Fragestellung: Mitarbeitende in kinder- und jugendpsychiatrischen (KJP) Einrichtungen stehen im Spannungsverhältnis zwischen der Durchsetzung von Rauchverboten für Patient_innen und dem eigenen Rauchverhalten. Bisher fehlen Daten, ob und wo Mitarbeitende rauchen und welche Entwöhnungsangebote KJP-Einrichtungen ihnen anbieten. Methodik: In einer Onlinestudie beantworteten n = 78 leitende Mitarbeitende deutscher KJP-Einrichtungen (41.9 % aller Angeschriebenen) Fragen zu stationsübergreifenden sowie stationsspezifischen Nichtraucherschutzmaßnahmen sowie zu Tabakentwöhnungsmaßnahmen. Ergebnisse: Umfassende Rauchverbote werden selten umgesetzt (< 20 % der Einrichtungen). Mitarbeitende dürfen vorrangig im Außengelände rauchen (z. B. in Raucherzonen: 69 bis 78 % je nach Stationstyp). Entwöhnungsangebote für Mitarbeitende bietet nur jede zweite KJP an (47 %). Schlussfolgerungen: Die Daten weisen auf zukünftige Handlungsfelder der Tabakkontrolle in der KJP-Pflege hin: transparente Regeln, Weiterbildungen und Ausbau betrieblicher Entwöhnungsangebote. / Objective: Whereas, on the one hand, employees in child and adolescent psychiatric institutions (CAP) have to enforce smoking bans among patients, on the other hand, they have a high likelihood of being smokers themselves. Little data are available on the enforcement of smoking regulations and what cessation support is offered by CAP institutions. Method: In an online survey, n = 78 senior staff members or directors of German CAP institutions (41.9 % of all addressed CAP institutions) responded to questions on smoking regulations, exceptions, and cessation support for employees. Results: The enforcement of comprehensive smoking bans is rarely reported (<20 % of CAP institutions). Employees are exempted or allowed to smoke mostly outside of the building (e. g., in designated smoking areas: 69-78 % depending on ward type). Cessation support was offered by less than half of the CAP institutions (47%). Conclusions: The data presented point toward future areas for tobacco control in CAP care, including transparent regulations, staff training, and dissemination of support for occupational smoking cessation.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-02-15T12:09:44Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Soraya A U Cavalcanti - Tese doutorado Serviço Social.pdf: 1252290 bytes, checksum: cea9de79bee82912ae7ecdea907cf614 (MD5) / Made available in DSpace on 2017-02-15T12:09:44Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Soraya A U Cavalcanti - Tese doutorado Serviço Social.pdf: 1252290 bytes, checksum: cea9de79bee82912ae7ecdea907cf614 (MD5) Previous issue date: 2015-11-30 / A presente tese de doutorado teve por objetivo analisar a Política Nacional de Controle do Tabagismo frente à Convenção-Quadro para o Controle do Tabaco no contexto da contrarreforma do Estado brasileiro e seus rebatimentos na oferta de tratamento para dependentes de nicotina no Sistema Único de Saúde – SUS. Mediante pesquisa documental foram analisadas 22 (vinte e duas) normativas brasileiras distribuídas nos seguintes eixos temáticos: oito normativas vinculadas a proteção à exposição à fumaça dos produtos derivados do tabaco – Lei nº 7.748/1986, Portaria nº 3.257/1988, Lei nº 9.294/1996, Decreto Presidencial nº 