Parent Education and Substance Use among Latin-American Early Adolescents.

OBJECTIVE: To examine the relationship between parent education, at individual- and school-level, and substance use behaviors (smoking, alcohol drinking, binge drinking, and illicit drug use) among young adolescents from Argentina and Mexico. METHODS: A cross-sectional, school-based survey of middle-school early adolescents from Mexico (N=10,123) and Argentina (N=3,172) queried substance use. RESULTS: After adjusting for age, sex and individual-level parent education, students from Mexican schools with lower parent education had higher likelihood of current smoking and drug use than those from schools with higher parent education. In Argentina, lower parent education at school-level was positively associated with all outcomes. CONCLUSION: Disadvantageous contextual school characteristics contributes to substance use among early adolescents in Mexico and Argentina.

Movie Language Orientation, Gender, Movie Smoking Exposure, and Smoking Susceptibility among Youth in Mexico.

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.

Portrayals of character smoking and drinking in Argentine-, Mexican- and US-produced films.

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.

Exposure of Secondary School Adolescents from Argentina and Mexico to Smoking Scenes in Movies: a Population-based Estimation.

BACKGROUND: Smoking scenes in movies promote adolescent smoking onset; thus, the analysis of the number of images of smoking in movies really reaching adolescents has become a subject of increasing interest. OBJECTIVE: The aim of this study was to estimate the level of exposure to images of smoking in movies watched by adolescents in Argentina and Mexico. METHODS: First-year secondary school students from Argentina and Mexico were surveyed. One hundred highest-grossing films from each year of the period 2009-2013 (Argentina) and 2010-2014 (Mexico) were analyzed. Each participant was assigned a random sample of 50 of these movies and was asked if he/she had watched them. The total number of adolescents who had watched each movie in each country was estimated and was multiplied by the number of smoking scenes (occurrences) in each movie to obtain the number of gross smoking impressions seen by secondary school adolescents from each country. RESULTS: Four-hundred and twenty-two movies were analyzed in Argentina and 433 in Mexico. Exposure to more than 500 million smoking impressions was estimated for adolescents in each country, averaging 128 and 121 minutes of smoking scenes seen by each Argentine and Mexican adolescent, respectively. Although 15, 16 and 18-rated movies had more smoking scenes in average, movies rated for younger teenagers were responsible for the highest number of smoking scenes watched by the students (67.3% in Argentina and 54.4% in Mexico) due to their larger audience. CONCLUSION: At the population level, movies aimed at children are responsible for the highest tobacco burden seen by adolescents.

INTRODUCCIÓN: Las escenas de consumo de tabaco en películas promueve el inicio del tabaquismo en adolescentes, por lo que el análisis de la cantidad de imágenes de tabaco en películas que realmente llega a los adolescentes se ha convertido en un tema de interés creciente. OBJETIVO: Estimar el nivel de exposición a imágenes de tabaco contenidas en películas vistas por adolescentes de la Argentina y México. MATERIAL Y MÉTODOS: Se realizó una encuesta a alumnos de primer año de nivel secundario de la Argentina y México. Se analizaron las 100 películas con mayor recaudación en cada año del período 2009-2013 (Argentina) y 2010-2014 (México). A cada participante se le asignó una muestra aleatoria de 50 de estas películas, preguntándosele si la había visto. Se estimó el número total de adolescentes que habían visto cada película en cada país y se multiplicó por el número de escenas que contenían tabaco (ocurrencias) en cada película para así obtener el número de impresiones crudas de tabaco vistas por los adolescentes escolarizados de cada país. RESULTADOS: Se analizaron 422 films en la Argentina y 433 en México. Más de 500 millones de imágenes de tabaco fueron vistas por la población joven de cada país, lo que promedia 128 y 121 minutos de escenas con tabaquismo por cada adolescente en la Argentina y México, respectivamente. Si bien los films calificados para mayores de 15/16/18 años tenían mayor promedio por película de escenas de tabaco, las películas calificadas para menores de esta edad fueron responsables de la mayor cantidad de escenas de tabaquismo vistas por adolescentes (67,3% en la Argentina y 54,4% en México) debido a su mayor audiencia. CONCLUSIÓN: A nivel poblacional, las películas para niños son las máximas responsables de la carga de tabaco vista por adolescentes.

Recall, appeal and willingness to try cigarettes with flavour capsules: assessing the impact of a tobacco product innovation among early adolescents.

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 adolescents' 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.

