Resumo: Introdução. O tabagismo é um problema de saúde pública mundial. Atualmente é considerado a principal causa de morte evitável do mundo. O uso simultâneo de tabaco e maconha está associado a um maior risco de persistência e recaída de ambos consumos. Nos últimos anos, o uso de sistemas eletrônicos de liberação de nicotina em jovens tem aumentado no mundo todo, devido à novidade do seu uso, ao grande número de sabores e à noção de que são menos nocivos. O objetivo foi conhecer a prevalência do consumo de tabaco, maconha e cigarro eletrônico na população uruguaia de entre 15 e 21 anos, a associação do consumo entre eles e a percepção do risco de seu uso. Metodologia: Foi realizado um estudo analítico transversal no período de fevereiro-abril de 2021. Uma pesquisa anônima, voluntária e autoadministrada foi divulgada por meio de redes sociais e centros educacionais públicos e privados em todo o país. Para o processamento dos dados foi utilizado o software de dados SPSS 25, considerando um nível de significância de 0,05. Resultados e Discussão: 1.517 respostas foram processadas. Constatou-se que 54% fumaram cigarro alguma vez e 19,7% usaram-o regularmente no último mês. 48% usaram maconha em algum momento e 19,4% o fizeram no último mês. As prevalências encontradas para tabaco e maconha são superiores às relatadas na literatura nacional. Com relação ao cigarro eletrônico, não há dados disponíveis em nosso meio para essa faixa etária, sendo que o presente estudo relata que 32% o utilizaram em algum momento. Dos que fumam cigarros, 84% e 58% já usaram maconha e cigarros eletrônicos, respectivamente. Dos que usaram cigarro eletrônico alguma vez, 50% nunca fumaram ou apenas experimentaram com cigarros tradicionais; esse fato pode corresponder ao fato do cigarro eletrônico atuar como porta de entrada para o tabagismo nos jovens. Encontrou-se associação significativa entre consumir uma das três substâncias e ter pai, mãe ou responsável que a consome ou consumiu, dados condizentes com o histórico no Uruguai. Em relação à percepção de risco, 98% concordaram que o tabaco é prejudicial à saúde, 66% concordaram com a maconha e 81% com o cigarro eletrônico. Ao analisar as patologias específicas, observam-se diferenças marcantes de acordo com a substância considerada, sendo que 73%. Conclusões: Observou-se alta prevalência de consumo dessas substâncias em jovens e apreciável associação entre elas. Curiosamente, foi encontrada uma prevalência semelhante de uso de cigarro e maconha no último mês. Isso é especialmente relevante tendo em vista que foi observada uma diferença significativa entre a percepção do risco de consumo dessas substâncias, sendo a maconha consideravelmente menor. Em relação aos cigarros eletrónicos, há uma subestimação dos malefícios que provocam entre os jovens inquiridos. Em razão do exposto, a elaboração de políticas públicas especificamente direcionadas a esse problema seria da hierarquia.

Abstract: Introduction: Smoking is a public health problem worldwide. It is currently considered the leading cause of preventable death in the world. The simultaneous use of tobacco and marijuana is associated with a higher risk of persistence and relapse of both substances. In the last few years, the use of electronic nicotine delivery systems in young people has increased worldwide, due to the novelty of their use, the large number of flavors and the conception that its use is less harmful. The aim of the present work was to estimate the prevalence of tobacco, marijuana and electronic cigarette consumption in the Uruguayan population between 15 and 21 years of age, the association of consumption between them and the perception of the risk linked to their use. Methodology: A cross-sectional analytical study was carried out during February-April 2021. An anonymous, voluntary and self-administered survey was distributed among social networks and public and private schools throughout the country. SPSS 25 data software was used for data processing, considering a significance level of 0.05. Results and Discussion: 1517 responses were processed. It was found that 54% smoked cigarettes at some point and 19.7% smoked regularly in the last month. 48% used marijuana at some point and 19.4% did so in the last month. The prevalences found for tobacco and marijuana are higher than those reported in the national literature. With regard to electronic cigarettes, there is no local data available for this age range, with the present study reporting that 32% used it at some point. Of those who smoke cigarettes, 84% and 58% used marijuana and e-cigarettes at some point, respectively. Of those who used electronic cigarettes at some point, 50% never smoked or only tried traditional cigarettes; this could attest to electronic cigarettes acting as a gateway to smoking in young people. A significant association between consuming one of the three substances and having a father, mother or guardian who consumes or consumed them was found, data consistent with local records. Regarding risk perception, 98% agreed that tobacco is harmful, 66% agreed so with marijuana and 81% agreed so with electronic cigarettes. When analyzing specific diseases, substantial differences were observed depending on the drug. 73% believe that electronic cigarettes are less harmful than smoking regular cigarettes. Conclusions: It was shown that there is a high prevalence of consumption of these substances in young people and a considerable association between them. Interestingly, there was a similar prevalence of consumption of cigarettes and marijuana in the last month. This is especially relevant given that there was a significant difference between the risk perception of cigarettes vs marijuana, with the latter being considerably less. Regarding electronic cigarettes, there is an underestimation of the harm associated with their use. Therefore, it would be of hierarchy to promulgate public policies directed to this problem.

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RESUMEN Objetivo: Colombia cuenta con una legislación de control del tabaco desde 2009 sin embargo, no existe una regulación específica sobre los Sistemas Electrónicos de Administración de Nicotina (SEAN), por lo tanto, es vital caracterizar las dimensiones cualitativas de consumo. El objetivo de este estudio fue identificar las prácticas y representaciones de los consumidores de SEAN con el fin de obtener elementos para orientar las acciones necesarias para prevenir su consumo. Materiales y métodos: Este artículo presenta los resultados identificados en el componente cualitativo de una investigación macro sobre la prevalencia del uso de SEAN entre estudiantes universitarios. Se realizaron 14 entrevistas individuales y 1 grupo focal, analizados con el software NVivo10®. Resultados: Se presentan como resultados principales la identificación de las prácticas de consumo, de las cuales se derivó que el núcleo central de la representación social sobre SEAN es no autónomo, lo que posibilita un cambio que desincentive su consumo; el sistema periférico de la representación está conformado por tres elementos: la dimensión social, el consumo de SEAN como estilo de vida y la dimensión corporal y emocional. Conclusiones: Se concluye que las acciones de prevención de consumo de SEAN deben partir de la identificación de características particulares y exclusivas del consumo de SEAN y la incorporación de los elementos del sistema periférico que permitan abordar un consumo que no se basa en la toma de decisiones informadas.

