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Introduction As a result of globalization, youth in Mexico may be exposed to US culture remotely. This remote intercultural contact may influence their movie language orientation and cigarette smoking. To examine how intercultural contact with U.S. culture influences the smoking behaviors of youth in Mexico, this study investigated the influence of English- and Spanish-language movie orientation on movie smoking exposure through US- and Mexico-produced movies. It also examined whether youth movie smoking exposure was associated with higher positive smoking-related expectancies and greater intentions to smoke cigarettes. Methods Participants were 7524 adolescent never smokers in Mexico (51% female, Mage = 12.39 years) who completed a school-based survey on movie language orientation, movie exposure (from which exposure to tobacco portrayals was estimated), smoking-related expectancies, and smoking susceptibility. Results Path and mediation analyses indicated that English-language movie orientation was associated with greater movie smoking exposure, leading to more positive smoking-related expectancies and greater youth smoking susceptibility. Conclusion Consistent with research on the influence of US culture on the smoking of Mexican-heritage youth in the United States, findings suggest that orientation toward English-language movies may put youth in Mexico at risk for smoking initiation. Findings extend existing research on intercultural contact and cigarette smoking with Hispanic youth in the United States to youth in Mexico. Implications for future research are discussed. Implications This study is one of the first to investigate the influence of remote intercultural contact with US culture on Mexican youth's smoking-related expectancies and susceptibility. This study investigated pathways by which youth's movie language orientation (English vs. Spanish) exposed them to movie smoking through US- and Mexico-produced movies, thereby influencing their smoking-related cognitions. Findings provide initial empirical evidence of a significant association between US remote intercultural contact and smoking among youth in Mexico. An important next step is to investigate how this process unfolds longitudinally and to investigate additional ways youth may engage with US culture to affect their smoking behaviors.

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.

Background Use of flavour capsule varieties (FCVs) of cigarettes has rapidly increased in many countries. Adolescents are attracted to flavours; yet, surprisingly, no quantitative study has explored adolescents9 perceptions of these products. Objective To characterise the appeal of FCVs for young adolescents in Mexico. Methods In 2015, surveys were conducted with a representative sample of Mexican middle school students (n=10 124; ages 11–16 years; mean 12.4 years). Students viewed and rated packs for FCVs and non-FCVs from major brands (Marlboro, Camel, Pall Mall), with brand names removed. For each pack, students were asked to write the brand name (ie, brand recall), to evaluate pack attractiveness, and to indicate the pack they were most interested in trying (including a ‘none’ option). Logistic generalised estimating equation (GEE) models regressed brand recall, pack attractiveness and interest in trying on brand and FCV (yes vs no), controlling for sociodemographics and smoking risk factors. Results Marlboro regular, Camel regular, Camel light and Pall Mall FCVs were most often recalled (25%, 17%, 9%, 8%). Packs for Pall Mall FCVs and Camel FCVs were most often rated as very attractive (13%, 9%, respectively) and of interest for trial (22%, 13%) along with Marlboro regular (14%). In GEE models, FCVs were independently associated with greater attractiveness (adjusted OR (AOR)=1.83, 95% CI 1.72 to 1.94) and interest in trying (AOR=1.74, 95% CI 1.54 to 1.96). Perceived pack attractiveness was also independently associated with greater interest in trying (AOR=5.63, 95% CI 4.74 to 6.68). Conclusions FCVs appear to be generating even greater appeal among young adolescents than established non-FCVs in dominant brand families.

