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Depression, suicidal behavior, excessive alcohol intake, and tobacco use are the main mental health problems in adolescents. To address these problems, it is necessary to understand the many factors associated with them, including parental factors. The aim of this study was to assess the associations between parental behavior and mental health problems in adolescents in Mexico. Data from the National Health and Nutrition Survey (ENSANUT) 2018–2019, representative for Mexico, were used. Households in which a parent–adolescent child pairing was identified (regardless of family type) were selected; n = 8758 households. The four outcomes of interest that were measured in the adolescents were: excessive alcohol intake, tobacco use, suicidal behavior, and depressive symptomatology. Logistic regression models using the adjusted odds ratio (AOR) and 95% confidence interval (95% CI) were estimated. Adolescents whose parents used alcohol or tobacco and reported depressive symptoms and suicidal behavior were more likely to present these behaviors themselves (AOR = 1.47, 95% CI: 1.17–1.85; AOR = 2.26, 95% CI: 1.51–3.39; AOR = 2.61, 95% CI: 1.88–3.61; AOR = 1.74, 95% CI: 1.16–2.61, respectively). Child sexual abuse was also strongly associated with the four outcomes of interest in adolescents (AOR = 1.89, 95% CI: 1.06–3.36 for excessive alcohol intake; AOR = 2.97, 95% CI: 1.49–5.91 for tobacco use; AOR = 5.15, 95% CI: 3.27–8.09 for depressive symptoms; AOR = 6.71, 95% CI: 4.25–10.59 for suicidal behavior). The family constitutes the central nucleus of care for children and adolescents; therefore, any effort to promote adolescent mental health must necessarily involve their parents and family.

Objetivo. Estimar los beneficios económicos y en salud, por sexo y por quintil de ingreso, del incremento de los precios de los cigarros mediante impuestos en México. Métodos. Con un modelo de costo-efectividad extendido (ECEA, por su sigla en inglés) se estimaron los beneficios distributivos en mujeres y hombres con un escenario de incremento del precio de los cigarros de 44% (de 56,4 pesos mexicanos [MX$] a MX$81,2 por cajetilla), como resultado de triplicar el impuesto específico actual (de MX$0,49/cigarro a MX$1,49/cigarro). El modelo se calibró con fuentes oficiales de información nacional Resultados. Con el incremento del impuesto de un peso por cigarro, cerca de 1,5 millones de fumadores abandonarían el consumo (351 300 mujeres y 1,1 millón de hombres). Así, se evitarían aproximadamente 630 000 muertes prematuras atribuibles al tabaco. La reducción de la carga de enfermedad permitiría ahorros para el sector salud cercanos a MX$42 800 millones y evitaría que más de 250 000 personas (entre ellas, 50 200 mujeres fumadoras) cayeran en situación de pobreza. Además, se recaudarían MX$16 200 millones adicionales por año, de los cuales el quintil más bajo aportaría menos de 3% (1% en el caso de las mujeres de menores ingresos). Conclusiones. La epidemia de tabaquismo tiene patrones claramente diferenciados entre mujeres y hombres y reflejan un componente de género. Si bien los beneficios del impuesto al tabaco en México tendrían magnitudes relativas al estado actual de la epidemia en cada caso, estos podrían contribuir a un objetivo más amplio de justicia social mediante la reducción de las inequidades de género.

Objective. To explore the association between reporting conflict of interest (COI) and having a positive outcome toward vaping in scientific articles. Methods. A cross-sectional study that analyzed a sample of 697 articles published between 2017 and 2020 regarding vaping. Information on the reporting of COI, type of COI (no conflict, conflict with the tobacco industry, pharmaceutical industry, or other), and country of publication were collected. To explore the association between reporting COI and having a positive result for vaping, two logistic regression models were fitted, both adjusted by country of publication. Results. From 88 articles that reported COI, 23 reported COI with the tobacco industry, 44 with the pharmaceutical industry, and 21 reported another type of conflict. We found that reporting any type of COI increased by 4.7 times the odds (OR 4.70; 95% CI [2.89, 7.65]) of having a positive result for vaping. Additionally, compared to other countries, manuscripts published in England had 2 times higher odds (OR 2.40; 95% CI [1.16, 4.98]) of reporting a positive result for vaping. Reporting COI with the tobacco and pharmaceutical industries increased the odds of favorable results by 29 times (OR 29.95; 95% CI [9.84, 90.98]) and 2 times (OR 2.87; 95% CI [1.45, 5.69]), respectively. Conclusions. In scientific articles, reporting COI and having positive results for vaping are highly associated. COI should be considered and caution should be exercised when using data for policy-making.

Objetivo. Examinar los cambios en la prevalencia de con­sumo de alcohol y tabaco antes y durante la pandemia de Covid-19 en México. Material y métodos. Se utilizaron datos de las Ensanut 2018 y 2020 para adolescentes y adultos y se obtuvieron prevalencias de consumo actual y excesivo de alcohol y de fumadores actuales y exfumadores. Resul­tados. El consumo de alcohol en mujeres incrementó de 33.5% en 2018 a 42.5% en 2020, mientras que en los hom­bres no hubo cambios significativos. En el mismo periodo, la prevalencia de consumo excesivo de alcohol disminuyó de 11.1 a 5.5% en mujeres y de 36.7 a 18.3% en hombres. La prevalencia de mujeres fumadoras disminuyó de 9.5 a 7.2%. En adolescentes, no se encontraron diferencias significativas en la prevalencia de consumo de alcohol y tabaco. Conclusión. El consumo de alcohol y tabaco continúa siendo elevado en adolescentes y adultos mexicanos. Urge la implementación de las medidas SAFER y MPOWER para abatir sinérgicamente estas epidemias.

ABSTRACTExposure to tobacco marketing is positively associated with smoking initiation and behaviours. There is limited literature examining disparities among reported exposure in low- and middle-income countries. This study sought to fill this gap with a survey among 1427 adolescents and 889 adult smokers in Mexico City in 2020. Data were analysed using chi-square and hierarchical regression models. Two-thirds of adolescents noticed cigarette pack displays in stores. Participants from low- and mid-socioeconomic status (SES) neighbourhoods were more exposed to tobacco marketing than their counterparts through several channels. After addressing the shared variance among participants from the same household nested in neighbourhood SES level and controlling for gender, adolescent non-smokers and adult smokers who noticed pack displays were more likely to be susceptible to smoking (OR = 1.8, 95% CI 1.4–2.4) and to smoke more (OR = 1.7, 95% CI 1.21–2.47); adult smokers who noticed tobacco marketing at more places were less likely to be certain about smoking risks (OR = 0.9, 95% CI 0.8–0.9). The results suggest that the tobacco industry targets youth and individuals from low-SES neighbourhoods through several channels. Greater exposure to tobacco marketing was associated with increased susceptibility to smoking and decreased risk perception. These findings support a comprehensive ban on tobacco marketing in Mexico.