ABSTRACT Objective: Colombia has had a tobacco control legislation since 2009, however there is no specific regulation on Electronic Nicotine Delivery Systems (ENDS). Therefore, it is crucial to characterize the qualitative dimensions of consumption. The study aimed to answer the question: What are the representations and practices of the university population regarding the consumption of SEAN? The objective of the study is to identify the practices and representations of ENDS consumers in order to obtain elements to guide the necessary actions to prevent their consumption. Methods: This paper presents the results identified in the qualitative component of a main study on the prevalence of ENDS use among university students. 14 individual interviews and 1 focus group were conducted and analyzed with the NVivo10® software. The corpus consisted of the transcripts of the 14 interviews and 1 focus group, which constitutes a total of 116 pages of raw data. The techniques used were semi-structured interviews and focus groups, using the Microsoft Teams platform. Taking into account ethical aspects, in each interview and in the focus group the informed consent was read and authorization was requested for the interview to be recorded. The average duration of each interview was one hour and forty-five minutes and the focus group lasted a total of 120 minutes. The capture of practices and representation related to the use/non-use of SEAN was achieved by incorporating two phases of analysis: a)Inductivephase: it was developed with an ordered matrix on the theoretical categories of the project, b)Phase of deductive analysis was carried out based on processes typical of the founded theory that allowed expanding the analytical framework having as its axis the identification of consumption practices and the elements that make up the central core and the peripheral system of representation. Results: The main results are the identification of consumption practices, from which it was derived that the central nucleus of the social representation of SEAN is non-autonomous, which enables a change that discourages its consumption. The reasons and practices for consuming ENDS are closely related to conventional cigarette consumption, which corresponds to the fact that 11 of the 14 interviewees who identify themselves as consumers have consumed conventional cigarettes and only two have been exclusive ENDS consumers. The following practices were identified: a) The consumption motivations were grouped like social, economic and socio-emotional; b) Three types of consumption spaces: prohibited, exclusive and recovered spaces. These last ones are places where you couldn't smoke cigarettes and now they feel empowered to vape; c) There are forms of differential consumption and access to ENDS related to the quality, price, exclusivity and adherence; d) Habits and rituals are not related to moments of daily life, as with cigarettes, but to practices such as searching for and mixing "salts" to obtain flavors, cleaning and maintaining the device, smoking tricks; e) About information channels among the interviewees it was noted that the practice of informed consumption is not frequent and that there are few sources of information that offer low confidence. Finally, the peripheral system of representation is made up of three elements: social dimension, the consumption of SEAN as a lifestyle, bodied and emotional dimension. Conclusion : It is concluded that the actions to prevent the consumption of ENDS should start from the identification of particular and exclusive characteristics of the consumption of ENDS and the incorporation of the elements of the peripheral system that allow addressing a consumption not based on making informed decisions. The main finding is the identification of a non-autonomous representation that stems from the difficulty of establishing notable differentiations between conventional cigarette consumption and e-cigarettes. Therefore, the main vein of research that opens up is to delve into the particular and exclusive characteristics of this consumption. It is essential to incorporate bodily, emotional, and especially social (interpersonal) dimensions as important variables in understanding the practices and representations of e-cigarettes through complex approaches that can break the solid elements on which conventional cigarette consumption is anchored, as it continues to define dynamics of electronic device consumption. It is important at this point to recognize that emotions can be understood as the intermediary between the lived experience in the body and everything that happens in the environment. Thus, it is not possible to think of this representation without recognizing that consumption is an embodied exercise, and the absence of the body in discourses about e-cigarettes can be a revealing element of a disconnection between practices and meanings that are reinforced in the insistence on an action (smoking is smoking) despite the recognition of its negative effects on health (even though it should not be). The understanding of the social representation of e-cigarette consumption in relation to specific practices related to it provides some clues on which to work on processes of information, communication, prevention, and regulation to discourage this consumption that appears relatively new.

RESUMEN Objetivo: analizar los factores asociados con el consumo de alcohol entre adolescentes escolares brasileños. Método: se trata de un estudio transversal analítico utilizando datos secundarios de la Encuesta Nacional de Salud del Escolar edición 2019, conducida por el Instituto Brasileño de Geografía y Estadística. La investigación evaluó a 125.123 adolescentes mediante la aplicación de un cuestionario. Para el modelo final se utilizó la regresión logística múltiple. Resultados: el uso de cigarrillo en la vida estuvo fuertemente asociado al uso de alcohol (Odds Ratio=3,25; Intervalo de Confianza 95% 2,28-4,62), seguido del uso de alcohol por amigos en los últimos 30 días (Odds Ratio=2,15; Intervalo de Confianza 95% 1,52-3,05) y tener padre y madre que fuman (Odds Ratio=1,29; Intervalo de Confianza 95%1,13-148). Conclusión: son importantes acciones integradas y políticas públicas que involucren a jóvenes y adolescentes para garantizar la salud y el bienestar de adultos saludables.

RESUMO Objetivo: analisar os fatores associados ao uso do álcool entre adolescentes escolares brasileiros. Método: trata-se de um estudo transversal analítico utilizando dados secundários da Pesquisa Nacional de Saúde do Escolar edição 2019, conduzida pelo Instituto Brasileiro de Geografia e Estatística. A pesquisa avaliou 125.123 adolescentes por meio da aplicação de um questionário. Para o modelo final foi utilizada a regressão logística múltipla. Resultados: o uso de cigarro na vida foi fortemente associado ao uso de álcool (Odds Ratio=3,25; Intervalo de Confiança 95% 2,28-4,62), seguido do uso de álcool por amigos nos últimos 30 dias (Odds Ratio=2,15; Intervalo de Confiança 95% 1,52-3,05) e ter pai e mãe que fumam (Odds Ratio=1,29; Intervalo de Confiança 95%1,13-148). Conclusão: são importantes ações integradas e políticas públicas envolvendo jovens e adolescentes para garantir a saúde e o bem-estar de adultos saudáveis.

