Search

Introduction Sociodemographic disparities in tobacco use are prevalent and persistent in the United States. Nevertheless, few studies have examined disparities in tobacco use from an intersectionality perspective. We developed a visualization tool to identify disparities in cigarette, e-cigarette, cigar, and smokeless tobacco use at the intersection of multiple social identities. Aims and Methods We used the 2018–2019 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) to estimate the prevalence of tobacco product use at the intersection of age (18–34, 35–54, ≥55 years), sex (male, female), race/ethnicity (Non-Hispanic [NH] White, NH Black, Hispanic, NH Other), and annual household income ( Results For cigarettes, the most defining characteristic was income, with the highest prevalence among low-income NH White male adults aged 35–54 years (30.7%) and low-income NH White female adults aged 35–54 years (29.7%). For e-cigarettes, the most defining characteristic was age, with adults 18–34 years old having the highest prevalence. High prevalence groups for cigars included young- and middle-aged NH Black and NH White males, while NH White males had the highest prevalence of smokeless tobacco use. Conclusions Our intersectionality visualization tool is helpful to uncover complex patterns of tobacco use, facilitating the identification of high-risk groups. Implications We created a visualization tool to identify disparities in cigarette, e-cigarette, cigar, and smokeless tobacco use at the intersection of age, sex, race/ethnicity, and income. Our visualization tool helps uncover complex patterns of tobacco use, facilitating the identification of high-risk population groups that would otherwise be masked. These results can be used to implement tobacco control policies targeted at factors that promote or sustain tobacco use disparities.

Sexual and reproductive health (SRH) is a very important issue in public health programs in low -and middle-income countries (LMICs). Health services that meet specific and differentiated needs of adolescents are increasingly relevant in LMICs. To provide quality services, it is necessary to know the profile of its users and the perspective that adolescents have about SRH services aimed at them.We conducted a cross-sectional analysis of primary data from a survey of 489 adolescents recruited in 11 primary-care facilities in the state of Morelos, Mexico. We followed the guidelines outlined in the World Health Organization Quality Assessment Guidebook: A guide to assessing health services for adolescent clients. Data on friendliness of services were obtained through 70 questions divided into 18 characteristics which, in turn, were grouped into five domains: equity, accessibility, acceptability, appropriateness, and effectiveness. The "friendliness" (a proxy for quality of care) of services was measured according to an additive index of friendliness (FI) ranging from 0 (no friendliness) to 1 (maximum friendliness). We also described the socio-demographic, SRH, and service utilization profiles of clients.The health services analysed were characterised as having low levels of accessibility (FI = 0.62) and effectiveness (FI = 0.77), moderate acceptability (FI = 0.84), and high levels of appropriateness (FI = 0.93) and equity (FI = 0.92). Of the total number of adolescents surveyed, 51% stated that they had initiated a sexual life, 37% did not use any method of protection during their first sexual intercourse and 64% of the adolescents had already experienced a pregnancy.It is essential to improve the accessibility and effectiveness dimensions of adolescent-friendly services in Mexico. This requires the implementation of strategies specifically designed to promote well-informed, planned and healthy sexual behaviours that avert risk and vulnerability. Strategies need to consider the profile of the adolescent client population.

Purpose To describe patterns of menthol/non-menthol cigarettes with flavored e-cigarettes (tobacco, menthol, sweet/spicy, and other flavorings) use. Design We used cross-sectional data from the 2018-2019 Tobacco Use Supplement to the Current Population Survey (TUS-CPS). Setting United States. Subjects Adults over 18 years old. Sample A nationally representative sample (n = 135 329). Measures We generated a 15-category variable of all combinations of cigarette and e-cigarette flavoring use. Analysis We estimated population prevalence (PP) for the 15-category flavored cigarette and e-cigarette use variable and proportion of flavored cigarette and e-cigarette use among adults who used cigarettes or e-cigarettes (PAU) by age, sex, race/ethnicity, and income. Results Exclusive menthol cigarette use was higher among NH Black (PP = 8.79%, PAU = 68.96%) and low-income (PP = 4.86%, PAU = 29.09%) compared to NH White (PP = 2.63%, PAU = 18.83%) and high-income participants (PP = 1.25%, PAU = 19.02%). Exclusive sweet/spicy e-cigarette use (PP = 1.32%, PAU = 10.22%) and exclusive menthol e-cigarette use (PP = .95%, PAU = 7.40%) was higher in younger (18-34) vs older (35+) adults (PP = .34% and PAU = 2.76%, and PP = .14%, PAU = 1.11%, respectively). Older dual users tended to combine the same flavor in both products (eg, menthol cigarettes + menthol e-cigarettes), while younger adults were more likely to combine menthol and non-menthol cigarettes with sweet/spicy e-cigarettes. Conclusion Findings suggest that a menthol cigarette ban might be most effective in conjunction with sweet/spicy e-cigarette flavor restrictions, given these flavors are attractive for younger adults.