2.018/1996, Lei nº 10.167/2000, Lei nº 10.702/2003, Lei nº 12.546/2011 e Decreto nº 8.262/2014; quatro normativas vinculadas a regulamentação da oferta de tratamento para dependentes de nicotina no Sistema Único de Saúde – Portaria MS / GM nº 1.575/2002, Portaria MS/GM nº 1.035/2004, Portaria SAS/MS nº 442/2004 e Portaria MS/ GM nº 571/2013; cinco normativas de políticas vinculadas ao controle de tabagismo no Brasil – Portaria nº 2.439/2005, Portaria nº 687/2006; Portaria nº 1.996/2006; Lei nº 11.343/2006; e Portaria nº 874/2013; e cinco vinculadas à implantação da ConvençãoQuadro para o Controle do Tabaco no Brasil – Decreto nº 3.136/1989; Decreto Presidencial de 01 de agosto de 2003, Decreto Legislativo nº 1.012, Decreto nº 5.658, de 02 de Janeiro de 2006 e Decreto Presidencial de 16 de março de 2012. Discutimos a contrarreforma do Estado na política de saúde e seus rebatimentos na oferta de tratamento para dependentes de nicotina no Sistema Único de saúde, identificando que oferta de tratamento está aquém da demanda apresentada, a proposta de tratamento e método único ofertado, da assistência centrada na cessação não condizem com as políticas e normativas vigentes, escassez de recursos no âmbito público e o repasse a iniciativa privada, a sobrecarga dos profissionais envolvidos na oferta de tratamento atualmente centrada na atenção básica. / The present doctoral thesis was to analyze the National Policy on Tobacco Control front of the Framework Convention on Tobacco Control in the context of counter-reform the Brazilian state and its repercussions on the provision of treatment for nicotine dependent in unified health system - SUS. By documentary research analyzed 21 (twenty-two) Brazilian normative distributed in the following themes: Eight regulations related to protection from exposure to smoke from tobacco products - Law No. 7,748 / 1986, Decree No. 3,257 / 1988, Law No. 9.294 / 1996 Presidential Decree No. 2,018 / 1996, Law No. 10.167 / 2000, Law No. 10,702 / 2003, Law No. 12,546 / 2011 and Decree No. 8,262 / 2014; four regulations related to regulation of the provision of treatment for nicotine dependent in unified health system - SUS - Ordinance MS / GM No 1575/2002, Decree MS / GM No 1035/2004, Ordinance SAS / MS No. 442/2004 and Decree MS / GM No 571/2013; five of regulatory policies related to tobacco control in Brazil - Ordinance No. 2439/2005, Ordinance No. 687/2006; Ordinance No. 1,996/2006; Law No. 11.343 / 2006; and Ordinance No. 874/2013five related to the implementation of the Framework Convention on Tobacco Control in Brazil - Decree No. 3,136 / 1989; Presidential Decree of August 1, 2003, Legislative Decree No. 1012, Decree No. 5658 of January 2, 2006 and Presidential Decree of 16 March 2012. We discussed the counter-reform of the state in health policy and its repercussions on the provision of treatment for nicotine dependent on the health System, identifying which treatment provision falls short of the presented demand, the proposed treatment and only offered method of focused assistance in cessation are not consistent with the policies and regulations in force, resource scarcity in the public sphere and lending to the private sector, the burden of professionals involved in treatment provision currently focused on primary care.