ABSTRACT Objective: To analyze the factors associated with alcohol use among Brazilian school adolescents. Method: This analytical cross-sectional study uses secondary data from the 2019 National School Health Survey edition conducted by the Brazilian Institute of Geography and Statistics. The research evaluated 125,123 adolescents through the application of a questionnaire. For the final model, multiple logistic regression was used. Results: Lifetime cigarette use was strongly associated with alcohol use (Odds Ratio=3.25; 95% Confidence Interval 2.28-4.62), followed by friends’ alcohol use in the last 30 days (Odds Ratio=2.15; 95% Confidence Interval 1.52-3.05) and having parents who smoke (Odds Ratio=1.29; 95% Confidence Interval 1.13-1.48). Conclusion: Integrated actions and public policies involving young people and adolescents are important to ensure the health and well-being of healthy adults.

RESUMEN Introducción: La leucoplasia es la lesión potencialmente maligna más común de la mucosa bucal; el consumo de tabaco es el principal factor etiológico; se presentan distintos grados de displasia epitelial. Su estudio permite conocer mejor las manifestaciones clínicas e histopatológicas de esta enfermedad. Objetivo: Caracterizar clínica e histopatológicamente la leucoplasia homogénea bucal en pacientes fumadores de tabaco. Métodos: Se realizó un estudio descriptivo y transversal. El universo estuvo compuesto por 75 pacientes fumadores de tabaco y cigarros, atendidos en la consulta estomatológica del Policlínico de Especialidades del Hospital Clínico-Quirúrgico Saturnino Lora Torres de Santiago de Cuba. Mediante el examen clínico e histopatológico se diagnosticó leucoplasia homogénea bucal. Para la recolección del dato primario se confeccionó un modelo con las siguientes variables: grupo de edad, sexo, diagnóstico clínico, tiempo en el hábito de fumar, localización anatómica y estudio histopatológico de la enfermedad. Resultados: En la casuística prevaleció el sexo masculino (58,6 %) y el grupo etario de 60 años y más (41,3 %); la hiperparaqueratosis (64,0 %), el infiltrado inflamatorio crónico ligero (60,0 %) y la displasia epitelial leve (73,3 %) fueron las alteraciones hísticas más comunes en fumadores con 21 y más años. La hipercromasia del núcleo (100,0 %) y el pleomorfismo nuclear (96,80 %) resultaron los cambios celulares más prominentes. Las alteraciones de los clavos interpapilares (92,0 %), la hiperplasia del estrato basal (88,9 %) y la pérdida de la polaridad (87,3 %) resultaron los signos displásicos tisulares más significativos en la leucoplasia bucal y la mucosa de carrillo (40,0 %) el sitio anatómico de mayor ocurrencia de lesiones. Conclusiones: Todos los pacientes fumadores de tabaco y cigarro presentaron, clínicamente, lesiones leucoplásicas bucales, confirmadas por el estudio histopatológico; el sexo masculino y el grupo de 60 y más años son los de mayor afectación. La hiperparaqueratosis, el infiltrado inflamatorio crónico ligero y la displasia epitelial leve fueron los de mayor predominio; la hipercromasia del núcleo y el pleomorfismo nuclear fueron los cambios celulares más prominentes. En el tejido displásico epitelial prevalecieron las alteraciones de los clavos interpapilares, la hiperplasia del estrato basal y la pérdida de la polaridad y el sitio más afectado, la mucosa de carrillo.

ABSTRACT Introduction: Leukoplakia is the most common potentially malignant lesion of the buccal mucosa; tobacco use is the main etiological factor; different degrees of epithelial dysplasia are present. Its study allows a better understanding of the clinical and histopathological manifestations of this disease. Objective: To clinically and histopathologically characterize homogeneous buccal leukoplakia in patients who smoke tobacco. Methods: A descriptive and cross-sectional study was performed. The universe was composed of 75 patients who smoked tobacco and cigars, attended in the stomatological consultation of the Specialties Polyclinic of the Clinical-Surgical Hospital Saturnino Lora Torres of Santiago de Cuba. By means of clinical and histopathological examination, homogeneous buccal leukoplakia was diagnosed. For the collection of the primary data, a model was made with the following variables: age group, sex, clinical diagnosis, time in smoking habit, anatomical location and histopathological study of the disease. Results: Male sex (58.6%) and age group 60 years and older (41.3%) prevailed in the casuistry; hyperkeratosis (64.0%), mild chronic inflammatory infiltrate (60.0%) and mild epithelial dysplasia (73.3%) were the most common histopathological alterations in smokers aged 21 years and older. Hyperchromasia of the nucleus (100.0%) and nuclear pleomorphism (96.80%) were the most prominent cellular changes. Interpapillary nail alterations (92.0%), stratum basale hyperplasia (88.9%) and loss of polarity (87.3%) resulted the most significant tissue dysplastic signs in buccal leukoplakia and cheek mucosa (40.0%) the anatomical site of highest occurrence of lesions. Conclusions: All tobacco and cigarette smoking patients presented, clinically, buccal leukoplastic lesions, confirmed by histopathological study; male sex and the 60 and older age group are the most affected. Hyperparapokeratosis, mild chronic inflammatory infiltrate and mild epithelial dysplasia were the most predominant; hyperchromasia of the nucleus and nuclear pleomorphism were the most prominent cellular changes. In the epithelial dysplastic tissue, interpapillary nail alterations, hyperplasia of the stratum basale and loss of polarity prevailed and the most affected site, the cheek mucosa.

Resumo Objetivou-se analisar os fatores associados ao policonsumo de álcool, tabaco e drogas ilícitas, entre adolescentes escolares brasileiros de 13 a 17 anos. Estudo transversal, com dados da Pesquisa Nacional de Saúde do Escolar (2019). A variável desfecho foi o relato de consumo das três substâncias nos últimos 30 dias. As variáveis independentes foram agrupadas em quatro blocos: características sociodemográficas; contexto familiar; situações estressoras; aspectos comportamentais. Foi realizada análise de regressão logística múltipla hierarquizada, permanecendo no modelo final as variáveis com p<0,05. A prevalência de policonsumo em adolescentes escolares foi 3,3%. No modelo final, sexo masculino, morar na região Centro-Oeste, Sul e Sudeste, faltar a escola sem permissão, pais não saberem o que fazem no tempo livre, ter pais fumantes, sofrer agressão física pelos pais, sentir que a vida não vale a pena ser vivida, experimentar bebida alcoólica e drogas ilícitas antes dos 13 anos, ter amigos que bebem bebida alcoólica, fumam e usam drogas na sua presença permaneceram associados ao desfecho. Os dados mostram alta prevalência de policonsumo de três substâncias entre adolescentes e sua associação a fatores sociodemográficos, familiares, comportamentais e a eventos estressantes.

