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Texto & Contexto - Enfermagem

Print version ISSN 0104-0707On-line version ISSN 1980-265X

Texto contexto - enferm. vol.28  Florianópolis  2019  Epub Apr 25, 2019 

Original article



Caique Veloso1

Claudete Ferreira de Souza Monteiro1

1Universidade Federal do Piauí, Programa de Pós-graduação em Enfermagem. Teresina, Piauí, Brazil.



to analyze the consumption of alcohol and tobacco by women and the occurrence of intimate partner violence against women.


a cross-sectional and analytical study with 369 women in the age group of 20 to 59 years, attended in Basic Health Units of five municipalities of Piaui, Brazil. The instruments used in data collection were Alcohol Use Disorders Identification Test, Non-Student Drugs Use Questionnaire and Revised Conflict Tactics Scales. Data were analyzed according to descriptive statistics and bivariate analysis with Pearson's chi-square test and logistic regression.


the overall prevalence of intimate partner violence against women was 64.0%, 61.5% of whom were victims of psychological aggression, 33.6% of physical abuse and 17.1% of sexual coercion. In addition, 50.1% and 17.9% of the women reported alcohol and tobacco consumption, respectively, which were statistically associated with the occurrence of intimate partner violence. Alcohol consumption increased by 2.15 times the chance of intimate partner raping (p=0.001, 95% CI=1.37-3.38), while smoking increased this chance by 2.04 times (p=0.038, 95% CI=1.04-4.00).


high prevalence of alcohol and tobacco use by women and intimate partner violence were identified. In addition, it was found that the consumption of these substances by women is a risk factor associated with the occurrence of intimate partner violence in the female universe.

DESCRIPTORS: Alcoholism; Tobacco use disorder; Women; Violence against women; Intimate partner violence; Health vulnerability; Gender and health



analizar el consumo de alcohol y tabaco por mujeres y la ocurrencia de violencia por conpañero íntimo contra la mujer.


estudio transversal y analítico, realizado con 369 mujeres en el grupo de edad de 20 a 59 años, atendidas en Unidades Básicas de Salud de cinco municipios piauienses. Los instrumentos utilizados en la recolección de datos fueron: Alcohol Use Desorders Identification Test, No-Student Drugs Use Questionnaire y Revised Conflict Tactics Scales. Los datos fueron analizados según estadística descriptiva y análisis bivariado con prueba qui-cuadrada de Pearson y regresión logística.


la prevalencia global de violencia por conpañero íntimo contra la mujer fue del 64,0%, siendo que el 61,5% de la muestra fue víctima de agresión psicológica, el 33,6% de abuso físico y el 17,1% de la coerción sexual. Además, el 50,1% y el 17,9% de las mujeres refirieron el consumo de alcohol y tabaco, respectivamente, los cuales se asociaron estadísticamente a la ocurrencia de violencia por conpañero íntimo. El consumo de alcohol aumentó en 2,15 veces la probabilidad de que la mujer fuera violada por el conpañero íntimo (p= 0,001, IC 95%=1,37-3,38), mientras que el consumo de tabaco aumentó tal posibilidad en 2,04 veces (p=0,038, IC 95%=1,04-4,00).


se identificaron elevadas prevalencias de consumo de alcohol y tabaco por mujeres y de violencia por conpañero íntimo. Además, se constató que el consumo de esas sustancias por mujeres figura como factor de riesgo asociado a la ocurrencia de violencia por conpañero íntimo en el universo femenino.

DESCRIPTORES: Alcoholismo; Tabaquismo; Mujeres; Violencia contra la mujer; Violencia de pareja; Vulnerabilidad en salud; Género y salud


The consumption of alcohol and tobacco has a differentiated connotation of the other drugs in society, since the legal character, facilitated access and low cost of these substances result in social acceptance and make difficult their confrontation.1 In this way, alcohol and tobacco are global problems, the negative effects of which are due not only to public health but also to safety, justice, the economy and social security.2-3

According to the World Health Organization, 65% of men and 45% of women consume alcohol in the world.4 In Brazil, the prevalence of harmful alcohol consumption is 13.7%, with emphasis on the Midwest (16.2%) and Northeast (15.6%). In this scenario, Teresina presents itself as the second northeastern capital with the highest percentage of harmful alcohol consumption (19.4%), being 28% among men and 8.9% among women.5

