La consommation de la cigarette constitue de nos jours un problème de santé publique. L’OMS a mis plusieurs outils à la disposition des Etats, dont les avertissements sanitaires pour lutter contre le tabagisme. Au Burkina Faso, l’avertissement sanitaire actuel en vigueur est sous forme textuelle de petite taille. La littérature en marketing social s’est intéressée à l’impact des avertissements sanitaires textuels et visuels sur les réactions affectives, cognitives et conatives des fumeurs et des non-fumeurs. Des divergences existent toujours sur l’efficacité des avertissements sanitaires de façon générale et de façon particulière, ceux qui suscitent des émotions négatives. Aussi très peu de recherches ont été réalisées sur des individus non-lettrés. Partant de ces constats, la présente thèse s’est fixée pour objectif de tester l’impact sur les fumeurs et les non-fumeurs, de l’avertissement sanitaire textuel actuel en vigueur au Burkina Faso et des 72 nouveaux avertissements sanitaires visuels proposés par l’OMS pour les pays africains. Nous avons mené une étude qualitative à travers des entretiens individuels. Les résultats indiquent que l’avertissement sanitaire textuel actuel a peu d’impact sur les réactions affectives, cognitives et les intentions comportementales des fumeurs et des non-fumeurs. En revanche, les avertissements sanitaires visuels ont plus d’impact sur les fumeurs et les non-fumeurs comparativement à l’avertissement sanitaire textuel. Les avertissements sanitaires qui suscitent plus d’émotions négatives (peur) ont plus d’impact sur l’intention comportementale des fumeurs et des non-fumeurs. Une étude quantitative a ensuite été réalisée pour comparer l’avertissement sanitaire textuel actuel en vigueur au Burkina Faso à 4 nouveaux avertissements sanitaires visuels choisis parmi les 72, à l’issue de l’étude qualitative. Les résultats de l’étude quantitative vont dans le sens de ceux de l’étude qualitative. A l’exception de la variable « lecture », le niveau d’instruction des fumeurs (lettré ou non-lettré) n’exerce pas une influence sur l’impact des avertissements sanitaires. Le sexe et la tranche d’âge des individus n’ont pas aussi d’effet significatif sur l’impact des avertissements sanitaires. La présente thèse contribue à enrichir la littérature sur les avertissements sanitaires dans les pays en développement et sur des cibles non-lettrées. Sur le plan de la santé publique, nos résultats suggèrent l’apposition des avertissements sanitaires visuels sur les paquets de cigarettes au Burkina Faso pour la lutte contre le tabagisme. / Smoking cigarettes is nowadays a public health issue. The World Health Organization has made several tools available to the States, including health warnings for nicotinism. In Burkina Faso, the current health warning in force is in small size textual form. Social marketing literature has focused on the impact of textual and visual health warnings on the affective, cognitive and conative responses of smokers and non-smokers. Divergences still exist on the effectiveness of health warnings in a general way and particularly, those which arouse negative emotions. Thus, very little research has been carried out on illiterate individuals. Based on these observations, the present thesis aims to test the impact on smokers and non-smokers, of the current textual health warning in force in Burkina Faso and the 72 new visual health warnings proposed by the WHO for African countries. We conducted a qualitative study through individual interviews. The results show that the current textual health warning has little impact on the emotional, cognitive and behavioral intents of smokers and non-smokers. But, visual health warnings have a greater impact on smokers and non-smokers compared to the textual health warning. Health warnings that cause more negative emotions (fear) have more impact on the behavioral intent of smokers and non-smokers. A quantitative study has then been carried out to compare the current textual health warning in force in Burkina Faso with 4 new visual health warnings selected from the 72, following the qualitative study. The quantitative study’s results are in line with those of the qualitative study. With the exception of the « reading » variable, smokers’ level of education (literate or non-literate) does not influence the impact of health warnings. Gender and age range of individuals do not also have a significant effect on the impact of health warnings. This thesis helps to enrich the literature on health warnings in developing countries and on non-literate people. In terms of public health, our results suggest the addition of visual health warnings on cigarette packets in Burkina Faso to fight against smoking.