espanolObjetivo. Describir el perfil de los usuarios duales y fumadores exclusivos, asi como los factores asociados con la frecuencia de uso de cigarro electronico. Material ymetodos. Se realizaron modelos logisticos de una encuesta en linea de fumadores adultos para estimar asociaciones de usuarios duales (fumador exclusivo vs. usuario dual) sobre variables sociodemograficas, tabaquismo y otras sustancias. Adicionalmente, mediante modelos binomiales censurados se evaluaron los factores asociados con la frecuencia de consu-mo de cigarro electronico. Resultados. Los usuarios duales fueron mas jovenes, con mayor educacion (AOR=2.22), tenian mayores niveles de dependencia de tabaquismo (AOR=1.31), preferirian usar cigarros con capsulas de sabor (AOR=1.58) y tuvieron una mayor proporcionde intentos de dejar de fumar (AOR=1.38).El consumo de marihuana y fumar diario se asocio con una mayor frecuencia de consumo de cigarro electronico. Conclusion. Eluso dual se asocio con un perfil de riesgo mas alto; este perfil es mas prominente en usuarios duales que usan cigarros electronicos con mayor frecuencia. EnglishObjective. To describe the profile and patterns of dual uses (n=954) and exclusive cigarette users (n=2 070) and determine the correlates of more frequent e-cigarette use among dual users and their reasons for e-cigarette use. Materials andmethods. An online survey of Mexican adult smokers. Logistic models regressed dual-use (exclusive smoking vs. dual user) on sociodemographic, smoking varia-bles and substance use behaviors. We conducted censorial binomial models to estimate the correlates of frequency of e-cigarette use among dual users. Results. Dual users were younger had higher education (AOR=2.22) and higher levels of smoking dependence (AOR=1.31), preferred cigarettes with flavor capsules (AOR=1.58) and had recently attempted to quit smoking (AOR=1.38). Marijuana use and being daily smokers were correlates of higher frequency of use among dual users. Conclusion. Dual users had a higher risk profile than exclusive smokers, which was even more prominent in dual-users who used e-cigarettes frequently.

espanolObjetivo. Estimar la prevalencia de violencia de pareja por sexo y su asociacion con el uso de tabaco, alcohol y drogas en Mexico. Material y metodos. Estudio transversal de la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2016, que incluyo a 34 861 personas de 12 a 65 anos. Se esti-maron modelos de regresion logistica para obtener razones de momios (RM) e intervalos de confianza al 95% (IC95%). Resultados. La prevalencia de violencia de pareja fue de 15.14%; 18.16% en mujeres y 11.89% en hombres. Factores asociados: consumo excesivo de alcohol (RM: 1.64; IC95% 1.38-1.96), consumo de tabaco (RM:1.71;IC95% 1.42-2.07), consumo de medicamentos psicotropicos sin receta (RM: 3.72; IC95% 1.76-7.88) y consumo de marihuana (RM: 3.06; IC95%: 1.58-5.91). Conclusiones. Los resultados apoyan la necesidad de implementar intervenciones multisectoriales, fortalecer competencias psicosociales para lograr la mejora de la calidad y acceso a los servicios de salud mental y adicciones en Mexico. EnglishObjective. Estimate the prevalence of intimate partner violence by sex and the association with tobacco, alcohol, and drugs use in Mexico. Materials and methods. A cross-sectional study of the 2016 National Survey on Drug, Alcohol, and Tobacco Consumption included 34 861 people aged 12 to 65 years old. Logistic regression models were estimated obtaining odds ratios (OR) and 95% confidence intervals (95%CI). Results. The prevalence of intimate partner violence was 15.14%, 18.16% in women, and 11.89% in men. The factors associated were: binge drinking (OR:1.64; 95%CI 1.38-1.96), tobacco consumption (OR: 1.71; 95%CI 1.42-2.07), use of psychotropic drugs without a prescription (OR:3.72; 95%CI 1.76-7.88) and marijuana use (OR: 3.06; 95%CI 1.58-5.91). Conclusions. The findings support the need to implement multisectoral interventions and strengthen psychosocial competencies to improve the quality and access to mental health and addiction services in Mexico.

Sociodemographic disparities in tobacco use are prevalent and persistent in the US. Nevertheless, few studies have examined disparities in tobacco use from an intersectionality perspective. We developed a visualization tool to identify disparities in cigarette, e-cigarette, cigar, and smokeless tobacco use at the intersection of multiple social identities.We used the 2018-2019 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) to estimate the prevalence of tobacco product use at the intersection of age (18-34, 35-54, 55+ years), sex (male, female), race/ethnicity (Non-Hispanic [NH] White, NH Black, Hispanic, NH Other), and annual household income ($50,000, $50,000-$99,999, ≥$100,000). Estimates accounted for the complex survey design.For cigarettes, the most defining characteristic was income, with the highest prevalence among low-income NH White male adults aged 35-54 years (30.7%) and low-income NH White female adults aged 35-54 years (29.7%). For e-cigarettes, the most defining characteristic was age, with adults 18-34 years old having the highest prevalence. High prevalence groups for cigars included young- and middle-aged NH Black and NH White males, while NH White males had the highest prevalence of smokeless tobacco use.Our intersectionality visualization tool is helpful to uncover complex patterns of tobacco use, facilitating the identification of high-risk groups.We created a visualization tool to identify disparities in cigarette, e-cigarette, cigar, and smokeless tobacco use at the intersection of age, sex, race/ethnicity, and income. Our visualization tool helps uncover complex patterns of tobacco use, facilitating the identification of high-risk population groups that would otherwise be masked. These results can be used to implement tobacco control policies targeted at factors that promote or sustain tobacco use disparities.

