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Bakgrund: Rökning är idag en av de största riskfaktorerna för kroniska sjukdomar så som cancer, KOL och hjärt- kärlsjukdomar. I Sverige röker ca 20% av befolkningen. Syftet med studien var att undersöka vad som motiverar rökare att fortsätta röka samt undersöka deras kunskaper kring de hälsoeffekter rökningen ger. Ökad medvetenhet medför ett bättre bemötande i vården samt en mer individualiserad rökavvänjningsplan. Metod: Kvalitativ deskriptiv intervjustudie. 12 intervjuer utfördes med rökande personer i Uppsala, intervjuerna baserades på en frågeguide. Data analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Resultatet delades in i fyra teman: 1) Motiv till fortsatt rökning, 2) Motiv mot fortsatt rökning, 3) Rökdebuten, och 4) Rökarens tankar om att röka. Huvudresultatet var att deltagarnas movation till forsatt rökning fanns i de pauser, lugn och belöning deltagarna fick ut av sin rökning. Rökningen var en del av vardagen med vanor och rutiner. Slutsats: Pauser, lugn, belöning och vanor motiverade deltagarna till fortsatt rökning. Vanorna försvårade möjligheten att sluta röka. För att vårdpersonal ska kunna skapa en individualiserad rökavvänjningsplan måste kunskap om rökarnas motivation för fortsatt rökning fördjupas. / Background: Smoking is today on of the biggest factors for chronic diseases like cancer, COPD and cardiovascular diseases. In Sweden 20% of the population smokes. The purpose of this study was to investigate motivations for smokers towards further smoking and investigate their knowledge about health risks from smoking. A elevated awareness about the topic may lead to a better treatment and a more individualized smoke cessation plan. Methods: Qualitative descriptive interviews. 12 interviews where done with smoking people in Uppsala, the interviews were based on a questionnaire. The data were analyzed with a qualitative content analysis. Results: The results were divided into four themes: 1) Motives towards continued smoking, 2) Motives against continued smoking, 3) Smoke initiation, and 4) Smokers thoughts about smoking. The main results were the motivations towards smoking were found in the pauses, the peace and the reward the smokers got out of their smoking. Smoking is a part of each day because habits and routines. Conclusions: Pauses, tranquility and habits were motivations towards continued smoking. The habits made it hard to quit smoking. To be able to offer a more individualized smoke cessation plan the smokers motivation towards continued smoking and earlier knowledge about health risks have to be illustrate and processed.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / O tabagismo e a obesidade são as principais causas de morbidade e mortalidade no mundo. Estudos populacionais relatam que fumantes, principalmente do sexo feminino, apresentam baixo índice de massa corporal. Porém, são escassos os estudos que avaliem a composição corporal de humanos e animais expostos a fumaça de cigarro, em especial nos adolescentes. Aos 35 d de idade, camundongos fêmeas foram expostos à fumaça de cigarros 3R4F (médio teor de nicotina), 8 h/dia, por 15 dias (F, n=12), paralelamente foi avaliado animais não expostos (C, n=12). Imediatamente após a exposição, metade dos animais de cada grupo foi sacrificada e a outra metade permaneceu em observação por 30dias. Durante todo o período experimental, a massa e comprimento corporal e ingestão alimentar foram avaliados. Ao final de cada período, os animais foram avaliados por DXA (Dual Energy X-ray Absorptiometry) e sacrificados por exsanguinação. Para avaliação e comprovação da exposição ao fumo foi utilizado a cotinina e morfologia do pulmão. No plasma foram avaliados colesterol, triglicerídeos, glicose, cotinina e insulina. Amostras de tecido adiposo intra-abdominal (IA) e subcutâneo (SC) foram coletadas e processadas por técnica histológica de rotina para análise morfológica. As expressões de PPAR, UCP2 e CPT1 foram avaliadas no tecido IA por western blotting. Durante a exposição, a massa, o comprimento corporal, a ingestão alimentar, a massa magra e a massa de tecido IA, bem como a glicose e o colesterol e a expressão de PPAR permaneceram inalterados. A expressão de UCP2 e CPT1, assim como a insulina circulante diminuiram. A gordura corporal total e do tronco, triglicerídeos e cotinina aumentaram. A análise morfológica não evidenciou alteração no tecido IA, mas, houve