This dissertation is an empirical investigation into the roles that different quantifiable and measurable perceptions play in defining individual behavior across a variety of decision-making contexts. In particular, the focus lies on smokers and the choices they make with regard to smoking and beyond. Chapter 1 analyzes a nationally representative sample of adults (23 years and older) in the United States, pertaining to the Annenberg Perception of Tobacco Risk Survey II (1999-2000). It is observed that three dimensions to smoking behavior viz., risk, temporality and addiction, interact to determine the smoking status of an individual. Although previous studies mostly looked into each of these dimensions in isolation, in this chapter, we empirically illustrate how perceptions on risk, time dimensions and addiction, jointly influence the smoking behavior of adults. Chapter 2 casts the smoker in the role of a parent and explores parental behavior towards the general health-risks facing their children. Using the dataset from a survey (2009), conducted in Orlando, Florida, on parents, having at least one child aged between 1 and 16 years, the chapter arrives at two findings relevant for policy: i) In each of the ‗smoker‘ and ‗non-smoker‘ parent categories, parents exhibit equal concern for themselves and their children, and ii) the level of concern shown by smoker-parents, towards health-risks faced by their children, is the same as that shown by their non-smoking counterparts. The analysis in this chapter also affirms the need to incorporate subjective risk assessment in willingness-to-pay (WTP) exercises to facilitate a deeper behavioral analysis of health risk valuation. Lastly, in Chapter 3, we focus on the issue of quantitative assessment of the perception of health risks from smoking. Particular interest lies in understanding how variants of a metric - namely, a survey question - have been employed in academic studies and industry-surveys, in order to measure smoking-related risk-perceptions. In the process of reviewing select tobacco-industry survey iv records, we analyze the implications of different features of this metric, (e.g., use of a ‗probe‘, the ‗Don‘t Know‘ option), and various interview modes (e.g. telephonic, face-to-face), for the estimates of perceived risk arrived at in these studies. The review makes clear that two aspects of health risks from smoking – the risk of contracting a smoking-related disease, as against the risk of prematurely dying from it conditional upon getting affected – have not been jointly explored so far. The dataset obtained from the Family Heart Disease and Prevention Survey (November 2010-March 2011), provides a unique opportunity to explore these two kinds of probabilities, particularly with regard to the risks of lung-cancer from smoking. Chapter 3 concludes by illustrating how individuals evaluate both these aspects of health-risks. While the probability of getting lung-cancer is found to be overestimated in conjunction with previous studies, the conditional probability of premature death is severely underestimated. Additionally, it is found that individuals‘ subjective assessments of either of these risk aspects predict smoking behavior in an identical manner. This calls into question the so-called ‗rationality‘ of smoking decisions with implications for policies designed for the control of tobacco consumption.

The purpose of this thesis is to determine through focus groups and individual interviews the identity gaps experienced by young adult smokers, the strategies they enact to minimize or avoid identity gaps, and contexts in which layers of identity are aligned in order to target those sites in future smoking cessation health campaign messages. Engaging in stigmatized health behaviors, like smoking, impacts the messages individuals receive from other people and the media about their health, identity, and behaviors, and the way they communicate about themselves. Michael Hecht's (1994) communication theory of identity (CTI) explains the process of enacting and shaping identities through communication and provides the framework of this thesis. Identities consist of four interpenetrating layers: enacted, personal, relational, and communal. When there is a discrepancy between layers an identity gap occurs. Identity gaps are associated with uncomfortable dissonance and negative communication outcomes. However, identity gaps also present opportunities for targeted health messages that draw attention to dissonance as a motivational tactic and offer behavior change strategies to decrease gaps. I conducted four focus groups and ten interviews focusing on the daily experiences of 20 young adult smokers. Identity gaps emerged involving all four layers of identity, though personal-enacted, enacted-relational, and personal-relational identity gaps were reported most frequently. Strategies to manage identity gaps included lying about smoking, hiding the behavior of smoking, and gauging others' reactions prior to disclosing smoking status. Participants voiced contexts and relationships in which layers of identity aligned, including around other college-age individuals and friends. Theoretical and practical implications of these findings are offered, including suggestions for health messages and interventions targeting management strategies and contexts where identity is aligned in order to decrease their efficacy and thus increase the magnitude of the already pervasive identity gaps young adults smokers experience in the hopes of motivating behavior change.

