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O Brasil segue como um modelo mundial de controle do uso do tabaco, inclusive na área de cessação do tabagismo. No entanto, vários grupos populacionais que usam tabaco ainda não se beneficiam desses serviços. Entre eles, se incluem as pessoas com diagnóstico de câncer. Os benefícios da cessação após o diagnóstico de câncer são bem estabelecidos. A cessação reduz a mortalidade, aumenta a sobrevida, e aumenta o sucesso do tratamento, inclusive diminuindo a prevalência de complicações. No entanto, profissionais de saúde ainda hesitam em abordar o uso do tabaco em pessoas com câncer. Ao negligenciar o tabaco na abordagem ao paciente, está se negando a esses pacientes a oportunidade de um prognóstico melhor. A rede de capacitação de profissionais de saúde para a cessação poderia ser mobilizada para preparar os profissionais da oncologia na abordagem ao tabagista. Precisa-se que tomadores de decisão coloquem em prática e façam cumprir medidas que são baseadas em evidência. Científica e eticamente, não existe justificativa para não oferecer a esses pacientes o cuidado que a eles se deve.

Trabalho elaborado como parte de um documento global sobre Saúde e Meio Ambiente da Fundação Oswaldo Cruz.

O presente estudo foi desenvolvido com o objetivo de atualizar os dados relativos ao ensino da cancerologia nos cursos de graduação em enfermagem no Brasil e oferecer subsídios para a discussão e proposta de um programa básico dessa matéria nos referidos cursos. A população do estudo foi constituída por 60 escolas que responderam a um questionário que lhes fora enviado pelas autoras, e 55 (91,7%) delas informaram que ministram conteúdos relativos à oncologia em seus currículos. Os resultados do estudo mostram que a concentração do ensino de enfermagem em oncologia se dá na disciplina Enfermagem Médico-Cirúrgica (52 indicações). A variação da carga teórica está situada entre o mínimo de 2 e o máximo de 87 horas e, da carga horária prática, de 4 a 198 horas. Quanto à forma de ministrar o conteúdo, 54,5% das escolas informaram que as aulas são dadas de forma estanque ou isolada em cada disciplina, e que o ensino prático é desenvolvido principalmente em unidades gerais onde eventualmente são internados pacientes com câncer (48 citações). Na maioria das escolas, o ensino da cancerologia se concentra nas 2 e 3a séries do gradeado curricular. As autoras consideram que o panorama epidemiológico do câncer no Brasil, assim como a constatação de deficiências no ensino e na assistência de enfermagem à clientela alvo da oncologia, requerem um posicionamento das escolas e dos serviços no sentido de investirem na formação de recursos humanos, a fim de capacitá-los para atuar na área da oncologia, nos níveis de prevenção, diagnóstico, tratamento e reabilitação.

Addressing conflicts of interest (COIs) when developing and implementing policies to address commercial determinants of health is pivotal to ensure that these policies are free from commercial and other vested interests of unhealthy commodities industry. As a concept, this is well accepted within the tobacco control community, and supported by the existence of an international treaty, the WHO Framework Convention on Tobacco Control (FCTC). But in nutrition policy the engagement of the food industry appears to remain controversial, as efforts to create partnerships are still underway. There is a need to undertake evaluation of existing COI policies to assess their implementation and outcomes, creating best practice models that can be replicated, and understanding how to change norms within governments. Additionally, a review of existing norms, codes of conduct, and ethics to determine their impact on preventing COI would guide future implementation of these measures. Finally, governments, academics, and advocates should consider how existing tools, guidelines or other instruments could help frame the COI discussion to ensure its political feasibility. There is a need for a discussion on whether the current approach of separate policies for distinct industries is preferable than a broader COI policy that would be applicable to a wide range of unhealthy commodities and across governmental sectors.