aumento do número e diminuição da área dos adipócitos no tecido SC. Após trinta de dias de abstinência a massa corporal, a massa e o número de adipócitos do tecido IA e a glicose aumentaram no grupo F, enquanto houve diminuição do colesterol, da área do adipócito IA e SC e do número do SC. Porém, sem alteração da ingestão, do comprimento corporal, da massa magra, da massa de gordura total e do tronco, da insulina e dos triglicerídeos e também da expressão de PPAR, UCP2 e CPT1 no IA. A exposição à fumaça de cigarro, em camundongos fêmeas jovens, desencadeou mudanças na adiposidade, que repercutiram de forma prejudicial e precoce sobre o metabolismo. Mesmo com a cessação do hábito de fumar os distúrbios metabólicos permanecem expressivos / Smoking and obesity are major causes of morbidity and mortality worldwide. Population studies have reported that smokers, especially women, have low body mass index. However, there are few studies that assess the body composition of humans and animals exposed to cigarette smoke, especially in teenagers. At 35 d of age (d) female mice were exposed to 3R4F cigarette smoke, with the average concentration of nicotine, 8 h / day for 15 days (group S= 12). Unexposed animals were evaluated in parallel (C= 12). Immediately after the expose half the animals of each group were sacrificed and the other half remained under observation for 30 d. During the experimental period, weight, body length and food intake were evaluated. At the end of the exposure period, animals were assessed by DEXA (Dual Energy X-ray Absorptiometry) and then sacrificed by exsanguination. For evaluation and confirmation of smoke exposure cotinine concentrations and lung morphology were evaluated. The serum cholesterol, triglycerides, glucose cotinine and insulin were measured. The samples of intra-abdominal and subcutaneous adipose tissue IA were collected and processed for morphological analysis. The expression of PPAR, CPT1and UCP2 were measured in IA by western blotting. During exposure body mass, corporal length, intake, lean mass and mass IA, such of glucose, cholesterol and the expression of PPAR did not differ .The expression UCP2 e CPT1, as circulating insulin decreased. The total body fat and trunk fat, triglycerides and cotinine increased. Morphological analysis revealed no change in IA tissue, but there was an increase and decrease in size of adipocytes in the SC tissue. During exposure the area and number of adipocytes IA were similar between groups, but decreased in SC in the area and increased number of adipocytes. After thirty days of abstinence, body mass, weight and number of adipocytes of IA tissue and glucose increased in group S, while decreased cholesterol, IA adipocyte area and number of SC. However, there were no chamber in the intake, the body length, lean mass, total fat mass and trunk, insulin and triglyceride levels and also the expression of PPAR , UCP2 and CPT1 IA. Smoke exposure in young female mice triggered changes in adiposity, which have affected in a detrimental way metabolism. Even with the cessation of smoking, metabolic disorders remain significant

The lifestyle of secondary school students in the town of Havlíčkův Brod. The objective of my thesis was to call attention to the current possible risks of adolescents at secondary schools who live an inappropriate lifestyle. This is primarily the risk of becoming addicted to alcohol and smoking. The consumption of alcohol and smoking is very widespread among young people in the Czech Republic. The lifestyle of adolescents is affected by numerous factors. It is important to beginning teaching children a healthy lifestyle as soon as possible. Addiction to alcohol and smoking adversely affects the human body and causes very many diseases. The thesis presents up-to-date information about the lifestyle of secondary school students in the town of Havlíčkův Brod. The age at which a child or adolescent acquires his first experience with alcohol or cigarettes has markedly decreased in the past two years. This fact, of course, disturbs a wide range of experts from ranks of pedagogues, educators, medical workers, and other experts. Czechs belong among the leading consumers of alcoholic drinks in the Word. The number of smokers among adolescents increases daily. The risk of premature death is associated with this. A lifestyle belongs among important factors that can influence not only behaviour but also a person's health.

