Programa de controle do tabaco: fatores associados ao risco de abandono do tratamento
Arquivos
Data
2021-08-31
Autores
Costa, Aline Leite de Oliveira
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: De acordo com a OMS, mais de oito milhões de pessoas morrem anualmente devido ao uso do tabaco. No Brasil, sua prevalência decresce na população geral, com o incentivo de políticas públicas, mas ainda é elevada em pessoas portadoras de Condições Crônicas não Transmissíveis (CCNT). A compreensão dos modelos de atenção e tratamento do tabagista é essencial para que as técnicas utilizadas possam ser aprimoradas, contribuindo com uma redução do abandono do tratamento. Objetivos: Identificar as características sociodemográficas e de saúde dos indivíduos que buscaram o Programa Nacional de Controle do Tabaco (PNCT) em duas Unidades Básicas de Saúde (UBS) no município de Campinas; estimar o percentual de abandono do tratamento e elencar os fatores associados a esse desfecho. Metodologia: Trata-se de um estudo de coorte histórica, cujos dados foram obtidos em grupos de cessação de tabagismo, em duas UBS de Campinas (SP), segundo modelo proposto pelo PNCT, compreendidos entre janeiro de 2016 e dezembro de 2019. A pesquisa incluiu 276 participantes. Foram levantadas variáveis sociodemográficas, relativas às condições de saúde, relativas ao tabagismo e relativas à participação no programa. A análise exploratória foi feita através de medidas de tendência central e dispersão para as variáveis contínuas e de frequências simples e percentuais para as variáveis categóricas. Além disso, foi estimado o índice de abandono do tratamento com intervalo de confiança ao nível de 95%. Foi ajustado um modelo de regressão múltipla de Cox para o risco de abandono no tratamento em função de variáveis significativas (p < 0,20) identificadas. Os missings foram imputados utilizando o método de predictive mean matching por meio da função mice no software R 4.0.3. Associações foram consideradas estatisticamente significativas no modelo de regressão múltipla se p < 0,05. Resultados: A média de idade foi de 50,7 anos; sendo 60% sexo feminino; 40,6% se declararam brancos e 29,7% não brancos; 42,8% com companheiro e 39,1% sem; 70,3% relataram ter filhos e 12,7% sem filhos; 2,2% de analfabetos, 41,7% ensino fundamental, 27,5% ensino médio e 8% nível superior; 0,7% responderam receber menos de um salário-mínimo,11,6% entre um e dois salários e 5,8% acima de dois salários.8% declararam trabalhar em setores administrativos,18,1% em setor industrial, 25,7% em serviços,12,3% outros setores e 35,9% não responderam; 43,5% são católicos e 31,5% referiram outra religião, sendo que desses, 131 consideraram-se praticantes. O percentual de abandono do tratamento foi de 31% (IC 95%, 26% – 37%), equivalente a 87 indivíduos. Dentre as variáveis estudadas, hipertensão foi a única que estatisticamente se relacionou com o abandono do tratamento (p = 0,030), reduzindo-o. Conclusão: O perfil dos indivíduos que procurou o PNCT foi semelhante ao encontrado em outras pesquisas. Dentre as comorbidades avaliadas na análise estatística, notou-se que indivíduos não hipertensos apresentaram maior índice de abandono. São necessários outros estudos que avaliem fatores associados ao abandono do tratamento para o aprimoramento das estratégias de cuidado com o tabagista.