Abstract Background Several studies have shown the beneficial effects of tobacco fiscal policy, but distributional effects have been less examined, especially at the subnational level. The objective of this study is to analyse the distributional effects of a one-peso tobacco tax increase (roughly equivalent to tripling the current excise tax) on health, poverty, and financial outcomes at the subnational level in Mexico. Methods We employ an extended cost-effectiveness analysis that estimates life-years gained, smoking attributable deaths averted, treatment costs averted, number of persons avoiding poverty and catastrophic health expenditures, and additional tax revenues by income group across five regions. Results With the one-peso tax increase (or 44% price increase), about 1.5 million smokers would quit smoking across the five regions, resulting in nearly 630 thousand premature deaths averted and 12.6 million life years gained. The bottom income quintile would gain three times more life years gains than the top quintile (ratio 3:1), and the largest gain for the most deprived would occur in the South (ratio 19:1), the region with the highest poverty incidence. Costs averted and additional tax revenues would reach 44.6 and 16.2 billion pesos, respectively. Moreover, 251 thousand individuals would avoid falling into poverty, including 53.2 in the lowest income quintile, and 563.9 thousand would avoid catastrophic health expenditures. Overall, the bottom income group would obtain 26% of the life years gained and 24% of the cost averted, while only paying 3% of the additional tax revenue. Conclusions The most significant gains from a substantial cigarette price increase would be for the poorest 20%, especially in the South, the most impoverished region of Mexico. Therefore, tobacco taxes are an opportunity for governments to advance in equity and towards the achievement of sustainable development goals on non-communicable diseases.

Objetivo. Conocer la magnitud del consumo excesivo de alcohol (CEA) y su asociación con los factores individuales, familiares y sociales entre agosto y noviembre de 2020 en México. Material y métodos. Con base en los datos de la Encuesta Nacional de Salud y Nutrición 2020 sobre Covid-19, se analizaron 8 595 adultos mayores de 20 años. Se estimaron modelos de regresión logística estratificados por sexo y se obtuvieron razones de momios (RM) con intervalos de confianza al 95% (IC95%). Resultados. El CEA fue de 40.43%; hombres 56.49% y mujeres 25.70%. Los principales factores asociados fueron ser hombre (RM=3.66; IC95%: 3.22,4.12), edad de 20 a 29 años (RM=3.65; IC95%: 2.89,4.63), salir a trabajar durante la pandemia (RM=1.56; IC95%: 1.33,1.81) y tener dos o más escolares en el hogar (RM=1.20; IC95%: 1.03,1.39). Conclusiones. En México, el patrón de CEA es prevalente; por su naturaleza de riesgo y su amplia distribución poblacional, es prioritario implementar intervenciones preventivas individuales y de salud pública.

The primary objective of this study was to evaluate the measurement of invariance by sex, age, and educational level of an online version of the Generalized Anxiety Disorder Scale in a five-item version (GAD-5). Configural, metric, scalar, and strict invariance were evaluated using data from 79,473 respondents who answered a mental health questionnaire during the COVID-19 pandemic in Mexico. The sex variable was classified as male or female; age was categorized as minors, youth, young adults, adults, and older adults; and educational level was divided into basic, upper secondary, higher, and graduate education. To test for configural invariance, confirmatory factor models were constructed. For metric invariance, equality restrictions were established for the factor loadings between the construct and its items; for scalar invariance, equality restrictions were established between the intercepts; strict variance implied the additional restriction of the residuals. Statistical analysis was performed in R software with the lavaan package. The results show that with respect to sex, age, and educational level, configural and metric measurement invariance was confirmed (ΔCFI < 0.002; ΔRMSEA < 0.015). However, with respect to scalar and strict invariance, the results showed significant differences regarding the fit model (ΔCFI > 0.002; ΔRMSEA > 0.015). We conclude that the GAD-5 presents configural and metric invariance for sex, age, and educational level, and scalar invariance for sex and age groups. However, the scale does not demonstrate strict invariance. We discuss the implications and suggest that this result could be related to the evaluation of sociodemographic variables.

Objetivo. Estimar la prevalencia de violencia de pareja por sexo y su asociación con el uso de tabaco, alcohol y drogas en México. Material y métodos. Estudio transversal de la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2016, que incluyó a 34 861 personas de 12 a 65 años. Se esti­maron modelos de regresión logística 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 psicotrópicos 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 México.

Background. While overall trends in tobacco use among men are declining, tobacco use continues to rise significantly among women in developing countries. This study aimed to explore the gender-related beliefs and attitudes about tobacco use and smoking cessation in Mexico, one of the top five Latin America countries with the highest prevalence of tobacco consumption. Materials and Methods. This study was conducted using an explanatory qualitative methods design. Semi-structured interviews were conducted with 14 adults smokers (8 women & 6 men) who visited primary healthcare clinics in Mexico City. Two researchers independently coded the interviews and applied the final codes upon consensus. Inter-rater reliability was assessed for four groups of codewords (92% agreement), based on an ecological model on socio-cultural factors. Findings. Initiation to smoking in women begins out of curiosity, and in men by imitation. Also, women start using tobacco at an older age compared to men. During maintenance of smoking, women report experiencing loneliness and anxiety about multiple responsibilities, e.g. women reveal that they feel guilty when they smoke due to their maternal role as caregivers. Additionally, some women report that smoking is a symbol of freedom, recalling the media messages associated with promoting tobacco products. Among men, the results show that they smoke for pleasure and to socialize, and consider that women smoke to imitate men and feel powerful. Regarding cessation, women are ambivalent about quitting smoking or not, and men mention not needing professional support. For organizational barriers, women mention the cost of treatment and men, the distance to clinics. Conclusion. Smoking cessation interventions should be proposed from an approach that involves changes in social norms, seeking a more equitable relationship between men and women. Therefore, there must be broad engagement from different sectors and not just at the health sector level.

Objetivo. Estimar la prevalencia de conducta suicida y su asociación con factores psicológicos en adolescentes mexicanos. Material y métodos. Estudio transversal proveniente de la Encuesta Nacional de Salud y Nutrición (Ensanut 2018-19). Se estimaron modelos de regresión logística, con lo que se obtuvieron razones de momios (RM) con intervalos de confianza al 95% (IC95%). Resultados. La prevalencia nacional de ideación e intento de suicidio fue de 5.1 y 3.9%, respectivamente; fue más alta en Guanajuato (ideación: 9.0%, intento: 7.8%). Factores asociados. Ideación suicida: tabaco (RM= 2.19; IC95%: 1.56-3.09), alcohol (RM= 1.98; IC95%: 1.53-2.60), sintomatología depresiva (RM= 5.67; IC95%: 4.56-7.07), abuso sexual (RM= 6.67; IC95%: 4.60-9.66). Intento de suicidio: tabaco (RM= 2.09; IC95%: 1.42-3.07), alcohol (RM= 2.15; IC95%: 1.65- 2.80), sintomatología depresiva (RM= 6.05; IC95%: 4.75-7.73), abuso sexual (RM= 6.86; IC95%: 4.65-10.13). Conclusiones. Debido al incremento de la conducta suicida en adolescentes mexicanos, es necesario implementar políticas públicas preventivas que articulen programas de salud mental, adicciones y violencia.

Objetivo. 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. Material y métodos. Se utilizó la Encuesta Nacional de Salud y Nutrición 2018-19. Se utilizó un modelo Poisson para obtener la razón de prevalencias del uso de cigarros con cápsulas de sabor ajustando por sexo, edad, educación e índice de bienestar. Resultados. 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. Conclusiones. 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.