This paper examines cancer health disparities and contributing factors at national, regional, and international levels. The authors all live in different countries and regions with different health-care systems and practices. Despite the shared cancer nursing perspective, each country or global region approaches cancer disparities differently. With globalization the world is becoming smaller, and in turn becoming interconnected and interdependent. This article focuses on cancer health disparities and global cancer nursing, exemplifying these concepts about the impact and implications of person-centered care.

The health consequences of tobacco use are well known, but less recognized are the significant environmental impacts of tobacco production and use. The environmental impacts of tobacco include tobacco growing and curing; product manufacturing and distribution; product consumption; and post-consumption waste. The World Health Organization's Framework Convention on Tobacco Control addresses environmental concerns in Articles 17 and 18, which primarily apply to tobacco agriculture. Article 5.3 calls for protection from policy interference by the tobacco industry regarding the environmental harms of tobacco production and use. We detail the environmental impacts of the tobacco life-cycle and suggest policy responses.

Abstract: This article aims to analyze the relationship between the Brazilian government’s adoption of a regulatory measure with a strong impact on the population and the opposition by invested interest groups. The methodology involves the analysis of official documents on the enforcement of health warnings on tobacco products sold in Brazil. In parallel, a search was conducted for publicly available tobacco industry documents resulting from lawsuits, with the aim of identifying the industry’s reactions to this process. The findings suggest that various government acts were affected by direct interference from the tobacco industry. In some cases the interventions were explicit and in others they were indirect or difficult to identify. In light of the study’s theoretical framework, the article provides original information on the Brazilian process that can be useful for government policymakers in the strategic identification of tobacco control policies.

Resumo: Esta pesquisa examina as características institucionais da Comissão Nacional para a Implementação da Convenção-Quadro sobre Controle do Tabaco (CONICQ) e como essas características institucionais facilitaram e impediram sua capacidade de promover o controle intersetorial do tabagismo. Os autores avaliam particularmente as características da CONICQ enquanto um dos principais fatores de mudanças e melhorias nas primeiras políticas de controle do tabaco, e que ajudaram a transformar o Brasil em líder mundial nessa área. O artigo também analisa como a Comissão evoluiu junto com a melhora do controle do tabaco, além de discutir alguns dos maiores desafios para reunir diversos setores do governo na elaboração de políticas de saúde pública.

Resumo: Com base nos resultados de dezenas de entrevistas com atores-chave envolvidos na formulação de políticas de controle do tabaco, examinamos as percepções desses atores em relação a ameaças ao controle do tabaco provenientes de políticas econômicas internacionais (comerciais e de investimento). Adotando uma perspectiva jurídica, avaliamos também as ameaças existentes e desafios potenciais que as políticas econômicas podem apresentar para os esforços do governo brasileiro na defesa da saúde pública. Segundo nossos achados, a maioria dos atores não percebe tais políticas econômicas como uma grande ameaça ao controle do tabaco. Objetivamente, de fato existem algumas ameaças. Por exemplo, a tentativa do Brasil de proibir a maioria dos aditivos e saborizantes do tabaco ainda enfrenta resistência na Organização Mundial do Comércio.

There are few educational programs in the United States that have a primary focus on preparing nurses to engage in all levels of public health, health policy, and climate change. The United Nations sustainability development goals (SDG) and the Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity (2021) report underscored the importance of key stakeholders, including nurses, engaging in advocacy and policy to promote health equity. We discuss the role of nursing at the intersection of public health, policy, climate change, and the SDG. We also discuss the history and merger of the University of California San Francisco (UCSF) School of Nursing public health and health policy specialties, a significant innovation in our effort to promote health equity. We provide a brief overview of the redesigning of our curriculum that meets the needs of today's learners by including content on climate change, data analytics, and racial, social, and environmental justice. Finally, we emphasize the need to train the next cadre of nurses interested in careers in public health and health policy for us to meet the challenges facing our communities. (Am J Public Health. 2022;112(S3):S321-S327. https://doi.org/10.2105/AJPH.2022.306826).