espanolObjetivo. Calcular la prevalencia de consumo de cigarros con capsula de sabor, la proporcion de uso entre los usuarios de tabaco en la poblacion mexicana de 10 anos o mas, y los factores asociados a su consumo. Material y metodos. Se utilizo la Encuesta Nacional de Salud y Nutricion 2018-19. Se utilizo un modelo Poisson para obtener la razon de prevalen-cias del uso de cigarros con capsulas de sabor ajustando por sexo, edad, educacion e indice de bienestar. Resultados. El 6.6% de los mexicanos fuma cigarros con capsulas de sabor, lo que corresponde a 43% del total de usuarios de tabaco. Las mujeres, adolescentes y adultos jovenes son los grupos con la mayor proporcion de consumo. Conclusiones. Mexico tiene una alta prevalencia de consumo de cigarros con capsula de sabor. Para reducirla, se deben implementar politicas para prohibir la venta de cigarros con saborizantes y eliminar los disenos atractivos en las cajetillas de los cigarros. EnglishObjective. To estimate the prevalence of flavor capsule cigarette, use among Mexicans who are 10 years and older, to determine the proportion of smokers who use flavor capsules, and to characterize the sociodemographic correlates of flavor capsule cigarette use. Materials and methods. Data came from the National Health and Nutrition Survey 2018-19. The prevalence and proportion of flavor capsule cigarette use were estimated by sex, age, education, and wealth. Poisson models were used to evaluate sociodemographic factors as-sociated with flavor capsule cigarette use. Results. Among Mexicans,the prevalence of flavor capsule cigarettes use was 6.6%, which is 43% of all smokers. Women, adolescents, and young adults were more likely than other groups to use flavor capsule cigarettes. Conclusions. Mexicans report a high prevalence of flavor capsule cigarette use. Banning cigarettes with flavors may reduce the appeal of smoking, particularly for youth and women.

Although increases in the variety of tobacco products available to consumers have led to investigations of dual/polytobacco use patterns, few studies have documented trends in these patterns over time. We used data from the 2014/2015 and 2018/2019 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) and the 2015–2019 National Health Interview Survey (NHIS) to estimate trends in the following use patterns: exclusive use of cigarettes, electronic nicotine delivery systems (ENDS), other combustibles (cigars/cigarillos/little filtered cigars and traditional pipes/hookah), and smokeless tobacco (four categories); dual use (two product groups) of each product group with cigarettes (three categories); polyuse with cigarettes (all four product groups; one category); and dual/polyuse without cigarettes (one category). We estimated trends in product use patterns overall and by age, sex, and race/ethnicity using two-sample tests for differences in linear proportions. From 2014/2015 to 2018/2019, exclusive ENDS use increased, whereas cigarettes and ENDS dual use decreased. Furthermore, polyuse with cigarettes decreased, whereas dual/polyuse without cigarettes increased, with trends varying by age, sex, and race/ethnicity. Our findings suggest that patterns of dual/polyuse with and without cigarettes have changed in recent years, indicating the need for further surveillance of concurrent tobacco product use patterns.

This study examines patterns of use for menthol/non-menthol cigarettes and Electronic Nicotine Delivery Systems (ENDS) from 2013 to 2019 among U.S. adults. We calculated the weighted population prevalence of current exclusive and dual use for each product (i.e., menthol/non-menthol cigarettes and ENDS) stratified by age, sex, race/ethnicity, household income, and education in all surveys using data from three nationally representative surveys: the Population Assessment of Tobacco and Health (PATH) Study Waves 1–4 (W1-W4), 2013–2018; the National Health Interview Survey (NHIS) 2015; and the Tobacco Use Supplement to the Current Population Survey (TUS-CPS) 2014–2015 (T1) and 2018–2019 (T2). Exclusive non-menthol cigarette use (PATH: 9.0%W1, 9.4%W4; NHIS: 8.7%; TUS-CPS: 8.1%T1, 6.9%T2) and dual non-menthol cigarette/ENDS use (PATH: 2.4%W1, 1.5%W4; NHIS: 1.5%; TUS-CPS: 1.1%T1, 0.6%T2) were the most common single and dual tobacco use patterns, respectively, across all surveys. Both exclusive menthol cigarette use (3.9%T1-3.3%T2) and non-menthol cigarette use (8.1%T1-6.9%T2) declined in TUS-CPS from 2014/5–2018/9. Dual menthol cigarette/ENDS use also declined (PATH: 1.5%W1-1.1%W4; TUS-CPS: 0.5%T1-0.3%T2), as did dual non-menthol cigarette/ENDS use (PATH: 2.4%W1-1.5%W4; TUS-CPS 1.1%T1-0.6%T2). Across surveys, exclusive menthol cigarette use and dual menthol cigarette/ENDS use were more common among individuals aged 25–34 years old; non-Hispanic Blacks (NHBs); and low-income earners. Single and dual use patterns of menthol/non-menthol cigarettes and ENDS have declined over time. Nevertheless, certain vulnerable population groups, including NHBs and low-income earners, disproportionately use exclusive menthol cigarettes and dual menthol cigarette/ENDS, making menthol bans a potential policy target for reducing tobacco-related health disparities.