As for smoking, a North American study conducted in 2015 estimated that 15.1% of adults were smokers, 16.7% were male and 13.6% female.6 National survey found that the percentage of Brazilian adult smokers in the same year was 10.4% (12.8% in males and 8.3% in females). In Teresina, 7.3% of adults were smokers, 10.3% among men and 5.4% among women.5

According to the II National Survey of Alcohol and Drugs, conducted in 2012 in the five Brazilian regions, alcohol and tobacco have the highest prevalence of consumption among psychoactive substances (50% and 16.9%, respectively) and figure as important risk factors for morbidity, mortality and disability in the population.7

Although the consumption of psychoactive substances is a phenomenon historically associated with men, there has been a decrease in the gap between genders, especially in the young population.8-9 In this context, economic development and changes in gender roles in contemporary society, coupled with double working hours, difficulties in dealing with daily problems and greater susceptibility of women to the development of mental disorders, are factors that contribute to the initiation and consumption of psychoactive substances in the female population.10-11

In this way, the harmful consumption of alcohol and tobacco is characterized as a complex situation and with multiple determinants that change according to culture, historical moment and social group. These substances are responsible for numerous social, psychological and biological damages, as well as other negative implications for the lives of women, among which is the exposure of these to situations of intimate partner violence.12-15

Intimate partner violence is defined as any behavior within an intimate relationship that causes physical, sexual, or psychological harm, including acts of physical aggression, sexual coercion, psychological abuse, and controlling behaviors.16 It is a multidimensional public health problem, which has high global prevalence and affects mainly women.16-17

Research carried out on different continents found that the prevalence of intimate partner violence against women was 11.9% in Saudi Arabia, 25.4% in Australia, 28.0% in Sweden and 69.0% in Ghana.18-21In Brazil, investigations carried out in Basic Health Units in the Southeast and Northeast regions showed that 55.7% of the women from São Paulo and 39.0% of the Paraíba women were victims of intimate partner violence.22-23

In addition, the women were victims of intimate partner violence against women covers a wide range of violent acts ranging from verbal aggression and other forms of emotional abuse to femicide. However, non-fatal cases are still marked by invisibility, since they occur mainly in the home and, in large part, do not generate care and notifications in the health services.24-25

In view of the above, the objective of this study was to analyze the consumption of alcohol and tobacco by women and the occurrence of intimate partner violence against women.


A cross-sectional, exploratory and analytical study, related to the project "Violence, alcohol consumption and drugs in the female universe: prevalence, risk factors and consequences for mental health", carried out in 72 Basic Health Units located in the municipalities of Teresina, Parnaíba, Picos, Floriano and Bom Jesus, which are the headquarters of the five macro-regions of health of the State of Piauí, Brazil.

The population was composed of women in the age group of 20 to 59 years old, living in the municipalities, totaling 347,414 women.26 After using the presumed prevalence of alcohol consumption among adult women of 39%,7 confidence level of 95% and maximum error of 5%, a sample of 369 women was obtained.

Proportional stratification was used to determine the number of women in each municipality, resulting in 232 women in Teresina, 36 in Parnaíba, 46 in Picos, 38 in Floriano and 17 in Bom Jesus. In addition, the same prevalence of 39% of alcohol consumption among adult women was applied, followed by random lottery, to define the number and the Basic Health Units that would be inserted in the study.

Finally, to define the number of women interviewed in the selected Basic Health Units, a stratified proportional sample was also used, considering the number of women attended at each Basic Health Unit in 2014.

We included women who had an intimate partner and who were attended in nursing consultations in the Basic Health Units of the selected municipalities. As an exclusion criterion, the presence of verbal communication difficulties was considered, since the data collection would be done through a dialogue with the interviewees. It is emphasized that they were considered intimate partners, the companions or ex-companions, regardless of the formal union, and the current boyfriends.27

As for the instruments, in addition to a structured form with questions related to the socioeconomic aspects of the sample, the Alcohol Use Disorders Identification Test (AUDIT) for the evaluation of alcohol consumption, the Non-Student Drugs Use Questionnaire (NSDUQ) for the investigation of tobacco use and the Revised Conflict Tactics Scales (CTS2) to predict the occurrence of intimate partner violence against women, in their different natures and severities.

