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Alejandra Ramírez-Venegas,1 Mónica Velázquez-Uncal,1 Rosaura Pérez-Hernández,2 Nicolás Eduardo Guzmán-Bouilloud,1 Ramcés Falfán-Valencia,3 María Eugenia Mayar-Maya,4 Adrian Aranda-Chávez,1 Raúl H Sansores5 1Tobacco Smoking and COPD Research Department, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico; 2Research Department of Tobacco Smoking, Centro de Investigacion de Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Mexico; 3HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico; 4Medical Attention Department, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico; 5Medica Sur Clinic & Foundation, Mexico City, Mexico Introduction: Biomass smoke exposure (BSE) is a recognized cause of COPD particularly in rural areas. However, little research has been focused on BSE in suburban areas. Objective: The aim of this study was to determine the prevalence of COPD, respiratory symptoms (RS) and BSE in women living in a suburban area of Mexico City exposed to BSE. Methods: A cross-sectional epidemiological survey of a female population aged >35years was performed using a multistage cluster sampling strategy. The participants completed questionnaires on RS and COPD risk factors. The COPD prevalence was based on the postbronchodilator forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) ratio. Of the 1,333 women who completed the respiratory questionnaires, spirometry data were obtained from 1,190, and 969 of these were scored as A–C. Results: The prevalence of BSE was 47%, and the estimated prevalence of COPD was 2.5% for the total population (n=969) and 3.1% for those with BSE only. The spirometry and oximetry values were significantly lower in women with greater exposure levels. The prevalence of RS (cough, phlegm, wheezing and dyspnea) was significantly higher in the women with BSE compared to those without exposure. We concluded that the association of COPD with biomass exposure is not only a rural phenomenon but also may be observed in the suburban areas of the big cities. Keywords: risk factor, gender, airway obstruction

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

Objective: To examine and compare overall prevalence and time trends in tobacco and alcohol portrayals and brand appearances in youth-rated US and nationally-produced films that were the most successful in Argentina and Mexico from 2004-2012. Materials and methods: Top-grossing nationally produced films from Argentina (n=73), Mexico (n=85) and the US (n=643) were content analyzed. Logistic regression was used to determine differences between Mexican, Argentine and US produced films. Linear regression models assessed significant cross-country differences in the mean number of tobacco and alcohol seconds. Results: Films from Mexico and Argentina were more likely than US films to contain tobacco, (OR=4.2; p

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

OBJECTIVE We examine whether having depressive symptoms (DS) is associated with different responses to cigarette package health warning labels (HWLs) before and after the implementation of pictorial HWLs in Mexico. METHOD We analyze data from adult smokers from Wave 4 and Wave 5 (n = 1,340) of the International Tobacco Control Policy Evaluation Project in Mexico. Seven Center for Epidemiological Studies Depression Scale (CES-D) items assessed DS, with scores ≥7 indicating elevated DS. Outcomes included: attention to HWLs, cognitive responses to HWLs, tobacco constituents awareness, putting off smoking due to HWLs, avoidance of HWLs, and awareness of telephone support for cessation (i.e., quitlines). Mixed effects models were used to assess main and interactive effects of DS and time (i.e., survey wave) on each outcome. RESULTS All HWL responses increased over time, except putting off smoking. Statistically significant interactions were found between DS and time for models of tobacco constituents awareness (b = -0.36, SE = 0.15, p = .022), putting off smoking (OR = 0.41, 95% CI [0.25, 0.66]), avoidance of HWLs (OR = 1.84, 95% CI [1.03, 3.29]), and quitline awareness (OR = 0.35, 95% CI [0.21, 0.56]). Compared to smokers with low DS, smokers with elevated DS reported stronger HWL responses at baseline; however, HWL responses increased over time among smokers with low DS, whereas HWL responses showed little or no change among smokers with elevated DS. DISCUSSION Population-level increases in HWL responses after pictorial HWLs were introduced in Mexico appeared mostly limited to smokers with low DS. In general, however, smokers with elevated DS reported equivalent or stronger HWL responses than smokers with low DS.