Au Canada, la prévalence du tabagisme a diminué de façon significative. Ce succès est attribué aux politiques populationnelles de lutte contre le tabagisme telles que les campagnes anti-tabac, les interdictions de fumer, les hausses de taxation et les restrictions sur la vente des produits tabagiques. Néanmoins, les inégalités sociales en matière de tabagisme s’accroissent; la prévalence de tabagisme demeure élevée au sein des groupes défavorisés, notamment ceux ayant un faible statut socio-économique (SSE). Malgré la recherche existante qui porte sur les effets des politiques de lutte contre le tabagisme selon le SSE, comment ces politiques affectent ces inégalités est peu documentée. Ainsi, dans le contexte où le Québec s’est engagé dans une lutte contre le tabagisme avec l’adoption d’une politique populationnelle en 2015, « Loi visant à renforcer la lutte contre le tabagisme » (L44), et le développement d’une stratégie populationnelle en 2020 qui priorisent la réduction des inégalités sociales en matière de tabagisme, cette thèse aborde une question de grande pertinence pour la santé publique : comment les politiques publiques populationnelles, telles que L44, pourraient-elles affecter les inégalités sociales de la santé? Cette thèse explore cette question de recherche par l’entremise de trois articles : un article conceptuel et deux articles empiriques. L’article conceptuel présente l’intérêt de la théorie de l’intersectionnalité pour la recherche sur les inégalités sociales de la santé, particulièrement lorsque cette recherche intègre les deux principes de l’intersectionnalité : le principe soulignant le rôle des structures sociales dans la reproduction d’inégalités sociales étant souvent négligé pour privilégier le principe faisant valoir les expériences des groupes sociaux défavorisés. Cet article permet donc d’encadrer cette thèse afin qu’elle considère les politiques de lutte contre le tabagisme et les pratiques des praticiens en lutte contre le tabagisme (PLT) comme étant des facteurs structuraux qui influencent les inégalités sociales en matière de tabagisme. Guidés par un devis qualitatif basé sur l’analyse critique du discours, les deux articles empiriques (articles 2 et 3) examinent le discours des politiques de lutte contre le tabagisme comme un mécanisme reliant ces politiques et les pratiques des PLT aux inégalités sociales en matière de tabagisme. D’abord, l’article 2 applique l’analyse poststructuraliste de Bacchi aux transcriptions des consultations parlementaires pour le projet de loi L44 avec des acteurs québécois de lutte contre le tabagisme. Cette analyse démontre que L44 renforce et avance des discours problématisant « le fumeur » comme groupe moralement déviant et duquel les non-fumeurs doivent être protégés. Il y est discuté la façon dont cette problématisation concrétise les relations de pouvoir entre les non-fumeurs et les personnes qui fument, ce qui donne le « droit » aux non-fumeurs de réguler ces dernières personnes. Il apparaît ainsi que L44 renforce l’identité sociale du fumeur qui se retrouve aux intersections du SSE, du genre, ou de la race. En employant un tel discours, il est soutenu que L44 pourrait perpétuer les inégalités sociales en matière de tabagisme. L’article 3 emprunte le concept poststructuraliste des « pratiques discursives » afin d’analyser des entrevues faites avec des PLT au Québec. Cet article illustre comment leurs pratiques sont issues de discours sur la prévention du risque et le changement de comportement. Ces pratiques favorisent les interventions visant la réduction de la prévalence du tabagisme auprès de groupes « à risque » au détriment d’interventions ciblant les facteurs structuraux inéquitables dont découlent les inégalités sociales en matière du tabagisme. Toutefois, les PLT qui travaillent avec des personnes défavorisées qui fument, contrairement à ceux qui travaillent en prévention du tabagisme, tiennent un discours plus nuancé qui attribue une importance à l’amélioration des conditions sociales liées au risque de fumer. Cet article suggère que d’élargir les discours dominants en santé publique, notamment en intégrant l’expérience vécue des groupes défavorisés, a le potentiel de produire des discours et des politiques axés vers la promotion de l’équité en santé. Bien qu’ancrée dans le contexte de la lutte contre le tabagisme, les connaissances générées par cette thèse pourront éclairer d’autres discours et politiques de santé publique. En utilisant une approche critique et théorique novatrice, l’importance d’adopter une perspective réflexive envers les connaissances, présuppositions et valeurs qui sous-tendent la problématisation d’un phénomène de la santé (p.ex. le tabagisme), est établie. Cette recherche démontre également qu’il est impératif d’intégrer l’expérience vécue dans l’élaboration de politiques publiques, de cibler les déterminants structuraux ainsi que d’engager les praticiens en santé publique dans