published_or_final_version / abstract / toc / Community Medicine / Doctoral / Doctor of Philosophy

Objective. Most biomarker studies of maternal smoking have been based on a single blood or urinary cotinine value, which is inadequate in capturing maternal tobacco exposure over the entire pregnancy. This thesis used maternal hair biomarkers to investigate the association between maternal active and passive smoking, and birthweight for gestational age (BW for GA). / Methods. Subjects were 444 term controls drawn from 5,337 participants of a multi-centre nested case-control study of preterm birth in Montreal. Maternal hair, collected after delivery, was measured for average nicotine and cotinine concentration across the pregnancy, assuming hair growth of 1 cm/month. The BW for GA z-score used Canadian population-based standards. Multiple linear regression was used to assess effects on the z-score, after controlling for potential confounders. / Results. In regression models for maternal active smoking analysis, the addition of hair nicotine to models containing either self-report or hair cotinine or both self-report and cotinine explained significantly more variance in the BW for GA z-score (p=0.009, p=0.017, and p=0.033, respectively). In maternal passive smoking analysis, no significant effect of ETS on BW for GA was found using hair biomarkers. / Conclusion. These results indicate that hair biomarkers are sensitive tools capable of predicting reductions in birthweight for maternal active smoking. The stronger results obtained for nicotine are reflective of the fact that hair nicotine is a better measure of maternal smoking, but it could also suggest that nicotine plays an aetiologic role in affecting foetal growth.

Submitted by Simone Souza (simonecgsouza@hotmail.com) on 2018-07-30T13:55:12Z No. of bitstreams: 1 DISS_2013_ Juliana Gomes Jorge.pdf: 733212 bytes, checksum: 3da461d3f230e5b2e0157865cb51e930 (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2018-08-02T12:54:36Z (GMT) No. of bitstreams: 1 DISS_2013_ Juliana Gomes Jorge.pdf: 733212 bytes, checksum: 3da461d3f230e5b2e0157865cb51e930 (MD5) / Made available in DSpace on 2018-08-02T12:54:36Z (GMT). No. of bitstreams: 1 DISS_2013_ Juliana Gomes Jorge.pdf: 733212 bytes, checksum: 3da461d3f230e5b2e0157865cb51e930 (MD5) Previous issue date: 2013-05-03 / A exposição ao tabagismo passivo se constitui um importante problema de saúde pública. A fumaça ambiental do tabaco afeta diversos processos fisiológicos, bem como as funções cognitivas relacionadas à aprendizagem. Objetivo: Analisar a associação entre o tabagismo gestacional e domiciliar na aquisição e/ou desenvolvimento da aprendizagem em escolares do ensino fundamental do município de Campo Verde – Mato Grosso. Métodos: estudo epidemiológico transversal analítico, em amostra representativa da população de 785 escolares do 2º ao 5º ano do ensino fundamental. Os alunos foram avaliados por meio do Protocolo de Triagem de Letramento Escolar, visando identificar a presença de dificuldades de aprendizagem. As mães/responsáveis foram entrevistadas por meio de um questionário contendo questões relativas ao fumo. Foram realizadas análises descritiva, bivariada e regressão logística. A análise descritiva dos dados foi realizada por meio de tabelas e descrição dos achados. Na análise bivariada foram identificadas as associações brutas através do cálculo da razão de prevalência (RP) e respectivos Intervalos de Confiança de 95% (IC 95%), cálculo da significância estatística da associação utilizando o teste de Qui-quadrado para Razão de Prevalência com intervalo de 95% de confiança pelo método de Mantel-Haenszel (IC 95%), ou teste exato de Fisher quando indicado. Na Regressão Logística foram consideradas as variáveis que apresentaram associação estatisticamente significante a partir das análises brutas, com p-valor menor que 0,20, mantendo-se no modelo final as variáveis com nível de significância menor ou igual 0,05 ou aquelas consideradas de importância, segundo a literatura consultada. Os dados foram analisados através dos programas estatísticos SPSS for Windows versão 15.0, EPI INFO 2000 versão 3.5.1 e STATA versão 9.0. Resultado: a análise bivariada indicou associação significativa para as variáveis Sexo, Escolaridade e Raça/Cor dos Escolares; Escolaridade, Raça/Cor, Estado Civil e Classe Econômica das