Evaluate the patterns of e-cigarette use andtheir association with smoking behavior.We analyzed data from a population-based representative cohort of adult smokers who participated in the International Tobacco Control Policy Evaluation Surveys in Mexico. The analytic sample (n=760) was restricted to participants who were followed up from wave 6 (2012) to wave 7 (2014-2015). GEE models regressed e-cigarette use at follow-up and changes in cigarettes per day (CPD) between waves, on baseline sociodemographic variables, smoking status (daily, non-daily, quit), e-cigarette trial, and quit intentions.Smokers who were younger, had a higher income, and had tried e-cigarettes at baseline were more likely to be current e-cigarette users at follow-up. Ecigarette use at follow-up was not associated with a change in CPD over time.E-cigarette use does not appear to have promoted smoking cessation or reduction in this sample of Mexican smokers.Evaluar los patrones de uso de cigarros electrónicos y su asociación con el uso de tabaco.Se usaron datos de una cohorte de fumadores adultos mexicanos de la Encuesta Internacional de Evaluación de Políticas del Control del Tabaco (n=760) con seguimiento de la ronda 6 (2012) a la 7 (2014-2015). Se usaron modelos GEE para evaluar el uso de cigarros electrónicos y el cambio en el número de cigarros por día (CPD) en variables de la basal sobre características sociodemográficas, consumo del cigarro (diario, no diario, haber dejado de fumar), prueba de cigarros electrónicos e intención de dejar de fumar.umadores jóvenes, con ingresos altos y que probaron cigarros electrónicos en la medición basal tenían más posibilidad de usar cigarros electrónicos. No se encontró relación entre uso de cigarros electrónicos y cambio en CPD.Los cigarros electrónicos no parecen promover el abandono ni la reducción del consumo de cigarros en esta muestra de fumadores mexicanos.

Purpose: To provide tobacco product use patterns for US adults by sociodemographic group. Design: A secondary analysis of Tobacco Use Supplement to the Current Population Survey (2014-15), National Health Interview Survey (2015), and Population Assessment of Tobacco and Health (2015-16). Setting: United States. Sample: Three nationally representative samples of adults (N = 28,070-155,067). Measures: All possible combinations of cigarette, Electronic Nicotine Delivery Systems (ENDS), other combustible product, and smokeless tobacco use, defined as current use every day or some days. Analysis: Weighted population prevalence and proportion among tobacco users of exclusive, dual, and polyuse patterns by sex, race/ethnicity, education, income, and age. Results: Exclusive cigarette use was the most prevalent pattern (10.9-12.8% of US population). Dual and polyuse were less prevalent at the population level (2.6-5.2% and 0.3-1.3%, respectively) but represented 16.7-25.5% of product use among tobacco users. Cigarette plus ENDS use was similar by sex, but men were more likely to be dual users of cigarettes plus other combustibles or smokeless tobacco. Among race/ethnic subgroups, non-Hispanic (NH) Whites were most likely to use cigarettes plus ENDS, while NH Blacks were most likely to use cigarettes plus other combustibles. Dual and polyuse were generally less common among adults with higher education, income, and age. Conclusion: Differences in product use patterns by sociodemographic group likely represent different risk profiles with important implications for resulting health disparities.

To estimate the prevalence of flavor capsule cigarette, use among Mexicans who are 10 years and older, to determine the proportion of smokers who use flavor capsules, and to characterize the sociodemographic correlates of flavor capsule cigarette use.Data came from the National Health and Nutrition Survey 2018-19. The prevalence and proportion of flavor capsule cigarette use were estimated by sex, age, education, and wealth. Poisson models were used to evaluate sociodemographic factors as-sociated with flavor capsule cigarette use.Among Mexicans,the prevalence of flavor capsule cigarettes use was 6.6%, which is 43% of all smokers. Women, adolescents, and young adults were more likely than other groups to use flavor capsule cigarettes.Mexicans report a high prevalence of flavor capsule cigarette use. Banning cigarettes with flavors may reduce the appeal of smoking, particularly for youth and women.Calcular la prevalencia de consumo de cigarros con cápsula de sabor, la proporción de uso entre los usuarios de tabaco en la población mexicana de 10 años o más, y los factores asociados a su consumo.Se utilizó la Encuesta Nacional de Salud y Nutrición 2018-19. Se utilizó un modelo Poisson para obtener la razón de prevalen-cias del uso de cigarros con cápsulas de sabor ajustando por sexo, edad, educación e índice de bienestar.El 6.6% de los mexicanos fuma cigarros con cápsulas de sabor, lo que corresponde a 43% del total de usuarios de tabaco. Las mujeres, adolescentes y adultos jóvenes son los grupos con la mayor proporción de consumo.México tiene una alta prevalencia de consumo de cigarros con cápsula de sabor. Para reducirla, se deben implementar políticas para prohibir la venta de cigarros con saborizantes y eliminar los diseños atractivos en las cajetillas de los cigarros.

This study describes the prevalence and correlates of adult smokers&rsquo, discussions about electronic cigarettes (e-cigarettes) with health professionals (HPs), including whether these discussions may lead smokers and vapers to use e-cigarettes for smoking cessation. Methods: We analyzed data from an online survey of Mexican smokers recruited from a consumer panel for marketing research. Participants who had visited an HP in the prior four months (n = 1073) were asked about discussions of e-cigarettes during that visit and whether this led them to try to quit. Logistic models regressed these variables on socio-demographics and tobacco use-related variables. Results: Smokers who also used e-cigarettes (i.e., dual users) were more likely than exclusive smokers to have discussed e-cigarettes with their HP (adjusted odds ratio (AOR) = 3.96, 95% C.I. 2.73, 5.74), as were those who had recently attempted to quit smoking (AOR = 1.89, 95% C.I. 1.33, 2.7). Of smokers who had discussed e-cigarettes, 53.3% reported that the discussion led them to use e-cigarettes in their quit attempt. Also, dual users (AOR = 2.6, 95% C.I. 1.5, 4.5) and daily smokers (&gt, 5 cigarettes per day) (AOR = 3.62, 95% C.I. 1.9, 6.8) were more likely to report being led by their HP to use e-cigarettes in the quit attempt compared to exclusive smokers and non-daily smokers, respectively. Conclusions: Discussions between HP and smokers about e-cigarettes were relatively common in Mexico, where e-cigarettes are banned. These discussions appear driven by the use of e-cigarettes, as well as by greater smoking frequency and intentions to quit smoking.

