Correlation between tobacco control policies and tobacco prevention in Mexico: a sub-national analysis.

This study aims to determinate the correlation between tobacco control policies (TCP) and the prevalence of tobacco use in the 32 Mexican states during the 2016-2017 period. This is an ecological study that measured TCP by the Tobacco Control Scale (TCS) which assigns a score (0-100) based on the level of these component's implementation: price, prohibition in public spaces, expenditures of public information campaigns, publicity prohibitions, health warnings, and treatments. We analyzed the associations between the TCS scores and prevalence of tobacco use extracted from the National Survey of Drug, Alcohol and Tobacco Consumption using Spearman correlations. Prevalence of daily smokers is negatively correlated with global TCS scores for adolescents (p = 0.026). Price showed similar negative correlations with daily prevalence in adolescents (p = 0.003), adults (p = 0.040), men (p < 0.006), and women (p = 0.040). Many Mexican states need to improve on tobacco control policies, especially targeting a key population: adolescents.

A Cross-Sectional Analysis of Parental Behavior and Adolescent Mental Health in Mexico: Insights into Excessive Alcohol Intake, Tobacco Use, Suicidal Behavior, and Depressive Symptomatology.

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.

Eventos de vida estresantes y su efecto en la conducta suicida en mujeres durante la pandemia por Covid-19 en México.

OBJETIVO: Analizar la estructura factorial, la validez convergente y divergente de la Escala Columbia de Severidad Suicida (CSSRS) y el Cuestionario de Eventos de Vida Estresantes (EVE) y medir la asociación entre EVE y conducta suicida (CS) en mujeres mexicanas durante la pandemia por Covid-19. Material y métodos. Se usaron datos de 2 398 mujeres que participaron en un estudio multicéntrico, realizado en México entre mayo y octubre de 2021. La información se recolectó mediante un cuestionario en línea que incluyó la CSSRS y el EVE. Se hizo un análisis factorial confirmatorio para valorar el ajuste de los modelos. RESULTADOS: El modelo final mostró asociación entre los EVE y la CS, y tuvo a la violencia como variable central. Dicho modelo presentó un ajuste adecuado (CFI = 0.950, IFI = 0.950, MFI = 0.975, RMSEA = 0.031, CI RMSEA = 0.026-0.036). CONCLUSIONES: La pandemia por Covid-19 evidenció la necesidad de crear e implementar estrategias que promuevan el cuidado de la salud mental, reduzcan la exposición a la violencia y faciliten los procesos de duelo para prevenir la CS en mujeres mexicanas.

Consumo de tabaco y uso de cigarro electrónico en adolescentes y adultos mexicanos. Ensanut Continua 2022.

OBJETIVO: Estimar la prevalencia de consumo actual y previo de tabaco y uso de cigarro electrónico en la población adolescente y adulta mexicana en 2022. Material y métodos. Se utilizó la Encuesta Nacional de Salud y Nutrición Continua 2022 para estimar la prevalencia de consumo de tabaco fumado y uso de cigarro electrónico, considerando variables sociodemográficas. RESULTADOS: El 4.6% de los adolescentes reportó fumar actualmente y 3.7% reportó fumar en el pasado. De los adultos, 19.5% fuma actualmente y 17.8% fumó en el pasado. El consumo de tabaco fue mayor en las áreas urbanas y metropolitanas, en comparación con las rurales y se encontraron diferencias por nivel educativo y región. El 2.6% de adolescentes y 1.5% de adultos reportaron usar cigarros electrónicos. Conclusión. El tabaquismo continúa siendo un problema de salud pública en México. Es prioritario acelerar la implementación completa del Convenio Marco de la Organización Mundial de la Salud para el Control del Tabaco.

Patrones de consumo de alcohol en adolescentes y adultos mexicanos: Ensanut Continua 2022.

OBJETIVO: Caracterizar los patrones de consumo (actual y excesivo) de alcohol en adolescentes y adultos mexicanos. Material y métodos. Se analizó información de la Encuesta Nacional de Salud y Nutrición Continua 2022 (Ensanut Continua 2022) representativa a nivel nacional y regional. Se estimaron las prevalencias de consumo de alcohol actual y consumo excesivo de alcohol en los últimos 12 meses y 30 días. RESULTADOS: En adolescentes, las prevalencias de consumo actual de alcohol, excesivo en los últimos 12 meses y 30 días fueron de 20.6, 13.9 y 5.2%. En adultos, las prevalencias de consumo actual de alcohol, excesivo en los últimos 12 meses y 30 días fueron 55.5, 40.4 y 19.1%. Las prevalencias fueron mayores en hombres que en mujeres, con diferencias significativas en adultos. En adolescentes, las prevalencias fueron mayores a mayor edad, nivel socioeconómico y en aquellos sin estudios. En adultos, las prevalencias fueron mayores a menor edad, mayor nivel socioeconómico y escolaridad, y en áreas metropolitanas. Conclusión. Estos resultados muestran la necesidad de fortalecer las acciones de implementación, seguimiento y protección ofrecidas por la estrategia SAFER para prevenir y reducir el consumo nocivo de alcohol en adolescentes y adultos.