Abstract The aim of this study was to analyze the factors associated with concurrent alcohol, tobacco and illicit drug use among Brazilian schoolchildren aged 13-17. We conducted a cross-sectional study using data from the 2019 National School-Based Health Survey. The outcome was use of the three substances during the last 30 days. Hierarchical multiple logistic regression was carried out with independent variables grouped into four blocks: sociodemographic characteristics; family context; behavioral aspects; and stressors. Variables with p<0.05 were retained in the final model. The prevalence of concurrent substance use was 3.3%. Being male, living in the Midwest, South and Southeast, skipping school without parent permission, parents not knowing what their children do in their free time, having parents who smoke, having experienced physical aggression from parents, feeling that life is not worth living, trying drinking and illicit drugs before the age of 13, and having friends who drink alcohol, smoke and use drugs in their presence remained associated with the outcome in the final model. The findings reveal high prevalence of concurrent alcohol, cigarette and illicit drug use among adolescents and that poly use is associated with sociodemographic, family, and behavioral factors and stressors.

ABSTRACT Objective: To analyze the factors associated with alcohol use among Brazilian school adolescents. Method: This analytical cross-sectional study uses secondary data from the 2019 National School Health Survey edition conducted by the Brazilian Institute of Geography and Statistics. The research evaluated 125,123 adolescents through the application of a questionnaire. For the final model, multiple logistic regression was used. Results: Lifetime cigarette use was strongly associated with alcohol use (Odds Ratio=3.25; 95% Confidence Interval 2.28-4.62), followed by friends’ alcohol use in the last 30 days (Odds Ratio=2.15; 95% Confidence Interval 1.52-3.05) and having parents who smoke (Odds Ratio=1.29; 95% Confidence Interval 1.13-1.48). Conclusion: Integrated actions and public policies involving young people and adolescents are important to ensure the health and well-being of healthy adults.

RESUMEN Objetivo: analizar los factores asociados con el consumo de alcohol entre adolescentes escolares brasileños. Método: se trata de un estudio transversal analítico utilizando datos secundarios de la Encuesta Nacional de Salud del Escolar edición 2019, conducida por el Instituto Brasileño de Geografía y Estadística. La investigación evaluó a 125.123 adolescentes mediante la aplicación de un cuestionario. Para el modelo final se utilizó la regresión logística múltiple. Resultados: el uso de cigarrillo en la vida estuvo fuertemente asociado al uso de alcohol (Odds Ratio=3,25; Intervalo de Confianza 95% 2,28-4,62), seguido del uso de alcohol por amigos en los últimos 30 días (Odds Ratio=2,15; Intervalo de Confianza 95% 1,52-3,05) y tener padre y madre que fuman (Odds Ratio=1,29; Intervalo de Confianza 95%1,13-148). Conclusión: son importantes acciones integradas y políticas públicas que involucren a jóvenes y adolescentes para garantizar la salud y el bienestar de adultos saludables.

RESUMO Objetivo: analisar os fatores associados ao uso do álcool entre adolescentes escolares brasileiros. Método: trata-se de um estudo transversal analítico utilizando dados secundários da Pesquisa Nacional de Saúde do Escolar edição 2019, conduzida pelo Instituto Brasileiro de Geografia e Estatística. A pesquisa avaliou 125.123 adolescentes por meio da aplicação de um questionário. Para o modelo final foi utilizada a regressão logística múltipla. Resultados: o uso de cigarro na vida foi fortemente associado ao uso de álcool (Odds Ratio=3,25; Intervalo de Confiança 95% 2,28-4,62), seguido do uso de álcool por amigos nos últimos 30 dias (Odds Ratio=2,15; Intervalo de Confiança 95% 1,52-3,05) e ter pai e mãe que fumam (Odds Ratio=1,29; Intervalo de Confiança 95%1,13-148). Conclusão: são importantes ações integradas e políticas públicas envolvendo jovens e adolescentes para garantir a saúde e o bem-estar de adultos saudáveis.

Abstract Background Unlike cigarette smoking, environmental tobacco smoke (ETS) has not been as well described as an environmental risk for Multiple sclerosis (MS) nor as a risk factor for disease progression. Objective We systematically reviewed the association between ETS and the risk of onset and/or progression of MS. Methods We systematically screened MedLine/PubMed, Science Direct, LILACs, and SciELO searching for publications between January 1st, 2010, and July 5, 2021, with the following keywords: "multiple sclerosis and smoking"; "multiple sclerosis and passive smoking"; "multiple sclerosis and secondhand smoking". Results Fifteen articles were included in this review, which consisted of systematic reviews with meta-analysis (N = 2), systematic reviews (N = 2), and observational studies (N = 11). Both meta-analyses reported an impact of ETS on MS onset among secondhand smokers. One of the systematic reviews selected two observational studies showing the association between ETS and MS development, and one study that did not find a significant association between ETS and the risk of MS development. The other systematic review identified selected eight articles showing a relationship between ETS and MS. Seven observational studies reported higher odds of MS onset when associated with ETS. Four observational studies did not show a relationship between ETS and MS onset or progression. Conclusion Most articles showed a positive association between ETS exposure and the risk of developing MS. On the other hand, an association between ETS and a higher risk for MS progression could not be established.

