Tabagismo em pessoas que vivem com HIV/aids
Carregando...
Data
2019-02-22
Autores
Devóglio, Ligia Lopes [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
Justificativa: Apesar de todos os esforços no combate ao tabagismo, em diversos países a prevalência de tabagistas na população com HIV/aids é elevada, aumentando a taxa de mortalidade nestes indivíduos, pois estes estão mais suscetíveis aos perigos do tabaco do que as pessoas não infectadas. O consumo do cigarro pode estar associado a diversos fatores como: baixo nível socioeconômico e de escolaridade, uso de drogas ilícitas e álcool, sintomas de depressão e falta de acesso aos serviços de saúde. O tabagismo é fator de risco que pode ser modificado e evitado. No Brasil há escassez de estudos de prevalência nas pessoas que vivem com HIV/aids, mas a hipótese é que este número também seja elevado. Objetivos: Analisar a prevalência do tabagismo em pessoas infectadas pelo HIV/aids; avaliar o grau de dependência da nicotina; avaliar o estágio de motivação relacionado à cessação de fumantes; analisar fatores associados ao tabagismo; compreender as representações sociais do tabaco em pessoas que vivem com HIV/aids tabagistas. Metodologia: O estudo foi realizado em duas etapas. A etapa I tratou-se de estudo exploratório e transversal e a II de estudo qualitativo. Foi desenvolvido no Serviço de Ambulatórios Especializados de Infectologia “Domingos Alves Meira”, que atende uma região de 30 municípios, com pacientes infectados pelo HIV/aids. Os dados foram obtidos por meio da aplicação de formulários a uma amostra calculada de 200 pacientes e participaram da etapa II do estudo 38 pacientes tabagistas, cuja amostra foi obtida por saturação dos dados. Para análise dos dados quantitativos utilizamos o banco de dados do sistema Excel e realizamos análises descritivas tanto para variáveis qualitativas como para quantitativas em ambos os grupos. A análise de regressão logística multivariada foi realizada para avaliar os fatores associados ao “status” de fumante e ex-fumante. Variáveis com resultados estatisticamente significantes na análise univariada foram incluídas no modelo final de regressão logística multivariada. Em todos os testes foi fixado o nível de significância de 5% ou o p-valor correspondente. Para a etapa II utilizou-se o Discurso do Sujeito Coletivo para sistematização dos dados e a Teoria das Representações Sociais de Moscovici como referencial teórico capaz de dar significados às entrevistas. Resultados: Etapa I: 51,0% eram mulheres; a idade média foi de 43,4 anos (±11,8); a prevalência de tabagismo foi de 32,0%; com relação à dependência 51,6% apresentaram níveis elevados ou muito elevados e o estágio motivacional para cessação do tabagismo foi maior na preparação (53,1%), ou seja, tinham desejo de cessar o tabagismo no próximo mês. Na análise multivariada, apenas menor nível de escolaridade (p=0,048) e presença de doença pulmonar (p=0,042) foram associados ao tabagismo. Porém, uso de álcool e drogas ilícitas, uso da medicação para o HIV, T CD4, carga viral, estresse, ansiedade e depressão não se associaram. Etapa II: As entrevistas dos indivíduos tabagistas selecionados deram origem a três representações sociais, evidenciando que estes reconhecem o cigarro como: I) fonte de prazer e prejuízos, II) parte da rotina, associado a diversos hábitos e III) revelando a relação do tabaco com o HIV/aids. Conclusões: A prevalência e a dependência do tabagismo mostraram-se elevadas, três vezes maior do que a prevalência geral no adulto no Brasil. O uso de tabaco foi associado a menor escolaridade e doença pulmonar. Observou-se que há um interesse da população em cessar o consumo de cigarro e os motivos para fumar relacionaram-se às condições emocionais, comportamentais e com a infecção pelo HIV. A partir disso, espera-se que estas informações possam favorecer às políticas de estratégias de prevenção e controle do tabagismo e problemas de saúde relacionados nesse grupo populacional.