The human bronchial epithelium is composed of multiple, discrete cell types that cooperate to perform mucociliary clearance. While previous studies have shown that cigarette smoke can alter bronchial epithelial gene expression, the underlying effects of this exposure on specific cell types are not well understood. In this thesis, single-cell RNA sequencing was used to profile bronchial epithelial cells from six current smokers and six never smokers. Thirteen cell clusters were identified that were defined by expression of unique combinations of nineteen distinct gene sets. This clustering revealed that smoke exposure induced expression of a toxin metabolism program that specifically associated with ciliated cells. Extensive airway remodeling was also observed, in which smoking was associated with loss of club cells as well as goblet cell expansion and hyperplasia. Additionally, a previously uncharacterized CEACAM5+ KRT8+ epithelial subpopulation was identified in the airways of smokers. While it has been shown that most smoking-associated gene expression alterations can be reversed upon smoking cessation, a subset of these alterations persists in former smokers. The basal layer of the bronchial epithelium is comprised of a multipotent progenitor subpopulation. When abnormalities persist in the bronchial epithelium despite normal tissue turnover, the source of these abnormalities may be traced to this progenitor population and its program of differentiation. Therefore, basal cells were procured from three current smokers and three never smokers, differentiated in vitro, and profiled by RNA sequencing at eight time points spanning the differentiation procedure. Twenty-seven unique sets of co-expressed genes associated with differentiation were identified and functionally characterized, a subset of which were abnormally expressed in smoker cells. Robust expression of genes involved with the unfolded protein response was specifically detected in smoker basal cells. Additionally, a smoking-associated delay in the onset of expression of genes involved with ciliogenesis was observed. These data therefore indicate that smoking has long-term consequences on the differentiated state of the airway epithelium. Collectively, the observations outlined in this thesis demonstrate that smoking drives a complex landscape of alterations that affects the function and composition of the human bronchial epithelium. / 2020-10-24T00:00:00Z

A tomada de decisão entre conseqüências imediatas ou de longo prazo tem sido estudada através do Modelo de Desvalorização pelo Atraso (DA). Investigou-se a DA em situações apetitivas e aversivas envolvendo valores monetários hipotéticos em fumantes, fumantes em tratamento em uma unidade de saúde e não fumantes. Participantes (20 fumantes, 20 fumantes em tratamento e 20 não fumantes), homens e mulheres, responderam a uma tarefa experimental de DA, ao questionário de tolerância de Fagerström, ao questionário sobre o comportamento de fumar e ao Teste de Triagem do Envolvimento com Álcool, Tabaco e Outras Substâncias (ASSIST). A DA em situações apetitivas (mas não em aversivas) foi maior para fumantes do que não fumantes e os fumantes em tratamento apresentaram uma DA intermediária. Os fumantes em tratamento podem ser um subgrupo menos impulsivo de fumantes ou a decisão de parar de fumar influenciou estratégias de tomada de decisão mais amplas. A DA pode ser testada como preditora do sucesso da cessação do tabagismo. / Delay Discounting Model (DD) has been used to study decision-making between immediate or delayed consequences. This research aims to study DD for hypotetical monetary gains (appetitive) and losses (aversive) in smokers, smokers who seeked out treatment to quit in a public outpatient clinic and non-smokers. Male and female participants (20 S, 20 ST and 20 NS) answer the DD task, the Fagerström Tolerance Questionnaire, a Smoking Behavior Questionnaire, and the Alcohol Smoking and Substance Involvement Screening Test (ASSIST). In the appetitive condition (but not in the aversive), smokers showed a greater DD than non-smokers and smokers on treatment showed an intermediate DD. Smokers on treatment might either be a less impulsive subgroup of smokers or the decision to quit smoking changed a broader strategy of decision making. Future studies could test DD as an outcome predictor in smoking cessation treatment.