Resumo Antecedentes Ao contrário do tabagismo ativo, o fumo passivo (FP) não é tão bem estabelecido como risco para o desenvolvimento de esclerose múltipla (EM) nem como um fator de risco para a progressão da doença. Objetivo Revisamos sistematicamente a associação entre FP e o risco de aparecimento e/ou progressão da EM. Métodos Fizemos uma triagem sistemática nas bases de dados MedLine/PubMed, Science Direct, LILACs e SciELO em busca de publicações entre 1° de janeiro de 2010 e 5 de julho de 2021 com as seguintes palavras-chave: "multiple sclerosis and smoking"; "multiple sclerosis and passive smoking"; "multiple sclerosis and secondhand smoking". Resultados Quinze artigos foram incluídos nesta revisão, que consistiu em revisões sistemáticas com metanálise (N = 2), revisões sistemáticas (N = 2) e estudos observacionais (N = 11). As metanálises relataram um impacto do FP no surgimento da EM entre fumantes passivos. Um revisão sistemática selecionou dois estudos observacionais mostrando a associação entre FP e desenvolvimento de EM, e um estudo que não encontrou associação significativa entre FP e o risco de desenvolvimento de EM. Outra revisão sistemática identificou oito artigos selecionados mostrando uma relação entre FP e EM. Sete estudos observacionais relataram maiores chances de aparecimento de EM quando associados a FP. Quatro estudos observacionais não mostraram uma relação entre FP e o desenvolvimento ou progressão da EM. Conclusão A maioria dos artigos mostrou uma associação positiva entre a exposição ao FP e o risco de desenvolver EM. Por outro lado, não foi possível estabelecer uma associação entre FP e maior risco de progressão da EM.

Abstract The aim of this study was to analyze the factors associated with concurrent alcohol, tobacco and illicit drug use among Brazilian schoolchildren aged 13-17. We conducted a cross-sectional study using data from the 2019 National School-Based Health Survey. The outcome was use of the three substances during the last 30 days. Hierarchical multiple logistic regression was carried out with independent variables grouped into four blocks: sociodemographic characteristics; family context; behavioral aspects; and stressors. Variables with p<0.05 were retained in the final model. The prevalence of concurrent substance use was 3.3%. Being male, living in the Midwest, South and Southeast, skipping school without parent permission, parents not knowing what their children do in their free time, having parents who smoke, having experienced physical aggression from parents, feeling that life is not worth living, trying drinking and illicit drugs before the age of 13, and having friends who drink alcohol, smoke and use drugs in their presence remained associated with the outcome in the final model. The findings reveal high prevalence of concurrent alcohol, cigarette and illicit drug use among adolescents and that poly use is associated with sociodemographic, family, and behavioral factors and stressors.

Resumo Objetivou-se analisar os fatores associados ao policonsumo de álcool, tabaco e drogas ilícitas, entre adolescentes escolares brasileiros de 13 a 17 anos. Estudo transversal, com dados da Pesquisa Nacional de Saúde do Escolar (2019). A variável desfecho foi o relato de consumo das três substâncias nos últimos 30 dias. As variáveis independentes foram agrupadas em quatro blocos: características sociodemográficas; contexto familiar; situações estressoras; aspectos comportamentais. Foi realizada análise de regressão logística múltipla hierarquizada, permanecendo no modelo final as variáveis com p<0,05. A prevalência de policonsumo em adolescentes escolares foi 3,3%. No modelo final, sexo masculino, morar na região Centro-Oeste, Sul e Sudeste, faltar a escola sem permissão, pais não saberem o que fazem no tempo livre, ter pais fumantes, sofrer agressão física pelos pais, sentir que a vida não vale a pena ser vivida, experimentar bebida alcoólica e drogas ilícitas antes dos 13 anos, ter amigos que bebem bebida alcoólica, fumam e usam drogas na sua presença permaneceram associados ao desfecho. Os dados mostram alta prevalência de policonsumo de três substâncias entre adolescentes e sua associação a fatores sociodemográficos, familiares, comportamentais e a eventos estressantes.

Abstract Cigarette smoke (CS) has been generally recognized as a chief carcinogenic factor in renal cell carcinoma (RCC). The stimulative effect of CS on renal cancer stem cells (RCSCs) has been described previously. The Sonic Hedgehog (SHH) pathway plays an essential role in self-renewal, cell growth, drug resistance, metastasis, and recurrence of cancer stem cells (CSCs). Renal cancer-related gene ΔNp63α is highly expressed in renal epithelial tissues and contributes to the RCSCs characteristics of tumors. The aim of this study was to elucidate the role of ΔNp63α and the SHH pathway on the activity of RCSCs induced by CS through a series of in vivo and in vitro studies. It was shown that in renal cancer tissues, ΔNp63α and RCSCs markers in smokers are expressed higher than that in non-smokers. RCSCs were effectively enriched by tumor sphere formation assay. Besides, CS increased the expression of RCSCs markers and the capability of sphere-forming in vitro and in vivo. Moreover, the SHH pathway was activated, and the specialized inhibitor alleviated the promotion of CS on RCSCs. ΔNp63α activated the SHH pathway and promoted CS-induced enhancement of RCSCs activity. These findings indicate that ΔNp63α positively regulates the activity of CS-induced RCSCs via the SHH pathway.

Resumo Os cigarros eletrónicos foram desenvolvidos há quase duas décadas. A sua utilização, coloquialmente conhecida como “vaping”, tem aumentado progressivamente entre os jovens. Apesar de inicialmente comercializados como uma alternativa ao cigarro tradicional, os cigarros eletrónicos expõem os consumidores a substâncias nocivas para a saúde, não sendo reconhecidos pela Organização Mundial da Saúde como um método de cessação tabágica. A utilização de novos sabores, estética atrativa e baixa perceção de risco parecem contribuir para o aumento da sua popularidade entre os adolescentes globalmente, uma tendência que também se verifica em Portugal. No entanto, as consequências para a saúde não estão totalmente esclarecidas. Foi recentemente descrita uma entidade específica - lesão pulmonar associada ao uso de cigarros eletrónicos (EVALI - e-cigarette or vaping-associated lung injury) - com incidência crescente e morbimortalidade significativa. O tratamento da dependência de nicotina em adolescentes que fumam cigarros eletrónicos é um desafio. Os cigarros eletrónicos estão a viciar uma nova geração, com riscos para a saúde associados. O aumento do seu consumo deve alertar os profissionais de saúde e promover o desenvolvimento de estratégias de abordagem desta situação junto dos adolescentes.

Abstract Electronic cigarettes were developed almost two decades ago. Their use, colloquially known as vaping, has gradually increased among young people. Although initially marketed as an alternative to traditional cigarettes, electronic cigarettes expose users to substances associated with adverse health effects and are not recognized by the World Health Organization as a smoking cessation method. The use of new flavors, esthetically appealing devices, and low perceived risk appear to be contributing to increased use among adolescents worldwide, a trend also observed in Portugal. However, their health risks are not fully understood. Recently, a new entity - e-cigarette or vaping-associated lung injury (EVALI) - has been described, with increasing incidence and significant morbimortality. The treatment of nicotine dependence in adolescents who smoke electronic cigarettes is challenging. Electronic cigarettes are addicting a new generation and posing associated health risks. Their increasing use should alert physicians and encourage the development of strategies to address this issue among adolescents.

