REVERSAL IN THE SMOKING PREVALENCE TREND IN BRAZIL: SOCIOECONOMIC IMPACTS AND THE DEVELOPMENT OF THE PNCT – AN INTEGRATIVE REVIEW (2017-2025)

Abstract

Tobacco use constitutes a preventable epidemic with severe socioeconomic and health impacts in Brazil, classified by ICD-11 as a nicotine-related disorder and a major modifiable risk factor for non communicable diseases. This integrative literature review analyzed 10 studies published between 2017 and 2025, sourced from SciELO, LILACS, BVS, and PubMed, to assess the social and economic impacts of smoking and the development of the National Tobacco Control Program (PNCT) within the Brazilian Unified Health System (SUS). Findings indicate a historical decline in smoking prevalence (from 35% in 1989 to 9.3% in 2023, Vigitel), followed by a recent reversal to 11.6% in 2024, with sharp increases among women and youth linked to electronic nicotine delivery systems (ENDS). The PNCT, established by GM/MS Ordinance No. 502/2023, shows progress in expanding primary care coverage, treatment initiation, and free pharmacotherapy (NRT, bupropion, varenicline). However, challenges persist, including high treatment dropout rates (up to 40%), access barriers, and socioeconomic/mental health vulnerabilities. Annual costs attributable to smoking reach R$ 153.5 billion. The results highlight the relevance of ongoing efforts to strengthen the PNCT, focusing on equity, interprofessional integration, and adaptation to emerging risks, in order to address recent upward trends in prevalence and enhance public health benefits. Strengthening the PNCT through interprofessional training, targeted campaigns, strict regulation of new products, and sustained fiscal investments is essential to reverse trends, enhance equity, and maximize public health benefits.