Tobacco Control Network among Women in Parana, Brazil - II

说明(申请人提供)：在过去几年出版的具有里程碑意义的指导性文件(如《世界卫生组织烟草控制框架公约》--《世界卫生组织烟草控制框架公约》)中，强调了对妇女及其烟草相关问题的了解，以及开展与性别有关的烟草控制努力的必要性，作为优先事项。巴西是世界第二大烟草生产国，95%的烟草产自南方三个州(巴拉那州、圣卡塔利纳州和南里奥格兰德州)。尽管从历史上看，发展中国家、特别是拉丁美洲妇女的烟草使用率低于男子，但吸烟流行病正在迅速蔓延到发展中国家的妇女，而且这三个南部州的妇女吸烟率是全国最高的。我们在巴西巴拉那建立了妇女烟草控制网络，目的是建立社区和机构能力，通过基于社区的参与性研究和培训在妇女中促进与性别有关的烟草控制努力。该网络的目标是减少巴兰州妇女的烟草使用和暴露在环境烟草烟雾中，并培养一支训练有素的研究人员队伍，他们将继续在多个层面上处理全面的烟草控制战略。该网络对巴兰州各地妇女的烟草使用情况及其相关因素进行了流行病学调查。根据结果，该网络确定了四个优先事项：(1)实施政策变化，以减少ETS；(2)了解烟草种植妇女的健康/社会问题；(3)制定和评估全面的、与文化和性别相关的、以学校为基础的吸烟预防计划；以及(4)通过公共卫生系统改善戒烟计划的获得和交付，特别关注“轻吸烟者”，因为在我们的研究中，74.8%的女性吸烟者报告每天吸烟10支或更少。该网络目前正在处理前三个优先事项，包括支持立法，这导致帕兰拥有全国最严格的室内烟草禁令。这一更新的总体目标有三个方面：(1)继续维持和加强该网络；(2)进行一项团体随机对照试验，以评估针对巴西女性“轻吸烟者”的基于理论、文化和性别因素的社区卫生工作者干预措施的有效性，该干预措施将加强通过公共卫生系统提供的戒烟计划；以及(3)将我们目前的职业发展和研究培训计划扩展到其他两个主要烟草种植州，以便培养一支训练有素的研究人员队伍，他们将继续在各级制定和实施与性别有关的全面烟草控制战略。 公共卫生相关性：非常需要开展与性别有关的烟草控制工作。我们建立了社区和机构能力，在巴西一个烟草生产州的妇女中促进与性别有关的烟草控制工作--巴西巴拉那妇女烟草控制网络。通过这次更新，我们建议1)继续维持和加强网络，2)进行一项团体随机对照试验，以评估一项基于理论、与文化和性别相关的社区卫生工作者干预措施的有效性，该干预措施将促进巴西女性“轻吸烟者”的戒烟，以及3)将我们目前的能力建设计划扩大到巴西的另外两个主要烟草生产州。

DESCRIPTION (provided by applicant): An understanding of women and their tobacco-related issues, as well as the need for the development of gender-relevant tobacco control efforts, have been highlighted as priorities in landmark guiding documents published in the past few years (e.g., WHO Framework Convention on Tobacco Control-WHO FCTC). Brazil is the second largest producer of tobacco in the world, and 95% of the tobacco is produced in the three Southern states (Paran¿, Santa Catarina, and Rio Grande do Sul). Although, historically, tobacco use among women in developing countries, particularly Latin America, has been relatively low as compared to men, the smoking epidemic is rapidly spreading to women in developing countries, and these three Southern states have the highest prevalence of women smokers in the country. We have established a Network for Tobacco Control among Women in Paran¿, Brazil with the purpose of establishing community and institutional capacity to promote gender-relevant tobacco control efforts among women through Community-Based Participatory Research (CBPR) and training. The goals of the network are to reduce tobacco use and exposure to environmental tobacco smoke (ETS) among women in Paran¿, and to develop a cadre of well-trained researchers who will continue to address comprehensive tobacco control strategies at multiple levels. The network conducted an epidemiological survey on the prevalence and factors associated with tobacco use among women across the State of Paran¿. Based on the results, the network identified four priorities: (1) to implement policy changes to decrease ETS; (2) to understand the health/social issues of women in tobacco farming; (3) to develop and evaluate a comprehensive, culturally- and gender relevant, school-based smoking prevention program; and (4) to improve access and delivery of smoking cessation programs through the public health system with a particular focus on "light smokers" as 74.8% of women smokers in our study reported smoking 10 or less cigarettes/day. The network is currently addressing the first three priorities, including support for legislation, which resulted in Paran¿ having the strongest indoor tobacco ban in the country. The overall goal of this renewal is three-fold: (1) to continue to sustain and strengthen the network; (2) to conduct a group randomized controlled trial to assess the efficacy of a theory-based, culturally- and gender- relevant Community Health Worker intervention for Brazilian women "light smokers" that will augment the smoking cessation programs offered through the public health system; and (3) to expand our current Career Development and Research Training Program to the other two major tobacco growing states in order to develop a cadre of well-trained researchers who will continue to develop and implement gender-relevant comprehensive tobacco control strategies at all levels. PUBLIC HEALTH RELEVANCE: There is a great need for the development of gender-relevant tobacco control efforts. We have established community and institutional capacity to promote gender-relevant tobacco control efforts among women in a tobacco producing state in Brazil - Network for Tobacco Control among Women in Paran¿, Brazil. Through this renewal, we propose to 1) continue to sustain and strengthen the network, 2) conduct a group randomized controlled trial to assess the efficacy of a theory-based, culturally- and gender-relevant Community Health Worker intervention that will augment smoking cessation of Brazilian women "light smokers", and 3) expand our current capacity building program to the other two major tobacco producing states in Brazil.