Resumen Introducción: La influencia o presión de pares que fuman es uno de los principales factores por los que los estudiantes universitarios inician el consumo del cigarro convencional; sin embargo, no se ha encontrado un instrumento que evalúe este fenómeno. Por lo tanto, el objetivo fue adaptar y validar la Escala de Resistencia a la Presión de Pares para el Consumo de Cigarro Convencional. Materiales y métodos: Participaron 237 estudiantes universitarios del estado de Nuevo León (México), de 18 a 24 años. Se realizó análisis factorial exploratorio, análisis de confiabilidad, correlación de Spearman y prueba de Kruskal-Wallis. Resultados: El 63.3 % de los estudiantes fueron mujeres y la media de edad fue de 19.66 años. Se identificaron dos factores con un total de 13 ítems. Se obtuvo un alfa de Cronbach de 0.81. Se encontraron diferencias estadísticamente significativas entre los distintos tipos de consumidores de cigarro convencional y los puntajes de la escala de resistencia a la presión de pares (H[4] = 23.85; p < 0.001). Conclusiones: La nueva versión de la Escala de Resistencia a la Presión de Pares para el Consumo de Cigarro Convencional evidenció adecuadas propiedades psicométricas para evaluar la presión que ejercen los pares en estudiantes universitarios para el consumo de cigarro convencional.

Abstract Introduction: Influence or peer pressure is one of the leading factors in developing cigarette smoking habits in university students; however, no effective strategy to assess this phenomenon has been developed yet. This study aimed to adapt and validate the peer pressure resistance scale to conventional cigarette consumption. Materials and methods: A total of 237 university students from the Nuevo León State (Mexico), aged 18-24 years, were enrolled. Exploratory factor and reliability analyses, the Spearman correlation, and the Kruskal-Wallis test were performed. Results: 63.3% of the students were women, and the mean age was 19.66 years. The exploratory analysis extracted two factors with a total of 13 items. A Cronbach's Alpha of 0.81 was found. Statistically significant differences were found between the different types of conventional cigarette users and peer pressure resistance scale scores [H(4) = 23.85; p < .001] were found. Conclusions: The peer pressure resistance scale showed appropriate psychometric properties for assessing the peer pressure to smoke conventional cigarettes in university students.

Resumo Introdução: A influência ou pressão dos pares que fumam é um dos principais fatores que levam os universitários a começarem a fumar cigarros convencionais, porém não foi encontrado nenhum instrumento para avaliar esse fenômeno. Portanto, o objetivo do trabalho foi adaptar e validar a escala de resistência à pressão dos pares para o consumo de cigarro convencional. Materiais e métodos: Participaram 237 estudantes universitários do estado de Nuevo León, México, de 18 a 24 anos. Foram realizadas análise fatorial exploratória, análise de confiabilidade, correlação de Spearman e teste de Kruskal-Wallis. Resultados: 63,3% dos alunos eram mulheres e a média de idade foi de 19,66 anos. Dois fatores foram identificados com um total de 13 itens. Obteve-se um alfa de Cronbach de 0,81. Diferenças estatisticamente significativas foram encontradas entre os diferentes tipos de usuários de cigarros convencionais e as pontuações na escala de resistência à pressão dos pares (H(4) = 23,85; p < 0,001). Conclusões: A nova versão da escala de resistência à pressão dos pares para o consumo de cigarros convencionais apresentou propriedades psicométricas adequadas para avaliar a pressão exercida pelos pares sobre os universitários para o consumo de cigarros convencionais.

RESUMEN La contaminación atmosférica se da por la presencia o combinación de contaminantes físicos, químicos o biológicos en el aire. En los últimos años, el más estudiado es el material particulado (PM), una mezcla variada de partículas sólidas y líquidas, que, además, transporta elevados componentes tóxicos provenientes de la combustión del humo del cigarrillo, con diferentes tamaños microscópicos presentes en la atmósfera, las cuales pueden inhalarse y provocar graves problemas de salud debido a la toxicidad a nivel celular y consecuencias a nivel inflamatorio. Actualmente, la exposición al PM se ha asociado con alteraciones en los procesos reproductivos en mamíferos, afectando la viabilidad de gametos y embriones. El objetivo de esta revisión fue describir los efectos de los contaminantes atmosféricos en el ámbito reproductivo y los posibles mecanismos de acción tanto celulares como moleculares, los cuales son de interés en las ciencias de la salud humana y animal. Los estudios evidencian una relación de causa-efecto entre la exposición a los contaminantes y la calidad de los gametos, generando daños del ADN, modificaciones epigenéticas, aumento de estrés oxidativo y alteraciones morfológicas. Asimismo, se reportan efectos en el periodo prenatal y postnatal, como nacimientos prematuros, neonatos con bajo peso y abortos espontáneos. Los resultados de revisión evidencian que los contaminantes atmosféricos influyen negativamente en el proceso reproductivo de algunos mamíferos, debido a que pueden alterar los mecanismos de regulación oxidativa y regulación en la expresión génica en los gametos, lo que conlleva a toxicidad celular y potenciales alteraciones en la estabilidad genómica.

ABSTRACT Atmospheric pollution is caused by the presence or combination of physical, chemical, or biological pollutants in the air. In recent years, the most studied pollutant is particulate matter (PM), a varied mixture of solid and liquid particles. PM also carry highly toxic components from cigarette smoke combustion, with different microscopic sizes present in the atmosphere that can be inhaled and cause serious health problems due to toxicity at the cellular level and consequences at the inflammatory level. Currently, exposure to PM is associated with alterations in processes of reproduction in mammals, affecting gamete and embryo viability. The objective of this review is to describe the effects of atmospheric pollutants on reproductive processes and the possible mechanisms of action, both cellular and molecular, which are of interest in human and animal health sciences. Studies show a cause and effect relationship between exposure to pollutants and gamete quality, with pollutants causing DNA damage, epigenetic modifications, an increase in oxidative stress and alterations in morphology. Likewise, effects in the prenatal and postnatal period are reported, such as premature births, low birth weight and spontaneous abortion. The results of this review show that atmospheric pollutants negatively influence reproductive processes in some mammals, as they can alter the mechanisms of oxidative regulation and regulation of gene expression in gametes, leading to cell toxicity and potential alterations in genomic stability.

