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Rationale, aims, and objectives There is limited research on how health care providers approach the topic of e-cigarettes in clinical encounters, especially in conjunction with other best-practice recommendations for smoking cessation. This qualitative study explored physician perceptions and recommendations involving e-cigarettes in the context of smoking cessation counselling, including their opinions about the implementation and content of patient educational materials that focus on e-cigarettes. Methods Semistructured interviews were conducted with 15 physicians from family medicine, internal medicine, and obstetrics/gynaecology (OB/GYN). Results Physicians did not routinely assess e-cigarette use among patients and reported that discussions were often initiated by patients. Only a minority of participants discussed e-cigarettes in conjunction with other best-practice recommendations for smoking cessation. Most others were more ambivalent about e-cigarette safety and effectiveness for cessation and did not address the topic, unless patients were already using e-cigarettes. Almost all, however, agreed that more research on e-cigarettes was needed. Physicians expressed an interest in having enhanced discussions about e-cigarettes with their patients and in using patient educational materials to accomplish this. Physicians recommended that these materials not actively promote e-cigarettes and be tailored to patients based on their demographics and motivation to quit. Conclusions Physicians were open to improving their smoking cessation counselling and to integrating new patient educational materials that addressed e-cigarettes. Patient educational materials that provide tailored information about e-cigarettes could potentially be used initiate e-cigarette discussions and inform smokers about what is known vs unknown about e-cigarettes.

Introduction Smokers increasingly use e-cigarettes to try to quit smoking, even more than recommended cessation methods. However, few smokers discuss the range of cessation options with their physicians. Decision aids can inform smokers about smoking cessation options, including evidence about e-cigarettes, and encourage smokers to engage in shared decision making with their physician. Aims and Methods This study aimed to evaluate a smoking cessation decision aid that included e-cigarette risks and benefits. Adult smokers were recruited from primary care clinics for two research phases: (1) usability and acceptability testing of the decision aid (n = 37); and (2) pre-post study that compared usual care (n = 90) with implementation of the decision aid in clinics (n = 90). For the latter, outcome measures included frequency of clinical discussions of readiness to quit, methods to quit in general, and of specific cessation methods, in addition to decisional conflict, communication satisfaction, and overall patient satisfaction. Results Smokers indicated high usability and acceptability of the decision aid. In the pre-post evaluation, decision aid implementation was associated with higher rates of smokers: being asked if they were ready to quit smoking (89% vs. 67%, respectively; p < .001); discussing methods for smoking cessation in general (81% vs. 48%; p < .001); and discussing specific cessation methods (NRT 55% vs. 26%, p < .001; prescription medications 26% vs. 12%, p = .022). Decision aid use was also associated with higher overall patient satisfaction with the physician visit. Conclusions Smoking cessation decision aids that incorporate information about e-cigarettes are acceptable among smokers and can lead to evidence-based clinical discussions about smoking cessation. Implications Smokers use e-cigarettes more than recommended cessation methods when they are trying to quit smoking, yet few physicians discuss the risks and benefits of e-cigarettes with their patients who smoke. This study presents preliminary findings about the feasibility and usability of a clinically based iPad-delivered smoking cessation decision aid that integrates information about e-cigarettes. Although promising, further research with randomized designs, larger samples, and longer-term follow-up is needed to determine whether this type of intervention can effectively promote cessation of all tobacco products and, for those not ready to quit smoking, the use of e-cigarettes for harm reduction.

While the literature on sexual scripts is substantive, with some scholarship examining the role of popular media in the production of dominant and divergent sexual practices and interactions, limited attention has been paid to the contemporary Mexican context. In this article, we share findings from a quantitative content analysis of popular Mexican films in order to explore how sexual behavior is portrayed and more specifically how relationship characteristics, condom use, and substance use interact with representations of sexual behavior. We find that more sexually explicit portrayals featured people engaged in heterosexual sexual interactions outside the context of marriage and also in age discordant relationships, where one partner was a minor. Few films featured safer sex practices or substance use in concert with sexual behavior. This research sheds light on how film as a powerful agent of socialization communicates sexual scripts in contemporary Mexican culture that may contribute to risky sexual behaviors among Mexican youth.

