Aula proferida pelo Dr Waldir Leopércio durante o Curso de Atualização em Tabagismo da SOPTERJ, em 8/6/2011, no Hospital COPA D'OR.

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Dr. Waldir Leopércio
E-mail: cdtorax@terra.com.br
A Legislação dos Ambientes
Livres de Tabaco no RJ:
Resultados Observados
XIII Congresso de Pneumologia e Tisiologia do Estado do RJ
Hospital COPA D’OR, 8 de Junho de 2011
Curso de Atualização em Tabagismo

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Tabagismo Passivo
Inalação da fumaça de derivados
do tabaco, por indivíduos não-
fumantes, que convivem com
fumantes em ambientes
fechados(OMS, 2001).
Fumaça que se origina do
cigarro aceso
+
Fumaça expirada pelo fumante

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Tabagismo Passivo
 No Brasil, pelo menos 7 pessoas morrem
diariamente por tabagismo passivo
(INCA/UFRJ)
 200 mil trabalhadores morrem por ano pelo
mesmo motivo (OIT), no mundo.

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 100 milhões no orçamento da saúde
 439,2 milhões no orçamento do INSS
Custos com tabagismo passivo
Brasil 2003-2008 (INCA/UFRJ)

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“Nenhuma tecnologia de engenharia de ventilação
demonstra controlar os riscos impostos pela
exposição à PTA; apenas pode reduzi-los e pode
controlar questões de conforto relacionadas ao odor
e à irritação sensorial impostos pela exposição.”.”
Sociedade Americana de Engenheiros
de Aquecimento, Refrigeração e
Condicionamento de Ar
Evidências

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 Os níveis de PTA em bares chegam a ser quase
6 vezes maior do que nos escritórios
 Garçons: 4 a 10 cigarros por jornada de
trabalho
Fumo Passivo em Ambientes da
Indústria da Hospitalidade

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CONVENÇÃO QUADRO
http://www1.inca.gov.br/inca/Arquivos/convencao_quadro_texto_oficial.PDF

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Estudo requisitado pela SEDESC-RJ ao
Dr. Alberto José de Araújo, MD Pneumologista,
Diretor do NETT-UFRJ
“Custo efetividade de intervenções de controle do tabaco no
Brasil”
(Baseado na Tese de Doutorado do autor)
Quanto custou aos cofres públicos do Estado do RJ
os cuidados com IAM, AVC e Ca de Pulmão
atribuíveis ao tabagismo nos últimos 5 anos?

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Quanto custou aos cofres públicos do Estado do RJ
os cuidados com IAM, AVC e Ca de Pulmão
atribuíveis ao tabagismo nos últimos 5 anos?
0 20 40 60 80
2004
2005
2006
2007
2008
Ca Pulmão
AVC
IAM
Custo Anual SUS para IAM, AVC e Ca Pulmão - RJ, 2004-2008, em
R$100.000,00
R$ 52.651.505,00
/ ano
R$ 263.257.527,00
/ 5 anos

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AÇÕES DO ESTADO PARA O CONTROLE DO
TABAGISMO
 Capacitação de 3 mil profissionais para
implantação de PROGRAMAS DE TRATAMENTO
DO TABAGISMO (INCA/MS)
 Rio de Janeiro é o estado com maior cobertura
para tratamento de fumantes
8 municípios
2008
81 municípios
2011

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Lei Estadual 5517 de 17/8/2009

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www.riosemfumo.rj.gov.br

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AÇÕES DO ESTADO PARA O
CONTROLE DO TABAGISMO
Balanço das Ações Executadas – 18/11/2009 a 16/05/2011
 21 fiscais
 80 fiscalizações semanais
 Bares, Restaurantes, Casas Noturnas, Similares e outros = 15.418
 99 estabelecimentos foram autuados
ADESÃO
99%

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Issa JS, Abe TM, Pereira AC, Megid MC, Shimabukuro CE, Valentin LS, et al. The effect of Sao Paulo's smoke-free legislation on carbon
monoxide concentration in hospitality venues and their workers. Tob Control. 2011 Mar;20(2):156-62.
Victora CG, Barreto ML, do Carmo Leal M, Monteiro CA, Schmidt MI, Paim J, et al. Health conditions and health-policy innovations in Brazil:
the way forward. Lancet. 2011 May 9.
Colgrove J, Bayer R, Bachynski K. Nowhere Left to Hide? The Banishment of Smoking from Public Spaces. May 25, 2011
(10.1056/NEJMp1104637)

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Background: Recent studies have shown that there is no safe level of exposure to secondhand smoke (SHS). A close link between SHS and the risk of
coronary heart disease and stroke is established as well as the fact that carbon monoxide (CO) is one of the most important components present in SHS.
Objective: To evaluate the impact of the smoking ban law in Rio de Janeiro city, Brazil, on the CO concentration in restaurants, bars, nightclubs, and
similar.
Methods: The CO concentration was measured in 146 hospitality venues by using portable CO monitors to measure CO concentration in different types of
establishments, and in different points inside these hospitality venues (indoor, semi-open, and open areas). These measurements were performed twice,
immediately before implementation of the law and 12 weeks after it. The quality of the air was verified during the same period of time through the analysis
of the databank of State Environmental Institute of Rio de Janeiro (INEA).
Results: The CO concentration pre- and post-ban in hospitality venues was indoor area 2.60 (1.77) vs 1.12 (1.01) ppm (p<0.0001); semi-open 2.74 (1.21) vs
1.3 (1.22) ppm (p<0.0001); open area 2.61(1.27) vs 1.14(1.09) ppm (p<0.0001). The differences are consistent in all types of venues, except in nightclubs,
where the levels of CO were similar in the pre- and post-ban measurements. It can be explained by non accomplishment of the law in these places and the
small number of nightclubs visited.
Conclusion: Rio de Janeiro’s smoke-free legislation significantly reduced the CO concentration in restaurants, bars, bakery and other hospitality venues.
Concerning nightclubs, it is necessary more information to have a conclusive result.
The effect of smoke-free legislation on carbon monoxide concentration in hospitality venues in Rio de Janeiro city.
Heart institute - University of São Paulo1
Rio de Janeiro Secretary of State for Health and Civil Defense2
Jaqueline S. Issa1, Tania M. O. Abe1, Alexandre C. Pereira1, José Waldir Leopércio Jr2, Sandra Helena Costa2, Sabrina Presman2.
Secondhand tobacco smoke (SHS) is one of the most important causes of death and disease worldwide.
Carbon monoxide is one of the most important components of SHS. Therefore, the WHO Framework
Convention on Tobacco Control (WHO FCTC) and its implementation guidelines have clearly indicated that
comprehensive smoke-free legislation eliminating tobacco smoking in all indoor public places and
workplaces must be implemented to protect all people from the harm effects of secondhand smoke.
Based on these, Rio de Janeiro State government approved a smoke-free legislation in 2009, forbidding the
consumption of all tobacco products in enclosed and partly closed collective sites.
Introduction
Disclosure form: JS Issa has consulted for Pfizer and has been the site principal investigator for clinical trials of smoking cessation medications funded by
Pfizer. The other authors reported no conflict.
Objective
The main goal of this study was to compare levels of secondhand smoke exposure, measured through
carbon monoxide concentrations in hospitality venues in Rio de Janeiro City before and after the
implementation of the law.
Material and Methods
A total of 146 hospitality venues in Rio de Janeiro city were visited before and after the tobacco-free policy
was implemented. The sites were a sample of convenience.
The first phase included the period prior to the implementation of the tobacco-free policy and the second
phase was performed approximately 12 weeks after the banning law was introduced. Bars, restaurants,
nightclubs, and similar venues were visited by agents from Rio de Janeiro Secretary of State for Health and
Civil Defense (Figures 1A and 1B). A specific type of portable CO monitor - ToxCo (Bedfont Scientific;
Rochester, England) was utilized.
Data collected from venues were compared with data obtained by the State Environmental Institute of Rio
de Janeiro (INEA) in 4 automatic stations, covering the same region of our collected data. These data were
used to test whether possible reductions in CO could be influenced by other conditions, such as
meteorological elements.
Results
In the pos-ban period, significant reductions in almost all the studied environments were observed (Table 1).
Moreover, the difference between indoor area and open area disappeared in all venue types (restaurants,
bars and others), thus suggesting equalization with outdoor levels. The only exception was observed in the
night clubs, where no significant reduction in the CO concentration was observed in the pre- and pos-ban
measurements (Figures 2 and 3). It can be explained by violation of the law in these places, resulting in
penalties application, and also because of the small number of nightclubs visited.
The quality of the air in the city during the same period of our study measured by INEA was less than 1 in the
pre- and pos-ban periods.
Conclusion
The smoking ban law significantly reduced the CO concentration in hospitality venues. Hence, one can
speculate that the significant reduction obtained in CO concentrations after the adoption of tobacco smoke free
legislation could be related to the reduction in cardiovascular events incidence observed in many places
where similar law has already been adopted.
Closed pre-ban Closed pos-ban
Semi-opened pre-
ban Semi-opened pos-ban Open pre-ban Open pos-ban
Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD
Bar 3.2 2.3 1.0 1.0 2.9 0.9 1.0 1.0 3.0 1.2 0.9 1.0
Night Club 2.6 0.5 2.5 0.6 3.2 0.8 3.0 1.4 3.7 1.5 3.5 2.1
Restaurant 2.3 1.4 1.2 1.0 2.2 1.2 1.2 1.2 2.2 1.3 1.1 1.0
Similar 2.6 1.6 1.0 0.6 3.5 1.8 1.6 0.7 3.1 1.0 1.7 1.3
Pre- and pos-ban CO measurement
0,00
0,50
1,00
1,50
2,00
2,50
3,00
3,50
4,00
Bar Night Club Restaurant Similar
Comeasurement
Closed pre-ban
Closed pos-ban
Semi-opened pre-ban
Semi-opened pos-ban
Open pre-ban
Open pos-ban
Restaurant Night ClubBar
2011 SRNT 17TH ANNUAL MEETING Toronto, Canada
Figure 1A – Team of agents from Rio de Janeiro
Secretary of State for Health and Civil Defense
(SESDEC).
Figure 1B – Agent from SESDEC during
fiscalization.
Figure 1C – Advertisement
about smoke-free law
Table 1 – Pre- and pos-ban mean CO level according to venue type and sampled environment. P value was <0,01 for all places, comparing pre- and pos-ban periods, except for night clubs (p value NS).
Figure 2 – Mean CO concentrations in pre- and pos-ban periods according to location within the venue and venue type.
Figure 3 – Mean CO concentration in bars, restaurants and night clubs in pre- (1) and pos-ban (2) periods. Blue line – open environments; green line – semi open environments; yellow line – closed environments.

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AÇÕES DO ESTADO PARA O
CONTROLE DO TABAGISMO
2.60 ppm 1.12 ppm
12 semanas
56.9%
co

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SAÚDE:
Direito de todos e Dever do Estado
cdtorax@terra.com.br