RESUMEN Introducción: El hábito de consumir cigarrillo provoca un sinnúmero de afecciones; una de ellas está relacionada con el cambio de color en dientes y materiales restauradores, puesto que la cavidad oral es la zona más afectada al estar en contacto directo con el humo. Objetivo: Evaluar el grado de pigmentación en carillas de composite sometidas al humo de dos tipos de cigarrillo. Material y Métodos: El estudio fue de tipo observacional, descriptivo, in vitro y de corte transversal; el grupo de estudio estuvo constituido por 20 carillas de composite elaboradas con resina Z350 XT, que se dividieron en dos subgrupos: G1 y G2, con 10 ejemplares cada uno. El G1 se expuso al humo de cigarrillo común y el G2 al humo de cigarrillo ligero; se utilizó un espectrofotómetro digital (Vita Easyshade) para la toma de color en tres tiempos: día 0, día 15 y día 30. Resultados: Se determinó que las alteraciones de color en las carillas elaboradas con la resina expuestas al cigarrillo ligero, demostró mayor tendencia en cambiar el tono y mayor convergencia en la alteración del color observadas en las muestras, teniendo en cuenta que llegaron a un grado de saturación entre 3 y 3.5 y hasta 4 en un mismo nivel de tono. Conclusiones: El humo de cigarrillo ligero provoca una pigmentación diferenciada al cigarrillo común con mayor impacto en la saturación lo que hace que las muestran tomen una pigmentación más opaca tendiendo a grisácea.

ABSTRACT Introduction: The habit of smoking causes a huge number of conditions; one of them is the color changes in teeth and restorative materials, since the oral cavity is the most affected area when in direct contact with smoke. Objective: To evaluate the degree of pigmentation in composite veneers subjected to the smoke of two types of cigarettes. Material and Methods: An observational descriptive cross-sectional in vitro study was carried out; the sample was constituted by 20 composite veneers made with Z350 XT resin, which met inclusion and exclusion criteria and were divided into two subgroups: G1 and G2, with 10 specimens each. G1 was exposed to common cigarette smoke, while G2 was exposed to light cigarette smoke; a digital spectrophotometer (Vita Easyshade) was used to take color in three times: day 0, day 15, and day 30. Results: It was determined that the color alterations in the veneers made with 3M's Z350 XT resin exposed to light cigarette showed a greater tendency to change the tone as well as a greater convergence in the color alteration observed in the samples, taking into account that they reached a degree of saturation between 3 and 3.5 and up to 4 at the same tone level. Conclusions: Light cigarette smoke causes a more differentiated pigmentation than the common cigarette with a greater impact on saturation, which causes the samples to take a more opaque pigmentation, tending to be greyish.

SUMMARY: A great deal of attention of air pollution on respiratory health is increasing, particularly in relation to haze days. It is that exposure to cigarette smoke augments the toxicity of common air contaminants, thereby increasing the complexity of respiratory diseases. Although there are various mechanisms involved to respiratory diseases caused or worsen by cigarette smoking, in which the role of AQPs in the lung with regard to fluid homeostasis still remains elusive. In this paper, we copied the rat models based on smoke generator, and investigated the morphological changes of mucosa and related functions depending on the balance of lining liquid of alveoli via AQPs expression. Compared with normal group, weak labelling of AQP1 and AQP5 protein abundance were clearly detected in the corresponding part of smoke exposure groups compared with normal group. Hence, it is suggested that the contribution of AQPs in the lung is diminished, thereby causing perturbed balancing between resorptive and secretory fluid homeostasis under cigarette smoking.

RESUMEN: Cada vez se presta más atención a la contaminación del aire en la salud respiratoria, particularmente, en relación con los días de neblina. En consecuencia la exposición al humo del cigarrillo aumenta la toxicidad de los contaminantes comunes del aire, lo que además aumenta la complejidad de las enfermedades respiratorias. Aunque existen varios mecanismos involucrados en las enfermedades respiratorias causadas o empeoradas por el tabaquismo, en las que el papel de las AQP en el pulmón respecto a la homeostasis de líquidos sigue siendo difícil de alcanzar. En este artículo, copiamos los modelos de rata basados en el generador de humo e investigamos los cambios morfológicos de la mucosa y las funciones relacionadas según el equilibrio del líquido de revestimiento de los alvéolos a través de la expresión de AQP. En comparación con el grupo normal, se detectó claramente un etiquetado débil de la abundancia de proteínas AQP1 y AQP5 en la parte correspondiente de los grupos de exposición al humo en comparación con el grupo control. Por lo tanto, se sugiere que la contribución de las AQP en el pulmón está disminuida, provocando así un equilibrio perturbado entre la homeostasis del líquido secretor y de reabsorción bajo el hábito de fumar cigarrillos.