Tobak är den drog i världen som skördar flest människoliv. Beroendet och påverkanbåde som aktiv och passiv rökare påverkar både individens hälsa och folkhälsannegativt och ett förebyggande hälsofrämjande arbete är ständigt aktuellt. Syftet meddetta arbete är att analysera diskurser kring rökande gravida kvinnor, de föreställningarsom finns och som skapar sociala konsekvenser för dessa kvinnor. Även en ökadförståelse kring hur diskurser formas och bildar de sanningar och normer som finns isamhället. Enligt diskurser föreställs den gravida rökaren som en avvikare från normen,en självisk, oansvarig person som medvetet utsätter sitt barn för stora hälsorisker. Attrökning är lika svårt att sluta med som ett alkohol- eller drogberoende inkluderas sällani diskursen som fokuserar mer på att det är viljan som avgör. Ilskan ochstigmatiseringen som dessa kvinnor blir bemötta av är sociala konsekvenser frånföreställningarna. Barnmorskorna inom mödravården har ett stort ansvar att lyssna påoch samtala med dessa kvinnor då empati är skammens enda motgift. Diskursanalyssyftar inte till att komma fram till någon ny sanning utan att visa på hur diskurserna serut och verkar inom samhället genom media samt skapa förståelse för hur våra sanningar,vår verklighet är diskursivt konstruerad. / AbstractPorsefalk, A. (2015). Notions of pregnant smokers. A critical discourse analysisaccording to Michel Foucault. Department of work- and public health science. Facultyof health and occupational studies. University of Gävle, Sweden.Introduction: The knowledge about risks associated with smoking and the impact ithas on the public health is well known, so also the knowledge of impact on the unbornchild when the mother smokes. The aim of this study is to analyze discourses in societyof pregnant women who smoke. Increase understanding of how a discursiveconstruction creates truths and knowledge in society which create social consequencesfor pregnant smokers. How does the discourse describe the behavior of pregnantsmokers? What social consequences can occur? Method: In a qualitative approach inthe form of discourse analysis, supported by the theory of Michel Foucault materialsfrom various sources online where notions of pregnant smokers are present. Thematerial is problemized, questioned and discussed. Result analysis: According to thediscourse the pregnant smokers are egotistic, selfish, want to hurt their children and lovecigarettes more than anything else. The social consequences that this leads to are thatwomen receive anger and mocking sarcasm which makes an already shameful situationeven worse. Discussion: Through communication, reflexive thinking and change of thedialog in maternitycare shame and stigma will reduce and therefore also the number of pregnant women smokers.

published_or_final_version / Clinical Psychology / Doctoral / Doctor of Psychology

Cigarette smoking is the leading cause of preventable disease and is the cause of nearly 1 in 5 deaths in the United States. The prevalence of smoking has had a leveling off effect after many years of significant decline. Certain subgroups of the population, such as those with low income and certain illnesses, continue to smoke at disproportionately high rates. Reasons for these disparities in smoking rates are complex. Developing a better understanding of the issues related to persistent smoking particularly for those with medical illness and limited access to cessation resources can help focus interventions to help these high risk smokers quit. This dissertation includes a systematic review of the literature associated with hardcore smoking; an analysis of the reliability and validity of a self-efficacy instrument in a sample of low-SES, medically ill smokers; and the results of a cross-sectional, non-experimental study exploring the relationship between smoking-related factors and planning to quit in a sample of medically ill smokers. A sample of 70 current and recent smokers was surveyed at a free clinic. Quitting self-efficacy was measured using an instrument not previously tested in a rural, medically ill sample. Modifications to the survey were made based on qualitative interviews with smokers and a single question measuring self-efficacy was also tested. There was a high correlation among the self-efficacy measures (Spearman’s rho .99, p < .001) and between the longer instrument and the single question (Spearman’s rho .65, p < .001). Each measure demonstrated acceptable reliability and validity. In the study exploring potential factors associated with planning to quit, the number of prior quit attempts and confidence to quit explained 43% of the variance in those planning versus not planning to quit. Providing interventions focused on increasing confidence and experience with quit attempts can be effective in promoting a plan to quit in this group of smokers who, because of their medical illness, can benefit significantly from cessation. Research is needed to explore cessation outcomes when employing these targeted interventions with medically ill smokers in rural areas.