Latin America and the Caribbean Code Against Cancer 1st edition: Tobacco and nicotine-related products, secondhand smoke, and alcohol and cancer.

Tobacco, secondhand smoke (SHS), and alcohol, all carcinogens, are leading preventable cancer risk factors in Latin America and the Caribbean (LAC). Since 2000, smoking and SHS exposure have significantly decreased in the region. Yet alcohol consumption remains high. The entry of nicotine-related products such as electronic cigarettes (e-cigs) threatens achievements made in tobacco control and chronic diseases prevention, including cancer. E-cigs use is likely associated with smoking initiation among adolescents who had never smoked and dual use with combustible tobacco products. Therefore, the LAC Code Against Cancer recommends to the public actions they can take to reduce their risk of cancer: 1. Don't smoke or use any type of tobacco. If you do, quitting is possible, with professional help if needed. Don't use e-cigarettes either, as they lead to tobacco use. 2. Make your home a smoke-free place. Respect and promote laws that ensure smoke-free spaces to protect our health. and 3. Avoid drinking alcoholic beverages. This helps prevent several types of cancer. The Code recommends to policymakers a package of cost-effective policies based on the MPOWER and SAFER to prevent cancer at the population level. It also recommends that primary care health professionals: 1. Ask all their patients and their families whether they smoke or vape, inform them about the harms of smoking and vaping, and promote tobacco and nicotine related products cessation strategies among users. 2. Inform about the harms of exposure to SHS, especially among children, and promote smoke-free environments, and 3. Prevent alcohol use by their patients and their families, use tools to assess use, intensity, and frequency, and apply brief counseling intervention to support alcohol abstinence in primary care.

The challenges of tobacco fiscal policy implementation in Mexico from the perspective of key actors.

INTRODUCTION: Raising tobacco taxes is considered the most effective strategy to avoid smoking initiation and discourage its use, especially among vulnerable groups. However, few low- and middle-income countries have adopted high tobacco taxes. Raising taxes is, therefore, an opportunity to strengthen and accelerate tobacco control. The objective of this study is to analyze the barriers and facilitators to the tobacco tax increase in Mexico. METHODS: Based on the Governance Analytical Framework (GAF), data were generated through 17 in-depth interviews with key intersectoral actors for fiscal policy. The interviews were transcribed and coded according to Hufty's theory of governance. RESULTS: Robust scientific evidence, intersectoral coordination, and the presence of "champions" boosted progress in tobacco control (facilitators). Main barriers were the incomplete implementation of the WHO-FCTC and MPOWER package and lack of commitment ("political will") by government decision-makers and legislators, misinformation about the effects of tobacco taxes, and strong tobacco industry interference. CONCLUSIONS: Robust evidence is necessary but not sufficient to advance the implementation of the MPOWER (WHO-FCTC) actions. To achieve tobacco tax increases and public policies that protect people from unhealthy products in general, the implementation of policies or legal frameworks against industry interference in the development of public policies is imperative. IMPLICATIONS: By analyzing the barriers and facilitators to increasing the tobacco tax in Mexico, this study identifies two key messages:1) The need to sensitize legislators and the general population to the problem of smoking not only through epidemiological data but also through testimonies that highlight the life experiences and adversities faced by people who smoke.2) The need for a regulatory framework to prevent industry interference in public affairs and conflicts of interest. The same framework could be very useful for public health policies to control the consumption of ultra-processed food products or alcohol.

Health, economic and social burden of tobacco in Latin America and the expected gains of fully implementing taxes, plain packaging, advertising bans and smoke-free environments control measures: a modelling study.