Introduction: According to the WHO (World Health Organization), more than 8 million people die, annually, from the use of tobacco. In Brazil, its prevalence among the overall population decreased as a result of public health policy adoption, although some prevalence persists among people with NTCC (Non-Transmissible Chronic Conditions). Comprehension of attention models and smoker treatment models is essential for devising techniques that contribute to reduce the number of treatment dropouts. Objectives: identify epidemiological and health aspects of smokers; estimate the dropout rates and list the facts associated with treatment dropout. Methodology: Historical cohort study on 276 smokers who were attended between 2016 and 2019. Sociodemographic variables, health conditions, forms of tobacco use and participation in the program were analysed relatively to smoking cessation. The analysis used the Cox regression model to model the risk of treatment abandonment as a function of the variables which presented significative associations to the number of dropouts (p < 0.20), as identified in a bivariate analysis. The missings were imputed using the “predictive mean matching” method through the mice function from the software R 4.0.3. Associations were considered statistically significant in the adjusted multiple regression model from the software SPSS 21 if p < 0.05. Results: The average age was of 50.8 years; mostly female (60%); 57.7% declared themselves white and 42.3% non-white; 52.2% with a partner and 47.8% without a partner; 84.7% have at least a child and 15.3% have no children; 2.7% are illiterate, 52.5% have primary school education, 34.7% have high school diplomas and 10.1% have a college degree; 4% receive less than the minimum wage; 64% receive between 1 to 2 minimum wages and 32% receive more than 2 minimum wages; 12.4% declare to work in administrative departments, 28.3% in the industrial sector, 40.1% in the services sector, 19.2% in other sectors; 58% are catholic and 42% declared to have another religion: among them, 62.4% consider themselves practitioners. The treatment abandonment rate was 31% (Trust Index 95%, 26% – 37%), equivalent to 87 individuals. Among the studied variables, hypertension was the only one that is statistically related to a reduction in treatment dropout (p = 0.030). Conclusion: The profile of individuals who sought the National Program for Tobacco Control was similar to the one found in other surveys. Among the evaluated comorbidities in the statistical analyses, it is noted that the individuals who are not hypertense show the highest rates of abandonment. Further studies are needed to assess factors associated with treatment dropout in order to enhance caring strategies for smokers.
Introduction: According to the WHO (World Health Organization), more than 8 million people die, annually, from the use of tobacco. In Brazil, its prevalence among the overall population decreased as a result of public health policy adoption, although some prevalence persists among people with NTCC (Non-Transmissible Chronic Conditions). Comprehension of attention models and smoker treatment models is essential for devising techniques that contribute to reduce the number of treatment dropouts. Objectives: identify epidemiological and health aspects of smokers; estimate the dropout rates and list the facts associated with treatment dropout. Methodology: Historical cohort study on 276 smokers who were attended between 2016 and 2019. Sociodemographic variables, health conditions, forms of tobacco use and participation in the program were analysed relatively to smoking cessation. The analysis used the Cox regression model to model the risk of treatment abandonment as a function of the variables which presented significative associations to the number of dropouts (p < 0.20), as identified in a bivariate analysis. The missings were imputed using the “predictive mean matching” method through the mice function from the software R 4.0.3. Associations were considered statistically significant in the adjusted multiple regression model from the software SPSS 21 if p < 0.05. Results: The average age was of 50.8 years; mostly female (60%); 57.7% declared themselves white and 42.3% non-white; 52.2% with a partner and 47.8% without a partner; 84.7% have at least a child and 15.3% have no children; 2.7% are illiterate, 52.5% have primary school education, 34.7% have high school diplomas and 10.1% have a college degree; 4% receive less than the minimum wage; 64% receive between 1 to 2 minimum wages and 32% receive more than 2 minimum wages; 12.4% declare to work in administrative departments, 28.3% in the industrial sector, 40.1% in the services sector, 19.2% in other sectors; 58% are catholic and 42% declared to have another religion: among them, 62.4% consider themselves practitioners. The treatment abandonment rate was 31% (Trust Index 95%, 26% – 37%), equivalent to 87 individuals. Among the studied variables, hypertension was the only one that is statistically related to a reduction in treatment dropout (p = 0.030). Conclusion: The profile of individuals who sought the National Program for Tobacco Control was similar to the one found in other surveys. Among the evaluated comorbidities in the statistical analyses, it is noted that the individuals who are not hypertense show the highest rates of abandonment. Further studies are needed to assess factors associated with treatment dropout in order to enhance caring strategies for smokers.
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Palavras-chave
Atenção primária à saúde, Tabagismo, Abandono do uso de tabaco, Tratamento, Smoking cessation, Treatment abandonment, Caring strategies