ABC | Volume 112, Nº4, April 2019

FSCLP Statement 2019: Recommendations for Reducing Tobacco Consumption in Portuguese-Speaking Countries - Positioning of the Federation of Portuguese Language Cardiology Societies Gláucia Maria Moraes de Oliveira, 1 Miguel Mendes, 2 Oscar Pereira Dutra, 3 Aloysio Achutti, 4 Mario Fernandes, 5 Vanda Azevedo, 6 Maria Beatriz Sena e Costa Santos Ferreira, 7 Armando Serra Coelho, 8 Miryan Bandeira dos Prazeres Cassandra Soares, 9 Mário Alberto Brito Lima Évora, 10 Mário Gomes Mariotto, 11 João Araujo Morais 12 Universidade Federal do Rio de Janeiro, 1 Rio de Janeiro, RJ – Brazil CHLO - Hospital de Santa Cruz, 2 Carnaxide – Portugal Instituto de Cardiologia, 3 Porto Alegre, RS - Brazil Universidade Federal do Rio Grande do Sul, 4 Porto Alegre, RS – Brazil Universidade de Luanda, 5 Luanda – Angola Colégio de Especialidade de Cardiologia, 6 Praia – Cabo Verde Instituto do Coração ICOR, 7 Maputo – Moçambique Clínica Santos Dumont, 8 Lisboa – Portugal Hospital Dr. Ayres de Menezes, 9 São Tomé – São Tomé e Príncipe Hospital do Governo de Macau, 10 Região Administrativa Especial de Macau – Macau Hospital Nacional Simão Mendes, 11 Bissau – Guiné-Bissau Centro Hospitalar de Leiria, 12 Leiria – Portugal Keywords Tobacco Use Disorder/epidemiology; Tobacco Use Disorder/ mortality; Smoking Prevention; Socioeconomic Factors; Urban Population; Rural Population; Tobacco Smoke Pollution. Mailing Address: Gláucia Maria Moraes de Oliveira • Universidade Federal do Rio de Janeiro – R. Prof. Rodolpho P. Rocco, 255 – 8°. Andar – Sala 6, UFRJ. Postal Code 21941-913, Cidade Universitária, RJ – Brazil E-mail: glauciam@cardiol.br , glauciamoraesoliveira@gmail.com DOI: 10.5935/abc.20190071 Introduction Depending on the epidemiological perspective of the observer and the extent of his concept of causality, tobacco consumption can be considered the second cause in the world of death attributed to classic cardiovascular risk factors, preceded only by hypertension, and the first cause of premature death and disabilities. When understood as an immediate cause without contextualization in the complex that determines and maintains population behavior, smoking was responsible in the world for about 8.10 (7.79-8.41) million deaths and 213.39 (201.16-226.66) million healthy life years lost ( disability-adjusted life-years, DALYs). Although the number of daily smokers (individuals aged 15 years and older who smoke daily) has decreased, the total number of smokers continues to increase, imposing a major global challenge for healthcare systems. 1 Physicians, who generally deal directly and individually with the patient, tend to consider health/illness limited to the patient's organic commitment and personal history and are less appreciative of the “causes of the causes” and the psychosocial determinants of the phenomena and behaviors, inseparable from the ecological context and interests. Environmental pollution (which has also a contribution from smoking and is progressively increasing) is currently considered to be the most important cause of morbidity and mortality in the world’s population, 2 extending the spectrum beyond the traditionally valued risk factors. This perspective is very important for an understanding of the resistance to smoking control and planning of strategies that are more effective to approach this issue. In all Portuguese-speaking countries (PSCs), smoking is more frequent among men; the difference in rates between men and women vary among the countries and are greater in the African countries. Table 1 describes the standardized prevalence by sex in 2015 and the annualized difference for men and women from 1990 to 2015 according to the sociodemographic index (SDI). 3 The rates of daily smokers vary from 19.0%, 16.8%, and 7.2%, in African countries, Portugal, and Brazil, respectively. 4 Available data from the National Health Surveys (NIH) (1987, 1995/96, 1998/99, 2005/06, and 2014) showed that daily consumption of tobacco in Mainland Portugal decreased among men by 35.2% (95% confidence interval [CI] 34.2‑36.2%) in 1987 to 26.7% (95% CI 25.2-28.3%) in 2014, and progressively increased in women from 6.0% (95% CI 5.6-6.4%) in 1987 to 14.6% (95% CI 13.6-15.8%) in 2014, with a higher daily consumption in men of more disadvantaged socioeconomic groups and the opposite in women. 5 The described prevalence of tobacco consumption in Mozambique in 2003 was 39.9% in men and 18.0% in women. 6 In a 2005 sample from the same country, the prevalence of daily smokers (including users of chewing tobacco, snuff, manufactured cigarettes, and hand-rolled cigarettes) reduced to 33.6% in men and 7.4% in women, with different prevalence rates by sex and country regions. 7 Brazil is the leading country in the control of smoking, with the third largest decline in prevalence of daily smokers since 1990: 57% and 56% for men and women, respectively. This was achieved with a robust public policy, in which advertisements about health damage caused by the tobacco were associated with restrictions on consumption and tax increases for such products, among other measures. 8 477