Mexico is one of the countries most affected by COVID-19. Studies have found that smoking behaviors have been impacted by the pandemic as well, however, results have varied across studies, and it remains unclear what is causing the changes. This study of an open cohort of smokers recruited from a consumer panel (n = 2753) examined changes in cigarettes per day (CPD), daily vs. non-daily smoking, recent quit attempts, perceived stress, depression, and perceived severity of COVID-19 at two points during the pandemic: March and July 2020. Differences in CPD between waves were estimated with Poisson regression using generalized estimating equations (GEE). Differences in perceived stress were estimated with linear regression using GEE, and differences in recent quit attempts, depression, and perceived severity of COVID-19 were estimated using separate logistic regression GEE models. Rates of depression were higher in July compared to March (AOR = 1.55, 95% C.I. 1.31–1.85), and the likelihood of recent quit attempt was lower in July compared to March (AOR = 0.85, 95% C.I. 0.75–0.98). There was no statistically significant change in CPD, daily smoking, or perceived stress. Perceived COVID-19 severity for oneself increased significantly (AOR: 1.24, 95% C.I. 1.02–1.52), however, the perceived COVID-19 severity for smokers remained constant. Our study suggests that as the COVID-19 pandemic expanded in Mexico, smoking frequency remained stable, and quit attempts decreased, even as adult smokers increasingly perceived infection with COVID-19 for themselves as severe. These results can aid in the development of health communication strategies to educate smokers about their risk for COVID-19, potentially capitalizing on concerns that stem from this syndemic of communicable and smoking-related non-communicable disease.

ObjectiveTo analyse trends in cigarette brand preference among Mexican smokers during the implementation period of key WHO’s Framework Convention on Tobacco Control recommendations.MethodsData came from two nationally representative, comparable surveys, namely the Global Adult Tobacco Survey 2009 and 2015 and the National Survey on Addictions 2011 and 2016. Logistic models were used to estimate the adjusted prevalence of each brand purchased, as well as individual correlates of purchasing the single brand with a large growth over the study period. Multiple linear regressions were also employed to analyse cigarette prices across brands.ResultsSix brand families accounted for about 90% of the cigarette market, with Marlboro clearly dominating all brands at 54%–61%. Only the share of Pall Mall brand, however, registered a rapid increase over the period—from 1% in 2009 to 14% in 2016. Women and younger smokers (15–24 years) were more likely to prefer Pall Mall over other brands. While the typical price segmentation between international (premium) brands and national (discount) brands was observed, the price of Pall Mall is within the range of the latter. Importantly, most varieties of this brand include flavour capsule varieties (FCVs).ConclusionsThis study suggests that the strong campaign of brand migration, the pricing strategy and the aggressive introduction of FCVs expanded Pall Mall in the Mexican cigarette market. Therefore, better control policies of cigarette contents and taxes that reduce price differentials across brands should be encouraged to promote public health.

Introduction The popularity of electronic cigarettes (e-cigarettes) has increased worldwide among youth, even in countries like Mexico that ban them. This study aimed to assess the correlates of e-cigarette use frequency among Mexican students who currently use ecigarettes, as well as to describe their reasons for use. Methods Data were analyzed from a school-based survey of 57 public middle schools from the three largest cities in Mexico. Primary analyses were confined to those who used e-cigarettes in the prior 30 days. Censored binomial models for truncated distributions were estimated, regressing lifetime and past month frequency of use on participant sociodemographics, other substance use (smoking, alcohol, drugs), technophilia (appeal of new technologies), characteristics of e-cigarettes used, and family's and friends' use of nicotine products. Results Being male (APR = 1.93 95% CI 1.53–2.44), using drugs, (APR = 1.51 95% CI 1.03–2.20), higher technophilia (APR = 1.66 CI 1.21–2.29) and having a family member who uses e-cigarettes and cigarettes were associated with more frequent use in the last month. Students who preferred fruit and combined flavors had used e-cigarettes more often in their lifetime compared to students who preferred mint/menthol flavors. Conclusions Some risk factors for more frequent e-cigarette use among Mexican youth are similar to those foudn in other countries (having relatives who use ecigarettes, using drugs, and use of fruit flavors). Additionally, the novel measure of technophilia was positively associated with frequency of e-cigarette use. The appeal of flavors, in particular, suggests the importance of reducing youth access to flavored products to impede product initiation and progression.

IntroductionMexico was the first Latin American country to ratify the Framework Convention on Tobacco Control (FCTC) in 2004, after which it implemented some key FCTC policies (e.g., taxes, smoke-free, pictorial warnings and ad bans). This study assessed trends in the prevalence of current, daily and non-daily smoking in Mexico before and after the implementation of key FCTC policies.MethodsData were analysed from two comparable, nationally representative surveys (i.e., the National Survey on Addictions 2002, 2011 and 2016, and the Global Adult Tobacco Survey 2009 and 2015). The pooled sample comprised 100 302 persons aged 15–65 years. Changes in the prevalence of current, daily and non-daily smoking were assessed.ResultsFrom 2002 to 2016, the prevalence of current smoking fell 11% in relative terms (from 21.5% to 19.0%). The decrease was registered between 2002 and 2009, and after that, a slight increase was observed (from 16.5% in 2009 to 19% in 2016). The prevalence of daily smoking decreased by about 50% between 2002 and 2016 (from 13.5% to 7.0%) with most of the decrease occurring by 2009. Conversely, the prevalence of non-daily smoking increased by 35% between 2009 and 2016 (from 8.8% to 11.9%).ConclusionsFull implementation of the FCTC is necessary to further reduce smoking. Specific interventions may be needed to target non-daily smokers, who now comprise more than half of current smokers in Mexico.