Justification: Despite all efforts in the fight against smoking, in several countries the prevalence of smokers in the population with HIV / AIDS is high, increasing the mortality rate in these individuals since they are more susceptible to tobacco dangers than non-smokers. infected. Cigarette smoking may be associated with several factors such as low socioeconomic status and schooling, use of illicit drugs and alcohol, symptoms of depression and lack of access to health services. Smoking is a risk factor that can be modified and avoided. In Brazil, there is a shortage of prevalence studies among people living with HIV / AIDS, but the hypothesis is that this number is also high. Objectives: To analyze the prevalence of smoking among people infected with HIV / AIDS; evaluate the nicotine dependence degree; evaluate the stage of motivation related to smoking cessation; analyze associated smoking factors; understand the social representations about tobacco among smokers with HIV / AIDS. Methodology: The study was carried out in two stages. Stage I was an exploratory and cross-sectional study, and the second was a qualitative study. It was developed in the Specialized Outpatient Clinic of Infectious Disease "Domingos Alves Meira", wich serves a region of 30 counties with patients infected by HIV / AIDS. The data were obtained through the application of forms to a calculated sample of 200 patients and participated in stage II of the study 38 smokers, whose sample was obtained by saturation of the data. To analyze the quantitative data we used the Excel system database and performed descriptive analyzes for both qualitative and quantitative variables in both groups. Multivariate logistic regression analysis was performed to assess the factors associated with smoker and ex-smoker “status”. Variables with statistically significant results in the univariate analysis were included in the final multivariate logistic regression model. In all tests, the significance level of 5% or the corresponding p-value was set. For stage II the Collective Subject Discourse was used for data systematization and the Theory of Social Representations of Moscovici as a theoretical reference capable of giving meaning to the interviews. Results: Stage I: 51.0% were women; the mean age was 43.4 years (± 11.8); the prevalence of smoking was 32.0%; 51.6% had high or very high levels of dependence, and the motivational stage for smoking cessation was higher in the preparation (53.1%), meaning they had the desire to stop smoking over the next month. In the multivariate analysis, only lower educational level (p = 0.048) and the presence of pulmonary disease (p = 0.042) were associated with smoking. However, the use of alcohol and illicit drugs, use of medication for HIV, T CD4, viral load, stress, anxiety and depression were not associated. Stage II: The interviews of the selected smokers gave rise to three social representations, evidencing that these individuals recognize the cigarette as I) source of pleasure and damages, II) part of the routine, associated with different habits and III) revealing the relation of tobacco with HIV / AIDS. Conclusions: The prevalence and dependence of smoking was high, three times higher than the general prevalence among adults in Brazil. Tobacco use was associated with lower schooling and lung disease. It was observed that there is an interest of the population to stop cigarette smoking and the reasons for smoking were related to the emotional, behavioral conditions and with HIV infection. From this, it is expected that this information may favor the policies of strategies for prevention and control of smoking and related health problems in this population group.
Justification: Despite all efforts in the fight against smoking, in several countries the prevalence of smokers in the population with HIV / AIDS is high, increasing the mortality rate in these individuals since they are more susceptible to tobacco dangers than non-smokers. infected. Cigarette smoking may be associated with several factors such as low socioeconomic status and schooling, use of illicit drugs and alcohol, symptoms of depression and lack of access to health services. Smoking is a risk factor that can be modified and avoided. In Brazil, there is a shortage of prevalence studies among people living with HIV / AIDS, but the hypothesis is that this number is also high. Objectives: To analyze the prevalence of smoking among people infected with HIV / AIDS; evaluate the nicotine dependence degree; evaluate the stage of motivation related to smoking cessation; analyze associated smoking factors; understand the social representations about tobacco among smokers with HIV / AIDS. Methodology: The study was carried out in two stages. Stage I was an exploratory and cross-sectional study, and the second was a qualitative study. It was developed in the Specialized Outpatient Clinic of Infectious Disease "Domingos Alves Meira", wich serves a region of 30 counties with patients infected by HIV / AIDS. The data were obtained through the application of forms to a calculated sample of 200 patients and participated in stage II of the study 38 smokers, whose sample was obtained by saturation of the data. To analyze the quantitative data we used the Excel system database and performed descriptive analyzes for both qualitative and quantitative variables in both groups. Multivariate logistic regression analysis was performed to assess the factors associated with smoker and ex-smoker “status”. Variables with statistically significant results in the univariate analysis were included in the final multivariate logistic regression model. In all tests, the significance level of 5% or the corresponding p-value was set. For stage II the Collective Subject Discourse was used for data systematization and the Theory of Social Representations of Moscovici as a theoretical reference capable of giving meaning to the interviews. Results: Stage I: 51.0% were women; the mean age was 43.4 years (± 11.8); the prevalence of smoking was 32.0%; 51.6% had high or very high levels of dependence, and the motivational stage for smoking cessation was higher in the preparation (53.1%), meaning they had the desire to stop smoking over the next month. In the multivariate analysis, only lower educational level (p = 0.048) and the presence of pulmonary disease (p = 0.042) were associated with smoking. However, the use of alcohol and illicit drugs, use of medication for HIV, T CD4, viral load, stress, anxiety and depression were not associated. Stage II: The interviews of the selected smokers gave rise to three social representations, evidencing that these individuals recognize the cigarette as I) source of pleasure and damages, II) part of the routine, associated with different habits and III) revealing the relation of tobacco with HIV / AIDS. Conclusions: The prevalence and dependence of smoking was high, three times higher than the general prevalence among adults in Brazil. Tobacco use was associated with lower schooling and lung disease. It was observed that there is an interest of the population to stop cigarette smoking and the reasons for smoking were related to the emotional, behavioral conditions and with HIV infection. From this, it is expected that this information may favor the policies of strategies for prevention and control of smoking and related health problems in this population group.
Descrição
Palavras-chave
Tabagismo, HIV, AIDS, Prevalência, Smoking, HIV, AIDS, Prevalence, Qualitative research, Pesquisa qualitativa