OBJECTIVE: To investigate the tobacco-attributable burden on disease, medical costs, productivity losses and informal caregiving; and to estimate the health and economic gains that can be achieved if the main tobacco control measures (raising taxes on tobacco, plain packaging, advertising bans and smoke-free environments) are fully implemented in eight countries that encompass 80% of the Latin American population. DESIGN: Markov probabilistic microsimulation economic model of the natural history, costs and quality of life associated with the main tobacco-related diseases. Model inputs and data on labour productivity, informal caregivers' burden and interventions' effectiveness were obtained through literature review, surveys, civil registrations, vital statistics and hospital databases. Epidemiological and economic data from January to October 2020 were used to populate the model. FINDINGS: In these eight countries, smoking is responsible each year for 351 000 deaths, 2.25 million disease events, 12.2 million healthy years of life lost, US$22.8 billion in direct medical costs, US$16.2 billion in lost productivity and US$10.8 billion in caregiver costs. These economic losses represent 1.4% of countries' aggregated gross domestic products. The full implementation and enforcement of the four strategies: taxes, plain packaging, advertising bans and smoke-free environments would avert 271 000, 78 000, 71 000 and 39 000 deaths, respectively, in the next 10 years, and result in US$63.8, US$12.3, US$11.4 and US$5.7 billions in economic gains, respectively, on top of the benefits being achieved today by the current level of implementation of these measures. CONCLUSIONS: Smoking represents a substantial burden in Latin America. The full implementation of tobacco control measures could successfully avert deaths and disability, reduce healthcare spending and caregiver and productivity losses, likely resulting in large net economic benefits.

Psychological distress, intimate partner violence and substance use in a representative sample from Mexico: A structural equation model.

Introduction: Intimate Partner Violence (IPV) is a public health concern associated with multiple adverse health outcomes, including psychological distress (PD). Objective: To assess the association of IPV and psychological distress, and the mediation of tobacco and alcohol consumption in a national representative sample from Mexico. Material and methods: Data from the Encuesta Nacional de Consumo de Drogas, Tabaco y Alcohol (ENCODAT) were analyzed. The sample included 34,864 people between the ages of 12 and 65 with a partner. Using Structural Equation Modeling (SEM), the association between IPV, use alcohol, tobacco and psychological distress was measured. Results: The population was composed of women (51.9%) and men (48.1%); 15.1% (women = 18.2% and men = 11.9%) reported IPV in the last year. The prevalence of psychological distress in the last year was 3.3%, being 3.8% in women, and 2.7% in men. Results from the SEM in women indicated a direct positive effect of the IPV construct on psychological distress (ß = 0.298, p < 0.01); these findings confirmed that IPV tended to systematically increase psychological distress. Likewise, the presence of IPV increased the consumption of tobacco (ß = 0.077, p < 0.01) and alcohol (ß = 0.072, p < 0.01). The SEM results in men showed that alcohol and tobacco consumption tended to increase in the presence of IPV (ß = 0.121, p < 0.01, and ß = 0.086, p < 0.01, respectively), and in turn, alcohol consumption and tobacco tended to increase psychological distress (ß = 0.024, p < 0.01, and ß = 0.025, p < 0.01, respectively). Conclusion: This study indicated that in women, IPV had a direct effect on psychological distress and on alcohol and tobacco consumption. Meanwhile in men, alcohol and tobacco consumption had a mediating effect between IPV and psychological distress. The empirical findings of this study will contribute toward the design of public health policies for the prevention and attention of IPV, alcohol and tobacco consumption, and consequently address the mental health consequences derived from these problems.

Violence against Women during the COVID-19 Pandemic in Mexico.

This study measured the prevalence of cases of domestic violence against women and some associated factors during the COVID-19 pandemic in Mexico. Data were collected through a remote survey during 2020. The sample included 47,819 women aged 15 years and older. Jointpoint regression and logistic regression models were used. The prevalence of violence was 11.5%, which decreased in July and subsequently increased. The associated factors were being unemployed (OR = 2.01; 95%CI 1.89-2.16); being partially and totally quarantined (OR = 1.58; 95%CI 1.43-1.75 and OR = 1.47; 95%CI 1.32-1.63); being a caregiver of children; being a caregiver of elderly and/or suffering from a chronic illness (OR = 1.27; 95%CI 1.19-1.36; OR = 1.42; 95%CI 1.33-1.53; OR = 1.59; 95%CI 1.47-1.73); losing a family member to COVID-19 (OR = 1.26; 95%CI 1.13-1.41); and binge drinking (OR = 1.94; 95%CI 1.78-2.12). The confinement measures increased gender inequalities, economic problems and workload which further evidenced violence against women.

Colours, capsules and concept flavour names on cigarette packs appeal to youth in Mexico.