Objective: Tobacco taxes are a well-established cost-effective policy to prevent Noncommunicable Diseases. This paper evaluates the expected effects of a tobacco tax increase on the Sustainable Development Goals in Colombia.Methods: We use microsimulation to build an artificial society that mimics the observed characteristics of Colombia’s population, and from there we simulate the behavioral response to a tax increase of COP$4,750 (an increase that has been discussed by policy makers and legislators) and the subsequent effects in all SDGs.Results: The tobacco tax hike reduces the number of smokers (from 4.51 to 3.45 MM smokers) and smoking intensity, resulting in a drop in the number of cigarettes smoked in Colombia (from 332.3 to 215.5 MM of 20-stick packs). Such reduction is expected to decrease premature mortality, healthcare costs, poverty and people facing catastrophic expenditure on healthcare, to increase health, income and gender equity, and to strengthen domestic resource mobilization even in the presence of illicit cigarettes.Conclusion: Tobacco taxes are an effective intervention for public health and a powerful instrument to advance on the 2030 Sustainable Development Agenda.Relevance: A comprehensive analysis of the impact of tobacco taxes on all areas of Sustainable Development is missing in the empirical literature. Such perspective is needed to break the barriers for further tobacco tax increases by gathering wider societal support, especially from stakeholders and key decision makers from development areas other than health.SDG Nr: SDG3 (health), SDG 1 (no poverty), SDG 4 (education), SDG 5 (gender equality), SDG6 (water), SDG10 (inequality), SDG12 (responsible production and consumption), SDG17 (partnerships).

Objective. To evaluate the social factors associated with tobacco and alcohol consumption in Mexican adolescents from populations under 100 000 inhabitants. Materials and methods. Cross-sectional study based on the National Health and Nutrition Survey (Ensanut100k). It included adolescents between 10-19 years. Adjusted logistic regression models were estimated, obtaining Odds Ratio (OR) and confidence intervals 95% (CI95%). Results. Prevalence of tobacco consumption in the last month was 5.5% (10-14 years= 1.0%, 15-19 years= 11.2%); alcohol consumption 9.3%, and excessive alcohol consumption, 2.8%. Associated factors: smoking, sex (male, OR=6.00, CI95%: 2.89-12.46), age (OR=1.73, CI95%: 1.46-2.04), remunerated work (OR=2.87, CI95%: 1.12-7.34), affiliation to health services (OR=0.26, CI95%: 0.08-0.82); alcohol consumption, (male, OR=5.11, CI95%: 2.38-11.00), age (OR=1.70, CI95%: 1.51-1.92), remunerated work (OR=2.51, CI95%: 1.01-6.24). Conclusions. To reduce the consumption of alcohol and tobacco in adolescents, comprehensive prevention strategies must be implemented that consider the individual and social context.

Objective. To assess the correlates of secondhand smoke exposure (SHS) in public and private settings. Materials and methods. Data came from the 2016 National Survey of Drug, Alcohol and Tobacco use. Multilevel Poisson models were conducted to evaluate factors associated with SHS. Results. 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. Conclusions. 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.

Objectives. To review the implementation of the WHO Framework Convention onTobacco Control in theAmericas, describe two national case studies and analyze the evidence on electronic cigarettes from a public health perspective. Materials and methods. Revision of the tobacco control legislation and the scientific evidence regarding electronic cigarettes. Results. Implementation of tobacco control policies is not homogeneous, with important advances in smoke-free environments, pictorial health warnings, and epidemiological surveillance, but challenges that remain for the implementation of a total ban of tobacco advertising, increases in tobacco taxes, and tobacco cessation programs. Tobacco industry interference is one of the main obstacles for advancing and novel products create uncertainty about their regulation. Conclusion. There is a need for political will for a comprehensive implementation of the Convention, with evidence-based decisions to confront challenges and to defend the achievements from tobacco industry interference.

Objective. Evaluate the patterns of e-cigarette use and their association with smoking behavior. Materials and Methods. 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. Results. 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. E-cigarette use at follow-up was not associated with a change in CPD over time. Conclusions. E-cigarette use does not appear to have promoted smoking cessation or reduction in this sample of Mexican smokers.

Mexico was the first country in the Americas to sign and ratify the World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC) in 2004. More than a decade later, it is appropriate to evaluate legislative and regulatory progress and the associated challenges; and also, to propose a roadmap to prioritize the problems to be addressed to achieve long-term sustainable solutions. Mexico has made substantial progress in tobacco control. However, regulations have been only weakly enforced. The tobacco industry continues to interfere with full implementation of the WHO-FCTC. As a result, tobacco consumption remains stable at about 17.6%, with a trend upwards among vulne­rable groups: adolescents, women and low-income groups. The growing popularity of new tobacco products (electronic cigarettes or e-cigs) among young Mexicans is an increasing challenge. Our review reveals the need to implement all provisions of the WHO-FCTC in its full extent, and that laws and regulations will not be effective in decreasing the tobacco epidemic unless they are strictly enforced.

Objective. To evaluate the physical and psychological dependence of Mexican smokers and its association with physical, psychological and social factors. Materials and methods. 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. Results. 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 was associated with high levels of psychological dependence in all smokers. Conclusion. 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.

Abstract Background Article 10 of the World Health Organization Framework Convention on Tobacco Control states the need for industry disclosure of tobacco contents and emissions. Currently, the profiles of key tobacco compounds in legal and illegal cigarettes are largely unknown. We aimed to analyze and compare concentrations of nicotine, nitrosamines, and humectants in legal and illegal cigarettes collected from a representative sample of smokers. Methods Participants of the International Tobacco Control cohort provided a cigarette pack of the brand they smoked during the 2014 wave. Brands were classified as legal or illegal according to the Mexican legislation. Nicotine, nitrosamines, glycerol, propylene glycol, and pH were quantified in seven randomly selected packs of each brand. All analyses were done blinded to legality status. Average concentrations per brand and global averages for legal and illegal brands were calculated. Comparisons between legal and illegal brands were conducted using t tests. Results Participants provided 76 different brands, from which 6.8% were illegal. Legal brands had higher nicotine (15.05 ± 1.89 mg/g vs 12.09 ± 2.69 mg/g; p

Objective Cancer care providers’ (CCPs) attitudes towards smoking cessation are influenced by many factors, including their smoking status and knowledge. Our objective was to assess CCPs’ characteristics, tobacco use and smoking cessation practices in two Latin American cancer centres.Design Cross-sectional survey.Settings Two urban cancer centres located in Colombia and Mexico.Participants A total of 238 CCPs.Measures Online survey consisted of 28 close-ended questions adapted from the 2012 International Association for the Study of Lung Cancer survey and the Global Adult Tobacco Survey developed by the WHO. Means, frequencies and proportions were reported for each country. Factors associated to providing of smoking cessation treatment or referral at initial visit were evaluated using logistic regression.Results Current smoking prevalence was 10.5% and 12.3% among Colombian and Mexican CCPs, respectively. Around three quarters of the Colombian (86.4%) and Mexican CCPs (66.1%) considered to have inadequate training in smoking cessation. Approximately two-thirds of Colombian (67.5%) and Mexican CCPs (63.9%) reported always or most of the time asking patients about tobacco use during the initial visit. In Colombia and Mexico, the most relevant barriers for providing cessation services were (1) difficulties for motivating patients with cancer, (2) patient resistance in quitting smoking, (3) lack of local resources or referral centres for smoking cessation and (4) lack of training in smoking cessation. CCPs appointed at Instituto Nacional de Cancerología were less likely to provide cessation treatment or referral to their patients if they had less than 50% of their time devoted to patient care and were former or current smokers. The regression model for Instituto de Cancerología did not retain statistically significant variables.Conclusion Our findings highlight an urgent need for assisting Latin American CCPs in their quitting efforts as well as expanding formal smoking cessation training specifically tailored to these professionals for improving patients’ cancer prognosis and quality of life.

