Tabagismo entre pacientes psiquiátricos no Brasil

Barros, Fabiana Cristina Ribeiro de; Melo, Ana Paula Souto; Cournos, Francine; Cherchiglia, Mariângela Leal; Peixoto, Eliane Rezende de Morais; Guimarães, Mark Drew Crosland

doi:10.1590/0102-311X00027113

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ARTICLE • Cad. Saúde Pública 30 (6) • Jun 2014 • https://doi.org/10.1590/0102-311X00027113 linkcopiar

Tabagismo entre pacientes psiquiátricos no Brasil

Autoria SCIMAGO INSTITUTIONS RANKINGS

O objetivo do estudo foi estimar a prevalência e os fatores associados com o tabagismo entre pacientes psiquiátricos no Brasil. Estudo multicêntrico de corte transversal foi conduzido com 2.475 pacientes com transtorno mental, selecionados de 26 serviços. Fumantes e ex-fumantes foram comparados com aqueles que nunca fumaram. Odds ratios foram estimados por meio de regressão logística. As prevalências de fumantes e ex-fumantes foram 52,7% e 18,9%, respectivamente. Sexo masculino, idade 40+ anos, uso de drogas e álcool, prática de sexo desprotegido e histórico de agressão física estiveram associados tanto com fumantes quanto com ex-fumantes. Já a escolaridade ≤ 8 anos, história de ter morado na rua, não ter prática religiosa, internação psiquiátrica atual ou anterior, e transtorno por uso de substâncias como diagnóstico psiquiátrico principal foram associados somente ao tabagismo atual. A prevalência de tabagismo nessa população foi alta e maior do que para a população geral brasileira. Políticas de intervenção e prevenção do tabagismo devem ser adotadas pelos serviços de saúde mental.

Hábito de Fumar; Saúde Mental; Fatores de Risco

Characteristics	n *	%
Sociodemographic
Gender (female)	1,269	51.6
Age (≥ 40 years)	1,346	54.7
Skin color (white)	1,265	51.8
Schooling (≤ 8 years)	1,976	81.7
Family income in the last month (≤ 1 minimum wage) **	556	35.4
Marital status (unmarried)	1,641	66.9
History of homelessness	443	18.2
Practicing a religion	1,355	55.2
Clinical
Treatment settings
Psychiatric hospital	895	36.4
CAPS	1,566	63.6
Main psychiatric diagnoses (ICD-10)
Psychoses and bipolar disorders	1,397	56.8
Substance use disorders	173	7.0
Other diagnoses	891	36.2
Previous psychiatric hospitalization	1,212	54.5
Other self-reported medical conditions	1,105	45.3
Behavioral
Lifetime alcohol use	1,587	64.9
Lifetime illicit drugs use	625	25.7
Lifetime unsafe sex ***	1,958	80.8
Received/Offered money/drugs for sex	650	29.4
Lifetime physical violence	1,423	58.0
Lifetime sexual violence	485	19.8

Characteristics	Current smokers			Ex-smokers
Characteristics	n	%	Mean (±SD)	n	%	Mean (±SD)
Total	1,298	52.7	-	465	18.9	-
Number of cigarettes smoked daily
Overall	-	-	15.6 (11.9) *	-	-	10.8 (12.2) *
Psychoses and bipolar disorders	-	-	16.0 (12.2) **	-	-	10.1 (12.2) ***
Substance use disorders	-	-	17.0 (12.9) **	-	-	9.0 (7.7) ***
Other diagnoses	-	-	14.3 (10.7) **	-	-	11.9 (12.3) ***
Started smoking (age years)	-	-	15.9 (6.9) ^#	-	-	17.3 (7.0)^#
Smoking inside the health facility	1,039	80.0	-	-	-	-