espanolIntroduccion: el tabaquismo en peliculas promueve el inicio de tabaquismo en adolescentes Objetivo: estimar el nivel de exposicion a imagenes de tabaco contenidas en peliculas vistas por adolescentes de Argentina y Mexico Metodos: Se realizo una encuesta a alumnos de primer ano del secundario de Argentina y Mexico. Se analizaron las 100 peliculas con mayor recaudacion en cada ano del periodo 2009-2013 (Argentina) y 2010-2014 (Mexico). A cada participante se le asigno una muestra aleatoria de 50 de estas peliculas, preguntandosele si la habia visto. Se estimo el numero total de adolescentes que habian visto cada pelicula en cada pais, y se multiplico por el numero de escenas que contenian tabaco (ocurrencias) en cada pelicula para asi obtener el numero de impresiones crudas de tabaco vista por los adolescentes escolarizados de cada pais. Resultados: Se analizaron 422 films en Argentina y 433 en Mexico. Mas de 500 millones de imagenes de tabaco fueron vistas por la poblacion joven de cada pais, lo que promedia 128 y 121 minutos de escenas con tabaquismo por cada adolescente en Argentina y Mexico respectivamente. Si bien los films calificados para mayores de 15/16/18 anos tenian mayor promedio por pelicula de escenas de tabaco, las peliculas calificadas para menores de esta edad fueron responsables de la mayor cantidad de escenas de tabaquismo vistas por adolescentes (67,3% en Argentina y 54,4% en Mexico) debido a su mayor audiencia. Conclusiones: A nivel poblacional son las peliculas para ninos las maximas responsables de la carga de tabaco vista por adolescentes. EnglishBackground: Smoking scenes in movies promote adolescent smoking onset; thus, the analysis of the number of smoking images inmovies really reaching adolescents has become a subject of increasing interest.Objective: The aim of this study was to estimate the level of exposure to images of smoking in movies watched by adolescents in Argentina and Mexico.Methods: First-year secondary school students from Argentina and Mexico were surveyed. One hundred highest-grossing films from each year of the period 2009-2013 (Argentina) and 2010-2014 (Mexico) were analyzed. Each participant was assigned a random sampleof 50 of these movies and was asked if he/she had watched them. The total number of adolescents who had watched each movie ineach country was estimated and was multiplied by the number of smoking scenes (occurrences) in each movie to obtain the numberof gross smoking impressions seen by secondary school adolescents from each country.Results: Four-hundred and twenty-two movies were analyzed in Argentina and 433 in Mexico. Exposure to more than 500 million smoking impressions was estimated for adolescents in each country, averaging 128 and 121 minutes of smoking scenes seen by each Argentine and Mexican adolescent, respectively. Although 15, 16 and 18-rated movies had more smoking scenes in average, moviesrated for younger teenagers were responsible for the highest number of smoking scenes watched by students (67.3% in Argentinaand 54.4% in Mexico) due to their larger audience.Conclusion: At the population level, movies aimed at children are responsible for the highest tobacco burden seen by adolescents.

Purpose Assess the prevalence and correlates of e-cigarette perceptions and trial among adolescents in Mexico, where e-cigarettes are banned. Methods Cross-sectional data were collected in 2015 from a representative sample of middle-school students (n = 10,146). Prevalence of e-cigarette awareness, relative harm, and trial were estimated, adjusting for sampling weights and school-level clustering. Multilevel logistic regression models adjusted for school-level clustering to assess correlates of e-cigarette awareness and trial. Finally, students who had tried only e-cigarettes were compared with students who had tried: (1) conventional cigarettes only; (2) both e-cigarettes and conventional cigarettes (dual triers); and (3) neither cigarette type (never triers). Results Fifty-one percent of students had heard about e-cigarettes, 19% believed e-cigarettes were less harmful than conventional cigarettes, and 10% had tried them. Independent correlates of e-cigarette awareness and trial included established risk factors for smoking, as well as technophilia (i.e., use of more media technologies) and greater Internet tobacco advertising exposure. Exclusive e-cigarette triers (4%) had significantly higher technophilia, bedroom Internet access, and Internet tobacco advertising exposure compared to conventional cigarette triers (19%) and never triers (71%) but not compared to dual triers (6%), although dual triers had significantly stronger conventional cigarette risk factors. Conclusions This study suggests that adolescent e-cigarette awareness and use is high in Mexico, in spite of its e-cigarette ban. A significant number of medium-risk youth have tried e-cigarettes only, suggesting that e-cigarettes could lead to more intensive substance use. Strategies to reduce e-cigarette use should consider reducing exposures to Internet marketing.

OBJECTIVE: To examine the relationship between parent education, at individual- and school-level, and substance use behaviors (smoking, alcohol drinking, binge drinking, and illicit drug use) among young adolescents from Argentina and Mexico. METHODS: A cross-sectional, school-based survey of middle-school early adolescents from Mexico (N=10,123) and Argentina (N=3,172) queried substance use. RESULTS: After adjusting for age, sex and individual-level parent education, students from Mexican schools with lower parent education had higher likelihood of current smoking and drug use than those from schools with higher parent education. In Argentina, lower parent education at school-level was positively associated with all outcomes. CONCLUSION: Disadvantageous contextual school characteristics contributes to substance use among early adolescents in Mexico and Argentina.