Depressive disorders impose a significant mental health burden on individuals and our society. Among smokers there is a high comorbidity of depression/depressive symptoms (e.g., Glassman et al., 1998). Here the parietal EEG alpha asymmetry was used as a dimensional neuropsychological marker of depressive symptoms (i.e., the more depressed, the higher alpha power in the right vs. left parietal lobe during visuospatial tasks [Henriques & Davidson, 1997; Rabe et al, 2005]). Participants, all of whom were smokers and none of whom were clinically depressed, were randomly assigned to the Bupropion group (n = 30) or Placebo group (n = 80) in this double blind study. EEG data during the performance of a visuospatial task were collected prior to and after 14 days on bupropion or placebo capsules. It was found that bupropion significantly reduced the right parietal alpha power and parietal asymmetry whereas placebo did not. Self-reports on depressive symptoms with the Beck Depression Inventory (BDI) were also collected but they did not change after bupropion treatment, suggesting that EEG measures are more sensitive to subtle/early bupropion’s antidepressant effects. Finally the close investigation of individual differences showed that positive (vs. negative) parietal asymmetry during pretreatment predicted greater benefits from bupropion treatment. The present study sheds light on the antidepressant mechanisms of bupropion and represents a valuable addition to the paucity of research on the effects of bupropion on brain activity with EEG measures in general.

In the context of developing effective PSAs to help increase the number of young adults who quit smoking or don’t start, this study took cultural orientation into account and assessed the persuasive effect of high and low source credibility. This present study showed that, in terms of attitude toward the ad message, people who were exposed to a commercial brand actually had a more positive attitude than those who saw the video that had CCTV as its producer. However, no significant differences were found in the other four constructs, including attitude toward antismoking, smoking-related social norms and subjective norms, smoking-related anticipated regret and intentions to quit or not start smoking.

Made available in DSpace on 2013-01-07T15:55:00Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 29.pdf: 1085268 bytes, checksum: 093f7b3db3cf5e9c7ded5c1f77c4ea9b (MD5) Previous issue date: 2010 / Em 1999 a Organização Mundial de Saúde (OMS) iniciou a elaboração do que se tornou o primeiro tratado internacional de Saúde Pública, a Convenção-Quadro de Controle do Tabaco (CQCT), documento que propõe uma série de medidas de combate ao tabagismo. As negociações do tratado, finalizadas em 2003, contaram com a liderança e efetiva participação do Brasil. Contudo, no país, a aprovação da Convenção foi marcada por controvérsias, e após dois anos de ampla discussão no Congresso o tratado foi ratificado através do Decreto Legislativo nº 1.012. O Brasil foi o 100º país a ratificar a CQCT. As discussões que envolveram a aprovação desse tratado no país ficaram polarizadas entre um discurso pró tratado, apoiado principalmente por instituições ligadas à saúde, lideradas pelo Inca, Instituto Nacional do Câncer, e entre agentes contrários à sua aprovação, principalmente instituições representantes dos interesses dos fumicultores, em especial a Afubra, Associação dos Fumicultores do Brasil. Além de instituições, a mobilização da comunidade civil teve influência direta no processo decisório. O presente trabalho apresenta o sucesso das negociações em nível internacional e as dificuldades na aprovação desse tratado num país que é, ao mesmo tempo, referência mundial em programas de controle do tabagismo e o maior exportador de tabaco do mundo. Para isso acompanhamos a atuação dos personagens e instituições envolvidas, através das atas das audiências públicas que discutiram o projeto e da repercussão que essas discussões provocaram na mídia. Esse trabalho contempla também a formação de um aparato legislativo de controle do tabagismo que foi se formando a nível federal a partir de meados da década de 1980.