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

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

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.

Ideation and suicide attempts are important pieces of the suicide behavior spectrum. Have both relative frequencies between adolescents because in this developmental stage many important social, familiar and psychological factors intervene. The present paper, part of a broader project in the same population, was aimed to identify the prevalence and associated factors to ideation and suicide attempts among high school students of University of Guanajuato. It was applied aquestionnaire to a two stages random sample (n=2 532), age range was 13 to 22 years old. Suicide ideation indicators were founded in almost a quarter of the sample, while 8.6 % have at least one suicide attempt, generally around the age of thirteen; motives for attempting suicide were mainly referred to interpersonal or affective aspects. Almost in every studied variable, women obtained the greater percentage. Suicide Ideation, as any other suicide act, is not an isolated event, but represents a serious risk at social and personal level, and its determination has to be found in a multiplicity of factors.La ideación y el intento suicida son parte del amplio espectro del comportamiento suicida. Ambos tienen una alta frecuencia entre los adolescentes porque en esta etapa del desarrollo concurren factores sociales, familiares y psicológicos. Este trabajo, que forma parte de uno más amplio en la misma población, tuvo como objetivo identificar la prevalencia ylos factores asociados a la ideación y el intento suicida en los estudiantes del nivel medio superior de la Universidadde Guanajuato. El cuestionario se aplicó a una muestra aleatoria, bietápica y por conglomerados (n=2532), el rango de edad de los estudiantes fue de los 13 a los 22 años. Indicadores de ideación suicida fueron encontrados en la cuarta parte de los estudiantes, mientras que el 8.6%de los mismos han tenido cuando menos un intento de quitarse la vida, mismo que generalmente se presentó alrededor de los 13 años; las principales motivaciones para intentarlo se refirieron a aspectos interpersonales o afectivos. En casi todas las variables evaluadas se encontró una mayor frecuencia de mujeres. La ideación, como cualquier otro acto suicida, no es un evento aislado sino que representa un grave riesgo a nivel social y personal, y su determinación sólo se encuentra en una multiplicidad defactores.

La ideación y el intento suicida son parte del amplio espectro del comportamiento suicida. Ambos tienen una alta frecuencia entre los adolescentes porque en esta etapa del desarrollo concurren factores sociales, familiares y psicológicos. Este trabajo, que forma parte de uno más amplio en la misma población, tuvo como objetivo identificar la prevalencia ylos factores asociados a la ideación y el intento suicida en los estudiantes del nivel medio superior de la Universidadde Guanajuato. El cuestionario se aplicó a una muestra aleatoria, bietápica y por conglomerados (n=2532), el rango de edad de los estudiantes fue de los 13 a los 22 años. Indicadores de ideación suicida fueron encontrados en la cuarta parte de los estudiantes, mientras que el 8.6%de los mismos han tenido cuando menos un intento de quitarse la vida, mismo que generalmente se presentó alrededor de los 13 años; las principales motivaciones para intentarlo se refirieron a aspectos interpersonales o afectivos. En casi todas las variables evaluadas se encontró una mayor frecuencia de mujeres. La ideación, como cualquier otro acto suicida, no es un evento aislado sino que representa un grave riesgo a nivel social y personal, y su determinación sólo se encuentra en una multiplicidad defactores.

Evaluate the effect of the first pictorial warning labels on cigarette packs in Mexican smokers.A population-based representative cohort of smokers from seven Mexican cities was surveyed before (2010) and after (2011) the implementation of pictorial warning labels. To determine the change variables representing the cognitive and behavioral impact of pictorial warnings, bivariate and adjusted generalized estimating equations were estimated. Data from the second survey (2011) were analyzed to determine the factors associated with aided recall of specific pictorial warnings, as well as the factors associated with self-report of the impact that these warnings had.From 2010 to 2011, significant increases were found in smoker's knowledge about smoking risks, the toxic components of tobacco, and the quitline number for receiving cessation assistance. Recall and impact of specific pictorial warnings was generally broad and equally distributed across the smoker population. In comparison with recent ex-smokers interviewed in 2010, more recent ex-smokers in 2011 reported that pack warnings had influenced their decision to quit (RM=2.44, 95% IC 1.27-4.72).The first pictorial warning labels on cigarette packages in Mexico have had a significant impact on knowledge and behavior.