Mães; Número de Consultas de Pré-Natal, Baixo Peso ao Nascer e Uso de Álcool; Tabagismo Materno Atual, Gestacional e durante a Amamentação; e Otite para as variáveis relacionadas aos fatores associados à Aprendizagem. No modelo final da regressão logística foi considerada estatisticamente significativa a variável tabagismo domiciliar. Conclusão: o estudo evidenciou associação entre a exposição passiva ao tabaco e as dificuldades de aprendizagem nos escolares. / Exposure to passive smoking constitutes a major public health problem. The environmental tobacco smoke affects many physiological processes as well as cognitive functions related to learning. Objective: To analyze the association of smoking during pregnancy and in the home acquisition and/or development of learning in school children of elementary school in the municipality of Campo Verde – Mato Grosso. Methods: We carried a cross-sectional epidemiological study. Participants consisted of a representative sample of the population of students from 785 2nd to 5th elementary school. Students were evaluated by the Protocol School Literacy Screening, to identify the presence of learning difficulties. Mothers / caregivers were interviewed using a structured questionnaire containing questions relating to household smoking. Analyses Descriptive, bivariate, and logistic regression. A descriptive analysis was performed by means of tables and description of the findings. In bivariate associations were identified by calculating the crude prevalence ratio (PR) and their confidence intervals of 95% (95%), calculating the statistical significance of the association using the chi-square test for prevalence ratio with the 95% confidence by the Mantel-Haenszel method (95%), or Fisher exact test when indicated. In logistic regression were considered all variables that showed a statistically significant association from the crude analyzes, with a p-value less than 0.20, remaining in the final model variables with a significance level less than or equal to 0.05 or those considered of importance, according to the literature. Data were analyzed using SPSS statistical software for Windows version 15.0, EPI INFO 2000 version 3.5.1 and STATA version 9.0. Result: The bivariate analysis showed a significant association for the variables Gender, Education and Race / Color School, Education, Race / Color, Marital Status and Economy Class Mothers, Number of Prenatal Consultations, Low Birth Weight and Usage alcohol, Tobacco Current Maternal, gestational and during breastfeeding, and Otitis for variables related to factors associated with learning. In the final model of logistic regression was considered statistically significant variable household smoking. Conclusion: The study showed an association between exposure to passive smoking and learning difficulties in schools children.

Chronic obstructive pulmonary disease is the fourth largest cause of death worldwide and the prevalence is predicted to increase even further to make it the third largest cause of death by 2020. The main cause of the disease is exposure to tobacco smoke. COPD is a complex disease and there is a strong need of better understanding of the pathogenetic mechanisms in order to come up with novel therapeutic interventions and preventive strategies. The golden standard to image the lungs today is to use computed tomography (CT) which is an imaging modality that involves ionizing radiation and could thus harm the patient, especially with repeated exposure. New techniques in the image acquisition of magnetic resonance imaging (MRI), an imaging modality that does not involve ionizing radiation, has emerged that allows for lung imaging. The work included segmentation of the lungs, image registration and partitioning of the lungs inorder to perform regional analysis. The results indicate that the mean value of the T1-parameter in the left and right lung is not affected to the same degree, where the left lung showed a greater decrease. The results also showed that the anterior parts of the lungs are not showing any statistically significant changes but the changes were instead seen in the center and posterior parts. Both lungs also showed results that indicate that the mean T1-value is recovered at the end of the longitudinal study, a phenomenon that couldn’t be explained and further studies have to be performed.

