This article is a literature review of the psychological aspects of smoking behavior, highlighting personality characteristics of the smoker as an obstacle to smoking cessation. It describes the relation between smoking behavior and personality, and between smoking and the principal psychiatric disorders. Studies reveal that smokers tend to be more extroverted, anxious, tense, and impulsive, and show more traits of neuroticism and psychoticism than do ex-smokers or nonsmokers. The literature also reveals a strong association between smoking and mental disorders, such as schizophrenia and depression. Understanding the psychological factors associated with tobacco smoking and dependence can further the development and improvement of therapeutic strategies to be used in smoking-cessation programs, as well as of programs aimed at prevention and education.

Keywords: Personality; Mental disorders; Smoking.

Objective: To investigate how social and psychological characteristics differ between pregnant women who smoke and do not smoke. To explore associations between social and psychological features with changes of smoking habits by the end of pregnancy. Methods: A case-control study was set up. Smokers cases were never-smokers and ex-smokers controls. Pregnant women (n=328) from public prenatal services were interviewed. Socio-demographic data and psychological variables - personality traits, anxiety, depression, perceived stress, maternal fetal-attachment - were measured. Saliva samples were collected to measure cotinine and to check self-informed smoking status. In addition, 66 smokers were also assessed regarding smoking habits by late pregnancy. Smoking status was defined as a dependent variable. Exposure factors were analyzed through odds ratios. Logistic models and contingency tables were employed according to the nature of variables. "Qualitative change in smoking" was defined as a dependent variable for the last evaluation, and a logistic regression model was built. Results: Lower schooling, higher age, use of alcohol and drugs, living without a partner, and passive smoking showed associations with smoking. Anxiety, depression and perceived stress also exhibited positive association with smoking. Among personality traits, only Neuroticism was associated with smoking. None of the variables were associated with qualitative change in smoking by the end of pregnancy. Conclusion: Smoking during pregnancy is associated with more unfavorable social conditions. Pregnant women who smoke exhibit more negative psychological states than nonsmokers, including a profile of accentuated Neuroticism. None of the investigated variables could predict changes in smoking during pregnancy.

Keywords: Smoking; Pregnancy; Psychology; Psychosocial factors; Personality traits; Big five factor model of personality; Perceived stress; Anxiety; Depression.

Among all causes of preventable deaths, smoking is responsible for the greatest number of deaths worldwide and predisposes to fatal, noncommunicable diseases, especially cardiovascular diseases. Lifestyle changes are effective in the treatment of patients with smoking-related diseases and assist in the prevention of premature mortality. Our objective was to investigate the available scientific evidence regarding the psychological distress related to smoking cessation in patients who have had acute myocardial infarction. To that end, we conducted an integrative review of the literature in order to summarize relevant studies on this topic. The selected databases were Scopus, PubMed Central, Institute for Scientific Information Web of Science (Core Collection), ScienceDirect, EMBASE, SciELO, LILACS e PsycINFO. On the basis of the inclusion and exclusion criteria adopted for this study, 14 articles were selected for analysis. Those studies showed that the prevalence of psychological distress is higher among smokers than among nonsmokers, and distress-related symptoms are much more common in smokers with acute myocardial infarction than in those without. Smoking cessation depends on the active participation of the smoker, whose major motivation is the underlying disease. Most studies have shown that there is a need to create treatment subgroups as a means of improving the treatment provided. This review article expands the knowledge regarding smoking cessation and shows the need to invest in future research that investigates subgroups of smokers diagnosed with the major smoking-related comorbidities, such as acute myocardial infarction, in order to develop specific interventions and psychological support strategies.

Keywords: Smoking; Stress, psychological; Myocardial infarction; Tobacco use cessation.

