{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T18:23:28Z","timestamp":1762712608200,"version":"build-2065373602"},"reference-count":32,"publisher":"BMJ","funder":[{"DOI":"10.13039\/501100004587","name":"Carlos III Health Institute","doi-asserted-by":"crossref","award":["PI22\/00727"],"award-info":[{"award-number":["PI22\/00727"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Tob Control"],"accepted":{"date-parts":[[2025,10,22]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To estimate the attributable mortality to secondhand tobacco smoke (SHS) exposure among the population aged 35 years and older in Brazil and its 27 federal units in 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>Attributable mortality analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prevalence-dependent method was applied. Attributable mortality to SHS exposure was estimated under two scenarios. In scenario 1, attributable mortality from three causes (ischaemic heart disease, lung cancer and stroke) was calculated using the relative risks (RRs) reported by the Surgeon General. In scenario 2, attributable mortality from eight causes (ischaemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, type 2 diabetes mellitus, asthma, lower respiratory tract infections and breast cancer) was calculated using RRs derived from a recent meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Scenario 1: in 2019, SHS exposure caused 10\u2009604 deaths in Brazil, 5451 of which were due to ischaemic heart disease, 830 to lung cancer and 4323 to stroke. The attributable mortality rate due to SHS exposure varied across federal units, ranging from 5.6 deaths per 100\u2009000 inhabitants in Amazonas to 16.1 in Piau\u00ed. Scenario 2: exposure to SHS caused 20\u2009292 deaths, 5258 of which were due to ischaemic heart disease. In scenario 2, mortality attributable to SHS exposure from lung cancer increased, while mortality from ischaemic heart disease and stroke decreased compared to Scenario 1.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In Brazil, exposure to SHS is estimated to cause between 30 and 60 deaths per day. The mortality rates varied across federal units. Differences in the risk sources and the selection of health outcomes significantly influence mortality estimates. These findings underscore the importance of strengthening the enforcement of tobacco control policies by health authorities in Brazil.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/tc-2025-059444","type":"journal-article","created":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T18:20:25Z","timestamp":1762712425000},"page":"tc-2025-059444","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Attributable mortality to secondhand tobacco smoke exposure in the 27 Brazilian federal units in 2019"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2696-4003","authenticated-orcid":false,"given":"Bibiana","family":"Wanderlei-Flores","sequence":"first","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2960-8437","authenticated-orcid":false,"given":"Julia","family":"Rey-Brandariz","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain"},{"name":"Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain"},{"name":"Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiolog\u00eda y Salud P\u00fablica - CIBERESP), Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paulo C\u00e9sar","family":"Rodrigues Pinto Corr\u00eaa","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidade Federal de Ouro Preto, Ouro Preto, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla","family":"Guerra-Tort","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain"},{"name":"Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guadalupe","family":"Garc\u00eda","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain"},{"name":"Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luc\u00eda","family":"Mart\u00edn-Gisbert","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Candal-Pedreira","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain"},{"name":"Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain"},{"name":"Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiolog\u00eda y Salud P\u00fablica - CIBERESP), Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agust\u00edn","family":"Montes","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain"},{"name":"Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain"},{"name":"Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiolog\u00eda y Salud P\u00fablica - CIBERESP), Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4456-6631","authenticated-orcid":false,"given":"M\u00f3nica","family":"P\u00e9rez-R\u00edos","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain"},{"name":"Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain"},{"name":"Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiolog\u00eda y Salud P\u00fablica - CIBERESP), Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,11,9]]},"reference":[{"key":"2025110910201849000_tc-2025-059444v1.1","doi-asserted-by":"crossref","unstructured":"World Health Organization . 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