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Brazilian Journal of Psychiatry

Print version ISSN 1516-4446On-line version ISSN 1809-452X

Rev. Bras. Psiquiatr. vol.29 no.2 São Paulo June 2007 



ASC - What does it measure and predict?


ASC - O que ele mensura e prevê?



Dear Editor,

Governmental anti-tobacco measures should be evidence-based. In order to become familiar with smokers' socio-demographic, biological and psychological characteristics, Gigliotti and Laranjeira undertook a study aiming at the analysis of habits, attitudes and beliefs of smokers in four major Brazilian cities.1 In order to permit comparisons with a similar study done in Europe by Fagerström et al.,2 this research used the same methodology.

Fagerström et al. state that "without an anti-smoking climate (ASC) it is difficult for politicians and others to control the health consequences of tobacco smoking with different actions such as e.g. increased excise taxes or restricting smoking in public places". It is also stated that "the ASC may also influence the health care providers' behavior vis-à-vis smoking and smokers own wish to give up smoking".2

What is the ASC? According to Fagerström et al., it was defined using "experts from each of the countries to arrive at a common definition of an ASC".2 Later, Gigliotti and Laranjeira defined it as "the tendency of a population to quit smoking".1

Based on findings from ASC, in the results section of their article, the latter authors report that "80.5% of smokers stated a desire to stop smoking". In the discussion section, they suggest that the factor that would most strongly influence future efforts to stop smoking was "concern about exposing children, family and friends to tobacco smoke". Although mentioning that "the idea of an ASC is quite complex, and the ASC thermometer instrument has not been tested for reliability and validity", it is concluded that "it is clear that the current level of anti-smoking consciousness creates a favorable climate in Brazil".1

Although recognizing that this kind of study is of utmost importance for evidence-based anti-tobacco policies, some caveats should be taken into account:

1) The absence of a content and construct validation of ASC cannot be minimized. Inter-judge agreement warrants only "educated common-sense".

2) Verbal responses do not always describe the truth;3 they depend on contingencies. People saying that they want to quit smoking is only such a verbal response. Every therapist knows that many patients describe verbally high motivation to change behaviors, but do everything but trying to change. Or should the statements against corruption by most congressmen taken as an evidence of a tendency to "quit" corrupt behaviors?

Therefore, some conclusions should be drawn only after studies verify that the verbal statements measuring ASC predict reliably actual quitting attempts. Such studies have already been done in other areas.4


Ivan Mario Braun
Interdisciplinary Group of Alcohol and Drug Studies,
Psychiatry Institute and Department, Medical School,
Universidade de São Paulo (USP), São Paulo (SP), Brazil



1. Gigliotti A, Laranjeira R. Habits, attitudes and beliefs of smokers in four Brazilian capitals. Rev Bras Psiquiatr. 2005;27(1):37-44.

2. Fagerstrom K, Boyle P, Kunze M, Zatonski W. The antismoking climate in EU countries and Poland. Lung Cancer. 2001;32(1):1-5.

3. Skinner BF. Verbal behavior. Acton, Mass.: Copley Publishing Group; 1992.

4. Weinstein ND, Kwitel A, McCaul KD, Magnan RE, Gerrard M, Gibons FX. Risk perceptions: assessment and relationship to influenza vaccination. Health Psychol. 2007;26(2):146-51.

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