BackgroundNondaily smoking has been on the rise, especially in Mexico. While Mexico has strengthened its tobacco control policies, their effects on nondaily smokers have gone largely unexamined. We developed a simulation model to estimate the impact of tobacco control policies on daily and nondaily smoking in Mexico.MethodsA previously validated Mexico SimSmoke model that estimated overall trends in smoking prevalence from 2002 through 2013 was extended to 2018 and adapted to distinguish daily and nondaily smoking prevalence. The model was then validated using data from Mexican surveys through 2016. To gauge the potential effects of policies, we compared the trends in smoking under current policies with trends from policies kept at their 2002 levels.ResultsBetween 2002 and 2016, Mexico SimSmoke underestimated the reduction in male and female daily smoking rates. For nondaily smoking, SimSmoke predicted a decline among both males and females, while survey rates showed increasing rates in both genders, primarily among ages 15-44. Of the total reduction in smoking rates predicted by the model by 2018, tax policies account for more than 55%, followed by health warnings, cessation treatment, smoke-free air laws, and tobacco control spending.ConclusionsAlthough Mexico SimSmoke did not successfully explain trends in daily and nondaily smoking, it helps to identify gaps in surveillance and policy evaluation for nondaily smokers. Future research should consider appropriate measures of nondaily smoking prevalence, trajectories between daily and nondaily smoking, and the separate impact of tobacco control policies on each group.

Introduction Nicotine Replacement Therapy (NRT) is an effective treatment for smoking cessation. However, medication usage and adherence remain a challenge that contributes to low smoking cessation rates. In Mexico, 8 in 10 smokers are interested in quitting. However, only 6% of Mexican smokers use medication for smoking cessation. The objective of this study is to assess the feasibility and acceptability of a mobile health (mHealth) intervention to increase usage and adherence of NRT in Mexico. Methods The study involves a secondary data analysis. Forty smokers were recruited to participate in a single-arm pilot study. Participants received an mHealth intervention that uses tablet-based decision support software to drive a 12-week text messaging smoking cessation program and pharmacotherapy support. The intervention allows two-way interactivity text messaging between participants and a tobacco treatment specialist. NRT was offered to participants in accordance with practice guidelines in Mexico. Outcome measures included utilization of NRT, text messaging interactivity with the program, and biochemically verified abstinence at 12 weeks. Results Thirty smokers met the criteria for use of NRT. Average age of participants was 38.1 years (SD=10.7), and they were primarily male (56.7%) with at least an undergraduate degree (60%). All participants requested NRT at baseline, and 60% requested a refill at week 4. During the 12-week intervention period, participants sent 620 messages to the program (mean=20.6, SD=18.34) of which 79 messages (12.7%) were related to NRT. Three themes were identified in the messages related to NRT: enthusiasm, instructions, and side effects. At 12 weeks, 40% of participants reported using NRT

The new tobacco products that include electronic cigarettes (called “E Cig”, “e-hookahs”, “mods”, “vape-pens”), electronic nicotine delivery systems (SEAN, Spanish acronym), similar systems without nicotine (SSSN, Spanish acronym) and alternative nicotine consumption systems (SACN, Spanish acronim), are positioned in the global market with a discourse of harm reduction and risk minimization. This manuscript summarizes the scientific evidence and present a regulatory proposal for this technological innovation, oriented to guide the decision making of legislators, government institutions and organized civil society. The scientific evidence concludes that there is no safe tobacco product for health, the addictive nature of nicotine and the health damages for children, adolescents and pregnant women is the fundamental argument. These new products promote the transition to conventional cigarettes and have not shown efficacy for smoking cessation, on the contrary, they promote dual use. High-level regulation must be formulated without the intervention of the manufacturers or institutions with a conflict of interest in the context of the complete and integral World Health Organization Framework Convention on Tobacco Control implementation.

Objective. To evaluate an e-Health tool designed to en­hance smoking cessation in Mexico in primary healthcare. Materials and methods. Smokers 18 years of age and older were recruited in the waiting room of two primary healthcare clinics in Mexico City. Participants used an e- Health smoking cessation tool that included smoking-related assessments, education on pharmacotherapy, and motivational videos. A follow-up assessment was conducted at 12 weeks week on smoking status. Logistic regression models were performed to identify factors associated with smoking ces­sation or consumption reduction. Results. A total of 132 smokers were enrolled in the study. At follow-up, 23.5% of participants self-reported smoking cessation. Among those who did not quit smoking, 65.0% decreased the number of cigarettes. Factors associated significantly with smoking cessation were: being a non-daily smoker, being interested in quitting smoking, having low level of physical dependence, and participating in cessation treatment. Conclusions. The e-Health tool produced a high rate of smoking cessation. Better outcomes are obtained when this tool is used with conventional cessation programs.

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.

Abstract Background Inconsistent associations between smoking status and prostate cancer (PC) could be due to exposure assessment error. Reconstructing smoking behaviors over the life course could reduce exposure assessment error. Methods As part of a case-control study, we identified 402 incident and histologically confirmed PC cases that were matched by age (±5 years) to 805 population controls. Through direct interview, we obtained information about: age at smoking onset, intensity and frequency of cigarette smoking at different life stages, and smoking cessation age. Smoking status at interview and average smoking index over the lifetime (packs/year) were estimated. Life course smoking patterns were obtained applying the k-means+ method for longitudinal data to the smoking index (pack/year) for each life stage. Results Two life-course smoking patterns were identified among ever smokers: “pattern A” characterized by males who reported low and constant smoking intensity (87.8%), and “pattern B” (12.2%) males with an initial period of low intensity, followed by an increase during the second period. Compared to never smokers, pattern B was associated with higher poorly differentiated PC, (OR 2.30; 95% CI 1.21–4.38). No association was observed with average smoking index. Conclusion Life course smoking patterns seem to capture the smoking variability during life course and reduce the likelihood of reverse causation. Using this assessment strategy our findings support the potential role of tobacco smoking in PC, particularly poorly differentiated PC. Prospective studies with comprehensive smoking history during the lifetime are needed to confirm these findings.

Tobacco smoking is causal risk factor of at least 16 different types of cancer. In Mexico, smoking causes 6 035 premature deaths annually of lung cancer and 5 154 from other types. Additionally, 16 408 new smoking- attributable cases are diagnosed, causing high costs in the Mexican health sector. The WHO Framework Convention on Tobacco Control is the global strategy to reduce morbidity and mortality caused by this risk factor. Four more cost-effective strategies to ensure the population benefit are: i) increase tobacco taxes, ii) create 100% smoke-free environments, iii) warn damage through health warnings with pictograms and iv) total ban of advertising and promotion. Mexico is call upon to implement with determination this comprehensive strategy to reduce cancer mortality and assuring the health population. DOI: http://dx.doi.org/10.21149/spm.v58i2.7794

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 Mexico has regulation addressing advertising, promotion and sponsorship of tobacco products. Social environment and availability must be considered to actualize tobacco control policies targeting young people. We aimed to examine changes on tobacco retail and publicity around secondary schools in Mexico. Methods 57 secondary schools where randomly selected by strata across three major cities in Mexico (Mexico City -CDMX-, Guadalajara and Monterrey) on 2014; urban marginalization and registered PoS according to the NAIC System were used. Tobacco retail, external and internal publicity were evaluated in each PoS within a ratio of 300 meters around schools and standardized questionnaires were fulfilled by trained observers; this exercise was repeated on 2016. Paired sample T test and tests on the equality of proportions were executed. This study was funded by the National Institute of Health, University of South Carolina through CODICE collaboration. Results Total number of PoS reduced from 796 (Density: 2816.5/km 2 ) in 2014 to 597 (Density: 2112.3/km 2 ) in 2016 (p< 0.05), no reduction was found in Monterrey. Street vendors were found almost exclusively in CDMX. Sales of single cigarettes reduced only in CDMX (71.4% to 57.1%; p< 0.05) and we were able to detect contraband sales in less than 5% of stores. Sale of flavored capsules was found in more than half of stores (2016). External publicity: was found in less than 2% of stores in both measurements. Internal publicity: announcements at the high of children eyes reduced in Monterrey (90.7% to 30.8%; p< 0.05), promotions were found in less than 4% of stores and counter-publicity augmented in Guadalajara from 0.4% to 14.0% (p< 0.05); in contrast, display of cigarettes augmented in CDMX from 22.3% to 34.2%; (p< 0.05). Conclusions Tobacco retail remain present around secondary schools and control policies should target display of tobacco cigarettes and reinforce control of contraband and single cigarettes sales.