RESUMO Objetivo: Avaliar a prevalência de experimentação e uso atual de narguilé e cigarros eletrônicos e os fatores associados entre estudantes de medicina. Métodos: Estudo transversal multicêntrico com uma amostra de conveniência de estudantes de faculdades de medicina da maioria das regiões geográficas brasileiras. Informações sobre experimentação e uso atual de cigarros convencionais, narguilé e cigarros eletrônicos; crenças e atitudes em relação aos produtos do tabaco; religiosidade; e dados demográficos foram coletados por meio de um questionário on-line estruturado. Utilizou-se estatística descritiva e regressão logística para analisar a associação desses fatores. Resultados: Nossa amostra foi composta por 700 indivíduos de quatro regiões brasileiras. As prevalências de experimentação e uso atual de cigarros, narguilé e cigarros eletrônicos foram, respectivamente, de 39,1% e 7,9%; 42,6% e 11,4%; e 13,1% e 2,3%. A experimentação de narguilé foi maior entre aqueles que tinham irmãos (OR ajustada = 2,64; IC95%: 1,24-5,61) ou amigos (OR ajustada = 2,33; IC95%: 1,63-3,31) fumantes. O mesmo ocorreu em relação à experimentação de cigarros eletrônicos: irmãos (OR ajustada = 2,76; IC95%: 1,17-6,50) e amigos (OR ajustada = 2,47; IC95%: 1,45-4,22). Curiosidade e aroma/sabor foram os principais motivos para o uso de narguilé e a experimentação de cigarros eletrônicos. Embora 93% dos respondentes tenham aprendido sobre os danos do tabagismo à saúde nas aulas da faculdade de medicina, 51,4% relataram já ter experimentado pelo menos um desses produtos do tabaco. A maioria dos respondentes que relataram sentir a presença de Deus/Espírito Santo em suas vidas nunca experimentou narguilé (59,2%) ou cigarros eletrônicos (55,3%). Conclusões: Há uma alta prevalência de experimentação de produtos do tabaco entre estudantes de medicina cujos irmãos ou amigos fumam, apesar de terem conhecimento sobre os malefícios do tabagismo. Objetivo Métodos brasileiras convencionais religiosidade online on line estruturado Utilizouse Utilizou se Resultados 70 respectivamente 391 39 1 39,1 7,9% 79 7 9 426 42 6 42,6 11,4% 114 11 4 131 13 13,1 23 2 3 2,3% OR 2,64 264 64 IC95% IC95 IC 1,245,61 124561 1,24 5,61 24 5 61 1,24-5,61 2,33 233 33 1,633,31 163331 1,63 3,31 63 31 1,63-3,31 fumantes 2,76 276 76 1,176,50 117650 1,17 6,50 17 50 1,17-6,50 2,47 247 47 1,454,22. 145422 1,45 4,22 . 45 22 1,45-4,22) aromasabor aroma sabor 93 514 51 51,4 DeusEspírito Deus Espírito 59,2% 592 59 (59,2% 55,3%. 553 55,3% 55 (55,3%) Conclusões fumam 39, 7,9 42, 11,4 13, 2,3 2,6 26 IC9 245 1,245,6 12456 124 1,2 561 5,6 1,24-5,6 633 1,633,3 16333 163 1,6 331 3,3 1,63-3,3 2,7 27 176 1,176,5 11765 117 1,1 650 6,5 1,17-6,5 2,4 454 1,454,22 14542 145 1,4 422 4,2 1,45-4,22 51, 59,2 (59,2 55,3 (55,3% 7, 11, 2, 1,245, 1245 12 1, 56 5, 1,24-5, 1,633, 1633 16 3, 1,63-3, 1,176, 1176 65 6, 1,17-6, 1,454,2 1454 14 4, 1,45-4,2 59, (59, 55, (55,3 1,245 1,24-5 1,633 1,63-3 1,176 1,17-6 1,454, 1,45-4, (59 (55, 1,24- 1,63- 1,17- 1,454 1,45-4 (5 (55 1,45- (

ABSTRACT Objective: To evaluate the prevalence of and factors associated with experimentation with and current use of water pipes and e-cigarettes among medical students. Methods: This was a cross-sectional multicentric study involving a convenience sample of students from medical schools in most Brazilian geographic regions. Information about experimentation with and current use of conventional cigarettes, water pipes, and e-cigarettes; beliefs and attitudes toward tobacco products; religiosity; and demographics were collected by means of an online structured questionnaire. We used descriptive statistics and logistic regression to analyze the association of those factors. Results: Our sample comprised 700 individuals from four Brazilian regions. Prevalence of experimentation with and current use of cigarettes, water pipes, and e-cigarettes were, respectively, 39.1% and 7.9%; 42.6% and 11.4%; and 13.1% and 2.3%. Water pipe experimentation was higher among those who had a sibling (adjusted OR = 2.64; 95% CI, 1.24-5.61) or friends (adjusted OR = 2.33; 95% CI, 1.63-3.31) who smoke. The same occurred regarding e-cigarette experimentation: siblings (adjusted OR = 2.76; 95% CI, 1.17-6.50) and friends (adjusted OR = 2.47; 95% CI, 1:45-4.22). Curiosity and scent/taste were the major reasons for water pipe use and e-cigarette experimentation. Although 93% of the responders learned about health damages of smoking during medical school classes, 51.4% reported having experimented with at least one of these tobacco products. Most responders who reported feeling the presence of God/the Holy Spirit in their lives were never experimenters of water pipes (59.2%) or e-cigarettes (55.3%). Conclusions: There is a high prevalence of experimentation with tobacco products among medical students whose siblings or friends smoke, despite their knowledge about smoking harms. Objective ecigarettes e cigarettes Methods crosssectional cross sectional regions religiosity questionnaire Results 70 respectively 391 39 1 39.1 7.9% 79 7 9 426 42 6 42.6 11.4% 114 11 4 131 13 13.1 23 2 3 2.3% adjusted 2.64 264 64 95 CI 1.245.61 124561 1.24 5.61 24 5 61 1.24-5.61 2.33 233 33 1.633.31 163331 1.63 3.31 63 31 1.63-3.31 smoke ecigarette cigarette 2.76 276 76 1.176.50 117650 1.17 6.50 17 50 1.17-6.50 2.47 247 47 1454.22. 145422 45 4.22 . 22 1:45-4.22) scenttaste scent taste 93 classes 514 51 51.4 Godthe God 59.2% 592 59 (59.2% 55.3%. 553 55.3% 55 (55.3%) Conclusions harms 39. 7.9 42. 11.4 13. 2.3 2.6 26 245 1.245.6 12456 124 1.2 561 5.6 1.24-5.6 633 1.633.3 16333 163 1.6 331 3.3 1.63-3.3 2.7 27 176 1.176.5 11765 117 1.1 650 6.5 1.17-6.5 2.4 1454 1454.22 14542 422 4.2 1:45-4.22 51. 59.2 (59.2 55.3 (55.3% 7. 11. 2. 1.245. 1245 12 1. 56 5. 1.24-5. 1.633. 1633 16 3. 1.63-3. 1.176. 1176 65 6. 1.17-6. 145 1454.2 4. 1:45-4.2 59. (59. 55. (55.3 1.245 1.24-5 1.633 1.63-3 1.176 1.17-6 14 1454. 1:45-4. (59 (55. 1.24- 1.63- 1.17- 1:45-4 (5 (55 1:45- ( 1:45 1:4 1: