A passion for tobacco control in Brazil

SONY DSCMontezuma Ferreira
Instituto de Psiquiatria da Faculdade de Medicina da Universidade de São Paulo
27-flag Brazil
28 Feb 2014

You have been very active and passionate about tobacco control/tobacco dependence treatment. What led to your involvement?

I developed an interest for psychiatry and drug addiction during medical school. During residence training, I did a lot of work in the field and was intrigued by the peculiarities of nicotine pharmacology, its subtle and fast psychological effects, by the fact that smokers seem to control its effects by very accurate dosing. I was interested in reward, learning and neuroplasticity in general, and in the effects of context on drug actions. But I do clinical work, and I soon became more aware of the importance of social and economic factors in the causation and maintenance of smoking. I made contact with people who do advocacy, and I think we’ve been working together for some time, now.

Tell us about your activity and passion about tobacco control.

Well, I’d say that what I do is mostly clinical work. But I think that doing some advocacy for tobacco is essential. As we know, tobacco control requires firm action in various areas, from education and advertising bans, to taxation and legal actions, and so on. And people look for doctors for information on the health effects of tobacco, on best treatments, etc.

What are some of the things you have been able to accomplish, specifically in the tobacco control arena?

Well, there has been a lot of success in tobacco control in Brazil. I would say the credit for that should go mainly to the people at the Instituto Nacional de Cancer (INCA) and for NGO’s such as ACTbr (Aliança de Controle do Tabagismo, or Tobacco Control Alliance). Obviously, there is a lot to be done, and I joined Global Bridges, ACTbr, and Treatobacco.net in that effort. When I started to work in the field, the Brazilian tobacco control movement had already been ignited by some heroic figures which had to face a huge challenge. I would say my generation has been able to continue and amplify the effort of those pioneers.

We need to continue monitoring the tobacco use and dependence in Brazil in order to get a clearer picture of where the epidemic is going. There has been a large decrease in the prevalence of smoking in the country but we know that the tobacco industry is very active in attracting new victims. We have to keep working on the denormalization of tobacco consumption. There is a need for increasing taxation and for the implementation of smoke-free public places, which are not a rule in all Brazilian states.

Also, there is a battle going on for the approval and implementation of legislation restricting the addition of sugars, flavoring agents and other substances to tobacco products and an important part of the Brazilian Congress seems not to understand the importance of that.

Describe some of the biggest challenges you face in your work.

Well, Brazil is one of the main growers and exporters of tobacco in the world, so there is a huge lobby against control measures. Despite the success in recent years, we cannot consider tobacco control to be an established national policy. There is always the danger of setbacks.

I think there are also important aspects of the treatment of smoking that still need improvement in my country. Knowledge on the principles of intervention and training in the practical aspects of treatment, on the “how-to-do” of counseling, is far from ideal. Many health professionals tell me they don’t feel confident to apply modern motivational interventions and behavioral counseling to smokers. Many of those professionals also tell me they have basic doubts about pharmacological component of treatment. They don’t know which treatments exist and whether they are really effective.

The idea that drug treatment is important and should be offered to smokers trying to quit is not widespread in Brazil. Availability of treatment for smoking still is a problem in my country.

One specific point is that Brazil is a very unequal society with a large number of poor people, which, of course, are also less educated. Unfortunately, these seem to have been less successful in quitting tobacco. I think that developing and delivering treatment to this population should be a priority.

Please tell us about some of the things you are working on now.

I am studying the treatment of smokers with psychiatric disorders and should be able to offer better interventions for those patients hospitalized for mood disorders, schizophrenia, or eating disorders. I am also studying pedagogical techniques and medical teaching in general and expect to be able share this knowledge in a project with Global Bridges.

Is there that you would like to add – something that you want people to know?

Working with the Center for Addiction and Mental Health (CAMH) has been a great experience for me. It has put me in contact with leading professionals not only from the USA and Canada, but also from Latin America and other parts of the world. So far, we’ve adapted a module on the treatment of smoking so that it can be available to Spanish-speaking health professionals in Latin America. I hope we can reach many professionals and help them learn about motivational interventions and so on.

We’ve also been learning about aspects specific to different cultures in the continent and I hope we can more specific materials. And I hope we can combine the internet module(s) with other forms of teaching, from face-to-face training sessions to massive open online courses (MOOCs), in order to combine breadth and depth of reach.