Objective: To identify preoperative characteristics associated with complete surgical resection of primary malignant mediastinal tumors. Methods: Between 1996 and 2006, 42 patients with primary malignant mediastinal tumors were submitted to surgery with curative intent at a single facility. Patient charts were reviewed in order to collect data related to demographics, clinical manifestation, characteristics of mediastinal tumors and imaging aspects of invasiveness. Results: The surgical resection was considered complete in 69.1% of the patients. Cases of incomplete resection were attributed to invasion of the following structures: large blood vessels (4 cases); the superior vena cava (3 cases); the heart (2 cases); the lung and chest wall (3cases); and the trachea (1 case). Overall survival was significantly better among the patients submitted to complete surgical resection than among those submitted to incomplete resection. The frequency of incomplete resection was significantly higher in cases in which the tumor had invaded organs other than the lung (as identified through imaging studies) than in those in which it was restricted to the lung (47.6% vs. 14.3%; p = 0.04). None of the other preoperative characteristics analyzed were found to be associated with complete resection. Conclusions: Preoperative radiological evidence of invasion of organs other than the lung is associated with the incomplete surgical resection of primary malignant mediastinal tumors.

Keywords: Thoracic surgery; Survival rate; Mediastinal neoplasms; Diagnostic imaging.

Objective: Water-pipe tobacco smoking is becoming increasingly more common among young people. The objective of this study was to estimate the prevalence of the use of water pipes and other forms of tobacco use, including cigarette smoking, among medical students, as well as to examine the attitudes, beliefs, and knowledge of those students regarding this issue. Methods: We administered a questionnaire to students enrolled in the University of São Paulo School of Medicine, in São Paulo, Brazil. The respondents were evaluated in their third and sixth years of medical school, between 2008 and 2013. Comparisons were drawn between the two years. Results: We evaluated 586 completed questionnaires. Overall, the prevalence of current cigarette smokers was low, with a decline among males (9.78% vs. 5.26%) and an increase among females (1.43% vs. 2.65%) in the 3rd and 6th year, respectively. All respondents believed that health professionals should advise patients to quit smoking. However, few of the medical students who smoked received physician advice to quit. Experimentation with other forms of tobacco use was more common among males (p<0.0001). Despite their knowledge of its harmful effects, students experimented with water-pipe tobacco smoking in high proportions (47.32% and 46.75% of the third- and sixth-year students, respectively). Conclusions: The prevalence of experimentation with water-pipe tobacco smoking and other forms of tobacco use is high among aspiring physicians. Our findings highlight the need for better preventive education programs at medical schools, not only to protect the health of aspiring physicians but also to help them meet the challenge posed by this new epidemic.

Keywords: Tobacco products; Smoking/prevention & control; Education, medical, undergraduate; Health knowledge, attitudes, practice.

Introduction: Data on the relationship between personality profile and nicotine addiction may help health professionals in the design and improvement of programs for the treatment and prevention of addiction. Objective: To investigate the relationship between the personality profile and nicotine addiction in a group of smoking undergraduate students. Methods: A total of 1,245 undergraduate students were randomly selected among 10,500 students enrolled at the UFMT - Cuiabá campus in 2001. A standard questionnaire was applied for social characterization and to determine the pattern of cigarette consumption, with 80 students being considered smokers. These students were then submitted to the Fagerström Test (1978) of nicotine addiction and to the reduced version of the Comrey Personality Scale (CPS) which determines personality dimensions. Results: Analysis of the mean scores (Student t-test) revealed a marginal or inversely proportional borderline association between addiction and the Order x Lack of Compulsion scale (p = 0.06), and a negative or inversely proportional association between the CPS Extroversion x Introversion (p = 0.002) and Control of Validity scales (p = 0.04). Linear regression of the Fagerström Test points confirmed the inversely proportional borderline association between addiction and the Order x Lack of Compulsion (p = 0.06) and CPS Extroversion x Introversion scales (p = 0.02). However, controlling for interference of daily cigarette consumption, only the Extroversion x Introversion scale remained associated with addiction (p = 0.001). Conclusions: Smoker and nicotine dependent students are less extrovert than non-dependent smokers.