Determinar en población fumadora el nivel de exposición a la mercadotecnia de la industria tabacalera (IT), a través de diferentes métodos de promocionar sus productos, antes y durante la publicación de la Ley General para el Control del Tabaco (LGCT) en 2008. Material y métodos. Estudio de cohorte en fumadores adultos (n=941 pre-LGCT y n=1 051 post-LGCT) de cuatro ciudades mexicanas. Se realizaron análisis multivariados mediante modelos de ecuaciones de estimación generalizada (GEE). Resultados. Se incrementó el autorreporte de recepción de muestras gratis de cigarros (3.7 a 8.1%), ropa o artículos con marcas o logos (3.6 a 6.4%), haber visto información sobre eventos especiales (1.9 a 4.7%), y publicidad en bares y discotecas para mayores de edad (21.4 a 28%). Se observaron decrementos de publicidad en exteriores (54.7 a 47.2%). Conclusión. Es necesaria una política integral con prohibiciones totales de la publicidad y promoción de los productos de tabaco que integre mayor vigilancia y sanciones para lograr la disminución y prevención del consumo de tabaco.

The objective of this study was to determine the most effective content of pictorial health warning labels (HWLs) and whether educational attainment moderates these effects.Field experiments were conducted with 529 adult smokers and 530 young adults (258 nonsmokers; 271 smokers). Participants reported responses to different pictorial HWLs printed on cigarette packages. One experiment involved manipulating textual form (testimonial narrative vs. didactic) and the other involved manipulating image type (diseased organs vs. human suffering).Tests of mean ratings and rankings indicated that pictorial HWLs with didactic textual forms had equivalent or significantly higher credibility, relevance, and impact than pictorial HWLs with testimonial forms. Results from mixed-effects models confirmed these results. However, responses differed by participant educational attainment: didactic forms were consistently rated higher than testimonials among participants with higher education, whereas the difference between didactic and testimonial narrative forms was weaker or not statistically significant among participants with lower education. In the second experiment, with textual content held constant, greater credibility, relevance, and impact was found for graphic imagery of diseased organs than imagery of human suffering.Pictorial HWLs with didactic textual forms seem to work better than those with testimonial narratives. Future research should determine which pictorial HWL content has the greatest real-world impact among consumers from disadvantaged groups, including assessment of how HWL content should change to maintain its impact as tobacco control environments strengthen and consumer awareness of smoking-related risks increases.

Objectives. We aimed to assess the level of awareness and impact of a social marketing campaign to promote Mexico City's 2008 comprehensive smoke-free law. Methods. Four months after the smoke-free law was implemented but before the campaign launch, we collected data from a population-based, random sample of 961 inhabitants of Mexico City. We analyzed data from 786 respondents who completed follow-up at the end of the campaign to determine campaign exposure and the association between campaign exposure and changes in campaign-targeted knowledge and attitudes. Results. Recall of any of the 5 campaign materials was 69%, with a uniform distribution of exposure to 1, 2, and 3 or more campaign materials (25%, 25%, and 19%, respectively). Exposure to a greater number of campaign materials was associated in a monotonic relation with campaign-targeted knowledge of ammonia and arsenic in cigarette smoke. In models assessing support for, perceived benefits of, and perceived right to smoke-free places, campaign exposure accounted for a positive change in half of the indicators within each of these domains. Conclusions. Social marketing campaigns can reinforce knowledge and attitudes that favor smoke-free laws, thereby helping to establish smoke-free norms.