This study aimed to assess sex differences in predictors for becoming a current exclusive electronic cigarette (e-cigarette) user, current exclusive smoker, or current dual user (concurrent smoking and e-cigarette use). This longitudinal study included 2399 females and 2177 males who had tried neither cigarettes nor e-cigarettes at baseline and attended 57 middle schools in the three largest cities in Mexico. We estimated multinomial logistic models stratified by sex. At follow-up, the prevalence of current exclusive e-cigarette use was 6.4% for males and 5.5% for females, current exclusive smoking was similar among males (3.6%) and females (3.5%), dual use was 2.4% females and 1.8% males. In the adjusted model, current e-cigarette use among females was associated with baseline current drinking (ARR = 1.85, p &lt, 0.05), having a job (ARR = 1.99, 0.05), higher technophilia (ARR = 1.27, 0.05), and higher positive smoking expectancies (ARR = 1.39, 0.05). Among males, only having friends who smoke cigarettes at baseline was a significant predictor of current exclusive e-cigarette use at follow-up (ARR = 1.44, 0.05). For both sexes, current exclusive smoking at follow-up was associated with baseline current drinking (male ARR = 2.56, 0.05, female ARR = 2.31, 0.05) and, among males, only with having a parent who smoked (ARR = 1.64, 0.05). For both sexes, dual use at follow-up was associated with baseline current drinking (male ARR = 3.52, 0.005, female ARR = 2.77, 0.05), among females, with having paid work (ARR = 2.50, 0.001), and among males, with parental smoking (ARR = 3.20, 0.05). Results suggested both common and different risk factors by sex, suggesting that interventions may need to consider targeting sex differences.

Objetivo. Evaluar los factores sociales asociados con el consumo de tabaco y alcohol en adolescentes mexicanos de poblaciones menores a 100 000 habitantes. Material y métodos. Estudio transversal a partir de resultados de la Encuesta Nacional de Salud y Nutrición (Ensanut 100k) que se enfocó en adolescentes de entre 10 y 19 años. Se estima­ron modelos de regresión logística ajustados y se obtuvieron razones de momios (RM) e intervalos de confianza al 95% (IC95%). Resultados. La prevalencia de consumo de tabaco en el último mes fue de 5.5% (10-14 años=1.0%, 15-19 años= 11.2%); de consumo de alcohol, 9.3%, y de consumo excesivo de alcohol, 2.8%. Factores asociados: consumo de tabaco, sexo (hombre, RM= 6.00; IC95%: 2.89-12.46), edad (RM=1.73; IC95%: 1.46-2.04), trabajo remunerado (RM= 2.87; IC95%: 1.12-7.34) y afiliación a servicios de salud (RM= 0.26; IC95%: 0.08-0.82); consumo de alcohol, (hombre, RM= 5.11; IC95%: 2.38-11.0), edad (RM= 1.70; IC95%: 1.51-1.92) y trabajo remunerado (RM= 2.51; IC95%: 1.01-6.24). Conclusiones. Para reducir el consumo de alcohol y tabaco en adolescentes deben implementarse estrategias de prevención integrales que tomen en cuenta el contexto individual y social.

To assess the correlates of secondhand smoke exposure (SHS) in public and private settings.Data came from the 2016 National Survey of Drug, Alcohol and Tobacco use. Multilevel Poisson models were conducted to evaluate factors associated with SHS.Having a higher education, being male and being a young adult were associated with higher SHS in bars and restaurants. Men had greater SHS at work, while women and adolescents had greater exposure at home. Adults older than 45 years had higher SHS on public transportation compared to adolescents between 12-17 years old.Exposure to SHS remains high and affects the population differentially. To reduce SHS, it is necessary to apply Article 8 of the Framework Convention on Tobacco Control.Determinar los factores asociados con la exposición al humo de tabaco de segunda mano (HTSM) en lugares públicos y privados.Se analizó la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2016. La exposición al HTSM se evaluó mediante modelos Poisson multinivel. La muestra del estudio incluye únicamente no fumadores.La exposición al HTSM fue similar en los estados que tienen prohibición total para fumar en espacios cerrados en comparación con estados con prohibición parcial. Adultos jóvenes, hombres y personas con nivel educativo alto tienen mayor exposición al HTSM en bares y restaurantes. Los hombres tienen mayor exposición al HTSM en el trabajo, los adultos de mayor edad en el transporte público, mientras las mujeres y adolescentes en el hogar.La exposición al HTSM continúa elevada y afecta diferencialmente a la población mexicana. Para reducirla, se requiere aplicar totalmente el artículo octavo del Convenio Marco para el Control del Tabaco.