Objective: To evaluate patient profiles and factors associated with successful treatment. Methods: A retrospective study of patients enrolled in the smoking cessation program at the Hospital de Messejana, located in the state of Ceará, Brazil, from October of 2002 to April of 2005. The treatment was evaluated based on patient profile, type of medication prescribed and time on that medication. Results: Of the 320 patients enrolled, 65.5% were women. The mean age at the outset of treatment was 48 years, and the mean duration of the smoking habit was 33 years. More than 90% of the patients had started smoking before the age of 20. Of the 258 individuals who had enrolled in the program at least one year prior, 50.8% had achieved treatment success; 17.8% had relapsed, and 31.4% had not quit smoking. On average, partial success was achieved in the fifth week of the treatment, and relapse occurred predominantly in the fourth month. Approximately 60% of the patients were treated with medication. Conclusion: Quitting smoking was significantly associated with the use of medication, regardless of the profile of the smoker evaluated. In the second year of the program, quitting smoking was more strongly associated with the use of bupropion and nicotine replacement, resulting in a higher success rate and a trend toward a reduction in the relapse rate.

Keywords: Smoking/therapy; Tobacco use cessation; Bupropion; Nicotine

Objective: To analyze psychological morbidity as a moderator of the relationship between smoking representations and quality of life in smokers and former smokers, as well as to determine which psychological variables discriminate between smokers with and without the intention to quit smoking. Methods: This was a quantitative, correlational cross-sectional study involving a convenience sample of 224 smokers and 169 former smokers. Results: In smokers and former smokers, psychological morbidity had a moderating effect on the relationship between mental/physical quality of life and smoking representations (cognitive representations, emotional representations, and comprehensibility). Smokers with the intention to quit smoking more often presented with low comprehensibility, threatening emotional representations, behavioral beliefs, and perceived behavioral control, as well as with normative/control beliefs, than did those without the intention to quit. Conclusions: The results of this study underscore the importance of the moderating effect exerted by psychological morbidity, as well as that of sociocognitive variables, among smokers who have the intention to quit smoking.

Keywords: Smoking/psychology; Smoking cessation; Smoking/prevention & control.

Objective: To evaluate the characteristics of smokers seeking treatment in a public smoking cessation program. Methods: This was a retrospective evaluation of data collected during the interview for enrollment in the smoking cessation program of the Smoking Outpatient Clinic of the Paulista State University School of Medicine in the city of Botucatu, Brazil, between April of 2003 and April of 2007. Demographic variables; previous use of the behavioral approach, medications or alternative treatments for smoking cessation; degree of nicotine dependence; and history of comorbidities were evaluated in 387 smokers. Results: In our sample, 63% of the smokers were female. The mean age of the subjects was 50 ± 25 years. More than half of the subjects (61%) had up to eight years of schooling, and 66% had a monthly income of less than twice the national minimum wage. The degree of nicotine dependence was high/very high in 59%, medium in 17% and low/very low in 24% of the subjects. Although 95% of the patients presented comorbidities, only 35% had been referred to the program by a physician. More than half of the subjects (68%) had made at least one smoking-cessation attempt, 83% of whom did so without the help of a structured program. Conclusions: Smokers seeking assistance for smoking cessation were socially disadvantaged, presented a high degree of nicotine dependence and had previously made smoking-cessation attempts without the benefit of a structured program. Therefore, in order to be effective, smoking control interventions should take into consideration the general characteristics of the smokers treated via the public health care system.

Keywords: Smoking; Tobacco use disorder; Smoking cessation.

Objective: To assess the prevalence of smoking and associated variables in female sex workers (FSWs). Methods: This was a quantitative cross-sectional study involving FSWs in the city of Botucatu, Brazil, who completed a sociodemographic questionnaire, including data regarding smoking status, motivational stage of change, and degree of nicotine dependence, as well as the Perceived Stress Scale and the Hospital Anxiety and Depression Scale. Results: We included 83 FSWs. The mean age was 26.8 years. Among the participants, 58 (69.8%) had at least a high school education, only 26 (31.3%) resided in the city of Botucatu, 59 (71.1%) were smokers, 5 (6.0%) were former smokers, 74 (89.2%) regularly consumed alcohol, and 43 (51.8%) used illicit drugs. The majority of the women were classified as having an intermediate stress level, and 51 (61.4%) were classified as having possible or probable anxiety, whereas depression was found to be improbable in 57 (68.7%). The level of nicotine dependence was high among the smokers, the majority of whom showed no intention to quit smoking. Smoking was associated with illicit drug use (p = 0.0271) and with alcohol consumption (p = 0.0001), although not with the levels of stress, anxiety, or depression; nor was the age at smoking initiation associated with the length of time as an FSW (p = 0.4651). Conclusions: The prevalence of smoking among the FSWs evaluated here was much higher than the 8.3% reported for the overall female population of Brazil. Our findings show that FSWs are exposed to various risk factors inherent to their profession. Therefore, harm reduction is an important strategy to be adopted.

