Smoking-Related Stigma: A Public Health Tool or a Damaging Force?

BACKGROUND: Tobacco control policies and other denormalization strategies may reduce tobacco use by stigmatizing smoking. This raises an important question: Does perceived smoking-related stigma contribute to a smoker's decision to quit? The aim of this study was to evaluate if perceived smoking-related stigma was associated with smoking cessation outcomes among smokers in Mexico and Uruguay. METHODS: We analyzed prospective data from a panel of adult smokers who participated in the 2008-2012 administrations of the International Tobacco Control Policy Evaluation Surveys in Mexico and Uruguay. We defined two analytic samples of participants: the quit behavior sample (n = 3896 Mexico; n = 1525 Uruguay) and the relapse sample (n = 596 Mexico). Generalized estimating equations were used to evaluate if different aspects of perceived stigma (ie, discomfort, marginalization, and negative stereotype) at baseline were associated with smoking cessation outcomes at follow-up. RESULTS: We found that perceived smoking-related stigma was associated with a higher likelihood of making a quit attempt in Uruguay but with a lower likelihood of successful quitting in Mexico. CONCLUSIONS: This study suggests that perceived smoking-related stigma may be associated with more quit attempts, but less successful quitting among smokers. It is possible that once stigma is internalized by smokers, it may function as a damaging force. Future studies should evaluate the influence of internalized stigma on smoking behavior. IMPLICATIONS: Although perceived smoking-related stigma may prompt smokers to quit smoking, smoking stigma may also serve as a damaging force for some individuals, making quitting more difficult. This study found that perceived smoking-related stigma was associated with a higher likelihood of making a quit attempt in Uruguay but with a lower likelihood of successful quitting in Mexico.

Workplace wellness programming in low-and middle-income countries: a qualitative study of corporate key informants in Mexico and India.

BACKGROUND: A qualitative study of key informant semi-structured interviews were conducted between March and July 2016 in Mexico and India to achieve the following aims: to explore corporations' and stakeholders' views, attitudes and expectations in relation to health, wellness and cancer prevention in two middle-income countries, and to determine options for health professions to advance their approach to workplace wellness programming globally, including identifying return-on-investment incentives for corporations to implement wellness programming. RESULTS: There is an unmet demand for workplace wellness resources that can be used by corporations in an international context. Corporations in India and Mexico are already implementing a range of health-related wellness programs, most often focused on disease prevention and management. A number of companies indicated interest is collecting return on investment data but lacked the knowledge and tools to carry out return-on-investment analyses. There was widespread interest in partnership with international non-governmental organizations (public health organizations) and a strong desire for follow-up among corporations interviewed, particularly in Mexico. CONCLUSIONS: As low-and middle-income countries continue to undergo economic transitions, the workforce and disease burden continue to evolve as well. Evidence suggests a there is a growing need for workplace wellness initiatives in low-and middle-income countries. Results from this study suggest that while corporations in India and Mexico are implementing wellness programming in some capacity, there are three areas where corporations could greatly benefit from assistance in improving wellness programming in the workplace: 1) innovative toolkits for workplace wellness initiatives and technical support for adaptation, 2) assistance with building partnerships to help implement wellness initiatives and build capacity, and 3) tools and training to collect data for surveillance as well as monitoring and evaluation of wellness programs.

The economic impact of Mexico City's smoke-free law.

OBJECTIVE: To evaluate the economic impact of Mexico City's 2008 smoke-free law--The Non-Smokers' Health Protection Law on restaurants, bars and nightclubs. MATERIAL AND METHODS: We used the Monthly Services Survey of businesses from January 2005 to April 2009--with revenues, employment and payments to employees as the principal outcomes. The results are estimated using a differences-in-differences regression model with fixed effects. The states of Jalisco, Nuevo León and México, where the law was not in effect, serve as a counterfactual comparison group. RESULTS: In restaurants, after accounting for observable factors and the fixed effects, there was a 24.8% increase in restaurants' revenue associated with the smoke-free law. This difference is not statistically significant but shows that, on average, restaurants did not suffer economically as a result of the law. Total wages increased by 28.2% and employment increased by 16.2%. In nightclubs, bars and taverns there was a decrease of 1.5% in revenues and an increase of 0.1% and 3.0%, respectively, in wages and employment. None of these effects are statistically significant in multivariate analysis. CONCLUSIONS: There is no statistically significant evidence that the Mexico City smoke-free law had a negative impact on restaurants' income, employees' wages and levels of employment. On the contrary, the results show a positive, though statistically non-significant, impact of the law on most of these outcomes. Mexico City's experience suggests that smoke-free laws in Mexico and elsewhere will not hurt economic productivity in the restaurant and bar industries.

