Brazil Leads the Way to Integrating Tobacco Surveys into its National Surveillance System

Data show that current tobacco smoking among adults in Brazil has declined almost 20% since 2008. Photos courtesy of David Snyder©.

In 2008, Brazil implemented the Global Adult Tobacco Survey (GATS), a stand-alone, nationally representative household tobacco survey that uses a consistent, standardized protocol in participating countries. GATS was conducted as a supplement of Brazil’s National Household Sample Survey (PNAD) among persons aged 15 years and above. Adding GATS as a supplement to PNAD was a visionary step taken by Brazil, making it one of the first countries to embed a stand-alone topical survey into a general household survey, resulting in increased efficiencies in both time and resources. The integrated survey generated more robust data on tobacco use relative to the determinants of health, noncommunicable diseases (NCDs), and other health metrics.

Impact of expanding National Health Survey

In 2013, Brazil also expanded the scope of its data collection by integrating standard Tobacco Questions for Surveys (TQS) into its National Health Survey (PNS), which is planned to be conducted every 5 years. TQS is a standard set of core questions taken from the GATS survey and is a component of the Global Tobacco Surveillance System (GTTS). It was developed by the World Health Organization (WHO), the U.S. Centers for Disease Control and Prevention (CDC), and other partners to assist countries in establishing tobacco control surveillance and monitoring programs. Brazil’s National Health Survey is an ongoing survey which produces national and subnational representative estimates of the health conditions and lifestyle risk factors among the Brazilian adult population. Due to methodological issues, the PNS included the population aged 18 years and older. The integration of the TQS into the framework of Brazil’s ongoing national surveys serves as a mechanism to:

• Harmonize and standardize the monitoring of key tobacco control indicators,
• Promote further efficiencies, and
• Ensure sustainable and consistent generation of data on tobacco use and key tobacco control measures.

According to GATS Brazil 2008, 18.2% (24.1 million) adults aged 18 years and older (22.9% men and 13.9% women) reported current tobacco use. In 2013, according to PNS, 14.7% (21.5 million) adults (18.9% men and 11.0% women) reported current tobacco use. Findings from these two surveys indicated that current tobacco smoking among adults in Brazil declined from 18.2% in 2008 to 14.7% in 2013, which translates to a 19.2% relative reduction in current smoking prevalence.

Model for integrated surveillance and tracking

The model implemented by Brazil carves a new path towards integrated surveillance by systematically tracking tobacco use, NCD risk factors, and other relevant health information to develop, implement and evaluate public health interventions. This method will enable countries to track the WHO NCD global voluntary targets. Brazil's model carves a new path towards integrated surveillance by systematically tracking tobacco use, NCD risk factors, and other relevant health information to develop, implement and evaluate public health interventions. Brazil's model is a best practice for other countries to consider and emphasizes the benefit of multiple stakeholders working together toward a common goal and finding innovative ways to simplify standard surveillance systems. Examples of such partnerships include:

• The Instituto Brasileiro de Geografia e Estatística (IBGE), working with the Brazilian Ministry of Health to implement the surveys. This partnership has been an example for other statistics institutes in the region; and
• The Pan American Health Organization (PAHO), WHO and CDC working collaboratively to support Brazil through technical exchange and workshops.

Brazil has been a pioneer in the development of the WHO Framework Convention on Tobacco Control. The decline in tobacco use in Brazil is a result of the country’s consistent commitment to implementing comprehensive tobacco control measures.

For further information, please contact Dr. Roberta Caixeta at caixetro@paho.org.

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