The AUDIT was developed by the World Health Organization28 and validated in Brazil by Mendez.29 It proposes a simple method for the tracking of alcohol consumption and is composed of ten questions, each with a margin of 0 to 4 points.28 The prevalence of alcohol consumption was detected through the first issue of the AUDIT (How often do you consume alcohol?). Thus, the value "0" (no) was attributed when the interviewee reported never having consumed alcoholic beverages (option 0) and "1" (yes) when consumption was positive at some frequency (options 1 to 4).

The NSDUQ is of American origin30 and was validated for use in Brazil by Hasselmann, Lopes and Reichenheim.31 It addresses the consumption of tobacco and other drugs by both the respondent and his or her current partner, and the positive response in an issue identifies the consumption of that substance.30 In this research, only the first part of the instrument was used, referring to the smoking of the women interviewed (yes or no).

The CTS2 were prepared by Straus and co-workers32 and had their cultural adaptation and validation for Brazil carried out by Moraes, Hasselmann and Reichenheim.33 They are composed of five scales: three of them deal with the occurrence of psychological aggression, physical abuse and sexual coercion, while the other two question the physical consequences of violence on individual health (injuries) and the tactics of conflict resolution through negotiation. They present 39 items grouped in pairs of questions regarding the actions of the respondent and, reciprocally, of their companion, which makes a total of 78 questions.32

In addition, they identify the frequency of occurrence of violent acts, which includes eight categories. The first six are intended to determine prevalence in the last three months: (1) once, (2) twice, (3) 3-5 times, (4) 6-10 times, (5) 11-20 times, (6) more than 20 times. The other two categories are designed to determine: global prevalence, (7) has occurred before; and the absence of such abuse; (8) never happened. In the present study, we opted to evaluate the global prevalence, assigning the value 1 (occurred at some point) to all response categories from 1 to 7 and the value 0 (never occurred) to category 8.34

Data collection took place from August 2015 to March 2016 and was conducted through an individual interview, in a space reserved in the Basic Health Units. In order to detect possible difficulties in the understanding of the socioeconomic form by the potential participants, a pre-test was performed with 10% of the sample in Basic Health Units that had not been selected from the sampling process. The analysis of the tests allowed to identify that the instrument did not need changes in its writing or structure.

The data obtained was coded and organized into Microsoft Excel 2010 spreadsheets through a double-digit process. Subsequently, the data was exported to the Statistical Package for the Social Science (SPSS), version 22.0, in which the statistical analysis was performed.

Descriptive statistics were performed by determining the measures of central tendency and dispersion. Bivariate analyzes were conducted to evaluate the association between the independent variables (alcohol consumption and smoking by women) and the dependent variable (intimate partner violence against women). Because they were categorical variables, Pearson's chi-square test was used.

The independent variables that obtained a p-value ≤0.02 in the bivariate analyzes made up the binary logistic regression model, with the respective p-values, odds ratio and confidence intervals. It should be emphasized that for all analyzes performed, a significance level of 5% and a 95% confidence interval were adopted.


The mean age of the sample was 33.1 years, with a predominance of women aged between 20 and 39 years (75.1%), browns (59.6%), heterosexuals (98.6%) and married or in a stable union (71.8%). In addition, 81.8% of the sample had eight years or more of schooling and 69.7% had monthly income less than or equal to two minimum wages (Table 1).

Table 1 Socioeconomic and demographic characterization of the sample. Teresina, PI, Brazil, 2016. (n=369) 

Variables n % ±‡ x̄† CI 95%§ Min-Max
Age group 33.1 9.9 32.1-34.1 20-59
20-39 years old 277 75.1
40-59 years old 92 24.9
Brown-skinned 220 59.6
Caucasian 72 19.5
Black 68 18.4
Asian 6 1.6
Indigenous 3 0.8
Sexual orientation
Heterosexual 364 98.6
Homosexual 4 1.1
Bisexual 1 0.3
Marital status
Single 82 22.2
Married/stable marriage 265 71.8
Divorced 14 3.8
Widow 8 2.2
With children
Yes 261 70.7
No 108 29.3
Schooling 10.0 3.5 9.8-10.6 0-20
None 14 3.8
< 8 years 53 14.4
≥ 8 years 302 81.8
Income* 799.8 637 722-877 0-5000
None 93 25.2
≤ 2 minimum wages 257 69.7
> 2 minimum wages 19 5.1

*The minimum reference wage was the data collection period (R$ 788.00); † 331. 𝑥 332. = mean; ‡ ±= standard deviation; §CI 95%= confidence interval; Min-Max= minimum and maximum.