Introduction: The World Health Organization (WHO) has declared hookah smoking to be a significant public health problem. According to Martinasek et al. the increase in the number of hookah smokers is due to lack of education and public awareness, there is a general impression that hookah is a safe alternative to cigarettes. (Martinasek et al., 2011). On the other hand, hookah is affordable and has appealing flavor. The US Food and Drug Administration does not regulate hookah and there is a lack of regulation in packet labeling (Martinasek et al., 2011). Hookah smoking and cigarette smoking produces the exact same toxic chemicals and carcinogens (Martinasek et al., 2011). The US Environmental Protection Agency claims that hookah smoking releases secondhand smoke which contains cancer causing agents (Martinasek et al., 2011). Overall, hookah smoking is increasing rapidly among youth due to social acceptance, low cost, appealing flavors, lack of regulatory policies and incorrect harm perception. Therefore, I propose a study that will aim to answer the following research questions: 1) What are the socio-demographic characteristics of middle school and high school students who have awareness of hookah? 2) What are the characteristics of middle school and high school students who report hookah is less harmful than cigarettes? 3) Does awareness of hookah, harm perception of hookah, ever user and current user of hookah differ by living with hookah users? 4) How does harm perception of hookah correlate with use of hookah among US youth? I hypothesize that American youth who perceive hookah as less harmful than cigarettes will more likely be users of hookah as compared to youth who perceive these products are more harmful. Methods: The secondary data analysis was conducted using the data from the 2013 National Youth Tobacco Survey (NYTS). The study population was middle and high school students. The independent variables of interest were students who were current users of hookah, had ever used hookah, as well as those aware of hookah smoking. The dependent variable was harm perception of hookah smoking. A weighting factor was adjusted in the survey to get a weighted proportion of students in each grade to match with the national population. The prevalence of current and ever users of hookah, as well as those aware of hookah among middle school and high school students, was examined. The frequency of high school and middle school students who are living with hookah users, and those who were not evaluated. The association of harm perception of hookah among current and ever users, as well as those aware of hookah smoking adjusted by those who are living with hookah users was assessed. Data was analyzed in SAS 9.3 to examine the association between the independent and dependent variables. Frequency, logistic regression and a chi-square tests were used to find the odds ratio and p-value between the dependent and independent variables. Results: Association of harm perception of hookah among current users of hookah, ever users, as well as those aware of hookah smoking, reported that 55.64% of current users of hookah (Adjusted OR = 4.99, CI: 3.78-6.59), 43.80% of ever users of hookah (Adjusted OR = 4.96, CI: 4.02-6.13) and 21.50% of those who were aware of hookah smoking (Adjusted OR = 3.20, CI: 2.82-3.91) believed that hookah smoking is less harmful than cigarette smoking in both middle and high school. Participants who were current users of cigar smoking i.e.26.57% (crude OR = 2.80 CI: 2.45-3.20), Adjusted OR = 1.18, CI: 0.96-1.45)) as well as ever users of cigar smoking i.e. 24.76% (crude OR= 3.18, CI: 2.78-3.65), adjusted OR = 2.24, CI: 1.85-2.71)) believe hookah smoking is less harmful than cigarette smoking compared to individuals who were not current as well as ever users of cigar smoking. There was no significant difference between odds of male and female in believing that hookah smoking is less harmful than cigarette smoking. Discussion: Overall these results suggest that students who were associated with hookah usage believe that hookah smoking is less harmful than cigarette smoking. Moreover, students who were ever users of cigar smoking had 2.24 odds of believing that hookah smoking is less harmful than cigarette smoking compared to individuals who were not ever users of cigar smoking. Conclusion: Therefore, American youth who perceive hookah as less harmful than cigarettes will more likely be users of hookah as compared to youth who perceive these products are more harmful

