In addition, they require more intensive, prolonged treatment. It is always necessary to educate such individuals about the fact that quitting smoking is the only measure that will reduce the progression of RD and improve their quality of life, regardless of the duration and severity of the disease. Physicians should always offer smoking cessation treatment. Outpatient or inpatient smoking cessation treatment should be multidisciplinary, based on behavioral interventions and pharmacotherapy. It will thus be more effective and cost-effective, doubling the chances of success.