Background In a previous cross-sectional study, we developed a marketing receptivity index (MRI), which had independent, positive associations with positive smoking expectancies, smoking susceptibility and current smoking behavior in a sample of early adolescents in Argentina. The current study aimed to assess the predictive validity of the MRI. Methods Data come from a longitudinal, school-based survey conducted in 33 secondary schools in Argentina. We included students who had never smoked at baseline and were successfully followed up approximately 17 months later (n=1700). Marketing receptivity was assessed with questions in three domains: frequency of going to stores that sell tobacco; cued recall of brand names for 3 cigarette packages with brand name removed; and ownership of branded merchandise. A four-level MRI was derived (low PoS marketing exposure only; high PoS exposure or recall of 1 brand; recall of 2 or more brands; and ownership of branded merchandise). Self-report of having tried to smoke at follow-up (i.e., initiation) was the primary outcome assessed. Logistic models regressed smoking initiation on the MRI, the MRI components (considered separately), and willingness to try one of the brands shown in the cued recall task, adjusting for sociodemographics, social influences and sensation seeking. Results The 4 level MRI had independent positive associations with smoking initiation (AOR 2 vs. 1 =1.42, 95% CI=1.12-1.79; AOR 3 vs 1 =2.04, 95% CI=1.38-3.00; AOR 4 vs. 1 =2.16, 95% CI=1.21-3.82). The index components, analyzed separately, were associated with outcomes except for ownership of branded merchandise. Willingness to try one of the brands shown in the recall task was also associated with initiation (AOR=1.73, 95% CI=1.31 - 2.28). Marketing Receptivity Index (MRI) OR (95% CI) p AOR (95% CI) p 1-Low PoS, 0 brands recalled 1 2-High PoS exposure or 1 brand recalled 1.12 (0.91 - 1.39) NS 1.42 (1.12 - 1.79)

Objective To describe trends, correlates of use and consumer perceptions related to the product design innovation of flavour capsules in cigarette filters. Methods Quarterly surveys from 2012 to 2014 were analysed from an online consumer panel of adult smokers aged 18–64, living in the USA (n=6865 observations; 4154 individuals); Mexico (n=5723 observations; 3366 individuals); and Australia (n=5864 observations; 2710 individuals). Preferred brand varieties were classified by price (ie, premium; discount) and flavour (ie, regular; flavoured without capsule; flavoured with capsule). Participants reported their preferred brand variety’s appeal (ie, satisfaction; stylishness), taste (ie, smoothness, intensity), and harm relative to other brands and varieties. GEE models were used to determine time trends and correlates of flavour capsule use, as well as associations between preferred brand characteristics (ie, price stratum, flavour) and perceptions of relative appeal, taste and harm. Results Preference for flavour capsules increased significantly in Mexico (6% to 14%) and Australia (1% to 3%), but not in the USA (4% to 5%). 18–24 year olds were most likely to prefer capsules in the USA (10%) and Australia (4%), but not Mexico. When compared to smokers who preferred regular brands, smokers who preferred brands with capsules viewed their variety of cigarettes as having more positive appeal (all countries), better taste (all countries), and lesser risk (Mexico, USA) than other brand varieties. Conclusions Results indicate that use of cigarettes with flavour capsules is growing, is associated with misperceptions of relative harm, and differentiates brands in ways that justify regulatory action.

Introduction In a previous cross-sectional study of early adolescents, we developed a marketing receptivity index (MRI) that integrates point-of-sale (PoS) marketing exposures, brand recall, and ownership of branded merchandise. The MRI had independent, positive associations with smoking susceptibility among never smokers and with current smoking behavior. The current longitudinal study assessed the MRI's predictive validity among adolescents who have never smoked cigarettes Methods Data come from a longitudinal, school-based survey of 33 secondary schools in Argentina. Students who had never smoked at baseline were followed up approximately 17 months later (n = 1700). Questions assessed: PoS marketing exposure by querying frequency of going to stores where tobacco is commonly sold; cued recall of brand names for 3 cigarette packages from dominant brands but with the brand name removed; and ownership of branded merchandise. A four-level MRI was derived: 1.low PoS marketing exposure only; 2. high PoS exposure or recall of 1 brand; 3. recall of 2 or more brands; and 4. ownership of branded merchandise. Logistic regression models regressed smoking initiation by follow up survey on the MRI, each of its components, and students' willingness to try a brand, adjusting for sociodemographics, social network smoking, and sensation seeking. Results The MRI had an independent positive association with smoking initiation. When analyzed separately, each MRI component was associated with outcomes except branded merchandise ownership. Conclusions The MRI and its components were associated with smoking initiation, except for branded merchandise ownership, which may better predict smoking progression than initiation. The MRI appears valid and useful for future studies.

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.