le travail intersectoriel afin de réduire les inégalités sociales de la santé. / Significant reductions in smoking prevalence in Canada are attributed to population-level tobacco control policies, such as media campaigns, smoke-free policies, tax increases, and restrictions on the sale of tobacco products. Despite this public health success, social inequalities in smoking have been increasing, with smoking prevalence remaining high in certain socially disadvantaged groups, notably those of low socio-economic status (SES). Although research investigates potential effects of tobacco control policies across SES groups, evidence on how such policies come to have these inequitable effects is lacking. With Quebec’s implementation of a 2015 population-level tobacco control policy, An Act to Bolster Tobacco Control (L44), and a 2020 strategy addressing the reduction of social inequalities in smoking, this thesis attends to a pressing public health question: how might population-level policies, such as L44, impact social inequalities in health? To answer this question, the thesis is comprised of one conceptual article and two empirical articles. The conceptual article discusses the important insights that can be gained from using intersectionality theory when researching social inequalities in health, notably when examining both tenets of intersectionality – the tenet highlighting the role of intersecting social structures in the reproduction of social inequalities is often neglected to privilege the tenet underlining the experiences of intersecting social identities – to better understand the complexity of such inequalities. This article led the thesis to focus on tobacco control policies and practices of tobacco control practitioners (TCP) as structural factors influencing social inequalities in smoking. Using a qualitative critical discourse analysis design, the two empirical articles (articles 2 and 3) critically examine tobacco control discourse as a mechanism linking tobacco control policies and TCP practices to social inequalities in smoking. Article 2 applies a Bacchian post-structuralist approach to policy discourse analysis to documents detailing L44 parliamentary consultations with Quebec tobacco control policy stakeholders. This article demonstrates that L44 reinforces and advances anti-smoking discourses by problematising “the smoker” as a distinct morally deviant category of people from which non-smokers need to be protected. This problematisation is further shown to reify power relations between non-smokers and people who smoke, providing non-smokers the “right” to regulate people who smoke. It appears that by subjectifying and regulating people who smoke, L44, via its discourse, contributes to anchoring smoking status as a social identity intersecting with other social identities such as SES, gender, and/or race. In this way, it may contribute to perpetuating social inequalities in smoking. In article 3, the post-structural concept of “discursive practices” is used to analyse interviews with Quebec TCP. This article illustrates how their practices are shaped by discourses of risk prevention and behaviour change. This was observed through their practices, which reproduced stigmatising representations of “the smoker” (echoing findings from article 2) and supported interventions targeting reductions in smoking prevalence for “at-risk” groups, rather than those addressing inequitable structural determinants of smoking. However, TCP working directly with socially disadvantaged people who smoke, compared to those working in policy, held comparatively more nuanced discursive practices, leading to reduced stigma and attention to the social conditions placing their patients at greater risk of smoking. This article concludes that broadening dominant public health discourses to integrate the lived experiences of socially disadvantaged people who smoke will likely produce more inclusive discourses and favour social policies that reduce social inequalities. This in contrast to risk prevention and behaviour change discourses that may entrench such inequalities. The insights from this thesis can be applied to the relationships between a range of public health policies and social inequalities in health. By offering a critical perspective on tobacco control discourse through a novel theoretically-combined approach, this thesis ultimately aims to inform public health policy design by demonstrating strategies to reduce social inequalities in health and promote health equity. Chiefly, it underlines the importance of questioning unexamined knowledge, assumptions, and values shaping conceptualisations of health problems (e.g., smoking) and policy responses (e.g., tobacco control policies). It also demonstrates the importance of integrating lived experience in policy design and for public health practitioners to work intersectorally in order to achieve reductions in social inequalities in health.