Objective. To analyze psychosocial factors associated with the decision to smoke in students 13 to 15 years in Mexico City. Materials and methods. Logistic regression models of Youth Tobacco Survey (n=945) and four Focus Groups (GF) in two secondary schools, conducted in 2011-2012, were used. Results. Factors associated with smoking: a) believe that it is safe (OR=2.4, CI95% 1.28-4.7), GF: ability to control over consumption and long-term damage; b) to have at least one smoking parent (OR=1.6, CI95% 1.1-2.3), GF: influence to start/maintain consumption; c) to have friends who smoke (OR=5.0, CI95% 1.9-13.6), GF: influence to experimentation/repeat, schools without rules on prohibition and have access to cigarettes (OR=2.1, CI95% 0.9-4.1). Protective factors: a) believe that it is harmful (OR=0.3, CI95% 0.14-0.65), GF: rejection of cohabitation with smokers; b) communication with family (OR=0.5, CI95% 0.36-0.91), GF: appeal to self-care; c) consider is young for smoking (OR=0.2, CI95% 0.12-0.43), GF: knowledge about damage and risk perception. Conclusion. It is necessary to strengthen positive psychosocial skills and strengthen compliance with youth protection legislation.

Objective. To identify factors associated with susceptibility, tobacco use and addiction in young people from 13 to 15 years of age, to determine conditions of risk and identify possible correlates to the development of public policies on smoking in Costa Rica. Materials and methods. Information available from the four rounds of the Global Youth Tobacco Survey (GYTS) Costa Rica was used. It was based on a sample size of 11 540 youngsters from public and private schools. Indicators of interest and logistic regression models for smoking, susceptibility and addiction were estimated. Results. The prevalence of current consumption shows a significant decrease over the 14 years of the study (17.3% in 1999 and 5.0% in 2013) and, to a lesser intensity, in the index of smoking susceptibility (19.3% in 1999 and 12.4% in 2013). The proportion of young people with addiction has shown a significant increase in the same period. Conclusions. The conditions that explained the significant reduction in smoking prevalence and less susceptibility must be maintained and deepened to achieve full compliance of the MPower measures.

La exposición a publicidad sobre tabaco está asociada con el inicio en el consumo, particularmente en población joven, por lo que su control es un objetivo clave para reducir la incidencia de tabaquismo. Históricamente, la industria tabacalera ha sido pionera en la utilización de tecnologías de comunicación para posicionarse ante nuevos mercados y mantener la preferencia de los consumidores. Internet y los videojuegos han trascendido el espacio del entretenimiento, convirtiéndose en medios de comunicación masiva con un alto potencial publicitario. El presente artículo hace una revisión de la literatura existente sobre la presencia de tabaco en internet y videojuegos, con la intención de definir líneas de trabajo para desarrollar mecanismos efectivos de regulación y control de la publicidad en estos medios.Exposure to tobacco advertisement is associated with smoking initiation among the youth, its elimination is a key objective to effectively curb the tobacco epidemic. Historically, the tobacco industry has pioneered the use of new communication technologies to keep and expand their market. Nowadays, Internet and video games have transcended the entertainment sphere, becoming significant media for massive communication and providing new opportunities for advertisement. The present essay reviews the existing literature on tobacco presence in the Internet and video games to define research and policy tasks required to develop effective means for tobacco advertisement regulation and control.

OBJETIVO: Identificar factores socioeconómicos, demográficos, historia de tabaquismo y contextuales asociados con el deseo de dejar de fumar, estimar la disponibilidad a pagar (DAP) por tratamientos de cesación tabáquica (TCT) efectivos, e identificar sus factores asociados. MATERIAL Y MÉTODOS: Mediante la Encuesta Global de Tabaquismo en Adultos, México 2009, caracterizamos a 1 626 fumadores. Modelos logit y de regresión lineal múltiple permitieron identificar factores asociados con el deseo de dejar de fumar y la DAP. RESULTADOS: 82.2% de los fumadores que no deseaban dejar de fumar fueron hombres. Entre quienes deseaban dejar de fumar, 49.8% fumaba diariamente y reportó más de 16 años de fumar, 57% manifestó intentos previos de cesación y 10% conocer centros de ayuda. La DAP promedio fue 2 708 MXN, destacando diferencias por nivel socioeconómico y educativo. CONCLUSIONES: Se contribuye al diseño de estrategias de cesación diferenciadas, propiciando mejoras en la respuesta del sistema de salud al combate del tabaquismo en México.OBJECTIVE: To identify environmental, demographic and socioeconomic factors associated with the desire to quit, estimate the willingness to pay (WTP) for smoking cessation treatments (SCT) and to identify associated factors with this valuation. MATERIALS AND METHODS: Using the Global Adult Tobacco Survey, Mexico 2009, we characterized 1 626 smokers. Logistic and multiple lineal regression models allowed to identify associated factors with the desire to quit and the WTP for SCT. RESULTS: 82.2 % of the current smokers who did not want to quit were men. Between those who wanted to quit, 49.8 % had been consuming tobacco every day, for more than 16 years, 57 % had made cessation attempts in the past, and around 10% knew about the existence of centers to help quit smoking. Average WTP was 2 708 Mexican pesos (MXP), with differences by educational and socioeconomic levels. CONCLUSIONS: This evidence supports policymakers in the design of smoking cessation interventions improving national health system interventions for quit smoking.

Cerca de dos terceras partes del total de muertes a nivel global son causadas por las enfermedades crónicas no transmisibles. Se han recomendando cinco intervenciones prioritarias para disminuir esta tendencia: 1. Control del tabaco (la más urgente e inmediata), 2. Reducción del consumo de sal, 3. Mejoría en la dieta y actividad física, 4. Reducción del consumo peligroso de alcohol y 5. Acceso a los medicamentos esenciales y la tecnología. En relación con los padecimientos derivados del consumo del tabaco, la OMS reconoce el conflicto fundamental de intereses entre las tabacaleras y la salud pública y sugiere la implementación del Convenio Marco para el Control del Tabaco de la OMS y las estrategias MPOWER, ya que su completa implementación podría evitar cerca de 5.5 millones de muertes en los siguientes 10 años. Todas estas recomendaciones son viables y factibles de implementar si se consideran la voluntad política de los gobiernos, la infraestructura disponible, la capacidad técnica existente, la participación coordinada de todos los sectores y grupos de interés, la sociedad civil organizada y la colectividad en su conjunto.Nearly two-thirds of all deaths globally are caused by noncommunicable diseases (cardiovascular diseases, cancer, respiratory diseases and diabetes). The UN General Assembly approved Political Declaration of the High-Level Meeting on the Prevention and Control of non communicable diseases and recommending five priority interventions: 1. Tobacco control (the most urgent and immediate), 2. Salt reduction, 3. Improved diet and physical activity, 4 Reduction of hazardous alcohol intake, 5. Access to essential drugs and technologies. The Assembly recognizes the fundamental conflict of interest between tobacco industry and public health and recommends the implementation of WHO Framework Convention on Tobacco Control (FCTC) and MPOWER strategies. The full implementation of FCTC could prevent 5.5 Million of death in the next 10 years in low and middle income countries. All these recommendations are feasible to implement considering the willingness of Governments, the infrastructure available, the capacity building existing and the participation of all sectors, including civil society and the community as a whole.

