ABC | Volume 112, Nº4, April 2019

FSCLP Statement Oliveira et al 2019: Recommendations for reducing tobacco consumption in Portuguese-Speaking countries Arq Bras Cardiol. 2019; 112(4):477-486 1. Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017:asystematicanalysisfortheGlobalBurdenofDiseaseStudy2017 GBD 2017Mortality Collaborators* Lancet. 2018;392(10159):1684-735 2. WorldHealthOrganization (WHO). Ambient air pollution: global exposure and burden of disease, 2016 update (in preparation). Geneva;2016.(update in preparation). [Internet]. [Cited in 2018 Dec 10]. Available from: https:// www.who.int/nmh/publications/ncd-profiles-2018/en/ 3. GBD2015TobaccoCollaborators.Smokingprevalenceandattributabledisease burden in195countriesandterritories,1990-2015:asystematicanalysis from theGlobalBurdenofDiseaseStudy2015.Lancet.2017;389(10082):885-1906. 4. Nascimento BR, Brant LCC, Oliveira GMM, Malachias MVB, Reis GMA, Teixeira RA, et al. Cardiovascular Disease Epidemiology in Portuguese- Speaking Countries: data from the Global Burden of Disease, 1990 to 2016. Arq Bras Cardiol. 2018;110(6):500-11. 5. Portugal. Ministerio da Saúde. Instituto Nacional de Saúde Doutor Ricardo Jorge, IP. Carateristicas sociodemograficas dos fumadores diarios emPortugal Continental. Analise comparativa dos Inqueritos Nacionais de Saude/ Leite A, Machado A, Pinto S, Dias CM. Lisboa:INSA;2017. 6. Araujo C, Silva-Matos C, Damasceno A, Gouveia ML, Azevedo A, Lunet N. Manufactured and hand-rolled cigarettes and smokeless tobacco consumption in Mozambique: Regional differences at early stages of the tobacco epidemic. Drug and Alcohol Depend. 2011; 119(3):e58-e65. 7. Padrao P, Damasceno A, Silva-Matos C, Carreira H, Lunet, N. Tobacco Consumption inMozambique: Use of distinct types of tobacco across urban and rural settings. Nicotine Tob Res. 2013;15(1):199-205. 8. GBD2015RiskFactorsColaborators.Global,regional,andnationalcomparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1659-724. 9. WorldHealthOrganization.WHO.[Internet].WHOFrameworkConvention on Tobacco Control. 2003. [Cited in 2018 Nov 18]. Available from: http:// apps.who.int/iris/bitstream/10665/42811/1/9241591013.pdf 10. Eriksen MP, Schluger N, Mackay J, Islami F. The Tobacco Atlas. 5th ed, Atlanta(Georgia): American Cancer Society;2015. 11. Van Schayck S,Williams V, BarchilonN, BaxterM, Jawad P A, Katsaounou BJ, et al. Treating tobacco dependence: guidance for primary care on life-saving interventions. Position statement of the IPCRGO. C. P. NPJ PrimCare Respir Med. 2017;27(1):38. 12. OliveiraGMM,MalletALR.Tabagismo.InManualdeprevençãocardiovascular / [RochaRM,MartinsWAeds.].SãoPaulo:Planmark;Riode Janeiro:SOCERJ - Sociedade de Cardiologia do Estado do Rio de Janeiro; 2017. p:49-60. 13. Barua RS, Rigotti NA, BenowitzNL, Cummings KM, Jazayeri M-A, Morris PB, et al. 2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation Treatment. J Am Coll Cardiol.2018;72(2):3332-65. 14. Kalkhoran S, Benowitz NL, Nancy A. Rigotti NA. Prevention and Treatment of Tobacco Use. JACC Health Promotion Series. J Am Coll Cardiol. 2018;72(9):1030-45. 15. European Network for Smoking and Tobacco Prevention aisbl. (ENSP). Information release 2. SILNE- Tacking socio-economic inequalities in smoking: learning from natural experiments by time trend analysis and cross- national comparisons. Amsterdam (the Netherlands): Department of Public Health, Academic Medical Centre; 2016. 16. World Health Organization. WHO. [Internet]. Tobacco. Factsheet 339, updated June 2016. [Cited in 2017 Feb 18]. Available from: http://www. who.int/mediacentre/factsheets/fs339/en 17. National Center for Chronic Disease Prevention andHealth Promotion (US) Office on Smoking andHealth. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention, 2014:17. 18. McEwen A, McRobbie H, West R, Hajek P. Manual for Smoking Cessation: a guide for counsellors and practitioners. Oxford: Blackwell;2006. 19. Simão AF, Precoma DB, Andrade JP, Correa FH, Saraiva JF, Oliveira GMM, et al; Sociedade Brasileira de Cardiologia. I Diretriz brasileira para prevenção cardiovascular. Arq Bras Cardiol. 2013;101(6 supl 2):1-63 Erratum in: Arq Bras Cardiol. 2014;102(4):415. 20. WorldHealthOrganization. (WHO). MPOWER: a policy package to reverse the tobacco epidemic. Geneva, Switzerland:2008. 21. WorldHealthOrganization. (WHO). Toolkit for delivering the 5A’s and 5R’s brief tobacco interventions in primary care. Geneva: WHO Press; 2014. 22. Fagerström KO, Schneider NG. Measuring nicotine dependence: a review of the Fagerström Tolerance Questionnaire. J Behav Med.1989;12(2):159- 82. 23. Prochaska JD, Di Clemente CC, Norcross JC. In search how people change: applications to addictive behavior. Am Psychol.1992;47(9):1102-14. 24. World Health Organization. WHO report on the global tobacco epidemic, 2013. [Cited in 2018Nov 18]. Available fromhttp://www.who.int/tobacco/ global_report/2013/en/ index.html 25. World Health Federation. WHO. [Internet]. World Heart Federation code of practice on tobacco control. Genebra, 2004. [Cited in 2018 Nov 18]. Available from http://www.world- heart-federation.org/fileadmin/ user_upload/documents/ tobacco-code-practice.pdf References Conclusions Smoking in all forms represents a serious public health problem in the prevention and treatment of chronic noncommunicable diseases. General practitioners and cardiologists must identify patients who smoke, become aware of all available tools, apply these tools to encourage smokers to seek professional help to quit smoking, and avoid missed key opportunities like diagnoses of coronary artery disease, peripheral arterial disease, or cerebral or tobacco-related malignancies among patients, their family members, and key society members. The increasing awareness of the population about the risks of smoking makes the current moment very favorable to approach smokers. Treatment is more accessible (NRT and bupropion are available in PSCs) and can be performed at any healthcare level. The association of CBT with pharmacological support to cope with abstinence increases the effectiveness of the interventions. Relapses are part of the smoking dependence cycle and should serve as a lesson for a new attempt. Finally, cessation of smoking at any age brings benefits to the individual’s health and to the health of those around him, and physicians must always be ready to offer care, whatever the stage in which the individual dependent on nicotine is. New forms of smoking, especially using electronic systems, are far from proving their innocence or even contributing to the overall reduction of smoking and its harmful effects, and their use should be discouraged. Smoking must be considered as a problem that transcends the damage caused to the organs affected by the smoke and tobacco products, and related to a set of problems produced by the individual himself involving economic, social, cultural, and ecological aspects compromising our quality of life and our own survival. 485