Epidemiology of smoking in the rural area of a medium-sized city in Southern Brazil

Xavier, Mariana Otero; Del-Ponte, Bianca; Santos, Iná S

doi:10.11606/S1518-8787.2018052000269

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Rural Health Supplement, Original Articles • Rev. Saúde Pública 52 (suppl 1) • 2018 • https://doi.org/10.11606/S1518-8787.2018052000269 linkcopy

Epidemiology of smoking in the rural area of a medium-sized city in Southern Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE To estimate the prevalence of smoking and associated factors among rural residents.

METHODS This is a population-based, cross-sectional study of 1,519 individuals carried out in 2016. We randomly selected 24 of the 50 census tracts that make up the eight rural districts of the city of Pelotas, State of Rio Grande do Sul, Brazil. All individuals aged 18 years or more living in the randomly selected households were eligible. Smokers were all those who smoked ≥ 1 cigarette/day for at least one month or declared that they had stopped smoking for less than one month. The independent variables included socioeconomic, demographic, behavioral, and health characteristics. We investigated age of onset, duration of addiction, number of cigarettes smoked/day, pack-years, and types of cigarettes consumed. Poisson regression was performed to calculate the adjusted prevalence ratios (PR) and 95% confidence intervals (95%CI).

RESULTS The prevalence of smoking was 16.6% (95%CI 13.6–20.0), and it was twice as high in men in relation to women (PR = 1.99, 95%CI 1.44–2.74), in socioeconomic class D or E in relation to class A or B (PR = 2.23, 95%CI 1.37–3.62), and in those who considered their health poor or very poor in relation those with good or very good health (PR = 2.02, 95%CI 1.33–3.08). It was also higher in persons aged 30–59 years (compared to those aged < 30 years), with 5–8 years of education level (compared to those with ≥ 9 years), and with positive screening for alcohol-related disorder. Prevalence was lower among individuals who were overweight or obese than in those with normal weight. Smoking began on average at 16.9 years, with an average consumption of approximately 14 cigarettes/day and mean pack-years of 22 packs/year. The paper hand-rolled cigarette was the most consumed (57.6%).

CONCLUSIONS Approximately one in six adults in rural Pelotas is a current smoker. The findings show the existence of social inequalities related to smoking addiction. Actions to prevent and control smoking should continue to be stimulated, especially in the most vulnerable subgroups.

Adult; Tobacco Use Disorder, epidemiology; Risk Factors; Socioeconomic Factors; Rural Population

Characteristic	n (%)	Smoking prevalence n (%)	95%CI	p*
Socioeconomic level (ABEP) (n = 1,503)				< 0.001
A or B	301 (20.0)	31 (10.2)	7.0–14.6
C	814 (53.7)	113 (14.1)	10.9–18.1
D or E	388 (26.3)	98 (25.7)	19.4–33.2
Education level (n = 1,509)				0.002
0–4 years	582 (38.7)	106 (18.6)	15.0–22.8
5–8 years	558 (36.9)	102 (18.5)	14.1–23.8
≥ 9 years	369 (24.4)	38 (10.7)	7.6–14.9
Current work situation (n = 1,517)				0.358
No work	613 (40.5)	99 (16.6)	12.9–21.2
No rural work	395 (26.1)	72 (18.3)	14.8–22.6
Rural work	509 (33.4)	76 (15.2)	11.8–19.3
Sex (n = 1,519)				< 0.001
Male	734 (48.3)	159 (21.9)	18.5–25.6
Female	785 (51.7)	88 (11.6)	8.2–16.2
Age (years) (n = 1,519)				< 0.001
18–29	287 (18.9)	34 (12.4)	7.3–20.2
30–39	228 (15.1)	41 (18.4)	13.2–24.9
40–49	296 (19.6)	60 (20.4)	15.5–26.3
50–59	297 (19.5)	66 (22.5)	18.1–27.5
60 or more	411 (26.8)	46 (11.3)	9.0–14.2
Race (n = 1,519)				0.026
White	1,296 (85.1)	195 (15.2)	12.7–18.2
Non-white	223 (14.9)	52 (24.0)	16.1–34.3
Marital status (n = 1,519)				0.012
Married or living with a partner	920 (60.3)	131 (14.4)	11.8–17.5
Divorced or separated	67 (4.4)	16 (24.0)	15.4–35.3
Single	397 (26.4)	83 (21.4)	15.7–28.4
Widow/Widower	135 (8.9)	17 (12.9)	8.1–19.8
Alcohol consumption (AUDIT) (n = 1,519)				< 0.001
Low risk	1,390 (91.4)	204 (15.0)	12.0–18.6
Alcohol-related disorder	129 (8.6)	43 (33.5)	25.7–42.2
Practice of physical activity (GPAQ) (n = 1,441)				0.371
Insufficiently active	235 (16.4)	33 (14.4)	10.0–20.4
Active	1,206 (83.6)	203 (17.1)	13.8–21.0
Nutritional status (n = 1,433)				< 0.001
Eutrophy	499 (35.1)	131 (26.5)	20.2–33.8
Overweight	509 (35.4)	62 (12.5)	9.4–16.5
Obesity	425 (29.5)	44 (10.5)	6.9–15.6
Depressive symptoms (EPDS) (n = 1,453)				0.749
No	941 (64.7)	152 (16.5)	12.9–20.9
Yes	512 (35.3)	88 (17.4)	13.5–22.1
Self-perception of health (n = 1,507)				0.001
Very good or good	964 (64.1)	142 (14.9)	11.9–18.5
Fair	461 (30.4)	80 (17.6)	14.9–20.6
Poor or very poor	82 (5.5)	23 (29.1)	19.6–40.9
***				***
Total	1,519 (100)	247 (16.6)	13.6–20.0