Tobacco use continues to be the leading cause of preventable death in the world. The disproportionate increase in tobacco use in low- and middle-income countries needs immediate attention. Many smokers begin smoking as adolescents and are most likely to become permanent smokers. Moreover, youth are highly targeted by tobacco industry strategies. However, a gap exists in literature to understand worldwide youth tobacco use and control. The purpose of this study is to 1) identify factors that influence never-smoking youths‟ smoking susceptibility, 2) explore characteristics that influence youth exposure to environmental tobacco smoke (ETS) and 3) to delineate key determinants of youth support for smoke-free policies (SFPs). Data related to worldwide youth tobacco use was obtained from the Global Youth Tobacco Survey for the years 1999-2008. Simple and multiple logistic regression analyses were conducted, after the sample was weighted for design effect, nonresponse patterns and poststratification. Unadjusted and adjusted odds ratios along with 95% confidence intervals were reported. Around 14% of never-smoking youth were susceptible to smoking worldwide. Around 40% and 50% youth were exposed to ETS inside and outside the home respectively, and 78% supported SPFs globally. Parental and peer smoking was strongly associated with smoking susceptibility in never-smoking youth [AOR 2.63, 95% CI 2.43 to 2.84], and youth exposure to ETS inside [AOR 5.09, 95% CI 4.84 to 5.35] and outside [AOR 2.51, 95% CI 2.39 to 2.63] the home, while anti-smoking school education was negatively associated. Youth having knowledge about smoking harm [AOR 2.37, 95% CI 2.22 to 2.54] supported SFPs, while youth exposed to tobacco industry promotion [AOR 0.83, 95% CI 0.78 to 0.89] did not support. The study highlighted a number of modifiable factors that can be used for augmenting global tobacco control in youth. Well-executed anti-smoking campaigns, parental and peer education, inclusion of anti-tobacco education in school curricula, comprehensive SFPs, and comprehensive ban on tobacco industry strategies are important approaches to prevent tobacco use and advance global tobacco control in youth.

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Acid-base equilibria in organic particulate matter (PM) are poorly understood, but have important implications for air quality and public health. First, acid-base reactions in organic particulate matter affect the gas/particle partitioning of organic compounds in the atmosphere, and these processes are not currently represented in atmospheric and climate change models. Second, the acid-base balance of tobacco smoke affects the amount of nicotine absorbed by the smoker, and a greater understanding of this balance would help to relate cigarette smoke composition to the addictive properties of cigarettes. This work presents data related to both air quality and tobacco smoke modeling. The gas/particle partitioning behavior of organic acids and bases is highly dependent on acid-base equilibria and speciation between neutral and ionic forms, because ionic compounds do not volatilize. Descriptions of acid dissociation behavior in atmospheric PM have, to date, focused primarily on phases in which the solvent is water; however, atmospheric PM may include up to 90% organic matter. Data is presented here describing the acid dissociation behavior of organic acids and protonated amines in organic/aqueous mixtures (chosen to approximate the characteristics of organic PM) with varying levels of water content. In such mixtures, the preferential solvation of ions and neutral molecules (by the aqueous portion or the organic portion, respectively) affects the acid-base equilibria of the solutes. It is demonstrated that neutralization reactions between acids and bases that create ions are likely to have non-negligible effects on gas/particle partitioning under certain atmospheric conditions. Thus, including acid-base reactions in organic gas/particle partitioning models could result in a greater proportion of acidic and basic compounds partitioning to the particulate phase. In addition, the acid dissociation constants (pKa values) of atmospherically-relevant acids and bases vary with water content. Specifically, as water content increases, the pKa values of organic acids decrease dramatically, while the pKa values of protonated amines changes only slightly. This situation can result in drastically different speciations and partitioning behavior depending on water content. This second part of this work reports some of the data needed to develop an acid-base balance for tobacco smoke PM using electroneutrality as a governing principle. Five brands of cigarettes were sampled and the smoke PM extracted. Cations (sodium, potassium, and ammonia) and anions (organic acids, nitrate, nitrite, and chloride) were measured using ion chromatography. Ammonia and organic acids were also re-measured after the acidification of the sample in order to determine whether "bound" forms of these compounds exist in cigarette PM. Weak acids were determined by acid-base titration to determine whether or not all of the weak acids (including organic acids) had been accounted for by the ion chromatography. Weak bases were also determined by acid-base titration, and the majority of weak base is expected to be accounted for by total nicotine (to be measured in a separate analysis). In terms of total acidic species and total basic species, two of the five cigarette brands measured were relatively basic, and three were relatively acidic. Between 50% and 89% of the titrated acids were accounted for by the anionic species measured in ion chromatography. Based on samples tested after sample acidification, about half of the potential ammonia in tobacco smoke PM exists in "bound" form. The speciation of weak acids and bases in tobacco smoke PM cannot be determined from this data alone, because the equilibrium constants of acid-base reactions are not understood in complex organic media. The data presented here, when combined with data from free-base and total nicotine analyses, represent a first step toward a predictive model of acid-base behavior in tobacco smoke PM.

