The article presents a review of Brazilian tobacco control policies from 1986 to 2016, based on contributions from political economics and analyses of public policies. The institutionalization of tobacco control in the country was marked by more general changes in health policies and by specific events related to the theme. Brazil's international leadership role, a robust National Tobacco Control Policy, the role of civil society and the media all contributed to the success of tobacco control in this country. However, challenges remain regarding crop diversification in tobacco farms, illegal trade in cigarettes, pressure from the tobacco industry and the sustainability of the Policy. This study reinforces the importance of bearing in mind the relationship between the domestic and international context, and the articulation between different governmental and non-governmental sectors and players when analyzing complex health policies. Continuity and consolidation of the tobacco control policies depend on the persistence of a broad institutional framework to guide the State's actions in social protection, in accordance with Unified Healthcare System guidelines.

Knowledge, attitudes, and practices of women farmers concerning tobacco agriculture in a municipality in Southern BrazilConhecimentos, atitudes e práticas de agricultoras sobre o processo de produção de tabaco em um município da Região Sul do Brasil Conocimientos, actitudes y prácticas de agricultoras sobre el proceso de producción del tabaco en un municipio de la Región Sur de Brasil

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Self-rated health and physical disabilities due to heath problems RESUMO OBJETIVO: Avaliar a autopercepção de saúde e a presença de limitações físicas devido a problemas de saúde. MÉTODOS: RESULTADOS:Os resultados mostraram que as piores condições de saúde são referidas por mulheres, indivíduos com 50 anos ou mais e com menor grau de escolaridade. Os percentuais relacionados à percepção de saúde regular ou ruim foram maiores nas cidades das regiões Norte e Nordeste quando comparados aos das cidades das regiões Sul e Sudeste. CONCLUSÕES:As piores condições de saúde das regiões Norte/Nordeste comparadas as das regiões Sul/Sudeste revelam um conjunto de fatores relacionados às desigualdades sociais, entre os quais o menor grau de escolaridade.

This study analyzes Brazil's tobacco control policy from 1986 to 2016, seeking to describe the policy's history and discuss its achievements, limits, and challenges. The study adopted a political economics approach and contributions from public policy analysis. Data were based on a search of the literature, documents, and secondary sources and semi-structured interviews with stakeholders involved in the policy. Factors related to the domestic and international contexts, the political process, and the policy's content influenced the institutional characteristics of tobacco control in the country. The study emphasizes the consolidation of Brazil's social rejection of smoking, government structuring of the policy, action by civil society, and Brazil's prestige in the international scenario. Inter-sector tobacco control measures like price and tax increases on cigarettes, the promotion of smoke-free environments, and the enforcement of health warnings contributed to the important reduction in prevalence of smoking. Implementation of the World Health Organization Framework Convention on Tobacco Control in Brazil, beginning in 2006, contributed to the expansion and consolidation of the national policy. However, tobacco-related economic interests limited the implementation of some strategic measures. The challenges feature the medium- and long-term sustainability of tobacco control and the solution to barriers involving crop diversification on current tobacco-growing areas, the fight against the illegal cigarette trade, and interference in the policy by the tobacco industry.

Randomized clinical trial carried out to investigate the effectiveness of the cognitive-behavioral approach and nicotine replacement therapy with nicotine patches for smoking cessation. Participated 1,199 adults, volunteers, in Rio de Janeiro, Brazil, randomly assigned to 10 different groups: intensive brief counseling group (GB), with 1 or 2 sessions (G1-G2), and with 3 or 4 sessions (G3-G4), with/without nicotine replacement therapy (NRT). Abstinence proportions were estimated during 12 months. These proportions among participants not assigned to NRT were 20% (GB), 17% (G1-G2), and 23% (G3-G4); and among assigned NRT groups were 30% (GBA), 34% (G1A-G2A), and 33% (G3A-G4A). After multiple adjustments, the abstinence proportions ratios seemed to follow a "dose-response" pattern: compared to GB, the ratios were 0.85 (G1-G2), 1.13 (G3-G4), 1.51 (GBA), 1.66 (G1A-G2A), and 1.75 (G3A-G4A). The results suggest that use of NRT increases the abstinence proportion for cessation. The "dose-response" pattern suggests that cognitive-behavioral could be the reasonable option in the smoking cessation therapy.