O objetivo do estudo foi avaliar o efeito de repetidas aplicações da Terapia Fotodinâmica antimicrobiana (TFDa) adjuvante ao tratamento periodontal não cirúrgico em pacientes fumantes. Foram selecionados 20 indivíduos fumantes com diagnóstico clínico de periodontite crônica. O estudo foi do tipo boca dividida, sendo um lado utilizado a TFDa associada à raspagem e alisamento radicular (RAR) e no outro apenas RAR. Foi utilizado laser com 660nm de comprimento de onda associada ao fotosensibilizador fenotiazida e as aplicações foram realizadas em 4 episódios (dias 0, 2, 7 e 14). Todos os pacientes foram acompanhados por 90 dias. As avaliações clínicas de índice de placa (IP), profundidade de sondagem (PS), nível clínico de inserção (NCI), sangramento à sondagem (SS) e sangramento marginal (SM) foram realizadas no baseline, 0, 30 e 90 dias após a execução do tratamento. Foi realizada análise microbiológica para contagem de 40 espécies bacterianas da amostra subgengival da placa bacteriana (Checkerboard DNA-DNA hybridization). Níveis das citocinas do fluido crevicular gengival foram avaliados (Interleucina-1&beta;, Interleucina-10 e Fator de Necrose Tumoral Alpha). Os dados obtidos foram analisados estatisticamente. Em geral não foram observadas diferenças estatisticamente significantes entre os grupos (p &lt0,05) nos parâmetros clínicos, microbiológicos e imunológicos 90 dias após o tratamento. O tratamento periodontal com RAR + TFDa em múltiplos episódios não promoveu benefícios adicionais à RAR no tratamento não cirúrgico da periodontite crônica em fumantes sem o uso de antibióticos sistêmicos / The aim of this study was to investigate the additional influence of multiple applications of antimicrobial Photodynamic Therapy (aPDT) in smokers without use of systemic antibiotics. Twenty smokers with chronic periodontitis were treated in a split-mouth design study with aPDT adjunct to Scaling and Root Planing (SRP) or SRP only. aPDT was performed by using a laser light source with 660 nm wavelength associated with a photosensitizer. The applications were performed in four episodes (at days 0, 2, 7 and 14). All patients were monitored for 90 days. Plaque index, probing depth, clinical attachment level, bleeding on probing and marginal bleeding were performed at baseline, 0, 30 and 90 days after the SRP. Counts of 40 subgingival species in plaque samples were monitored (Checkerboard DNA-DNA hybridization). Gingival crevicular fluid and subgingival plaque samples were collected (Interleukin 1&beta;, Interleukin 10 e Tumor necrosis factor. Data obtained were statistically analyzed. aPDT as an adjunct to SRP did not demonstrate statistically significant advantages on clinical parameters when compared with SRP alone. In general no statistic significant differences between groups were observed (p &lt0.05). Levels of anti-inflammatory cytokines and bacterial species were comparable in both groups at day 90 after treatment. Periodontal treatment with SRP + aPDT in multiples episodes was not able to improve results in the non-surgical treatment of chronic periodontitis in smokers when compared SRP alone, without the use of systemic antibiotics

O tabagismo durante a gravidez é o principal fator de risco previsível associado com complicações tanto no parto quanto na gestação. Estão relacionados, por exemplo, partos prematuros, baixo peso ao nascer, doenças no trato respiratório do feto e, com a morte infantil. A exposição à fumaça do tabaco pode ser avaliada através da presença de nicotina e cotinina nos fluidos biológicos, incluindo plasma, soro, urina, saliva, cabelo e unha. A saliva é uma matriz alternativa que apresenta como vantagens a facilidade de obtenção, não é uma amostra invasiva, a coleta pode ser assistida, é de baixo custo, o risco de contração de infecções durante a coleta e manuseio da amostra é mínimo e pode ser utilizada em situações que é difícil a obtenção de outro tipo de amostra. Como a prevalência de gestantes fumantes de cigarro é relativamente alta, é importante uma confirmação por um laboratório de análise para classificar de forma correta e confiável se a gestante é fumante ou não. O objetivo desta pesquisa foi desenvolver e validar um método para análise de nicotina e cotinina em amostras de saliva de gestantes. Foi utilizada a extração líquido-líquido para o preparo das amostras de saliva e foi realizada a cromatografia em fase gasosa com detector termiônico específico para a separação, identificação e quantificação dos analitos nicotina, cotinina e do padrão interno ketamina. O limite de detecção foi de 10 ng/mL para nicotina e de 6 ng/mL para cotinina. Os limites inferiores de quantificação foram de 40 ng/mL e 20 ng/mL para a nicotina e cotinina, respectivamente. O método foi considerado linear na faixa de concentração de 40 a 2000 ng/mL (R=0,996) para a nicotina e de 20 a 2000 ng/mL (R=0,999) para a cotinina. Os valores de recuperação dos analitos variaram de 66,1% a 