To evaluate the physical and psychological dependence to tobacco of Mexican smokers and its association with physical, psychological and social factors.The 2016 National Alcohol and Tobacco Drug Consumption Survey (n=7 331) was analyzed using the Fagerström nicotine physical dependence scale (FTND) and the short scale of psychological dependence on tobacco (TAPDSc). Bivariate analyzes and generalized ordinal logistic regressions were performed to evaluate the associated factors.82.3% of daily smokers and 98.8% of occasional smokers reported mild physical dependence, while 47.9 and 37.9% respectively reported moderate psychological dependence. The age of initiation of tobacco use, drug use, high alcohol consumption and high emotional distress were associated with high levels of psychological dependence in all smokers.The exclusive use of FTND does not allow to adequately evaluate Mexican smokers. The physical and psychological dependence on tobacco should be assessed with independent and validated scales in this population.Evaluar la dependencia física y psicológica de los fumadores mexicanos y su asociación con factores físicos, psicológicos y sociales.. A partir de la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2016 (n=7 331), se analizó la escala de dependencia física a la nicotina de Fagerström (FTND) y la escala corta de dependencia psicológica al tabaco (TAPDSc). Se realizaron análisis bivariados y regresiones logísticas ordinales generalizadas para evaluar los factores asociados.82.3% de fumadores diarios y 98.8% de ocasionales reportaron dependencia física leve, mientras que 47.9 y 37.9%, respectivamente, presentaron dependencia psicológica moderada. La edad de inicio temprana de consumo de tabaco, uso de drogas, consumo alto de alcohol y malestar emocional se asociaron con niveles altos de dependencia psicológica en todos los fumadores.El uso exclusivo de FNTD no permite evaluar adecuadamente a los fumadores mexicanos. La dependencia física y psicológica al tabaco debe ser diagnosticada con escalas independientes y validadas en esta población.

Background Mexico joined the Framework Convention on Tobacco Control in 2005 and introduced the general law of tobacco control in 2008. Monitoring tobacco consumption, addressing sex and age in relation to social context, is important to plan tobacco control strategies. This study was aimed at assessing social determinants of smoking in Mexico using data from GATS 2009 and 2015. Methods Data from GATS Mexico 2009 and 2015 was used to perform a secondary analysis. Weighted descriptive statistics and stratified multivariate logistic regression models were executed. Results 13,617 people in 2009 and 14,664 in 2015 were interviewed. Prevalence of current smoking was higher among men than in women (24.8% vs 7.8% in 2009 and 25.2% vs 8.2% in 2015). In 2015, women living in urban areas were more likely to be current smokers (OR: 3.1; CI: 1.5,6.8 in young and OR: 4.9; CI: 3.3,7.2 in adult women). In young women , higher odds of being current smoker were found in those exposed to secondhand smoke at home (OR: 3.5; CI: 1.9,6.4). Adult women with high socioeconomic status were more likely to be current smokers (OR: 2.5; CI: 1.2,5.0). Among young men , likelihood of being a current smoker increased with age (OR: 5.5; CI: 3.1,9.9 for 21-24 group, reference group 15-17) and in those exposed to second hand smoke at home (OR: 1.6; CI: 1.0,2.6). In adult men , likelihood of being a current smoker decreased with age (OR: 0.3, CI: 0.2,0.5 age ≥65 reference group 25-34) and in those with high education level (OR: 0.5; CI: 0.3,0.8) while living in urban areas increases the likelihood (OR: 1.6; CI: 1.3,1.9). The results were similar for 2009. Conclusions Being young and living in urban areas remain important determinants of tobacco use in Mexico. Other factors vary according to sex and age, and these should be considered for control policies.

Background The tobacco industry has targeted low and middle-income countries and vulnerable groups such as women and young people. In Mexico we observe a slow decrease in tobacco consumption among adults, while in adolescents the trend in tobacco use shows an increase. Previous research in Mexico do not measure determinants at neighborhood level. The aim of the study is evaluate whether the contextual and individual factors are associated with tobacco use among Mexican adolescents. Methods Data from this study came from NAS 2011 and National Census 2010. Descriptive statistics were estimated after adjusting for sampling weights. The study had two levels: individual (adolescents between 12-17 years) and contextual (neighborhoods). Multilevel logistic regression stratified by sex was conducted. Results The final sample includes 2785 adolescents from 364 neighborhoods. Prevalence of 30 days smoking in women adolescents was 3.8% and in male adolescents was 10.3%. Female adolescents exposed to second hand smoke at home were more likely to be a current smoker (OR 2.87 CI: 1.37,6.04) and in those who have an employment (OR 4.35 CI: 1.03,18.3). School attendance was inversely associated with tobacco use (OR 0.38 CI: 0.16,0.89). In Male adolescents the likelihood of being a current smoker increase according to age (OR 4.35 CI: 1.51,12.4 for 15-17 vs 12-14) and in those exposed to second hand smoke at home (OR 5.03 CI 2.38,10.6), while school attendance decrease the likelihood of being a current smoker (OR 0.14 CI: 0.05,0.39). Conclusions This study suggest that school attendance is a protective factor for smoking. Second hand smoke at home is an important factor of tobacco use. Have an employment increase the likelihood of being a current smoker only in female adolescents. Implement a successful tobacco control policy in Mexico needs to take into account educational, economics, social and gender determinants.