Linking Global Youth Tobacco Survey (GYTS) data to the WHO Framework Convention on Tobacco Control (FCTC): the case for Mexico.

BACKGROUND: The adoption of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) in 2004 marked a critical achievement in efforts to stem the tobacco epidemic in Mexico. The Global Youth Tobacco Survey (GYTS) findings are useful for evaluating achievement of FCTC articles and designing tobacco control programs. OBJECTIVE: To use data from the GYTS conducted in 21 Mexican cities between 2000 and 2005 to monitor Articles in the WHO FCTC. METHODS: The GYTS uses a two-stage cluster sample survey design that produces representative samples of students aged 13-15 years enrolled in public, private and technical schools. The survey was undertaken at 542 schools in 21 cities. The GYTS surveyed 43,950 students during 2000-2005. RESULTS: The current smoking rate ranged from 10.7% to 29.4%. Among never smokers, susceptibility to initiate smoking ranged from 20.2% to 34.4%. Among current smokers, the percentage who bought their cigarettes in a store was above 40% in 6 cities, but significantly declined over five years in the only city with two assessments (Monterrey). Exposure to secondhand smoke in public places was greater than 50% in 15 of the 21 cities. Over 80% of students in all 21 cities reported that they saw of advertisements for cigarettes on billboards. CONCLUSION: Using determinants measured by GYTS in Mexico, the government can monitor the impact of enforcing various provisions of the National Health Law and the progress made in achieving the goals of the WHO FCTC and the Regional strategy. When these goals are met, tobacco consumption and exposure in Mexico will have declined substantially.

Does neighborhood social cohesion modify the relationship between neighborhood social norms and smoking behaviors in Mexico?

The aim of this study was to examine the separate and combined relationships of neighborhood social norms and neighborhood social cohesion with smoking behavior in a cohort of adult Mexican smokers. Neighborhood anti-smoking norms were measured as the proportion of residents in each neighborhood who believed that society disapproves of smoking. Perceived social cohesion was measured using a 5-item cohesion scale and aggregated to the neighborhood level. Higher neighborhood anti-smoking norms were associated with less successful quitting. Neighborhood social cohesion modified the relationship between neighborhood social norms and two smoking behaviors: smoking intensity and quit attempts. Residents of neighborhoods with weaker anti-smoking norms and higher social cohesion had lower smoking intensity and more quit attempts than residents living in other areas. Social cohesion may help buffer smoking behavior in areas with weak social norms.

Level of cigarette consumption and quit behavior in a population of low-intensity smokers--longitudinal results from the International Tobacco Control (ITC) survey in Mexico.

BACKGROUND: Mexican smokers are more likely to be non-daily smokers and to consume fewer cigarettes per day than smokers in other countries. Little is known about their quit behaviors. AIM: The aim of this study is to determine factors associated with having made a quit attempt and being successfully quit at 14-month follow-up in a population-based cohort of adult Mexicans who smoke at different levels of intensity. DESIGN: A longitudinal analysis of wave-III and wave-IV (2010) Mexican administration of International Tobacco Control Policy Evaluation Project was conducted. SETTING: This study was conducted in six large urban centers in Mexico PARTICIPANTS: The participants of this study comprised 1206 adults who were current smokers at wave-III and who were followed to wave-IV. MEASUREMENTS: We compared three groups of smokers: non-daily smokers-who did not smoke every day in the past 30 days (n=398), daily light smokers who smoked every day at a rate of ≤5 cigarettes per day (n=368) and daily heavy smokers who smoked every day at a rate of >5 cigarettes per day (n=434). Data on smoking behavior, psychosocial characteristics and socio-demographics were collected at baseline and after 14 months. FINDINGS: In multivariate logistic regression predicting having made a quit attempt at follow-up, significant factors included being a non-daily smoker versus a heavy daily smoker (ORadj=1.83, 95% CI: 1.19-2.83), less perceived addiction (ORadj=1.86, 95% CI: 1.20-2.87), greater worry that cigarettes will damage health (ORadj=2.04, 95% CI: 1.16-3.61) and having made a quit attempt in the past year at baseline (ORadj=1.70, 95% CI: 1.23-2.36). In multivariate logistic regression predicting being successfully quit at one-year follow-up, significant factors included being a non-daily smoker versus a heavy daily smoker (ORadj=2.54, 95% CI: 1.37-4.70) and less perceived addiction (not addicted: ORadj=3.26, 95% CI: 1.73-6.14; not much: ORadj=1.95, 95% CI: 1.05-3.62 versus very much). CONCLUSIONS: Mexican adult smokers who are non-daily smokers were more likely than daily heavy smokers to have attempted to quit during follow-up and to succeed in their quit attempt. Future research should determine whether tobacco control policies and programs potentiate this tendency and which interventions are needed to help heavier smokers to quit.