This study aimed to evaluate the occurrence of the green tobacco sickness (GTS) and its associated factors in tobacco familiar farmers residing in Dom Feliciano, Rio Grande do Sul State, Brazil. A cross-sectional study was conducted evaluating the sickness in 354 small tobacco farmers, between October 2011 and March 2012. The urinary concentration of cotinine, a biomarker of exposure to nicotine, was determined during the tobacco harvest period. Subjects presenting cotinine urinary levels ≥ 50ng/mL, that had contact with tobacco leaves up to 48 hours before the sample collection and reported at least one disease symptom were deemed as cases. A non-conditional logistic analysis was performed to evaluate the association between GTS and the population characteristics. A total of 122 (34.5%) cases were identified, with 39% of them being smokers and 61% being males. The median cotinine urinary concentrations were 75.6ng/mL (74.1ng/mg of creatinine) for non-cases and 755.8ng/mL (632.1ng/mg of creatinine) for the cases (p-value ≤ 0.01). The multivariate analysis showed a positive association between GTS and sunlight exposure time, exposure to pesticides, worse health status, and inverse association with wood cultivation. This study presented a high GTS prevalence and suggest that the use of urinary cotinine is a significant biomarker to determine GTS cases, influencing in the distribution by sex. Once the tobacco production involves health hazards, is important to implement measures to prevent the harm caused to tobacco farmers, as set in articles 17 and 18 of the World Health Organization Framework Convention on Tobacco Control.

EDITORIAL EDITORIALThis Supplement of CSP was organized in collaboration with the Center for Studies on Tobacco and Health, National School of Public Health, Oswaldo Cruz Foundation (CETAB/ ENSP/Fiocruz). It has an unprecedented focus, shedding light on and systematically organizing current knowledge on the magnitude of smoking as a public health issue and on best practices, and obstacles to tobacco control policy implementation in Brazil, a country regarded worldwide as a success story.Smoking is one of the leading avoidable causes of early death and health inequality in the world. An estimated 7.2 million persons worldwide, including 156,200 Brazilians, die every year from diseases associated with active and passive smoking, and these deaths are concentrated in the poorest and most vulnerable populations 1 . The (still underestimated) total annual cost of smoking in Brazil, is nearly BRL 57 billion, 39.3 billion of which due to medical care and treatment costs and 17.5 billion due to lost productivity 2 . According to the Brazilian National Health Survey in 2013, 22 million Brazilian adults (15% of the population aged 18 years or older) were smokers 3 .Tobacco production and consumption have devastating consequences for health, the environment, and the economy, but a long and victorious negotiation process headed by the World Health Organization (WHO) led to one of the most solid strategies and instruments for equitable health protection: the WHO Framework Convention on Tobacco Control (WHO-FCTC), the first and only global public health treaty to this day. Approved in 2003 by the 56th World Health Assembly, the WHO-FCTC came into effect in February 2005 following ratification by 40 countries, including Brazil.Consisting of 38 articles and a series of effective measures backed by current scientific evidence for curtailing the consumption of tobacco products and its consequences, the WHO-FCTC serves as the framework and pillar for the success of smoking control policies. Due to the treaty's huge importance, four articles in this Supplement analyze the WHO-FCTC's relevance for tobacco control policy in Brazil, highlighting the government's leading role in the treaty's negotiations, the obstacles faced by ratification, and the role and conflicts of the institutions involved in the policy's implementation. The authors discuss the fact that Brazil is a leading producer and exporter of tobacco leaves and analyze how tobacco farmers are used by the tobacco industry to manipulate the opinions of politicians