Made available in DSpace on 2016-03-15T19:35:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-02-14 / The theses is about the control of production, commerce, use and publicity of tobacco by the State, in three ways of performance (state control), according to Federal Constitution of 1988, the Framework Convention on Tobacco Control and the internal Legislation. It is due to the Legislative Power, to elaborate the restritive rules of the using of tobacco; it is due to the Executive Power the planning and the execution of public politics concerning to the prevention of tobacco use; and to Judiciary, to judge the compensation procedure by the healthy damage caused by tobacco use. Because it involves the fundamental right to the health of the smoking and non-smoking citizen (second hand smoking), this work analyses the collision of fundamental rights and the acting of the tobacco industry, for misinformation from the 1920 decade in XX century. At last, it stablishes a comparison between hard cases to judge, taking into account the relationship between right and reality, specially the conclusions of science concerning to the diseases caused by cigarette smoking which can lead to death. / A tese aborda o controle pelo Estado da produção, comercialização, consumo e publicidade do tabaco, numa tríplice esfera de atuação, denominada de dirigismo estatal, de acordo com a Constituição Federal de 1988, a Convenção-Quadro de Controle do Tabaco e a legislação infraconstitucional no Brasil. Cabe ao Poder Legislativo, notadamente, a elaboração de normas restritivas à utilização do tabaco; cabe ao Executivo o planejamento e a execução de políticas públicas voltadas à prevenção do tabagismo; e, ao Judiciário, o julgamento das ações de indenização pelos danos causados à saúde pelo consumo de cigarro. Em razão de envolver direito fundamental à saúde do cidadão fumante e não fumante (fumante passivo), este trabalho analisa a colisão de direitos fundamentais e a conduta da indústria de tabaco, por defeito de informação perpetrado desde a década de 1920, do século XX. Por fim, estabelece um parâmetro de julgamento de casos difíceis, levando-se em conta a relação direito e realidade, especialmente as conclusões da ciência no tocante às doenças causadas pelo cigarro, que podem levar à morte.

[pt] Este artigo tem como objetivo analisar a relevância de tratados internacionais e como eles afetam políticas domésticas, bem como são afetados pelos Estados que participam dele. Para isso, será analisada a Convenção-Quadro para Controle do Tabaco da Organização Mundial da Saúde. Este tratado, de 2003 e ratificado pelo Brasil em 2005, é um bom exemplo, como será defendido neste artigo, de como o doméstico e internacional se afetam e, deste contato, são formuladas as políticas nacionais e internacionais. Esta pesquisa irá realizar um estudo de caso para analisar as disputas que ocorrem em âmbito doméstico e são externalizadas para o internacional, em particular na temática do tabagismo. Para tal, a indústria de tabaco Souza Cruz, maior do território brasileiro, será analisada sob a ótica de suas estratégias de publicidade, propaganda e patrocínio de produtos de tabaco, enquanto as Conferências das Partes, que ocorrem a cada dois anos entre os Estados- Membros da Convenção-Quadro, buscam eficiência na implementação das diretrizes do Artigo 13 da Convenção, que lida com esse tema. O estudo de caso tem como objetivo mapear a relação entre as estratégias da indústria e ação reativa das Conferências das Partes, de modo a entender como os Estados-Membros poderiam alcançar o controle do tabaco de forma mais rápida e eficiente, sem que as empresas encontrem brechas nas legislações nacionais ou na dificuldade de fiscalização das normas já implementadas no país. / [en] This article aims to analyze the relevance of international treaties and how they affect domestic policies as well as are affected by the states that participate in it. To this end, the Framework Convention on Tobacco Control of the World Health Organization will be analyzed. This treaty, from 2003 and ratified by Brazil in 2005, is a good example, as will be defended in this article, of how the domestic and the international affect eachother and from this contact, national and international policies are formulated. This research will carry out a case study to analyze the disputes that occur in the domestic sphere and are outsourced to the international, in particular in the theme of smoking and tobacco. To this end, the Souza Cruz tobacco industry, the largest in Brazil, will be analyzed from the point of view of its strategies for advertising and sponsorship of tobacco products, while the Conferences of the Parties, which take place every two years between the Member States, seek efficiency in the implementation of the Article 13 guidelines of the Convention, which deals with this theme. The case study aims to map the relationship between industry strategies and reactive actions of the Conferences of the Parties, in order to understand how Member States could achieve tobacco control more quickly and efficiently, without companies finding gaps in national legislations or in the difficulty of monitoring the norms already implemented in the country.