Characteristics	Total *	Non-smokers (n = 698)		Current smokers (n = 1,298)				Ex-smokers (n = 465)
Characteristics	Total *	n **	%	n **	%	OR (95%CI) ***	p-value	n **	%	OR (95%CI) ***	p-value
Sociodemographic
Gender
Male	1,192	222	31.8	761	58.6	3.03 (2.50-3.69)	< 0.001	209	44.9	1.75 (1.37-2.23)	< 0.001
Female	1,269	476	68.2	537	41.4	1.00		256	55.1	1.00
Age (years)
≥ 40	1,346	319	45.7	764	58.9	1.70 (1.41-2.05)	< 0.001	263	56.6	1.55 (1.22-1.96)	< 0.001
< 40	1,114	379	54.3	533	41.1	1.00		202	43.4	1.00
Skin color
Non-white	1,178	295	42.7	658	51.1	1.40 (1.16-1.68)	< 0.001	225	48.6	1.27 (1.00-1.61)	0.048
White	1,265	396	57.3	631	48.9		1.00	238	51.4	1.00
Schooling (years)
≤ 8	1,976	502	73.7	1,114	87.0	2.38 (1.88-3.01)	< 0.001	360	79.1	1.35 (1.02-1.79)	0.037
> 8		441	179	26.3	167	13.0	1.00		95	20.9	1.00
Family income in the last month (US$)
≤ 200	556	152	33.5	290	37.2	1.18 (0.92-1.50)	0.191	114	33.9	1.02 (0.76-1.37)	0.895
> 200	1,014	302	66.5	490	62.8	1.00		222	66.1	1.00
Marital status
Unmarried	1,641	440	63.1	928	71.9	1.50 (1.23-1.82)	< 0.001	273	58.8	0.83 (0.66-1.06)	0.141
Married or in union	810	257	36.9	362	28.1	1.00		191	41.2	1.00
History of homelessness
Yes	443	53	7.7	324	25.2	4.07 (2.99-5.53)	< 0.001	66	14.4	2.02 (1.38-2.97)	< 0.001
No	1,992	639	92.3	960	74.8	1.00		393	85.6	1.00
Sociodemographic
Practicing a religion
Yes	1,355	435	62.4	626	48.4	0.56 (0.47-0.68)	< 0.001	294	63.4	1.04 (0.82-1.33)	0.742
No	1,099	262	37.6	667	51.6	1.00	< 0.001	170	36.6	1.00	0.742
Clinical
Treatment setting
Psychiatric hospital	895	172	24.6	614	47.3	2.75 (2.24-3.37)	< 0.001	109	23.4	0.94 (0.71-1.23)	0.639
CAPS	1,566	526	75.4	684	52.7	1.00	< 0.001	356	76.6	1.00	0.639
Main psychiatric diagnoses (ICD-10)
Psychoses and bipolar disorders	1,397	371	53.2	760	58.5	1.69 (1.39-2.05)	< 0.001	266	57.2	1.21 (0.95-1.54)	0.114
Substance use disorders	173	9	1.3	153	11.8	14.0 (7.05-27.9)	< 0.001	11	2.4	2.07 (0.84-5.08)	0.113
Other diagnoses	891	318	45.5	385	29.7	1.00		188	40.4	1.00
Previous psychiatric hospitalization
Yes	1,212	263	41.1	732	64.1	2.56 (2.10-3.12)	< 0.001	217	49.2	1.39 (1.09-1.77)	0.008
No	1,011	377	58.9	410	35.9	1.00	< 0.001	224	50.8	1.00	0.008
Other self-reported medical condition
Yes	1,105	321	46.3	543	42.3	0.85 (0.71-1.02)	0.085	241	52.3	1.27 (1.00-1.61)	0.047
No	1,333	372	53.7	741	57.7	1.00	0.085	220	47.7	1.00	0.047
Behavioral
Lifetime alcohol use
Yes	1,587	293	42.5	951	73.6	3.78 (3.11-4.59)	< 0.001	343	74.1	3.87 (2.99-5.01)	< 0.001
No	858	397	57.5	341	26.4	1.00	< 0.001	120	25.9	1.00	< 0.001
Lifetime illicit drugs use
Yes	625	47	6.8	484	37.7	8.29 (6.04-11.3)	< 0.001	94	20.3	3.49 (2.40-5.06)	< 0.001
No	1,811	643	93.2	799	62.3	1.00	< 0.001	369	79.7	1.00	< 0.001
Lifetime unsafe sex ^#
Yes	1,958	495	72.2	1,071	83.9	2.02 (1.61-2.52)	< 0.001	392	85.2	2.22 (1.64-3.02)	< 0.001
No	464	191	27.8	205	16.1	1.00	< 0.001	68	14.8	1.00	< 0.001
Received or offered money or drugs for sex
Yes	650	81	13.7	458	38.6	3.97 (3.06-5.16)	< 0.001	111	25.9	2.21 (1.61-3.04)	< 0.001
No	1,558	512	86.3	729	61.4	1.00	< 0.001	317	74.1	1.00	< 0.001
Lifetime physical violence
Yes	1,423	317	45.7	824	63.7	2.08 (1.73-2.51)	< 0.001	282	60.7	1.83 (1.44-2.33)	< 0.001
No	1,030	377	54.3	470	36.3	1.00	< 0.001	183	39.3	1.00	< 0.001
Lifetime sexual violence
Yes	485	131	18.9	261	20.3	1.09 (0.86-1.38)	0.463	93	20.0	1.07 (0.80-1.45)	0.631
No	1,959	562	81.1	1,026	79.7	1.00	0.463	371	80.0	1.00	0.631

Characteristics	Current smokers *		Ex-smokers **
Characteristics	OR ***	95%CI	OR ***	95% CI
Gender (male)	1.70	1.30-2.22 ^#	1.50	1.14-1.98 ^##
Age (40 + years)	2.54	1.97-3.27 ^#	2.14	1.62-2.82^#
Schooling (≤ 8 years)	1.93	1.42-2.63 ^#	-	-
History of homelessness	2.26	1.51-3.38 ^#	-	-
Practicing a religion	0.56	0.44-0.72^#	-	-
Treatment settings (psychiatric hospital)	1.63	1.23-2.16 ^#	-	-
Main psychiatric diagnosis (ICD-10)
Psychoses and bipolar disorders	1.05	0.81-1.37
Substance use disorders	4.48	1.95-10.31 ^#	-	-
Other diagnoses	1.00
Previous psychiatric hospitalization	1.59	1.23-2.06 ^#	-	-
Lifetime alcohol use	2.05	1.59-2.65 ^#	3.30	2.49-4.37 ^#
Lifetime illicit drugs use	4.73	3.19-6.99 ^#	2.43	1.61-3.67 ^#
Lifetime unsafe sex ^###	1.72	1.26-2.33 ^#	1.57	1.12-2.21 ^##
Lifetime physical violence	1.39	1.09-1.79 ^##	1.61	1.23-2.10 ^#

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[tfn01t01] CAPS: Psychosocial Care Centers; ICD-10: International Classification of Disease, 10^th revision.

[tfn02t01] ^*
n (total) varies due to missing information;

[tfn03t01] ^**
Minimum wage: US$200;

[tfn04t01] ^***
Not always using condoms in all practices.