Objectives. We assessed attitudes and beliefs about smoke-free laws, compliance, and secondhand smoke exposure before and after implementation of a comprehensive smoke-free law in Mexico City. Methods. Trends and odds of change in attitudes and beliefs were analyzed across 3 representative surveys of Mexico City inhabitants: before implementation of the policy (n = 800), 4 months after implementation (n = 961), and 8 months after implementation (n = 761). Results. Results indicated high and increasing support for 100% smoke-free policies, although support did not increase for smoke-free bars. Agreement that such policies improved health and reinforced rights was high before policy implementation and increased thereafter. Social unacceptability of smoking increased substantially, although 25% of nonsmokers and 50% of smokers agreed with smokers' rights to smoke in public places at the final survey wave. Secondhand smoke exposure declined generally as well as in venues covered by the law, although compliance was incomplete, especially in bars. Conclusions. Comprehensive smoke-free legislation in Mexico City has been relatively successful, with changes in perceptions and behavior consistent with those revealed by studies conducted in high-income countries. Normative changes may prime populations for additional tobacco control interventions.

"Porque todos respiramos lo mismo" is a mass media campaign to promote smoke-free places (SFP). The development stages were: strategic planning; formative research; message development; media plan; and impact evaluation. Development involved formation of a coalition of key actors in various sectors. The target population was smokers and nonsmokers, with the aim of changing social norms around SFP. Nonsmokers were targeted because they comprised the majority and were most likely to appreciate the benefits of SFPs. Campaign materials were aired on television, radio, print and on billboards. One key limitation was the lack of evidence for previous campaigns, which increased the importance of formative research and of including a rigorous evaluation for this one. The campaign evaluation indicates a significant impact, which suggests that future campaigns use similar strategies in their development.

"Porque todos respiramos lo mismo" es una campana en medios masivos de comunicacion para promover espacios libres de humo de tabaco (ELHT). Las etapas de diseno fueron: planeacion estrategica, investigacion formativa, desarrollo de mensajes, plan de medios y evaluacion de impacto. Se formo una coalicion de actores sociales para su desarrollo. La poblacion blanco fueron fumadores y no fumadores y el objetivo modificar la norma social sobre ELHT. Se utilizaron television, radio, prensa y vallas en via publica. Se corroboro que una gran parte de la defensa de los espacios libres de humo de tabaco depende de los no fumadores. Una limitante en el desarrollo de esta campana fue el carecer de evidencia del impacto de campanas similares previas, por lo que esta incluyo un componente de evaluacion riguroso. La campana parece haber tenido un impacto social significativo, por lo que se sugiere utilizar estrategias similares para el desarrollo de futuras campanas.

Objective This study assessed the effects of pictorial health warning labels (HWLs) and a linked media campaign in Mexico. Methods Cross-sectional data were collected from a population-based sample of 1756 adult smokers, aged 18–55 years, during the initial implementation of pictorial HWLs, which some smokers had seen on cigarette packages while others had seen only the text-based HWLs. Exposure to the campaign and pictorial HWLs was assessed with aided recall methods, and other questions addressed attention and cognitive impact of HWLs, knowledge related to HWL and campaign content, and quit-related thoughts and behaviours. Logistic and linear regression models were estimated to determine associations between key outcomes and intervention exposure. Results In bivariate and multivariate adjusted models, recall of pictorial HWLs and of the campaign were positively associated with greater attention to and cognitive impact of HWLs, whereas only pictorial HWL exposure was associated with having refrained from smoking due to HWLs. Both recall of pictorial HWLs and of the campaign were independently associated with greater knowledge of secondhand smoke harms and toxic tobacco constituents. Smokers who recalled only the pictorial HWLs were more likely to try to quit than smokers who recalled neither the pictorial HWLs nor the campaign (17% vs 6%, p Conclusions Consistent with other studies, adult smokers9 exposure to new pictorial HWLs in Mexico was associated with psychosocial and behavioural responses related to quit behaviour. Exposure to the complementary media campaign was associated with independent additive effects on campaign-related knowledge, and it enhanced psychosocial responses to pictorial HWLs.