The overall prevalence of intimate partner violence against women was 64.0% (n=236). When considering the nature of violent action, it was detected that 61.5% of the women were victims of psychological aggression, 33.6% of physical abuse and 17.1% of sexual coercion, while the prevalence of injuries was 16.0 %. Concerning severity, it was observed that the occurrence of minor violence was superior to that of severe violence (Table 2).

Table 2 Prevalence of intimate partner violence against women, according to the nature and severity of violent action. Teresina, PI, Brazil, 2016. (n=369) 

Nature of violence* n %
Psychological aggression 227 61.5
Minor 224 60.7
Severe 153 41.5
Physical abuse 124 33.6
Minor 118 32.0
Severe 59 16.0
Sexual coercion 63 17.1
Minor 50 13.6
Severe 23 6.2
Injury 59 16.0
Minor 54 14.6
Severe 26 7.0

*Multiple answers.

The prevalence of alcohol consumption in the sample was 50.1% (n=185) and the prevalence of smoking was 17.9% (n=66) (Figure 1). It is noteworthy that 132 women reported consuming only alcohol (35.7%), 13 of them reported consuming only tobacco (3.5%) and 53 consumed both alcohol and tobacco (14.4%).

Figure 1 Prevalence of alcohol and tobacco consumption in the sample. Teresina, PI, Brazil, 2016. (n=369) 

The bivariate analysis between the independent categorical variables and the dependent variable showed that there is a statistically significant association between the consumption of alcohol (p<0.001) and tobacco (p=0.001) by women and the occurrence of intimate partner violence against women (Table 3).

Table 3 Bivariate analysis between independent categorical variables (alcohol consumption and smoking by women) and the dependent variable (intimate partner violence against women). Teresina, PI, Brazil, 2016. (n=369) 

Independent variables Intimate partner violence OR* CI 95%† p-value‡
Yes No
n % n %
Alcohol consumption 2.45 1.58-3.80 <0.001
Yes 137 74.1 48 25.9
No 99 53.8 85 46.2
Tobacco use 2.99 1.54-5.83 0.001
Yes 54 81.8 12 18.2
No 182 60.1 121 39.9

*OR= odds ratio; †CI= confidence interval; ‡Pearson's chi-square test.

The binary logistic regression model confirmed that both alcohol consumption and smoking by women were statistically associated with the occurrence of intimate partner violence against women. It was identified that alcohol consumption increased by 2.15 times the chance of women being intimate partner violence, while tobacco use increased by 2.04 times (Table 4).

Table 4 Logistic regression involving alcohol consumption and smoking by women in the face of intimate partner violence against women. Teresina, PI, Brazil, 2016. (n=369) 

Independent variables OR* CI 95%† p-value
Alcohol consumption 2.15 1.37-3.38 0.001
Tobacco use 2.04 1.04-4.00 0.038

*OR= odds ratio; † CI=confidence interval


Although the scientific literature evidences the existence of an association between psychoactive substance use and intimate partner violence against women, the debates about the consumption of these substances by women who are violated are still incipient, since a large part of the studies an intimate male partner and one who practices violent acts.35-36

In addition, the possible underreporting of intimate partner violence against women in different health services, as well as the lack of verification of their main associated factors, makes it feasible to conduct research that explores such problems in the community context, which favors the detection of violent acts and possible risk factors pertinent to the daily life of women.

Intimate partner violence against women was identified in 64.0% of the women interviewed, a high percentage when compared to results from other Northeastern capitals. In Recife and João Pessoa, it was detected that the prevalence of intimate partner violence among women enrolled in the Family Health Strategy was 24.4% and 39.0%, respectively.22,37 However, a similar result was observed among 661 women attending health services in the public network of São Paulo, since 60.9% of them were victims of intimate partner violence.17

In the international scenario, the percentage of intimate partner violence against women also was mostly lower. On the African continent, investigations found that 53.6% of women in Côte d'Ivoire, 43.7% in Uganda and 42.0% in Nigeria were victims of intimate partner violence.38-40 However, the lowest prevalence were found in the European and Asian continents. In Norway, 13.5% of women reported intimate partner violence, while in Saudi Arabia the prevalence was 11.9%.18,41

On the other hand, research developed with a sample of Ghanaian women showed a prevalence of intimate partner violence against women higher than that found in the five Piauí counties investigated. Of the 443 women interviewed, 306 (69.0%) had experienced intimate partner violence of some kind, and 62%, 34% and 27% of them suffered psychological, sexual and physical violence in that order.21