BACKGROUND: Flavoured cigarettes are popular in Mexico. We examined how cigarette packaging design features used to communicate flavour influence perceptions of appeal, harm, perceived interest and pack preference among Mexico City residents. METHODS: We conducted an experimental survey. Participants aged 13-34 years were randomly assigned to one of three conditions, viewed packs with systematically manipulated design features (colour, capsule image and flavour name) and answered questions on appeal, perceived harm, perceived interest and pack preference. Data were analysed using mixed effects and conditional logistic regression. RESULTS: 1500 adolescents and 950 adults participated. Regardless of flavour, cigarette packs with a background colour and capsule image were more appealing to adolescents (OR=13.19, 95% CI 11.53 to 15.10; OR=1.68, 95% CI 1.45 to 1.88) and adults (OR=4.18, 95% CI 3.73 to 4.69; OR=1.66, 95% CI 1.49 to 1.85) than packs without. Among adolescents, 'Tropical Burst' named packs were more appealing (OR=1.43, 95% CI 1.20 to 1.72) than packs without a flavour name and among adults, 'Arctic Air' named packs were more appealing (OR=1.20, 95% CI 1.02 to 1.14). Adolescents and adults reported a preference for trying packs that displayed a flavour name, background colour or capsule image (b=0.104, b=0.702, b=1.316, p<0.001 and b=0.126, b=0.619, b=0.775, p<0.001). CONCLUSIONS: Colours and flavour capsule images appeal to adolescents and adults in Mexico. Mexico should consider adopting plain packaging to reduce appeal and interest.

Disparities in self-reported exposure to tobacco marketing among youth and young adults from low-socioeconomic status neighbourhoods in Mexico City.

Exposure 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.

Measurement invariance of the GAD-5 Generalized Anxiety Disorder Scale in a Mexican general population sample.

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.

[Benefits of the cigarette tax in Mexico, by sex and income quintileBenefícios do imposto sobre cigarros no México: análise por sexo e quintil de renda]. / Beneficios del impuesto a los cigarros en México: análisis por sexo y quintil de ingreso.

Objective: Estimate economic and health benefits, by sex and income quintile, of tax-based cigarette price increases in Mexico. Methods: An extended cost-effectiveness analysis (ECEA) model was used to estimate distributional benefits for women and men in the scenario of a 44% increase in the price of cigarettes (from 56.4 Mexican pesos [MX$] to MX$81.2 per pack), as a result of tripling the current specific excise tax (from MX$0.49/cigarette to MX$1.49/cigarette). The model was calibrated with official national information sources. Results: With a tax increase of one peso per cigarette, about 1.5 million smokers would quit (351 300 women and 1.1 million men). This would prevent approximately 630 000 smoking-attributable premature deaths. Reducing the burden of disease would save the health sector close to MX$42.8 billion and prevent more than 250 000 people (including 50 200 women smokers) from falling into poverty. It would also result in an additional MX$16.2 billion in revenue per year, of which the lowest income quintile would contribute less than 3% (1% for low-income women). Conclusions: The tobacco epidemic has clearly differentiated patterns between women and men, reflecting a gender component. While the tobacco tax in Mexico would have great benefits with respect to the current state of the epidemic, this could also contribute to the broader goal of social justice by reducing gender inequities.

Objetivo: Estimar os benefícios econômicos e de saúde, por sexo e quintil de renda, do aumento dos preços dos cigarros por meio de impostos no México. Métodos: Com um modelo de análise ampliada de custo-efetividade (ECEA, na sigla em inglês), foram estimados os benefícios distributivos em mulheres e homens com um cenário de aumento de 44% no preço dos cigarros (de 56,4 pesos mexicanos [MX$] para MX$ 81,2 por maço), como resultado da triplicação do imposto específico atual (de MX$ 0,49/cigarro para MX$ 1,49/cigarro). O modelo foi calibrado com fontes oficiais de informação nacional. Resultados: Com o aumento do imposto de um MX$ por cigarro, cerca de 1,5 milhão de fumantes abandonariam o consumo (351.300 mulheres e 1,1 milhão de homens). Assim, seriam evitadas aproximadamente 630.000 mortes prematuras atribuíveis ao tabaco. A redução da carga de doenças permitiria uma economia para o setor da saúde de cerca de MX$ 42,8 bilhões e evitaria que mais de 250.000 pessoas (incluindo 50.200 mulheres fumantes) caíssem na pobreza. Além disso, seriam arrecadados MX$ 16,2 bilhões adicionais por ano, dos quais o quintil mais baixo contribuiria com menos de 3% (1% no caso de mulheres de baixa renda). Conclusões: A epidemia de tabagismo tem padrões claramente diferenciados entre mulheres e homens e reflete um componente de gênero. Embora os benefícios do imposto sobre o tabaco no México tenham importância relativa no atual estado da epidemia em cada caso, poderiam contribuir para um objetivo mais amplo de justiça social ao reduzir as desigualdades de gênero.

Moving forward in the Americas: tobacco control fosters sustainable development

[EXTRACT]. This special issue applies this lens, bringing an equity focus to tobacco control measures, with particular attention paid to vulnerable groups (e.g., youth and low-income quintiles) and including a gender perspective. Further, one analysis empha- sizes the extent of environmental damage posed across the tobacco production chain, including the economic cost of tobacco products waste, and proposes policies to address this.