OBJETIVO: Calcular los costos por ausentismo laboral atribuibles al tabaquismo en los asegurados del IMSS y población ocupada en México para el periodo 2006-2009. MATERIAL y MÉTODOS: Los costos se estimaron usando fracciones atribuibles para cáncer pulmonar, enfermedad cerebrovascular, enfermedad pulmonar obstructiva crónica e infarto agudo de miocardio, así como registros de salarios y días de incapacidad por esas enfermedades en asegurados del IMSS. Los parámetros encontrados se extrapolaron a la población ocupada. RESULTADOS: El IMSS erogó 143.9 millones de pesos a precios de 2009 atribuibles al tabaquismo como subsidio por incapacidad en el período 2006-2009. La productividad perdida atribuible al tabaquismo en asegurados del IMSS ascendió a 298.2 millones de pesos y a 437.8 millones de pesos en población ocupada del país en el mismo período. CONCLUSIONES: El tabaquismo impone costos importantes a las instituciones de seguridad en el país y causa pérdidas en la productividad. Por tanto, deben fortalecerse las políticas gubernamentales de control del tabaco incluidas en el Convenio Marco para el Control del Tabaco.OBJECTIVE: To calculate the absenteeism costs by lung cancer, cerebrovascular disease, chronic obstructive pulmonary disease and acute myocardial infarction attributable to smoking in the Mexican Social Security Institute (IMSS) and the occupied population from 2006 to 2009. MATERIALS AND METHODS: Productivity loss data from selected illnesses were obtained from IMSS records. The smoking attributable fraction was used, and extrapolation to occupied population was conducted. RESULTS: IMSS paid $143.9 million pesos (2009 prices) attributable to smoking between 2006 and 2009. The productivity loss was $298.2 million pesos and $437.8 million pesos in the occupied population, attributable to smoking. CONCLUSIONS: Tobacco smoking implies costs to the individual, families and society, which urge to strengthen policies contained in the Framework Convention on Tobacco Control by the WHO.

This essay tries o develop classification criteria to identify smoke-free spaces using environmental monitoring, direct inspection and worker reports, comparing their agreement and deriving a proposal useful for the epidemiological surveillance of environmental tobacco smoke. Environmental nicotine monitoring, direct inspections and worker’s surveys regarding tobacco smoke presence were conducted in ten institutions. For each method, criteria were defined to classify institutions as smoke-free spaces. Results were compared to evaluate between-methods agreement. Good agreement between environmental monitoring and direct inspections were observed, although they disagreed in 20% of the cases. Worker reports were too frequent to discriminate. Combining environmental monitoring and inspection would provide the most sensitive classification. Cost-effectiveness studies are required to identify the best strategy.Este texto pretende establecer criterios para identificar espacios libres de humo de tabaco ambiental (HTA) utilizando monitoreo, inspección directa y reporte de los trabajadores, comparando su capacidad de discriminación y derivando una propuesta con aplicación a un sistema de vigilancia epidemiológica. En 10 instituciones se monitoreó nicotina ambiental, realizando inspecciones y obteniendo el reporte de los trabajadores sobre la presencia de HTA. Para cada método se definieron criterios para clasificar a las instituciones como espacios libres de HTA. Los resultados fueron comparados para analizar el nivel de acuerdo entre métodos. Se observó buen acuerdo entre monitoreo ambiental e inspección directa, discrepando en 20% de las decisiones. El reporte de los trabajadores fue demasiado frecuente para discriminar. La combinación del monitoreo ambiental con la inspección proporcionaría la clasificación más sensible. Se requieren estudios de costo-efectividad para identificar la mejor estrategia.

Background Smoking is a public health problem in Mexico and worldwide; its economic impact on developing countries has not been well documented. The aim of this study was to assess the direct medical costs attributable to smoking incurred by lung cancer patients treated at the National Cancer Institute of Mexico (INCan). Methods The study was conducted at INCan in 2009. We carried out a cost of illness (COI) methodology, using data derived from an expert panel consensus and from medical chart review. A panel of experts developed a diagnostic-therapeutic guide that combined the hospital patient pathways and the infrastructure, human resources, technology, and services provided by the medical units at INCan. Cost estimates in Mexican pesos were adjusted by inflation and converted into US Dollars using the 2013 FIX exchange rate for foreign transactions (1 USD = 13.06 Mexican pesos). Results A 297 incident cases diagnosed with any type of lung cancer were analyzed. According to clinical stage, the costs per patient were 13,456; 35,648; 106,186; and 144,555 USD, for lung cancer stages I, II, III, and IV respectively. The weighted average annual cost/patient was and 139,801 USD and the average annual cost/patient that was attributable to smoking was 92,269 USD. This cost was independent of the clinical stage, with stage IV representing 96% of the annual cost. The total annual cost of smoking-related lung cancer at INCan was 19,969,781 USD. Conclusions The medical care costs of lung cancer attributable to smoking represent a high cost both for INCan and the Mexican health sector. These costs could be reduced if all provisions established in the Framework Convention of Tobacco Control of the World Health Organization were implemented in Mexico.

OBJETIVO: Estimar los costos de atención médica en el Instituto Mexicano del Seguro Social (IMSS), Delegación Morelos, de las enfermedades mayores atribuibles al consumo de tabaco. MATERIAL Y MÉTODOS: Las estimaciones de costos se realizaron desde la perspectiva del proveedor utilizando la metodología de costeo de enfermedad. Un panel de expertos multidisciplinario caracterizó la atención médica, en términos de la frecuencia de utilización de servicios en el primer y segundo niveles de atención, considerando el grado de severidad de la enfermedad. Los costos unitarios se estimaron en pesos mexicanos del 2001. Para estimar los costos atribuibles al tabaquismo se utilizó la fracción atribuible al consumo de tabaco para cada enfermedad (FA). RESULTADOS: Los costos promedio anuales de atención médica en el primer y segundo niveles de atención en la Delegación Morelos corresponden a 79 530 pesos para infarto agudo del miocardio (IAM), 73 303 pesos para enfermedad pulmonar obstructiva crónica (EPOC) y 102 215 pesos para cáncer de pulmón (CP). El costo total anual para la Delegación por estas tres enfermedades asciende a 147 millones 390 mil 688 pesos. Los costos atribuibles al consumo de tabaco corresponden a 124 millones de pesos, lo cual equivale a 7.3% del presupuesto anual de la Delegación. CONCLUSIONES: Estos resultados confirman el alto costo de la atención médica en el IMSS correspondiente a las enfermedades atribuibles al consumo de tabaco. Se recomienda realizar este estudio en el plano nacional, de tal manera que los tomadores de decisiones tengan herramientas para fortalecer las políticas de control del tabaquismo en México.OBJECTIVE: To estimate the cost of medical care for the major diseases attributable to tobacco consumption at the IMSS, Morelos. MATERIAL AND METHODS: A cost of illness (COI) analysis was carried out from the perspective of the health provider. An expert panel characterized medical care in primary and secondary care levels according to severity of disease. The smoking attributable fraction (SAF) by disease was used to derive costs attributable to tobacco consumption. The unitary cost was valuated in 2001 Mexican pesos (MP). RESULTS: The estimated annual average cost of medical care (diagnosis and first year of treatment) was 79 530 MP for acute myocardial infarction (AMI); 73 303 MP for chronic obstructive pulmonary disease (COPD); and 102 215 MP for lung cancer (LC). The annual total cost of medical care for IMSS was 147 390 688 MP. The total annual cost of medical care attributable to tobacco consumption corresponds to $124 million MP, which is equivalent to 7.3% of the annual budget of the Morelos Delegation. CONCLUSIONS: These results confirm the high medical costs associated with smoking. A repetition of this study at the national level is recommended in order to support decision-makers in strengthening public policies to control tobacco use in Mexico.