Variable	Mean	Standard deviation	Median	IQR (75-25)
Age of onset (years)	16.9	5.3	16.0	4.0
Duration of smoking (years)*	28.6	14.0	28.0	20.5
Mean current intensity (cigarettes/day)	14.4	10.8	11.0	14.0
Mean lifetime intensity (cigarettes/day)	14.9	9.2	15.0	11.0
18–29 years	12.5	6.8	15.0	15.0
30–39 years	15.0	9.4	15.0	10.0
40–49 years	15.6	9.7	15.0	10.0
50–59 years	15.9	10.8	15.0	11.0
60 years or more	14.0	7.2	12.0	10.0
Pack-years	22.0	18.7	16.2	22.0
18–29 years	5.5	4.0	4.0	5.2
30–39 years	13.8	11.1	11.5	9.1
40–49 years	21.1	15.1	18.2	17.5
50–59 years	29.9	22.4	23.0	28.1
60 years or more	32.9	16.9	32.9	27.1

Variable^a	Current smokers

	Crude analysis		Adjusted analysis

	PR (95%CI)	p^b	PR (95%CI)	p^b
1st level

Socioeconomic level (ABEP)		< 0.001^c		0.002^c
A or B	1		1
C	1.38 (0.87–2.20)		1.27 (0.80–2.03)
D or E	2.52 (1.58–4.02)		2.23 (1.37–3.62)
Education level (full years)		0.004		0.050
0–4	1.74 (1.28–2.37)		1.51 (1.00–2.28)
5–8	1.73 (1.23–2.44)		1.64 (1.11–2.42)
≥ 9	1		1
Current work situation		0.375		0.163
No work	1		1
No rural work	1.11 (0.83–1.47)		1.28 (0.92–1.79)
Rural work	0.91 (0.74–1.13)		0.95 (0.78–1.15)

2nd level

Sex		< 0.001		< 0.001
Male	1.88 (1.39–2.54)		1.99 (1.44–2.74)
Female	1		1
Age (years)		< 0.001		< 0.001
18–29	1		1
30–39	1.48 (1.01–2.16)		1.62 (1.11–2.37)
40–49	1.64 (1.06–2.54)		1.84 (1.13–2.99)
50–59	1.81 (1.12–2.92)		1.97 (1.16–3.35)
60 or over	0.91 (0.53–1.57)		0.92 (0.52–1.63)
Race		0.022		0.111
White	1		1
Non-white	1.58 (1.08–2.31)		1.33 (0.93–1.89)
Marital status		< 0.001		0.082
Married or living with a partner	1		1
Divorced or separated	1.66 (1.08–2.56)		1.38 (0.85–2.23)
Single	1.49 (1.09–2.02)		1.38 (1.03–1.86)
Widow/ widower	0.89 (0.54–1.49)		1.00 (0.55–1.81)

3rd level

Alcohol consumption (AUDIT)		< 0.001		0.037
Low risk	1		1
Alcohol-related disorder	2.24 (1.60–3.12)		1.47 (1.02–2.10)
Nutritional status		< 0.001		< 0.001
Eutrophy	1		1
Overweight	0.47 (0.34–0.65)		0.48 (0.35–0.65)
Obesity	0.40 (0.24–0.66)		0.41 (0.27–0.63)
Self-perception of health		0.003		0.008
Very good or good	1		1
Fair	1.18 (0.97–1.44)		1.15 (0.89–1.48)
Poor or very poor	1.95 (1.36–2.78)		2.02 (1.33–3.08)

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Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
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[TFN1] ABEP: Associação Brasileira de Empresas de Pesquisa (Brazilian Association of Research Companies); AUDIT: Alcohol Use Disorder Identification Test; GPAQ: Global Physical Activity Questionnaire; EPDS: Edinburgh Postnatal Depression Scale

[TFN2] * Chi-square test of heterogeneity.