Os Transtornos por Uso de Substâncias (TUS) são propostos pela Associação Norte-Americana de Psiquiatria e englobam diversas dependências químicas, incluindo o tabagismo e a dependência de crack. O uso de crack tem aumentado consideravelmente nos últimos anos, segundo dados de levantamentos brasileiros e mundiais. Com mecanismo de ação semelhante ao da cocaína, porém com efeito mais rápido, o crack é uma droga que causa grave prejuízo a seus usuários e conduz à dependência em pouco tempo. O tabagismo também é uma condição bastante prevalente no mundo inteiro, sendo que os prejuízos relacionados a esse transtorno envolvem principalmente o desenvolvimento de doenças respiratórias e câncer. Diversos trabalhos têm buscado identificar fatores de suscetibilidade a esses transtornos, sendo que estudos de associação envolvendo genes do sistema de resposta a estresse vêm ganhando importância. O eixo Hipotálamo- Pituitária-Adrenal (HPA) é o sistema de resposta a estresse mais conhecido em humanos e alvo do presente trabalho, uma vez que o funcionamento dessa cascata de sinalização da produção de cortisol pode desempenhar um papel relevante no desenvolvimento de psicopatologias. Além disso, o eixo HPA pode ser considerado um mediador da relação entre situações adversas na infância e o surgimento de TUS. O objetivo desse trabalho, portanto, é investigar o papel de polimorfismos no gene CRHR1 (que codifica o receptor tipo 1 do hormônio liberador de corticotrofina – CRH, hormônio inicial do eixo HPA) sobre o desenvolvimento e características clínicas da dependência química. Para isso, foram realizados dois estudos, envolvendo amostras de mulheres. No primeiro artigo, a partir de três amostras – (1) 136 usuárias de crack, (2) 55 tabagistas e (3) 262 voluntárias saudáveis – foram identificadas diferenças de freqüências alélicas e genotípicas do SNP rs12944712; além disso, a análise de haplótipos envolvendo tal SNP e o rs110402 revelou maior frequência do haplótipo contendo o alelo G nos dois polimorfismos nos grupos de usuárias de crack e tabagistas. No segundo artigo, foi avaliado o efeito da interação geneambiente envolvendo os mesmos polimorfismos e situações adversas na infância – estimada pela escala Childhood Trauma Questionnaire (CTQ) –sobre características clínicas da amostra de usuárias de crack, como craving e gravidade da dependência – estimados, respectivamente, pelas escalas Cocaine Selective Severity Assessment (CSSA) e Addiction Severity Index (ASI6). A análise não revelou uma interação significativa. A presente dissertação, portanto, revela um efeito do gene CRHR1 sobre o desenvolvimento de TUS, embora esse efeito pareça não se manifestar sobre a gravidade. Mais estudos são necessários visando esclarecer o real efeito do gene e do eixo HPA como um todo sobre os fenótipos e comportamentos aditivos, bem como os mecanismos subjacentes a essa relação. / The Substance Use Disorders (SUD) are proposed by the American Psychiatric Association and comprise several addictions, including tobacco and crack cocaine smoking. The prevalence of crack cocaine dependence has grown considerably, according to survey data from Brazil and worldwide. With mechanism of action similar to cocaine but with faster effect, crack is a drug that causes severe impairments to its users and leads to dependence in a short time. Tobacco smoking is also a highly prevalent condition worldwide, and the impact related to this disorder includes cancer and respiratory diseases. Several studies have attempted the identification of susceptibility factors to these disorders, and association studies involving stress response system genes have been performed. The Hypothalamic-Pituitary-Adrenal (HPA) axis is the best known stress response system, and the signaling cascade production of cortisol may play a role in the development of psychopathology. In addition, HPA axis can be considered a mediator of the relationship between early life adversity and SUD. The aim of this study is to investigate the role of polymorphisms in CRHR1 gene (encoding the corticotrophin releasing factor – CRH – receptor type 1, an initial factor in HPA axis response) on the development and clinical traits of drug dependence. Two studies were conducted on women samples. In the first article, three groups were compared - (1) 136 crack smokers, (2) 55 tobacco smokers and (3) 262 healthy volunteers. Differences in allele and genotype frequencies of the SNP rs12944712 were identified; in addition, the haplotype analysis involving this SNP and rs110402 revealed a higher frequency of the haplotype containing G allele in both polymorphisms in the groups of nicotine dependents and crack smokers. In the second article, we evaluated the effect of a gene-environment interaction involving the same polymorphisms and childhood adversity - estimated by Childhood Trauma Questionnaire (CTQ) scale – on clinical characteristics of the sample of crack users, such as craving and severity of dependence - estimated respectively by the Cocaine Selective Severity Assessment (CSSA) and Addiction Severity Index (ASI6) scales. The analysis did not reveal a significant interaction. This dissertation thus shows an effect of CRHR1 genepolymorphism on the development of SUD, although this effect does not seem to impact disorder severity. More studies are needed in order to clarify the actual effect of the gene and of the HPA axis as a whole on addictive behaviors.