Keywords: Women, Smoking, Sex workers; Prevalence; Risk factors.

Objective: To compare smokers and never smokers in terms of the following: quality of life; BMI; hospitalizations; functionality; family history of mental disorder; tobacco-related diseases; depression; and psychoactive substance use. Methods: We evaluated 167 smokers enrolled in a smoking cessation program at the Londrina State University Referral Center for Understanding and Treating Smoking, together with 272 never-smoking blood donors. We employed the following instruments, all validated for use in Brazil: a structured questionnaire for the collection of sociodemographic data; the Alcohol, Smoking and Substance Involvement Screening Test; the World Health Organization Quality of Life Instrument, brief version (WHOQoL-BREF); and the Fagerström Test for Nicotine Dependence. We also applied diagnostic criteria for the investigation of depressive disorders. Results: The mean age of the smokers and never smokers was, respectively, 45 and 44 years. Females predominated in both groups. Smokers more often presented with impaired work/domestic functionality, hospitalizations, depressive disorders, smoking in the household, sedative use and a family history of mental disorders, as well as scoring lower in all domains of the WHOQoL-BREF. The mean age at smoking onset was lower for smokers with depression or using psychoactive substances than for smokers without such comorbidities. Diabetes, arterial hypertension, heart disease, respiratory disease and peptic ulcer were more common in smokers than in never smokers. The mean BMI was lower in the smokers than in the never smokers. Conclusions: This study suggests that, for smoking cessation programs, subgroups of smokers with specific characteristics (early age at smoking onset, tobacco-related diseases, depressive disorders and use of psychoactive substances) should be identified.

Keywords: Smoking; Depressive disorder; Smoking cessation; Tobacco use disorder.

Objective: To determine the prevalence of smoking and to describe the profile and smoking habits of students attending the Universidade de Brasília (University of Brasília) in Brasília, Brazil. Methods: A total of 1341 students responded to a smoking questionnaire, adapted from the World Health Organization questionnaire, including questions directed at smokers, former smokers and nonsmokers. Twenty different courses in the areas of health, exact sciences and human sciences were evaluated. The students included in the study were duly enrolled in day courses and were evaluated during the second semester of 2003. Results: The overall prevalence of smoking was 14.7%. Approximately 80.8% of the students were nonsmokers, and 4.5% were former smokers. In the study sample, 57.3% of the students were male. No significant difference (p > 0.05) in the prevalence of smoking was observed in terms of gender or class year. The mean age of the study population was 21.6 ± 3.6 years, and the mean age at which the smoking habit was acquired was 17 ± 2.8 years. The percentage of smokers was higher in the Geology, Communication, and History courses (32.9, 26.3 and 24.4%, respectively). Mean consumption was 7.5 cigarettes per day. The majority (72.6%) of the students used commercial cigarettes rather than other types of tobacco. Conclusion: The high prevalence of smoking observed in the present study is similar to that reported for other universities and indicates the need for smoking control policies in university environments.

Keywords: Smoking/epidemiology; Students; Questionnaires

Objective: To profile the characteristics of smoking among physicians working in the Federal District of Brazil. Methods: A questionnaire on smoking, adapted from that used by the World Health Organization, was mailed to all physicians registered with the Federal District Regional Council of Medicine. Of the 7023 questionnaires mailed, 830 (12%) were duly completed and returned. Results: Among the physicians participating in the study, the prevalence of smoking was 7.2% (5.9% being regular smokers and 1.3% being occasional smokers). The remainder of the sample consisted of nonsmokers (70.1%) and former smokers (22.7%). In terms of gender, approximately 8.5% of the male physicians were smokers, compared with 5.3% of the female physicians (p > 0.05). Of the physicians who smoked, 80% had taken up the habit before the age of 20, 13% from 21 to 30, and 7% after the age of 31. The prevalence of smoking by specialty was as follows: Surgeons, 10.3%; Anesthesiologists, 10.3%; Clinicians, 9.1%; Gynecologists, 2.9%; and Pediatricians, 2.4%. Approximately 75% of the smoking physicians had been advised by their own doctors to stop smoking, although only 34.9% had tried to quit smoking with the preceding year. Of the physicians responding, 57.1% agreed that smoking is a health hazard, and 26.3% reported smoking in hospitals or doctors' offices. Conclusion: Efforts to control smoking in the Federal District should be intensified and, despite the fact that the prevalence of smoking is declining among physicians, smoking cessation programs should target this population.

