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Numerous studies from high-income countries document the causal relationship between cigarette smoking during pregnancy and adverse maternal and child health (MCH) outcomes. Less research has been conducted in low and middle income countries, but a burgeoning literature can be found for Brazil. We review Brazilian studies of the prevalence of maternal smoking, the relative risk of smoking-attributable adverse MCH outcomes, and present new estimates for these outcomes, using the attributable fraction method. We found that Brazilian studies of the relative risks of smoking-attributable adverse MCH outcomes were broadly consistent with previous reviews. Based on a comparison of maternal smoking over time, smoking during pregnancy has declined by about 50% over the last 20 years in Brazil. For 2008, we estimate that 5,352 cases of spontaneous abortion, 10,929 cases of preterm birth, 20,717 cases of low birth weight, and 29 cases of sudden infant death syndrome are attributable to maternal smoking. Between 1989 and 2008, the percent of smoking-attributable adverse MCH outcomes in Brazil was at least halved. The results show that over a 20-year period, during which Brazil implemented numerous effective tobacco control measures, the country experienced a dramatic decrease in both maternal smoking prevalence and smoking-attributable adverse MCH outcomes. Countries that implement effective tobacco control measures can expect to reduce both maternal smoking and adverse MCH outcomes, thereby improving the public health.

ObjectiveAccording to WHO, smoking is an important cause of death in many countries. To encourage smoking cessation, persuasive messages can be used to raise smokers' risk perception. This work discusses challenges and solutions in designing a study to evaluate the impact of two different communication strategies (“gains from quitting” vs “losses from continuing smoking”) in encouraging calls to a Quitline.MethodologyA pragmatic intervention study was conducted in two subway stations for 4 weeks. Large posters containing non-age specific images and texts, based on the theme “shortness of breath”, were displayed on central dividing columns on the boarding platforms. Call rates from the selected stations, and respective rate ratios, overall and per study week, were calculated.ResultsPassengers who were smokers, exposed to the positive-content message, called on average 1.7 times more often than those exposed to the negative-content message (p=0.01). Moreover, call rate ratios did not decline over the 4 weeks of the study (multiplicative interaction p=0.40).ConclusionsThe effectiveness findings suggest that anti-smoking campaigns could use positive-content messages in order to recruit a larger smoker population. The proposed methodology can also be used to evaluate effectiveness of messages for “capturing’ individuals with other health problems (eg, alcohol abuse), thereby increasing its potential impact.

The trade-off between welfare and environmental quality is clear in the refining industry. Economic development and well-being are still related to oil product demands in contemporary society. However, the refining industry is usually aggressive to the environment, bringing externalities out to localities where facilities are built. Therefore, there is a dilemma between meeting national oil product demands growth and preventing environmental damages in the locations eligible for a green field project. This paper shows that Brazil should expand its refining industry over the next twenty years by two to four new refineries. One of these refineries, focused on petrochemicals, might be located close to major consumption centers. In this case, Rio de Janeiro State is an interesting option. The analysis indicates the trade-offs between the positive and negative external effects of a new refinery in the Itaguai Municipality. The advantages of good logistics and infrastructure might be offset by the cumulative environmental problems related to air, water and solid wastes management in the region.

ObjectiveTo evaluate the differences in cigarette smoking prevalence in Brazil between 1989 and 2008.MethodologyWe compared absolute and relative differences in smoking prevalence, overall and stratified by selected socio-demographic variables and birth cohort (20-year interval from 1925 to 1934 onwards). Data were obtained from National Household Survey on Health and Nutrition (1989, n=39 969) and Global Adult Tobacco Survey (2008, n=38 461). Generalised linear models with binomial family distribution, and either gaussian or logarithmic link function, were specified in order to obtain estimates, as well as to assess potential effect modification.ResultsCrude and adjusted overall differences in smoking prevalences between 1989 and 2008 were, respectively: absolute, 15.4% and 11.8; relative, 47.5% and 38.7%. We observed the highest declines in smoking prevalences among individuals aged 25–34 years-old (additive or multiplicative interaction ps<0.001) and those with 8 years of schooling or more (multiplicative interaction p<0.001). Moreover, while stratifying by birth cohort, we found that, only in the absolute scale and with the exception of the youngest birth cohort (ie,1965–1974), men presented higher reductions than women (additive interaction terms <0.001).ConclusionsA large amount of laws against tobacco consumption have been adopted in Brazil since 1986, which may have contributed to the observed decline in smoking prevalence. It is of paramount importance to better understand the effectiveness of tobacco control actions implemented in a country and the evolution of its tobacco epidemic in order to improve/develop actions targeted to those who continued to smoke and/or started smoking in a “more hostile” environment.