92,2%. A precisão intradia apresentou uma variação de 6,06% a 11,50% e a precisão interdia variou de 6,89% a 10,57%. A exatidão intradia variou de -11,29% a 19,81%, e os valores da exatidão interdia variaram de -11,78% a 13,08%. Ambos os analitos apresentaram estabilidade nas amostras biológicas e em solução. Na primeira avaliação (período gestacional de 1 a 25 semanas), o método foi aplicado em 259 amostras de saliva de gestantes fumantes e não fumantes. E na segunda (período gestacional de 36 a 40 semanas e até 113 dias após o parto), foi aplicado em 45 amostras de gestantes fumantes. Foi observada uma diferença significativa ao comparar o autorrelato das gestantes fumantes e não fumantes, na primeira avaliação, com a concentração de nicotina e cotinina nas amostras de saliva (p<0,001). As concentrações de cotinina em amostras de saliva correlacionaram positivamente com o número de cigarros consumidos diariamente pelas gestantes fumantes, na primeira avaliação (p<0,001). Não foram obtidas diferenças estaticamente significativas para as variáveis: número de cigarros diários (p=0,255), concentração de nicotina (p=0,949) e cotinina (p=0,665). O ponto de corte da nicotina foi maior que zero, com sensibilidade de 36,8% e especificidade de 97,7%. Para a cotinina, o ponto de corte foi maior que 17,2 ng/mL, com sensibilidade de 94,3% e especificidade de 98,8%. O método analítico desenvolvido e validado atendeu aos critérios exigidos pela resolução 27/2012 e à 899/2003 da Agência Nacional de Vigilância Sanitária. / Smoking during pregnancy is the main factor associated with complications in both and gestation. It is related, for example, premature births, low birth weight, diseases in the respiratory tract of the fetus and, with child death. Exposure to tobacco smoke can be assessed by the presence of nicotine and cotinine in biological fluids including plasma, serum, urine, saliva, hair and nails. The saliva is an alternative matrix that presents as advantages the ease of obtaining, is not an invasive sample, the collection can be assisted, it is of low cost, the risk of contraction of infections during the collection and handling of the sample is minimal and can be used in situations where it is difficult to obtain another type of sample. As the prevalence of pregnant cigarette smokers is relatively high, confirmation by an analysis laboratory is important to correctly and reliably classify whether the pregnant woman is a smoker or not. The objective of this research was to develop and validate a method for the analysis of nicotine and cotinine in saliva samples from pregnant women. Liquid-liquid extraction was used for the preparation of saliva samples and gas chromatography with specific thermionic detector was performed for the separation, identification and quantification of the analytes nicotine, cotinine and the internal standard ketamine. The limit of detection was 10 ng/mL for nicotine and 6 ng/mL for cotinine. The lower limits of quantification were 40 ng/mL and 20 ng/mL for nicotine and cotinine, respectively. The method was considered linear in the concentration range of 40 to 2000 ng/mL (R=0.996) for nicotine and 20-2000 ng/mL (R=0.999) for cotinine. The recovery values of the analytes range from 66.1% to 92.2%. The intraday precision ranged from 6.06% to 11.50% and the interday precision ranged from 6.89% to 10.57%. The intraday accuracy ranged from -11.29% to 19.81%, and the interday accuracy ranged from -11.78% to 13.08%. Both analytes presented stability in the biological samples and in solution. At the first evaluation (gestational period of 1 to 25 weeks), the method was applied to 259 saliva samples from pregnant smokers and nonsmokers. And in the second (gestational period of 36 to 40 weeks and up to 113 days postpartum), it was applied in 45 samples of pregnant smokers. A significant difference was observed when comparing the self-report of pregnant smokers and nonsmokers in the first evaluation with the concentration of nicotine and cotinine in saliva samples (p<0.001). The concentrations of cotinine in saliva samples correlated positively with the number of cigarettes consumed daily by pregnant smokers in the first evaluation (p<0.001). No statistically significant differences were found for the variables: number of daily cigarettes (p=0.255), nicotine concentration (p=0.949) and cotinine (p=0.665). The cutoff point of nicotine was greater than zero, with sensitivity of 36.8% and specificity of 97.7%. For cotinine, the cutoff point was greater than 17.2 ng/mL, with sensitivity of 94.3% and specificity of 98.8%. The analytical method developed and validated met the criteria required by resolution 27/2012 and 899/2003 of the National Sanitary Surveillance Agency.