Smoking scenes in movies promote adolescent smoking onset; thus, the analysis of the number of images of smoking in movies really reaching adolescents has become a subject of increasing interest.The aim of this study was to estimate the level of exposure to images of smoking in movies watched by adolescents in Argentina and Mexico.First-year secondary school students from Argentina and Mexico were surveyed. One hundred highest-grossing films from each year of the period 2009-2013 (Argentina) and 2010-2014 (Mexico) were analyzed. Each participant was assigned a random sample of 50 of these movies and was asked if he/she had watched them. The total number of adolescents who had watched each movie in each country was estimated and was multiplied by the number of smoking scenes (occurrences) in each movie to obtain the number of gross smoking impressions seen by secondary school adolescents from each country.Four-hundred and twenty-two movies were analyzed in Argentina and 433 in Mexico. Exposure to more than 500 million smoking impressions was estimated for adolescents in each country, averaging 128 and 121 minutes of smoking scenes seen by each Argentine and Mexican adolescent, respectively. Although 15, 16 and 18-rated movies had more smoking scenes in average, movies rated for younger teenagers were responsible for the highest number of smoking scenes watched by the students (67.3% in Argentina and 54.4% in Mexico) due to their larger audience.At the population level, movies aimed at children are responsible for the highest tobacco burden seen by adolescents.Las escenas de consumo de tabaco en películas promueve el inicio del tabaquismo en adolescentes, por lo que el análisis de la cantidad de imágenes de tabaco en películas que realmente llega a los adolescentes se ha convertido en un tema de interés creciente.Estimar el nivel de exposición a imágenes de tabaco contenidas en películas vistas por adolescentes de la Argentina y México.Se realizó una encuesta a alumnos de primer año de nivel secundario de la Argentina y México. Se analizaron las 100 películas con mayor recaudación en cada año del período 2009-2013 (Argentina) y 2010-2014 (México). A cada participante se le asignó una muestra aleatoria de 50 de estas películas, preguntándosele si la había visto. Se estimó el número total de adolescentes que habían visto cada película en cada país y se multiplicó por el número de escenas que contenían tabaco (ocurrencias) en cada película para así obtener el número de impresiones crudas de tabaco vistas por los adolescentes escolarizados de cada país.Se analizaron 422A nivel poblacional, las películas para niños son las máximas responsables de la carga de tabaco vista por adolescentes.

Objective: To determine the prevalence, correlates and changes in secondhand smoke (SHS) exposure over the period after comprehensive smoke-free policy implementation in two Latin American countries. Methods: Data were analysed from population-based representative samples of adult smokers and recent quitters from the 2008 and 2010 waves of the International Tobacco Control Policy Evaluation Survey in Mexico (n = 1766 and 1840, respectively) and Uruguay (n = 1379 and 1411, respectively). Prevalence of SHS exposure was estimated for regulated venues, and generalized estimating equations were used to determine correlates of SHS exposure. Results: Workplace SHS exposure in the last month was similar within and across countries (range: Mexico 20–25%; Uruguay 14–29%). At the most recent restaurant visit, SHS exposure was lower where comprehensive smoke-free policies were implemented (range: Uruguay 6–9%; Mexico City 5–7%) compared with Mexican cities with weaker policies, where exposure remained higher but decreased over time (32–17%). At the most recent bar visit, SHS exposure was common (range: Uruguay 8–36%; Mexico City 23–31%), although highest in jurisdictions with weaker policies (range in other Mexican cities: 74–86%). In Uruguay, males were more likely than females to be exposed to SHS across venues, as were younger compared with older smokers in Mexico. Conclusions: Comprehensive smoke-free policies are more effective than weaker policies, although compliance in Mexico and Uruguay is not as high as desired.

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: Canada is the first country in the world to require cigarette manufacturers to enclose package inserts to supplement the exterior pictorial health warning label (HWL). In June 2012, Canada implemented new HWL package inserts that include cessation tips accompanied by a pictorial image. This study aims to assess the extent to which adult smokers report reading the newly mandated HWL inserts and to see whether reading them is associated with making a quit attempt. Methods: Data were analyzed from an online consumer panel of Canadian adult smokers, aged 18–64 years. Five waves of data were collected between September 2012 and January 2014, separated by 4-months intervals (n= 1,000 at each wave). Logistic generalized estimating equation (GEE) models were estimated to assess correlates of reading inserts and whether doing so is associated with making a quit attempt by the subsequent wave. Results: At each wave, between 26% and 31% of the sample reported having read HWL package inserts at least once in the prior month. Smokers who read them were more likely to be younger, female, have higher income, intend to quit, have recently tried to quit, and thought more frequently about health risks because of warning labels. In models that adjusted for these and other potential confounders, smokers who read the inserts a few times or more in the past month were more likely to make a quit attempt at the subsequent wave compared to smokers who did not read the inserts. Conclusions: HWL package inserts with cessation-related tips and messages appear to increase quit attempts made by smokers.