The WHO Framework Convention on Tobacco Control (WHO FCTC) has accomplished much in advancing tobacco control. Non-governmental organisations (NGOs) were critical to the development of the Convention, who aided in mobilising stakeholders and advocated for core provisions of the treaty. NGOs and intergovernmental organisation are well recognised within the Convention and deemed essential to its continued implementation and evolution. Further, the treaty has been understood to be multidisciplinary in its aspiration to improve public health, and the role of both health sector and non-health sector stakeholders is an important component for describing the reach and potential for the Convention. In 15 years, however, non-state actors' participation in the WHO FCTC Conference of the Parties (COP) - where Parties to the treaty engage in discussions that shape the treaty's implementation and evolution - has been underrepresented in terms of sectoral diversity. We reviewed COP documents and assessed non-state actors' participation in the COPs since the Convention's entry into force. We conclude that greater inclusion in COPs from health and non-health sector NGOs, intergovernmental organisations and UN Special Agencies would strengthen the global reach and full implementation of the WHO FCTC.

Tobacco-related diseases kill eight million people worldwide ever year and are responsible for thousands of cases of cancer, cardiovascular disease and other illnesses in Brazil. Cigarette filters are believed by many to reduce the health risks of smoking. This article outlines the history of the technology of filters and discusses the impacts of these cigarette design features and their regulation. We conducted a literature review to assess the impacts of this technology. The results show that filters were initially developed for aesthetic purposes and later improved and marketed as a harm reduction technology. The most widely-used filters are those made of cellulose acetate with or without activated carbon. Despite smokers' beliefs and advertising claims, filters have no health benefits and filter tip ventilation can increase the health risks of smoking. Filters can also make cigarettes more appealing and cause significant environmental impacts. Cigarette filters have no health benefits and lull smokers into a false sense of security and should therefore be banned.

BackgroundThe tobacco industry (TI) uses several strategies to attract new consumers, including using additives in tobacco products, which makes tobacco especially attractive to youth. Based on scientific evidence and the principles of the WHO Framework Convention on Tobacco Control, the Brazilian Health Regulatory Agency (ANVISA, for the name in Portuguese), published the Collegiate Board Resolution (RDC, for the name in Portuguese) 14/2012 in 2012, prohibiting the addition of substances that enhance the flavour and taste of tobacco products in order to make them more attractive. In response, the TI used various strategies to prevent RDC 14/2012 from entering into force. At the time, the Brazilian additive ban was the most comprehensive in the world as it included a ban on menthol.ObjectivesThis paper analyses the arguments and strategies used by the TI to prevent the implementation of the additives ban.MethodsReview of published articles, reports, legislation and legislative activity, internal TI documents, media stories and other documents to describe TI's reaction to the ban.ResultsThe results show that the TI used some well-known strategies to delay or cancel the entering into force of the resolution. For example, the TI attempted political interference, used litigation and commissioned studies with findings that questioned the resolution's rationale. The TI strategies used in Brazil are similar to those used at the global level to oppose other tobacco control measures.ConclusionsTI successfully delayed the most comprehensive additive ban in the world using its usual tactics, despite the fact that none of the arguments presented by the TI had an acceptable scientific basis or evidence.

Negative impacts of tobacco result from human consumption and from tobacco-growing activities, most of which now occur in low- and middle-income countries. Malawi is the world's largest producer of burley tobacco and its population is affected by the negative consequences of both tobacco consumption and production. In countries like Malawi, tobacco control refers to control of the tobacco supply chain, rather than control of consumption. We review the impact of tobacco cultivation, using Malawi as an example, to illustrate the economic, environmental, health and social issues faced by low- and middle-income countries that still produce significant tobacco crops. We place these issues in the context of the sustainable development goals (SDGs), particularly 3a which calls on all governments to strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control. Other goals address the negative effects that tobacco cultivation has on development. The SDGs offer an opportunity for low- and middle-income countries that are dependent on tobacco production and that are not yet parties to the Convention, to reconsider joining the FCTC.