Keywords: Smoking; Physicians; Smoking cessation

Objective: To determine the prevalence of smoking and the level of knowledge about smoking among undergraduate health sciences students. Methods: This was a cross-sectional study. A self-administered structured questionnaire was completed in the classroom by senior undergraduate health sciences students in the cities of Cuiabá and Várzea Grande, Brazil. We evaluated students at one public university and two private universities. Five variables were studied: age, gender, type of course, smoking status, and knowledge about smoking. The knowledge variable was divided into five parts: smoking as a disease; smoking/nicotine as a cause of dependence; specific education on smoking; major obstacles to the success of smoking cessation; and forms of smoking treatment. Only the medical students responded to questions related to the last two items. Results: The prevalence of smoking ranged from 9.3% at the public university to 21.1% at one of the two private universities. Approximately 30% of the respondents were unable to identify nicotine as the cause of dependence, 20.8% did not consider smoking a disease, and 47.2% reported that they had never received any instruction on the topic of smoking. The medical students enrolled at the public university showed the highest level of knowledge regarding the various forms of smoking treatment. Conclusions: The prevalence of smoking among the university students in our sample was high. Their knowledge about smoking was insufficient, which suggests inadequacy of the curricula at these universities.

Keywords: Tabagismo/epidemiologia; Estudantes; Questionários.

A 79 year-old man sought treatment in the emergency room complaining of persistent fever, chest pain, and general fatigue. A chest X-ray showed a giant infectious bulla (24 cm in diameter) in the left lung. The patient had no history of abnormalities on X-rays, and his latest medical check-up, conducted in the preceding year, had produced no abnormal findings. Diagnostic procedures, including bronchoscopy, revealed lung cancer (large cell carcinoma) in the left lower bronchus. The tumor obstructed the airway. Although there have been various reports of giant bullae, their etiology remains unknown. We suggest that an obstruction, such as that caused by the tumor in this case, can lead to air trapping, resulting in the formation of a bulla. In the case of a giant bulla that rapidly increases in size, lung cancer should be included in the differential diagnosis.

Keywords: Lung neoplasms/complications; Infection; Drainage.

Objective: To determine the prevalence of factors associated with difficult-to-control asthma. Methods: Patients with severe asthma were selected from the outpatient asthma clinic of the Ribeirão Preto School of Medicine Hospital das Clínicas. The patients were divided into two groups: controlled severe asthma and difficult-to-control severe asthma. After new attempts to optimize the severe asthma treatment, a questionnaire was applied, and additional tests for factors associated with difficult-to-control asthma, such as environmental and occupational exposure, smoking history, social factors, rhinitis/sinusitis, gastroesophageal reflux disease (GERD), obstructive sleep apnea, congestive heart failure (CHF), pulmonary embolism, cystic fibrosis, vocal cord dysfunction, α-1 antitrypsin deficiency, and Churg-Strauss syndrome, were performed. Results: 77 patients with severe asthma were selected, of which 47 suffered from hard-to-control asthma, being 68.1% female, with mean age of 44.4 years (±14.4), and forced expiratory volume in one second of 54.7% (±18.3). The most factors most often associated with difficult-to-control asthma were noncompliance with treatment (68%), rhinitis/sinusitis (57%), GERD (49%), environmental exposure (34%), occupational exposure (17%), smoking history (10%), obstructive sleep apnea (2%), and CHF (2%). At least one of these factors was identified in every case. Conclusions: Noncompliance with treatment was the factor most often associated with difficult-to-control asthma, underscoring the need to investigate comorbidities in the evaluation of patients with this form of the disease.

Keywords: Asthma; Smoking; Gastroesophageal reflux; Patient compliance; Rhinitis; Sinusitis.