Introduction. La fumée secondaire est considérée comme un agent neurotoxique. À ce jour, la littérature traitant des liens entre l’exposition à la fumée secondaire à l’enfance et les comportements antisociaux repose majoritairement sur des devis transversaux ou porte sur la période développementale de l’enfance. Objectif. D’une part, nous souhaitons repousser l’âge auquel les comportements antisociaux sont mesurés en le portant à la préadolescence. De plus, nous souhaitons utiliser des données autorapportées afin d’utiliser une mesure possiblement plus valide des comportements antisociaux. Finalement, nous souhaitons confirmer les résultats longitudinaux précédemment rapportés par les parents ou les enseignants à l’âge de 10 ans. Méthode. Les parents de 1035 enfants ayant participé à l’Étude longitudinale des enfants du Québec ont rapporté si au moins un individu fumait au domicile (entre l’âge d’un an et demi et sept ans). Les variables dépendantes autorévélées (mesurées à douze ans) comprenaient les problèmes de conduite, l’agressivité proactive, l’agressivité réactive, l’indiscipline scolaire et le risque de décrochage. Résultats. Après l’inclusion des variables de contrôle, nous avons observé que l’exposition à la fumée secondaire est prospectivement associée aux problèmes de conduite, l’agressivité proactive, l’agressivité réactive, l’indiscipline scolaire et le risque de décrochage autorévélés. Discussion. Les jeunes exposés à la fumée secondaire à l’enfance rapportent avoir plus de comportements antisociaux. Nos résultats corroborent les recommandations du American Surgeon’s General indiquant qu’aucune exposition à la fumée secondaire ne peut être considérée sécuritaire à l’enfance. / Introduction. Secondhand smoke is considered a developmental neurotoxicant. Up to this day, research on secondhand smoke and later antisocial behavior has remained cross-sectional or in the developmental period of childhood. Objective. We sough to extend previous research by extending to age 12 our prospective associational model. Also, we use self-reported data for validity reasons and to cross-match previous research using parent and teacher-rated data at age 10. Method. Parents reported the amount of household smoke exposure (between ages 1.5 and 7) for 1035 children from the Quebec Longitudinal Study of Child Development. Main outcome measures include self-reported conduct problems, proactive aggression, reactive aggression, dropout risk, and school indiscipline at age 12. Results. After adjusting for potential confounders, we observed that secondhand smoke is prospectively associated to conduct problems, proactive and reactive aggression, school indiscipline, and dropout risk. Discussion. Children exposed to household smoke reported increased risks of reporting antisocial behavior at age 12. Our findings corroborate the recommendation of the American Surgeon’s General that no smoke exposure can be considered safe.