Mozambique ranks fifth on the list of tobacco producing countries in Africa, while also being a Party to the WHO Framework Convention on Tobacco Control (FCTC). Tobacco farming is regarded by some governments as a strategic economic commodity for export and remains deeply entrenched within Mozambique's political and economic landscape. This study uses a qualitative description methodology to identify tensions, conflicts and alignment or misalignment in policy on tobacco across government sectors and levels in Mozambique. We conducted semi-structured qualitative interviews with 33 key informants from sectors across national and subnational levels including health, agriculture, economic and commercial sectors, as well as non-state actors from civil society organizations, the tobacco industry, farmers unions and associations and individual farmers. Incoherence was present across sectoral mandates, perspectives on industry's presence in the country and regions and between FCTC provisions and informant perceptions of tobacco production as a development strategy. Despite tobacco being viewed as an important economic commodity by many informants, there was also widespread dissatisfaction with tobacco from both farmers and some government officials. There were indications of an openness to shifting to a policy that emphasizes alternatives to tobacco growing. The findings also illustrate where points of convergence exist across sectors and where opportunities for aligning tobacco policy with the provisions of the FCTC can occur. [ABSTRACT FROM AUTHOR]

The health consequences of tobacco use are well known, but less recognized are the significant environmental impacts of tobacco production and use. The environmental impacts of tobacco include tobacco growing and curing; product manufacturing and distribution; product consumption; and post-consumption waste. The World Health Organization's Framework Convention on Tobacco Control addresses environmental concerns in Articles 17 and 18, which primarily apply to tobacco agriculture. Article 5.3 calls for protection from policy interference by the tobacco industry regarding the environmental harms of tobacco production and use. We detail the environmental impacts of the tobacco life-cycle and suggest policy responses.

The tobacco industry's future depends on increasing tobacco use in low-income and middle-income countries (LMICs), which face a growing burden of tobacco-related disease, yet have potential to prevent full-scale escalation of this epidemic. To drive up sales the industry markets its products heavily, deliberately targeting non-smokers and keeps prices low until smoking and local economies are sufficiently established to drive prices and profits up. The industry systematically flaunts existing tobacco control legislation and works aggressively to prevent future policies using its resource advantage to present highly misleading economic arguments, rebrand political activities as corporate social responsibility, and establish and use third parties to make its arguments more palatable. Increasingly it is using domestic litigation and international arbitration to bully LMICs from implementing effective policies and hijacking the problem of tobacco smuggling for policy gain, attempting to put itself in control of an illegal trade in which there is overwhelming historical evidence of its complicity. Progress will not be realised until tobacco industry interference is actively addressed as outlined in Article 5.3 of the Framework Convention on Tobacco Control. Exemplar LMICs show this action can be achieved and indicate that exposing tobacco industry misconduct is an essential first step.

Purpose: To understand why and how two tobacco companies have been promoting the Life Skills Training program (LST), a school-based drug prevention program recommended by the Centers for Disease Control and Prevention to reduce youth smoking. Methods: We analyzed internal tobacco industry documents available online as of October 2005. Initial searches were conducted using the keywords “life skills training,” “LST,” and “positive youth development.” Results: Tobacco industry documents reveal that since 1999, Philip Morris (PM) and Brown and Williamson (B&W) have worked to promote LST and to disseminate the LST program into schools across the country. As part of their effort, the companies hired a public relations firm to promote LST and a separate firm to evaluate the program. The evaluation conducted for the two companies did not show that LST was effective at reducing smoking after the first or second year of implementing the program. Even so, the tobacco companies continued to award grants to schools for the program. PM and B&W’s role in promoting LST is part of a public relations strategy to shift the “youth smoking paradigm” away from programs that highlight the tobacco industry’s behavior and toward programs in which the industry can be a partner. Conclusions: Individuals and organizations responsible for developing and implementing tobacco control and youth smoking prevention programs should be aware of PM and B&W’s role and motivations to encourage the wide-spread adoption of LST in schools.