Objetivo. Describir las estrategias de publicidad, mercadeo, y venta productos del tabaco en 12 ciudades de México. Material y métodos. Los puntos de venta de tabaco, a 500mts alrededor de escuelas participantes de la Encuesta de Tabaquismo en Jóvenes (2005-2006), fueron identificados usando formatos observacionales y un Sistema de Información Geográfica en línea. Resultados. En promedio se encontraron 8 establecimientos y 5 puestos de calle alrededor de las 257 escuelas visitadas. 44.4% de los establecimientos tenía publicidad en interior, 8.3% poseían productos a la altura de los ojos de los niños y 6.5% tenía alguna promoción. El 33.6% tenía letrero de prohibición de venta a menores, en tanto que 44.4% de los establecimientos y 58.8% puestos de calle vendían cigarros sueltos. Conclusiones. Los productos de tabaco son ampliamente publicitados y comercializados alrededor de las escuelas. Existe un alto incumplimiento de las leyes referentes a la venta a menores y por menores. Es urgente implementar un sistema que permita una vigilancia continua de las estrategias de la industria y para el control del tabaco.Objective. To describe strategies used in the publicity, marketing, and sale, of tobacco products in 12 cities in Mexico. Material and Methods. Tobacco products points of sale (POS) were identified within a 500 m radius of Global Youth Tobacco Survey (2005-2006) schools. We used observational surveys and an online Geographic Information System (GIS). Results. In the 257 schools visited, we found, on average, 8.3 stores and 5 street vendors around each of them. Forty-four percent of the stores had interior tobacco publicity, 8.3% had tobacco products at children's eye level, 6.5% had some promotion, 33.6% had a no selling to minors sign, and 44.4% of stores and 58.8% of street vendors sold single cigarettes. Conclusions. Tobacco products are largely publicized and marketed around schools. There is no compliance of tobacco control legislations in regards to selling to minors and single cigarettes. It is necessary to implement a surveillance system to monitor strategies for tobacco control and the tobacco industry.

Objetivo. Cuantificar la exposición al humo de tabaco ajeno (HTA) en lugares públicos de México, con el fin de impulsar políticas locales de ambientes 100% libres de humo de tabaco. Material y métodos. Se monitoreó aleatoriamente 20% de las áreas interiores de hospitales, escuelas y oficinas públicas de Monterrey, Guadalajara y la Ciudad de México. La concentración mediana de nicotina ambiental fue estimada por ciudad, tipo de espacio público y área interior. Resultados. La concentración mediana en los espacios donde se detectó nicotina fue de 0.06 µg/m3 (P25=0.03, P75=0.12 µg/m3), las mayores concentraciones se obtuvieron en la Ciudad de México y en las oficinas públicas. No se detectó nicotina en 75% de los espacios monitoreados. Conclusiones. El monitoreo ambiental de nicotina es una herramienta útil para fortalecer la implementación y evaluar el cumplimiento de la política de ambientes 100% libres de humo de tabaco.Objective. To quantify environmental tobacco smoke exposure in public places in Mexico to promote policies of 100% smoke-free environments. Materials and Methods. In hospitals, schools and public offices of Monterrey, Guadalajara and Mexico City 20% of inner areas were monitored. Median nicotine concentrations were estimated by city, type of public space and type of inner area. Results. Median concentration in areas where nicotine was detected was 0.06 µg/m3 (P25=0.03, P75=0.12 µg/m3). Higher concentrations were found in Mexico City and in public offices. Nicotine was not detected in 75% of monitored areas. Conclusions. Monitoring environmental nicotine is a useful tool to evaluate compliance of public places with the smoke-free environments legislation, and could constitute an important source of information to strengthen implementation efforts.

Objetivo. Analizar las percepciones y apreciaciones sobre espacios libres de humo de tabaco de los responsables de bares y restaurantes en cuatro ciudades del centro de México. Material y métodos. Se encuestó a los administradores de 219 bares y restaurantes de la Ciudad de México, Colima, Cuernavaca y Toluca, acerca de opiniones e implementación de espacios libres de humo. Simultáneamente, se monitorearon concentraciones de nicotina ambiental. Resultados. La mayoría de los encuestados consideró que los espacios públicos deben ser libres de humo, más de la mitad refirió preocupación por pérdidas económicas. La implementación de espacios libres de humo fue más frecuente en la Ciudad de México (85.4%) que en las demás ciudades (15.3% global), lo que se refleja en menores concentraciones de nicotina ambiental. Conclusión. Los administradores reconocen la necesidad de crear espacios libres de humo. La preocupación sobre posibles efectos económicos negativos de la prohibición podría explicar, al menos parcialmente, el rechazo a la implementación de este tipo de políticas.Objective. To analyze the perceptions and appreciations over smoke-free environments of restaurant and bar managers from four cities in central Mexico. Material and Methods. Managers from 219 restaurants and bars from Mexico City, Colima, Cuernavaca and Toluca were surveyed about smoke-free environments opinions and implementation. Simultaneously, environmental nicotine was monitored. Results. The majority of surveyed managers considered public places should be smoke-free, although more than half were concerned with potential economic loses. Implementation of smoke-free environments was more frequent in Mexico City (85.4%) than in the other cities (15.3% overall), with consequently lower environmental nicotine concentrations. Conclusion. Managers acknowledge the need to create smoke-free environments. Concerns over economic negative effects derived from the prohibition could explain, at least partially, the rejection of this sector towards the implementation of this type of policy.

Objetivo. Estimar la elasticidad precio de la demanda de cigarros en México con base en fuentes de información y metodología distintas a las utilizadas en estudios previos sobre el tema. Material y métodos. Se utilizaron series trimestrales de consumo, ingreso y precio para el periodo de 1994 a 2005. Se estimó un modelo de demanda de largo plazo mediante mínimos cuadrados ordinarios (MCO) y se investigó la existencia de una relación de cointegración. Además, se estimó un modelo mediante mínimos cuadrados ordinarios dinámicos (MCOD) para corregir posibles problemas de endogeneidad de las variables independientes y autocorrelación de los residuales. Resultados. Las estimaciones mediante MCOD mostraron que un incremento del precio de los cigarros de 10% podría reducir el consumo en 2.5% (pObjective. To estimate the price elasticity of the demand for cigarettes in Mexico based on data sources and a methodology different from the ones used in previous studies on the topic. Material and Methods. Quarterly time series of consumption, income and price for the time period 1994 to 2005 were used. A long-run demand model was estimated using Ordinary Least Squares (OLS) and the existence of a cointegration relationship was investigated. Also, a model using Dinamic Ordinary Least Squares (DOLS) was estimated to correct for potential endogeneity of independent variables and autocorrelation of the residuals. Results. DOLS estimates showed that a 10% increase in cigarette prices could reduce consumption in 2.5% (p