INTRODUÇÃO: O tabagismo é reconhecido, atualmente, como um dos maiores problemas de saúde em todo o mundo. Há uma \"epidemia\" global de uso de tabaco nos países em desenvolvimento, no século 21. OBJETIVOS: Analisar: as características gerais dos indivíduos matriculados espontaneamente em um ambulatório antitabágico; a eficácia geral do tratamento antitabágico e dos medicamentos; as mudanças nas características dos participantes antes e após a Lei Ambiente Fechado Livre do Cigarro em São Paulo e os níveis de cotinina urinária em fumantes ativos, passivos e controles. CASUÍSTICA E MÉTODOS: Foi realizado um estudo de coorte histórica cujo critério de inclusão foi a matrícula no ambulatório antitabágico do HU USP, no período de 2004 a 2011. Os dados foram coletados por meio de consulta a protocolos padronizados e ao sistema informatizado do serviço. Foram analisados os resultados de dosagens de cotinina e creatinina realizadas em amostras biológicas. RESULTADOS: Dentre os 1736 pacientes atendidos houve predomínio de mulheres (62,1%), brancos (75,3%) e indivíduos com idade entre 41 e 60 anos (63,1%). Aproximadamente 80% iniciaram o tabagismo antes dos 20 anos e 75% apresentaram grau de dependência moderado a grave. Dentre os 620 indivíduos acompanhados a partir de 2009, 34,5% abandonaram o tabagismo. Dentre eles, 21,5% obtiveram êxito até o quarto contato com o ambulatório. O uso de vareniclina e terapia de reposição de nicotina (TRN) aumentaram a probabilidade de sucesso (RRR= 2,73 e 2,78, respectivamente; p < 0,001 para ambas). Quanto maior o número de reuniões frequentadas no ambulatório, maior a probabilidade de sucesso terapêutico (p < 0,001). A análise da dosagem da cotinina urinária mostrou concentrações de cotinina urinária 18,7 vezes maior no grupo de tabagistas ativos comparados aos tabagistas passivos. CONCLUSÃO: O sucesso do ambulatório antitabágico do HU manteve-se em acordo com grande parte dos índices de sucesso terapêutico presentes na literatura médica. O abandono do hábito de fumar foi fortemente associado ao número de contatos dos fumantes com o grupo e a terapêutica medicamentosa. A cotinina urinária mostrou-se um bom marcador do tabagismo ativo / INTRODUCTION: Smoking is recognized today as one of the major health problems worldwide. There is a global \"epidemic\" of tobacco use in developing countries in the 21st Century. OBJECTIVES: Analyze: the general characteristics of individuals spontaneously enrolled in an outpatient smoking cessation clinic; the overall effectiveness of the smoking cessation treatment and medication; the changes in the characteristics of participants before and after the Smoke-Free Environment Act in São Paulo and the levels of urinary cotinine in active and passive smokers and controls. CASES AND METHODS: A historical cohort study was conducted, of which the inclusion criterion was the registration in the outpatient smoking cessation Clinic in the HU USP, in the period from 2004 to 2011. Data were collected by consultation of standardized protocols and of the computerized service system. The results of cotinine and creatinine measurements performed on biological samples were analyzed. RESULTS: Among the 1736 patients treated, there was a predominance of women (62.1%), whites (75.3%) and individuals aged between 41 and 60 years (63.1%). Approximately 80% began smoking before age 20 and 75% showed moderate to severe degree of dependence. Among the 620 individuals monitored from 2009 on, 34.5% quit smoking. Among them, 21.5% obtained success up to the fourth contact with the clinic. The use of varenicline and nicotine replacement therapy (NRT) increased the probability of success (RRR= 2.73 and 2.78, respectively; p < 0.001 for both). The greater the number of meetings attended at the clinic, greater the probability of treatment success (p < 0.001). The analysis of urinary cotinine dosage showed urinary cotinine concentrations 18.7 times higher in the active smokers group, compared to the passive smokers group. CONCLUSION: The success of the smoking cessation clinic in the HU remained largely in accordance with most therapeutic success rates found in medical literature. Quitting smoking was strongly associated to the number of contacts of the smokers with the group and drug therapy. Urinary cotinine proved to be an accurate marker for active smoking