Introduction The impact of pregnancy-related health warning labels (HWLs) appearing on cigarette packages on women of reproductive age and other socio-demographic groups is not well understood. The current study analyzes how different age/gender groups respond to pregnancy-related HWLs as compared to non-pregnancy HWLs. Methods Data were analyzed from four waves of an online longitudinal study with adult smokers aged 18–64 in Australia, Canada, Mexico, and the US. Participants were classified into four age\gender groups: women 40 and under; men 40 and under; women over 40; men over 40. Participants rated one pregnancy-related and several non-pregnancy related labels on worry, believability, and motivation to quit. Country-specific adjusted linear GEE were estimated regressing ratings for each of the three key outcomes for 1) pregnancy-related HWLs and 2) a rating difference score that subtracted the average ratings of the non-pregnancy warning from the rating of the pregnancy warning. All models adjusted for socio-demographics and smoking related variables. Results In Mexico and Australia, where graphic pregnancy-related HWL imagery is used (i.e., premature infant), women of reproductive age reported stronger believability, worry, and quit motivation than all other groups. Results were similar in the US, where text only HWLs are used. In contrast in Canada, where the pregnancy-related HWL imagery features a pregnant woman, ratings were unassociated with gender/age groups. Stronger effects among women of reproductive age were limited to pregnancy HWLs in each country, except Canada. Conclusions HWLs that depict graphic effects to illustrate smoking-related pregnancy risks appear to be perceived as particularly effective among women of reproductive age.

The aim of this study was to assess film character portrayals of tobacco and alcohol use in US and nationally-produced films that were popular in Argentina and Mexico from 2004–2012. We performed a content analysis of these films (n = 82 Argentine, 91 Mexican, and 908 US films, respectively). Chi-squares and t-tests were used to compare characteristics of characters who smoked or drank by country of movie production. Then data from all countries were pooled, and generalized estimating equation (GEE) models were used to determine independent correlates of character smoking or drinking. There were 480 major characters for Argentine-, 364 for Mexican-, and 4962 for US-produced films. Smoking prevalence among movie characters was similar to population smoking prevalence in Mexico (21%) and Argentina (26%), but about half in the US (11%), where movie product placements are restricted. Movie smoking declined over the period in all three countries. Movie alcohol prevalence was 40–50% across all countries and did not change with time. Demographic predictors of character smoking included: being male, 18 and older, having negative character valence. Movie smoking was not associated with lower SES. Predictors of character drinking included: being age 18 and older and positive character valence. Smoking and drinking predicted each other, illicit drug use, and higher scores for other risk behaviors. This suggests that policy development in Mexico and Argentina may be necessary to reduce the amount of character tobacco and alcohol use in films.

Objective. To evaluate the inter-rater reliability of a data collection instrument to assess the tobacco retail environ- ment in Mexico, after major marketing regulations were implemented. Materials and methods. In 2013, two data collectors independently evaluated 21 stores in two census tracts, through a data collection instrument that assessed the presence of price promotions, whether single cigarettes were sold, the number of visible advertisements, the pre- sence of signage prohibiting the sale of cigarettes to minors, and characteristics of cigarette pack displays. We evaluated the inter-rater reliability of the collected data, through the calculation of metrics such as intraclass correlation coefficient, percent agreement, Cohen’s kappa and Krippendorff’s alpha. Results. Most measures demonstrated substantial or perfect inter-rater reliability. Conclusions. Our results indicate the potential utility of the data collection instrument for future point-of-sale research.

Background To inform consumers, U.S. Federal Courts have ordered the tobacco industry to disseminate "corrective statements" (CSs) about their deception regarding five topics: smoker health effects, nonsmoker health effects, cigarette addictiveness, design of cigarettes to increase addiction, and relative safety of light cigarettes. Purpose To determine how smokers from diverse backgrounds respond to the final, court-mandated wording of these CSs. Methods Data were analyzed from an online consumer panel of 1,404 adult smokers who evaluated one of five CS topics ( n =280–281) by reporting novelty, relevance, anger at the industry, and motivation to quit because of the CS. Logistic and linear regression models assessed main and interactive effects of race/ethnicity, gender, education, and CS topic on these responses. Data were collected in January 2013 and analyzed in March 2013. Results Thirty percent to 54% of participants reported that each CS provided novel information, and novelty was associated with greater relevance, anger at the industry, and motivation to quit because of the message. African Americans and Latinos were more likely than non-Hispanic whites to report that CSs were novel, and they had stronger responses to CSs across all indicators. Compared to men, women reported that CSs were more relevant and motivated them to quit. Conclusions This study suggests that smokers would value and respond to CSs, particularly smokers from groups that suffer from tobacco-related health disparities.