Introdução: O hábito de fumar causa inúmeros prejuízos à saúde, entre os quais aumenta o risco de disfunção endotelial. Atualmente, o método mais utilizado para a avaliação não invasiva da função vascular, é a dilatação mediada por fluxo da artéria braquial: através da ultrassonografia. Objetivos: Avaliar em que tempo ocorre à máxima dilatação, e se existe diferença na avaliação da função endotelial avaliada pela ultrassonografia ao comparar quatro grupos de mulheres (gestantes ou não e fumantes ou não). Métodos Estudo transversal no qual foi realizada a mensuração do diâmetro da artéria braquial em repouso e em quatro tempos após estímulo (30, 60, 90 e 120 segundos) em quatro grupos de mulheres entre 20 e 30 anos de idade, incluindo gestantes entre 24 e 28 semanas de idade gestacional: gestantes não fumantes (N=47), gestantes fumantes (N=33), mulheres não fumantes (N=34) e mulheres fumantes (N=19), resultando em 133 avaliações. Resultados: Dados antropométricos, idade, paridade e idade gestacional não houve diferença significativa nos grupos estudados, bem como, os níveis de pressão arterial diastólica (PAD) (mmHg) e índice de massa corporal. Uma diferença significativa foi observada entre o número de cigarros consumidos por semana entre gestantes e não gestantes (p=0,04). A DMF foi maior entre as gestantes não fumantes em comparação às fumantes (11,50 ± 5,77 vs. 8,74 ± 4,83; p=0,03) como também no grupo de não gestantes não fumantes em comparação as fumantes (10,52 ± 4,76 vs. 7,21 ± 5,57; p=0,03). Ambas com diferença significativa em relação ao grupo controle. Em relação à avaliação da dilatação nos diferentes tempos, esta foi máxima para todos os grupos no tempo 60 segundos após a desinsuflação. Uma diferença significante foi observada em todos os tempos e entre todos os grupos. Conclusões: A máxima dilatação mediada por fluxo foi observada 60 segundos, após o estímulo em todos os grupos. O hábito de fumar parece levar a disfunção endotelial, tanto em mulheres gestantes quanto em não gestantes, o que foi demonstrado por uma menor dilatação mediada por fluxo nas fumantes. / There is innumerous health problems associated with smoking habits, among them an increased risk of endothelial dysfunction. Currently, the most used method for noninvasive evaluation of vascular function is flow-mediated dilatation (FMD) of the brachial artery determined by ultrasonography. Objectives: To determine at what time the maximum dilatation occurs and whether there is a difference in the evaluation of endothelial function determined by ultrasonography when comparing four groups of women (pregnant smokers and pregnant no smokers, and non-pregnant smokers and non-pregnant no-smokers). Methods This cross sectional study included a total of 133 women. The women were divided into 4 groups non-smoking pregnant women (N=47), smoking pregnant women (N=33), non-smoking women (N=34), and smoking pregnant women (N=19). The diameter of the brachial artery was measured at five times (rest, after a stimulus (30, 60, 90 and 120 seconds). Results: Anthropometric data, age, parity, gestational age, diastolic blood pressure (DBP) and body mass index did not differ significantly between groups. A significant difference was observed in the number of cigarettes smoked per week between pregnant women and non-pregnant women (p=0.04). The FMD was greater among non-smoking pregnant women compared to smoking pregnant women (11.50 ± 5.77 vs. 8.74 ± 4.83; p=0.03) and also among non-smoking non-pregnant women compared to smoking non-pregnant women (10.52 ± 4.76 vs. 7.21 ± 5.57; p=0.03). The difference was significant in both cases. Regarding the evaluation of dilation at the different time points, the maximum value was obtained for all groups at the 60 second time point after disinsufflation. A significant difference was observed at all times and between all groups. Conclusions: Maximum FMD was observed 60 seconds after the stimulus in all groups. The smoking habit seems to lead to endothelial dysfunction both in pregnant and non-pregnant women, as demonstrated by the lower FMD among smokers.