From a regulation based only on command and control instruments, applied up to the 1970s, Brazilian environmental policy switched to a more preventive approach in the 1980s, and finally became, at least in conception, an integrated environmental policy in the 1990s. The target of this new policy is the use of environmental management policies and economic-based instruments. Law 9433 (enacted in 1997), which focused on water management, incorporated this issue by defining the hydrographic basin as a unit for environmental planning, considering the multiple uses of water resources. However, almost 10 years after this law took effect, Brazil's policy has in many ways regressed to the command and control instruments that prevailed in the 1970s. An example of this is the revision of the code that defines water quality standards and effluent limits. This revision established fixed limits for effluent discharges, thus making no distinction between these discharges according to the related activity or technology. It did not consider the carrying capacity of the water bodies that will receive the discharges, and is not linked to the other instruments set forth in Law 9433 (e.g., economic-based instruments). This might reduce the efficacy of the instruments and generate diseconomies for public and private agents. To contribute to a new revision of Brazilian water codes, this paper presents a cross-sectional analysis comparing the Brazilian water regulation to those applied in France (whose water regulation inspired the Brazilian model) and the United States. Effluent discharge regulation is emphasized in this comparison, along with water quality standards. Finally, the comparison also analyzes how the regulation of effluent discharges is incorporated in the water management policy of these countries.

The effectiveness in the prevention of perinatally transmitted HBV infection was assessed in 11858 pregnant women consecutively recruited in public and private hospitals in six Italian regions during a 2 months period in 2001. Of them 10881 (91.8%) attended HBsAg antenatal screening. The overall HBsAg prevalence was 1.7% (CI 95%: 1.4–1.9); it was 1.4% (CI 95%: 1.2–1.7) in pregnant women born in Italy but 5.9% (CI 95%: 4.1–8.1) in those born in Asia, Africa, central and south America, and eastern Europe. Results of multiple logistic regression analysis indicate that birth in foreign countries (OR 2.0; CI 95%: 1.3–3.0), family size with more than 4 members in the household (OR 3.5; CI 95%:2.7–4.6), and birth in a private hospital (OR 1.9; CI 95%: 1.3–2.8) were all independent predictors of lack of adherence to HBsAg screening. Out of the 182 new-borns of HBsAg positive mothers 172 (95.0%) were given active plus passive immunisation; this figure was 100% in new-borns of foreign mothers. These findings evidence a good effectiveness in the prevention of perinatally transmitted HBV in Italy. More efforts should be addressed to improve the effectiveness of the programme among foreign pregnant women who have high rate of HBsAg and more likely escape HBsAg screening than Italian pregnant women.

This paper studies a decentralized process for solid, liquid and gas waste management in a single-person household (HH), in which the kitchen produces less or no garbage and returns valuable products to support its own system. It particularly focuses on two CO2-consuming solid waste management scenarios; (1) to use garbage as a power source with a home incinerator to run a Sabatier-reactor with an outcome of energy (methane) and water; and (2) to produce hydrogen from methane and water in order to close the lifecycle, which otherwise has to be supplied from outside. Further integration of a hydroponic unit controls the flow of excess gases to produce food, provide clean air while cooling the incinerator and improving combustion efficiency. The volume requirement of approximately 2m[sup3 could be integrated inside a prefabricated wall so that the waste management utility can be easily commercialized and installed without additional space requirements. Due to decentralization process and elimination of municipal waste collection, process and treatment infrastructure, installing the IF system could serve as a catalyst in the reduction of approximately 187 million tons of CO2-emission in the case of Japan; a 9% decrease from the 1990 emission values, where the target is set for 6% by 2012. Thus, it minimizes stress to expensive landfill area; integrating the potential of solid waste into the daily lifecycle and proposing a future kitchen system for everyday and emergency use, both in developing and industrialized countries.

This paper presents the Eco Industrial Park (EIP) concept, an environmental management tool that is being spread in many nations as an industrial model that can reconcile the three 'Es' of sustainability - environment, social equity and economic efficiency - as it reorganizes industrial practices and activities in order to meet sustainable development goals. This mutual benefit results in more sustainable communities and environment, in the reduction of pollution, by products and waste discarded in the environment, increasing companies' competitiveness and access to new markets. Although this is an emerging concept, there are many EIP projects being implemented, and many of them already operating in North America, Europe, Asia, Central and South America, including in Rio de Janeiro State (RJS), Brazil. This paper highlights the problem of waste generation increase from the industrial sector. All over the world, economic growth has increased resource consumption and environmental degradation. Industrialization brought wealth and development; however it has also brought many externalities. One of these externalities is the high level of by products and waste discarded by societies, being disposed in the environment without proper treatment and management. The objective of this paper is to present how EIPs can contribute to the reduction, reuse and recycling (3R's) of by products and waste from the industrial sector. As a case study, this paper presents the Paracambi EIP, located in RJS, in which the methodology of the software Facility Synergy Tool (FaST), developed by the US-EPA, was a major tool used in order to develop by products and waste synergies among the different industrial typologies suggested for this EIP. Finally this paper presents an analysis and recommendations in the long term, regarding EIP development that may be implemented by the public sector in partnership with the private sector, communities and university.

The South African Constitution provides the basis for defining the promotion of equity, equality and the advancement of the quality of life of all people of South Africa. The National Water Act has been hailed internationally as providing a promising legal framework within which to implement equitable and sustainable water management. This framework mandates a process of bringing together all stakeholders for the purpose of building partnerships and networks and promoting consensus on water management issues in an empowering, democratic and transparent manner. A core focus is the need to promote an effective and efficient approach to the structured promotion of stakeholder participation in water resource management. This Paper documents the work undertaken and successes achieved in the empowerment and involvement of previously disadvantaged communities through the training of 'Catchment Mentors'. Training has allowed the initiative to fully support and integrate with existing initiatives to promote accreditation and develop opportunities for certificated training courses that will promote career options and opportunities.