Objective To assess whether exposure to movie smoking is associated with cigarette smoking among Argentinian adolescents. Study design A school-based longitudinal study involving 33 secondary schools in Argentina was performed. The sample included 2502 never smokers (average age at entry = 12.5 years), 1700 (67.9%) of whom completed follow-up surveys 17 months later. Exposure to the top 100 highest-grossing films for each year between 2009 and 2013 was assessed by content-coding films for tobacco and then by asking adolescents whether they had seen each of 50 titles, randomly selected from the larger pool, then parsing exposure into tertiles. Logistic regression models estimated aOR for the following transitions: nonsusceptible to susceptible never smoker, never smoker to ever smoker, and never smoker to current smoking (last 30 days). Results At follow-up, 34.4% of nonsusceptible never smokers became susceptible, 24.1% reported having tried smoking, and 9.4% were current smokers. Most exposure to movie smoking was from US-produced films (average 60.3 minutes compared with only 3.4 minutes from Argentine films). Greater exposure to smoking in movies was significantly associated with increased odds of becoming susceptible (aOR first vs third tertile 1.77, 95% CI 1.30-2.41), of trying smoking (aOR first vs third tertile 1.54, 1.14-2.08), and marginally associated with current smoking (AOR first vs third tertile 1.54, 0.99-2.40). Exposure to smoking in US- or Argentine-produced films had similar associations. Conclusion In Argentina, exposure to smoking in the movies predicted future smoking transitions among early adolescents, with most exposure coming from viewing US movies.

Tobacco, alcohol and drug use starts at an early age. It is important to identify risk factors associated with initiation. In 2014, a survey was conducted among students attending first year of secondary schools in Buenos Aires, Córdoba, and Tucumán. A total of 3172 students completed the survey (42% were girls); their mean age was 12.8 years old. Findings showed that 10% had smoked; 32% had consumed alcohol; 17% had a heavy drinking episode in the past month; and 8% had used at least one illegal drug once in their lifetime. A high sensation seeking index was associated with the use of tobacco (odds ratio [OR]: 4.25, 95% confidence interval [CI]: 2.2-8.1), alcohol (OR: 5.56, 95% CI: 3.73-8.31), and marijuana, coca paste or cocaine, (OR: 11.73, 95% CI: 5.81-23.69). Having friends who smoke or drink was associated with tobacco (OR: 12.6, 95% CI: 7.8-20.5) and alcohol use (OR: 5.17, 95% CI: 4.15-6.40). Having permissive parents in terms of media use was associated with tobacco use (OR: 3.7, 95% CI: 2.1-6.5), and perceiving a low parental support and control (OR: 3.02, 95% CI: 1.40-6.52) was associated with marijuana, coca paste and cocaine use.El consumo de tabaco, alcohol y otras drogas comienza a temprana edad. Es importante identificar los factores de riesgo asociados al inicio. En 2014, se encuestaron estudiantes de primer año del secundario en Buenos Aires, Córdoba y Tucumán. Respondieron 3172 alumnos (42% de mujeres); edad media de 12,8 años. El 10% había fumado; el 32% había consumido alcohol; el 17% había tenido consumo excesivo durante el último mes, y 8% había consumido, al menos, una droga ilícita en su vida. El índice de búsqueda de emociones alto se asoció al consumo de tabaco (OR 4,25; IC 95%: 2,2-8,1), alcohol (OR 5,56; IC 95%: 3,73-8,31) y marihuana/paco/cocaína (OR 11,73; IC 95%: 5,81-23,69). Tener amigos que consumían tabaco/alcohol se asoció al consumo de tabaco (OR 12,6; IC 95%: 7,8-20,5) y alcohol (OR 5,17; IC 95%: 4,15-6,40). Tener padres que imponían pocas restricciones en el uso de medios se asoció al consumo de tabaco (OR 3,7; IC 95%: 2,1-6,5) y percibir un bajo control y soporte parental (OR 3,02; IC 95%: 1,40-6,52) se asoció al consumo de marihuana/paco/cocaína.

Purpose: To determine characteristics of smokers discussing e-cigarette use with their physician and receiving recommendations from their physician to use e-cigarettes for smoking cessation. Methods: US adult smokers who had visited a physician in the previous 12 months (n = 2671) were surveyed. Logistic generalized estimating equation models were used to assess the characteristics of smokers who (1) talked to a physician about e-cigarettes, and (2) received physician advice to use e-cigarettes for smoking cessation. Results: 15% (n = 406) of smokers who visited a physician talked with their physician about e-cigarettes. Among those asked whether their physician recommend e-cigarettes for smoking cessation (n = 257), 61% responded affirmatively. Current e-cigarette users were more likely to talk to their physicians about e-cigarettes (nondaily users vs never users: OR, 2.70; 95% CI, 1.79–4.05; daily users vs never users: OR, 4.29; 95% CI, 2.34–7.84) and have their physician recommend e-cigarettes for smoking cessation (daily users vs never users: OR, 9.40; 95% CI, 2.54–34.71). Conclusions: The majority of smokers who talk to their physician about e-cigarettes report that they received advice to use e-cigarettes to quit smoking, despite limited evidence for their efficacy. More studies are needed to better understand e-cigarette recommendations in clinical settings.