Although the present study also identified a predominance of psychological aggression (61.5%), it contrasts with the results found in Ghana, since there was a higher prevalence of physical abuse (33.6%) than of sexual coercion (17.1%). Similar results were observed in the state of São Paulo, where the prevalence of intimate partner psychological, physical and sexual violence was 53.8%, 32.2% and 12.4%, respectively.23

As for the nature of violent actions, high percentages were also identified in Iran, where 79.7% of women were victims of intimate partner violence, 60.0% intimate partner violence, and 32.9% intimate partner violence sexual.42 In Sweden, the prevalence of intimate partner violence against women was lower than in most publications: 25.0% psychological, 7.5% physical and 2.8% sexual.20

Although it is often neglected by women's protection services and by health professionals, psychological aggression deserves attention, since it is usually the first form of violence in the context of a chain that can reach its peak, femicide.

It should be noted that intimate partner violence can result in a wide range of physical and mental health problems for women, including injuries (injuries), chronic pain, mental disorders (anxiety and depression, especially) and sleep disorders. In the present study, it was observed that 14.6% of women victims of intimate partner violence presented minor injuries and 7.0% of them reported severe injuries because of intimate partner physical abuse. This finding corroborates with those found in Sri Lanka, where 11.2% of women who were raped by the intimate partner developed severe injuries.43

In addition, multicentric research conducted in more than 40 countries, located in five different continents, pointed out that there is a direct relationship between the severity of intimate partner physical violence and alcohol consumption, and the severity of intimate physical partner violence is greater when it involves the consumption of such substance, either only by the violated partner or by both involved in the violent action.44

In this context, the national and international literature confirms the consumption of alcohol as one of the main risk factors for the occurrence of intimate partner violence against women.40-41,45 Results obtained in Spain showed a high prevalence of gender violence among women users of more than one substance of abuse, with alcohol being the main drug of consumption.46

The factors that trigger the consumption of psychoactive substances by women are related to their individual characteristics, as well as to their sociocultural aspects, especially the early age group, low schooling, low insertion in the labor market, intrafamilial conflicts, weak affective bond and consumption drugs in the family environment or in groups of friends.47

It was found that 50.1% of the women interviewed reported alcohol consumption, which represents a prevalence higher than that detected nationally. In a study carried out periodically in the five Brazilian regions, the prevalence of alcohol consumption among women in the last 12 months was 41.0% in 2006 and 38.0% in 2012.7

Similar results were observed in Puerto Ricans living in the United States, since 25.0% of them declared themselves to be former drinkers and 35.0% reported current consumption of alcoholic beverages, of which 27% were moderate drinkers and 8% heavy drinkers.48

On the other hand, Russia presents itself with one of the countries with the highest prevalence of alcohol consumption in the female universe. Research conducted with Russian women of childbearing age found that 89.0% of them had consumed alcoholic beverages in the last three months, with 65.0% reporting consumption of four or more doses on a single occasion.49

Regarding the consequences of such consumption in the female universe, the investigation of reports published in Brazilian magazines of national circulation about the social and health repercussions of women's drug use, highlighted their victimization in situations of intimate partner violence, as well as the increase of drug use by women, especially alcohol.50

It should be noted that a statistically significant association was found between alcohol consumption by women and intimate partner violence against Piauí women, and 74.1% of women who reported alcohol consumption were victims of partner violence intimate.

Alcohol consumption can increase the tendency to violent and impulsive behaviors, including in the female universe, which can determine the occurrence of morbidities and mortalities due to violent causes. Thus, women become more susceptible to the development of conflicting relationships, which increases the likelihood of victimization in episodes of intimate partner violence.51

A study carried out from a representative household sample of all geographic regions in Brazil showed that alcohol consumption increased by 1.6 times the probability of victimization in cases of intimate partner violence.45 This association was more significant in the present study, since alcohol consumption increased by 2.15 times the chance of women being victims of intimate partner violence. Thus, it is confirmed that alcohol consumption plays an important role in the occurrence of intimate partner violence.

In addition to the problem about alcohol, tobacco use among women is also a major public health problem.52 Even in the face of strong global policies to combat smoking and its successful results, female smoking still worries and deserves attention, especially in developed countries.