OBJETIVO: Analizar la información de la Encuesta sobre tabaquismo en jóvenes (ETJ) sobre consumo de cigarro y otros indicadores propuestos en el Convenio Marco para el Control del Tabaco (CMCT). MATERIAL Y MÉTODOS: La ETJ usa un diseño de muestreo por conglomerado en dos etapas que genera muestras representativas de estudiantes de 12 a 15 años de las escuelas secundarias públicas, privadas y técnicas. Incluye 33,297 estudiantes de 399 escuelas de nueve ciudades. Se obtuvieron prevalencias puntuales y diferencias de proporciones, así como razones de momios ajustadas por edad. RESULTADOS: La prevalencia de fumadores en el mes anterior a la encuesta es de 24.9% (IC 95% 22.5-27.3). El índice de susceptibilidad de iniciarse en el consumo de cigarros es de 28%. Al comparar con la aplicación en 2003, no se observa una disminución del consumo ni de la exposición al humo de tabaco, ni aumento en las tasas de cesación. En los programas escolares se han incrementado significativamente los contenidos de daños a la salud causados por fumar. No se observan avances en cuanto a reducción de la publicidad del tabaco, ni reducción del acceso de los menores al tabaco. Se presentan estimados nacionales y por ciudad. CONCLUSIÓN: Dos años después de ratificado el CMCT todavía no hay avances significativos en las principales áreas abordadas por dicho convenio, especialmente no ha disminuido el consumo de tabaco entre los estudiantes de secundaria.OBJECTIVE: The aim of this paper is to present findings from the GYTS on current cigarette smoking and other tobacco epidemic indicators. MATERIAL AND METHODS: The GYTS uses a two-stage cluster sample survey design that produces representative samples of students aged 12 to 15 years enrolled in public, private and technical schools. The survey was undertaken in 2003 and 2006 at 399 schools in nine cities. The GYTS surveyed 33 297 students. Point prevalence, differences of proportions and adjusted odds ratio were estimated. RESULTS: The overall rate for current smoking in 30 days preceding the survey is 24.9% (95% CI, 22.5-27.3). Among never smokers, 28% are likely to initiate smoking next year. As compared to the previous survey in 2003, there is not a reduction in cigarette smoking or exposure to secondhand smoke. Cessation rates have not changed and advertisements and access by minors to tobacco products are still unresolved problems. However, tobacco related materials have significantly been added to school curricula. National estimates are presented, as well as city level estimates. CONCLUSION: Two years after FCTC ratification, there is no major improvement in critical areas of tobacco control in Mexico; particularly, there is no evidence of reduction in cigarette smoking among students in secondary schools.

OBJETIVO: En México no se han efectuado evaluaciones de la exposición al humo de tabaco ambiental en los hogares ni en sus habitantes. El objetivo de este estudio es cuantificar los niveles de nicotina ambiental en hogares de la Ciudad de México, evaluando simultáneamente los niveles de nicotina en el cabello de niños y mujeres. MATERIAL Y MÉTODOS: En julio de 2005 se seleccionaron 41 hogares de la Ciudad de México a conveniencia, 20% sin fumadores y 80% con fumadores. Se colocaron monitores pasivos de nicotina en los hogares por una semana y se obtuvieron muestras de cabello de mujeres no fumadoras y niños para cuantificar nicotina. Las muestras fueron enviadas a la Universidad Johns Hopkins, donde la nicotina se extrajo y analizó con cromatografía de gases. De manera adicional, se aplicaron encuestas de opinión y conductas relacionadas con el humo de tabaco ambiental. RESULTADOS: Las concentraciones de nicotina ambiental tuvieron una mediana de 0.08 µg/m³ (RIC 0.01-0.64), en el cabello de los niños 0.05 ng/mg (RIC 0.05-0.29) y en el cabello de las mujeres 0.05 ng/mg (RIC 0.05-0.19). Las concentraciones de nicotina ambiental y en el cabello de los niños mostraron una correlación alta (rS=0.49), y se incrementó con el número de fumadores en el hogar. La mayoría de los encuestados apoya las medidas de control del humo de tabaco ambiental. CONCLUSIONES: Se observaron grados particularmente altos de exposición en niños atribuibles a la presencia de nicotina ambiental en el hogar. Deben implementarse acciones preventivas integrales para eliminar el tabaquismo activo y evitar el consumo de tabaco en el hogar.OBJECTIVE: In Mexico no evaluation of environmental tobacco smoke exposure in homes or habitants has been conducted. The objective of this study is to quantify environmental nicotine in Mexico City homes, simultaneously evaluating nicotine levels in children and women. MATERIAL AND METHODS: In July 2005 a convenience sample of 41 homes was selected, 20% without smokers, 80% with smokers. Nicotine passive monitors were allocated in homes for one week, obtaining samples of hair from inhabitant non-smoking women and children. Samples were taken to the Johns Hopkins University where nicotine was extracted and analyzed using gas chromatography. A survey of opinions and behaviors related to environmental tobacco smoke was conducted. RESULTS: Environmental nicotine concentrations had a median of 0.08 µg/m3 (IQR 0.01-0.64), in children’s hair 0.05 ng/mg (IQR 0.05-0.29), and in women’s hair 0.05 ng/mg (IQR 0.05-0.19). Environmental nicotine concentrations and in children’s hair were highly correlated (rS=0.49), and increased with the number of smokers at home. The majority of adults surveyed showed support towards measures of environmental tobacco smoke control. CONCLUSIONS: Homes are important spaces of exposure to environmental tobacco smoke. Particularly high levels of exposure were observed in children’s hair, attributable to the presence of environmental nicotine at home. Integral preventive activities to eliminate active smoking and to avoid tobacco consumption at home are required.

OBJECTIVE: To assess the degree of compliance with current legislation using Geographic Information Systems. MATERIAL AND METHODS: Schools and billboards advertising tobacco were geo-referenced and the distance to schools were measured. Students’ access to purchasing tobacco products was observed. RESULTS: In Cuernavaca, billboards were found within 250 meter from schools and students had access to buying cigarettes. In Culiacan, students were less exposed to tobacco advertising. CONCLUSIONS: Geographic Information Systems were useful for studying compliance with the law and could also be useful for its continuous monitoring and for suggesting changes for diminishing tobacco advertising exposure. This exposure and the ease of access to purchasing cigarettes could explain the higher prevalence of active smokers among students in Cuernavaca. This suggests that current legislation is still not enough enforced for diminishing Mexican adolescents’ exposure to tobacco advertising and products.OBJETIVO: Determinar el grado de cumplimiento de la legislación y su impacto mediante la utilización de Sistemas de Información Geográfica (GIS). MATERIAL Y MÉTODOS: Se georreferenciaron escuelas y espectaculares con propaganda de tabaco en Culiacán y Cuernavaca. Se midió la distancia a las escuelas. Se observó si los estudiantes tenían acceso a comprar productos de tabaco. RESULTADOS: En Cuernavaca se encontraron espectaculares a 250 m de escuelas. Los estudiantes tenían acceso a adquirir productos del tabaco. En Culiacán los estudiantes estuvieron menos expuestos a propaganda y productos del tabaco. CONCLUSIONES: Los GIS fueron útiles para estudiar la observancia de la legislación actual y podrían serlo para monitorear su cumplimiento, así como para sugerir modificaciones que disminuyan la exposición a la propaganda de tabaco. Esta exposición y la facilidad para adquirir cigarrillos podrían explicar la prevalencia de fumadores activos más elevada en los estudiantes de Cuernavaca. Esto sugiere que la legislación vigente no es suficiente para la disminución de la exposición de los jóvenes mexicanos a propaganda y productos del tabaco.