Among high-income countries, awareness and use of e-cigarettes is lower in countries with more restrictive e-cigarette regulations. Little is known about e-cigarettes in middle-income countries, many of which like Mexico, ban e-cigarette sales and marketing. The current study determined the national-level prevalence and correlates of e-cigarette awareness and consumption in Mexico. Data were analyzed from a 2016 nationally representative survey. Prevalence of e-cigarette awareness, trial and current use was estimated separately for adolescents (n = 12,436), adult nonsmokers (n = 36,966), and adult smokers (n = 7347). For each group, crude and adjusted logistic models regressed e-cigarette outcomes on sociodemographic and smoking-related variables, adjusting for the sampling design and weights. Prevalence varied across subgroups for e-cigarette awareness (adolescents = 45.3%; adult nonsmokers = 33.9%; adult smokers = 54.3%), e-cigarette trial (adolescents = 6.5%; adult nonsmokers = 2.6%; adult smokers = 18.2%) and current use of electronic cigarettes (adolescents = 1.1%; adult nonsmokers = 0.3%; adult smokers = 4.5%). Among adolescents and adults, current smoking and higher smoking frequency were significantly associated with e-cigarette awareness, trial and use. Among adolescents and nonsmokers, awareness, trial and use of e-cigarette were significantly lower among females than males. Among adult smokers, however, females were more likely to use e-cigarettes than males (AOR = 1.80; 95% CI = 1.08–3.02). Higher education and greater wealth increased the likelihood of trial of e-cigarettes among adult nonsmokers and smokers. Despite the ban on the distribution and sales of e-cigarettes, a substantial number of Mexicans, have access to e-cigarettes. Decision makers and advocates should consider e-cigarette regulations as recommended by the WHO, at the same time Mexico must invest in the infrastructure needed to enforce these regulations.

Introduction Public health surveillance of smoking prevalence is essential in gauging the magnitude of the problem, identifying groups most affected, and evaluating polices. However, little attention has focused on how prevalence is measured, particularly in low- and middle-income countries, where smoking patterns may not mirror those in high-income countries and where the burden of tobacco use is rapidly growing. Mexico provides a unique opportunity to gauge how the questions used to define established smokers can affect prevalence estimates. This study assesses how using the 100-cigarette lifetime question to define smoking status affects estimates of smoking prevalence. Methods We consider data from four nationally representative surveys in Mexico, from 2002 to 2016. These surveys ask about current smoking even for adults who do not indicate having smoked 100 cigarettes in their lifetime. We compare estimates of daily and nondaily smoking prevalence by age and gender with and without the 100-cigarette screen. Results The relative difference in prevalence estimates with and without the screen was greater for nondaily than daily smoking and for females than males. The difference was especially pronounced for nondaily smokers aged 15–24, where there was a 50%–75% relative difference in estimates, albeit smaller discrepancies (20–49% relative difference) were also found among older smokers. In recent years, the relative difference was greatest at lower levels of educational attainment. Conclusions With the growth in nondaily smoking, using the 100-cigarettes screen to define smoking status can have important implications regarding size of smoking population. Further research is warranted in other countries.

Objetivo. Determinar los factores asociados con la ex­posición al humo de tabaco de segunda mano (HTSM) en lugares públicos y privados. Material y métodos. Se analizó la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2016. La exposición al HTSM se evaluó mediante modelos Poisson multinivel. La muestra del estudio incluye únicamente no fumadores. Resultados. La exposición al HTSM fue similar en los estados que tienen prohibición total para fumar en espacios cerrados en comparación con estados con prohibición parcial. Adultos jóvenes, hombres y personas con nivel educativo alto tienen mayor exposición al HTSM en bares y restaurantes. Los hombres tienen mayor exposición al HTSM en el trabajo, los adultos de mayor edad en el transporte público, mientras las mujeres y adolescentes en el hogar. Conclusiones. La exposición al HTSM continúa elevada y afecta diferencialmente a la población mexicana. Para reducirla, se requiere aplicar totalmente el artículo octavo del Convenio Marco para el Control del Tabaco.

Objetivo. Evaluar la dependencia física y psicológica de los fumadores mexicanos y su asociación con factores físicos, psicológicos y sociales. Material y métodos. A partir de la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2016 (n=7 331), se analizó la escala de dependencia física a la nicotina de Fagerström (FTND) y la escala corta de depen­dencia psicológica al tabaco (TAPDSc). Se realizaron análisis bivariados y regresiones logísticas ordinales generalizadas para evaluar los factores asociados. Resultados. 82.3% de fumadores diarios y 98.8% de ocasionales reportaron dependencia física leve, mientras que 47.9 y 37.9%, respec­tivamente, presentaron dependencia psicológica moderada. La edad de inicio temprana de consumo de tabaco, uso de drogas, consumo alto de alcohol y malestar emocional se asociaron con niveles altos de dependencia psicológica en todos los fumadores. Conclusión. El uso exclusivo de FNTD no permite evaluar adecuadamente a los fumadores mexicanos. La dependencia física y psicológica al tabaco debe ser diagnosticada con escalas independientes y validadas en esta población.

Los nuevos productos de tabaco, entre los que se incluyen los cigarros electrónicos (denominados “E Cigs”, “e-hookahs”, “mods”, “vape-pens”), los sistemas electrónicos de admi­nistración de nicotina (SEAN), los sistemas similares sin nicotina (SSSN) y los sistemas alternativos de consumo de nicotina (SACN), incursionan en el mercado global con un discurso de reducción del daño y minimización del riesgo. Este manuscrito resume la evidencia científica y una propuesta regulatoria sobre esta innovación tecnológica, con el fin de orientar la toma de decisiones de legisladores, instituciones gubernamentales y la sociedad civil organizada. La evidencia científica concluye que no existe un producto de tabaco seguro para la salud; la naturaleza adictiva de la nicotina y los daños a la salud causados en niños, adolescentes y mujeres embarazadas constituyen el argumento fundamental. Estos nuevos productos promueven la transición al consumo de cigarros combustibles y no han demostrado eficacia para la cesación tabáquica; por el contrario, promueven el uso dual. Toda regulación debe formularse sin la intervención de los fabricantes o instituciones con conflicto de interés y en el marco de la implementación completa e integral del Con­venio Marco de la Organización Mundial de la Salud para el Control del Tabaco.