BACKGROUND: Our objective was to assess whether exposure to alcohol use in films (AUF) is associated with alcohol use susceptibility, current alcohol use, and binge drinking in adolescents from 2 Latin American countries. METHODS: We performed a cross-sectional study with 13,295 middle school students from public and private schools in Mexico and Argentina. Exposure to alcohol use in over 400 contemporary top box office films in each country was estimated using previously validated methods. Outcome measures included current drinking (i.e., any drink in the last 30 days), ever binge drinking (i.e., more than 4 or 5 drinks in a row for females and males, respectively) and, among never drinkers, alcohol susceptibility (i.e., might drink in the next year or accept a drink from a friend). Multivariate models were adjusted for age, sex, parental education, peer drinking, sensation seeking, parenting style, and media access. RESULTS: Mean age was 12.5 years (SD = 0.7), and the prevalence of alcohol consumption and binge drinking was 19.8 and 10.9%, respectively. Mean exposure to alcohol from the film sample was about 7 hours in both countries. Adjusted models indicated independent dose-response associations between higher levels of exposure to AUF and all outcomes; the adjusted odds ratios (aORs) comparing quartiles 4 and 1, 1.99 (95% confidence interval [CI] 1.73 to 2.30) for current drinking, aOR 1.68 (CI 1.39 to 2.02) for binge drinking, and aOR 1.80 (1.52 to 2.12) for alcohol susceptibility. Compared to Mexican adolescents, Argentine adolescents were significantly more likely to have engaged in binge drinking (aOR 1.40, 95% CI 1.12 to 1.76) and, among never drinkers, were more susceptible to try drinking (aOR 1.40, 95% CI 1.20 to 1.64). CONCLUSIONS: Higher levels of exposure to AUF were associated with higher likelihood of alcohol use, binge drinking, and alcohol susceptibility in Latin American adolescents. Language: en

Background Studies that have evaluated tobacco and alcohol portrayals in films have mainly focused on US films. Our aim is to describe tobacco and alcohol portrayals in nationally produced films from six European and two Latin American countries, and compare them with US produced films. Methods A sample of 337 nationally produced and 502 US produced films, consisting of top grossing films from 2004 to 2009 in each country, was content coded for presence of tobacco or alcohol and seconds of tobacco or alcohol use. Logistic and linear regression models were estimated for all films and youth-rated films (Ages 0–14) to assess cross country differences in tobacco and alcohol content, with US films as the reference category. Results Domestically produced films from several countries were more likely than US films to contain any tobacco use both overall (Iceland (OR = 9.29, CI: 1.22–70.89), Italy (OR = 3.58, CI: 1.72–7.43), Argentina (OR = 5.06, CI: 2.13–12.03), Mexico (OR = 4.87, CI: 2.17–10.90)) and for youth-rated films (Germany (OR = 2.24, CI: 1.21–4.16), Iceland (OR = 13.79, CI: 1.80–105.5), Italy (OR = 5.31, CI: 2.54–11.1), and Argentina (OR = 6.9, CI: 0.88–1.34)). Models for alcohol showed few differences compared to US, regardless of rating. Linear regression models for seconds of use in films with tobacco indicated that only Argentine films had more seconds of smoking than US films, regardless of the rating category. For films with alcohol use, Mexican films had higher seconds of alcohol use than US films. Conclusions Smoking was more commonly depicted in films produced outside the US, however there were few differences in the means for smoking screen time in films that contained smoking. This may be partly explained by the prohibition of tobacco product placement in the US. Countries should consider banning paid placement of both products and eliminating subsidies for films with content that promotes tobacco and alcohol use.

Across the Americas, Chile has the highest prevalence of adult and youth smoking (40.6% and 39.2%, respectively).1 ,2 The WHO's Framework Convention on Tobacco Control recommends prohibiting direct and indirect tobacco advertising, promotion and sponsorship (TAPS), including portrayals of tobacco in films.3 The tobacco industry has long used films to promote its products.3 ,4 Evidence from numerous countries consistently demonstrates that exposure to tobacco use in films promotes youth smoking, which provides the rationale for policy development in this area.3 ,4 In May 2011, Chile introduced legislation to ban smoking in enclosed public spaces. From May 2011 to January 2013, Chilean lawmakers discussed amending this legislation to include a ban of all forms of indirect TAPS. The tobacco and entertainment industries lobbied against this legislation, and the TAPS provisions were weakened when they passed in January 2013. Only partial TAPS restrictions were adopted, which included prohibition of paid tobacco product placement. The media can influence policy decisions.5 Prior studies have examined how media represent tobacco control policies, particularly smoke-free policies6 …