In Piauí women, the prevalence of tobacco use was 17.9%, higher than that found in a population-based household survey, involving 60,202 Brazilian individuals aged 18 years or over, which pointed out that 11.0% of women were current tobacco users.53

Research involving women from 14 countries, located in different continents, aged 15-49, identified that current smoking among women of reproductive age ranged from 0.4% in Egypt to 30.8% in Russia. The prevalence was less than or equal to 2.3% in Bangladesh, China, India, Thailand and Vietnam and more than 10% in Brazil, Uruguay, Poland, Turkey and Ukraine.54

Thus, the highest prevalence of female smoking is found in the European and American countries, while the African and Asian countries stand out because they present the lowest prevalence of smoking among women of childbearing age.

The literature also points out that female smoking also appears as a risk factor for the occurrence of intimate partner violence against women.14,55 Epidemiological survey conducted in a US adult sample (n=25,778) found that nicotine was the substance most commonly used by women who had been victims of intimate partner violence in the past year.56

Smoking presents itself to deal with the stress of a conflict-damaged relationship. However, nicotine in tobacco may be related to intimate partner violence through behavioral changes, since women who smoke tobacco may become more impulsive, irritable, and likely to conflict with the intimate partner, which may increase the likelihood of intimate partner violence against women.57

In the present study, 81.8% of women who reported smoking were victims of intimate partner violence. In addition, it was found that the chance of experiencing intimate partner violence increased by 2.04 times among smokers.

A similar result was observed in an urban community in the Northeast of the United States, from a sample of 123 women, aged 18 years or more and victims of violence by the current intimate partner. It was identified that 86% of the raped women consumed tobacco in the last three months, and 73% of them had a daily consumption pattern.58

A survey of 21,162 women living in the United States on intimate partner violence and the risks associated with cardiovascular health found that 4975 women were victims of intimate partner violence throughout their lives, and more than one-third of them reported smoking current, which resulted in a statistical association between the phenomena (OR=2,8).59

Considering the above, the direct relationship between alcohol and tobacco consumption by women and their victimization in cases of intimate partner violence is noticed. When considering the adverse health consequences of these phenomena, there is a need for better coordination between prevention and support services for women, as well as the awareness of nurses and other health professionals on the issues, which must be constantly discussed health services.

However, a Brazilian study carried out in Rio Grande do Sul highlighted that the majority of nursing professionals working in health services who received victims of domestic violence were unaware of the need and obligation to report domestic and sexual violence, address the victim, identify cases of violence, adopt conduct and refer women to other services.60 Thus, training and continuing education of nursing professionals who work in health institutions, including ethical and legal aspects in nursing care for victims of violence, becomes indispensable.

Regarding the limitation of the study, we highlight the use of the cross-sectional design, since it makes it impossible to define causality between alcohol consumption and smoking by women and the occurrence of intimate partner violence against women.


The results showed the existence of high prevalence of alcohol and tobacco consumption by women, as well as intimate partner violence against women, confirming such phenomena as public health problems of great magnitude and present in the daily lives of women in the municipalities of Piauí. In addition, they highlighted the consumption of alcohol and tobacco by women as a risk factor associated with the occurrence of violence by intimate partner in the female universe.

In view of the evident need to strengthen coordination between prevention and support services for women who consume alcohol and tobacco and who experience intimate partner violence, the above findings may contribute to the formulation of strategies that address such problems in the context of assistance comprehensive and humanized approach to women's health.

In addition, it is believed that the present study provides information that will support nurses and other health professionals about the preventive practice and management of cases of violence by intimate partner against women and their associated factors, in addition to influencing the conduct of other research and favoring the debates about the phenomena in different social spheres.


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Article from the dissertation - Alcohol and tobacco consumption by women and the occurrence of intimate partner violence, presented to the Programa De Pós-Graduaçao em Enfermagem, Univerisdade Federal do Piauí, in 2017.


Financial support of the National Council for Scientific and Technological Development (CNPq). Process n. 443107/2014-9.


The research was approved by the Research Ethics Committee of the Univerisdade Federal do Piauí no. 1,806,588 and CAAE no. 60420416.5.0000.5214.

Received: December 08, 2017; Accepted: March 07, 2018



Study design: Veloso C, Monteiro CFS. Data collect: Veloso C, Monteiro CFS. Data analysis and interpretation: Veloso C, Monteiro CFS. Discussion of the results Veloso C, Monteiro CFS. Writing and / or critical review of content: Veloso C, Monteiro CFS. Review and final approval of the final version: Veloso C, Monteiro CFS.


There is no conflict of interest.

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