Exposición de adolescentes de escuela secundaria de la Argentina y México a escenas de tabaco en películas de cine: una estimación poblacional / Exposure of Secondary School Adolescents from Argentina and México to Smoking Scenes in Movies: a Population-based Estimation

Introducción: Las escenas de consumo de tabaco en películas promueve el inicio del tabaquismo en adolescentes, por lo que el análisis de la cantidad de imágenes de tabaco en películas que realmente llega a los adolescentes se ha convertido en un tema de interés creciente. Objetivo: Estimar el nivel de exposición a imágenes de tabaco contenidas en películas vistas por adolescentes de la Argentina y México. Material y métodos: Se realizó una encuesta a alumnos de primer año de nivel secundario de la Argentina y México. Se analizaron las 100 películas con mayor recaudación en cada año del período 2009-2013 (Argentina) y 2010-2014 (México). A cada participante se le asignó una muestra aleatoria de 50 de estas películas, preguntándosele si la había visto. Se estimó el número total de adolescentes que habían visto cada película en cada país y se multiplicó por el número de escenas que contenían tabaco (ocurrencias) en cada película para así obtener el número de impresiones crudas de tabaco vistas por los adolescentes escolarizados de cada país. Resultados: Se analizaron 422 films en la Argentina y 433 en México. Más de 500 millones de imágenes de tabaco fueron vistas por la población joven de cada país, lo que promedia 128 y 121 minutos de escenas con tabaquismo por cada adolescente en la Argentina y México, respectivamente. Si bien los films calificados para mayores de 15/16/18 años tenían mayor promedio por película de escenas de tabaco, las películas calificadas para menores de esta edad fueron responsables de la mayor cantidad de escenas de tabaquismo vistas por adolescentes (67,3% en la Argentina y 54,4% en México) debido a su mayor audiencia. Conclusión: A nivel poblacional, las películas para niños son las máximas responsables de la carga de tabaco vista por adolescentes.

Prevalence and Correlates of E-Cigarette Perceptions and Trial Among Early Adolescents in Mexico.

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.

Exposure to Alcohol Use in Motion Pictures and Teen Drinking in Latin America.

BACKGROUND: Our objective was to assess whether exposure to alcohol use in films (AUF) is associated with alcohol use susceptibility, current alcohol use, and binge drinking in adolescents from 2 Latin American countries. METHODS: We performed a cross-sectional study with 13,295 middle school students from public and private schools in Mexico and Argentina. Exposure to alcohol use in over 400 contemporary top box office films in each country was estimated using previously validated methods. Outcome measures included current drinking (i.e., any drink in the last 30 days), ever binge drinking (i.e., more than 4 or 5 drinks in a row for females and males, respectively) and, among never drinkers, alcohol susceptibility (i.e., might drink in the next year or accept a drink from a friend). Multivariate models were adjusted for age, sex, parental education, peer drinking, sensation seeking, parenting style, and media access. RESULTS: Mean age was 12.5 years (SD = 0.7), and the prevalence of alcohol consumption and binge drinking was 19.8 and 10.9%, respectively. Mean exposure to alcohol from the film sample was about 7 hours in both countries. Adjusted models indicated independent dose-response associations between higher levels of exposure to AUF and all outcomes; the adjusted odds ratios (aORs) comparing quartiles 4 and 1, 1.99 (95% confidence interval [CI] 1.73 to 2.30) for current drinking, aOR 1.68 (CI 1.39 to 2.02) for binge drinking, and aOR 1.80 (1.52 to 2.12) for alcohol susceptibility. Compared to Mexican adolescents, Argentine adolescents were significantly more likely to have engaged in binge drinking (aOR 1.40, 95% CI 1.12 to 1.76) and, among never drinkers, were more susceptible to try drinking (aOR 1.40, 95% CI 1.20 to 1.64). CONCLUSIONS: Higher levels of exposure to AUF were associated with higher likelihood of alcohol use, binge drinking, and alcohol susceptibility in Latin American adolescents.

Interpersonal communication about pictorial health warnings on cigarette packages: Policy-related influences and relationships with smoking cessation attempts.

This study evaluated the relationship between interpersonal communication about cigarette health warning labels (HWLs), psychological responses to HWLs, and smoking cessation attempts. Data were analyzed from online consumer panels of adult smokers in Australia, Canada and Mexico, during implementation of new pictorial health warning labels (HWLs) on cigarette packs. Approximately 1000 adult smokers were surveyed in each country every four months (September 2012, January 2013, May 2013, September 2013, January 2014). Only smokers followed for at least two waves were included in the analytic sample. Participants reported the frequency of talking about HWLs in the last month (in general, with family members, and with friends). For each country, poisson generalized estimating equation (GEE) models were estimated to assess the bivariate and adjusted correlates of talking about HWLs. Logistic GEE models regressed having attempted to quit by the subsequent wave on HWL talk, sociodemographics and psychological responses to HWLs. The frequency of HWL talk gradually decreased in Canada (48%-36%) after new HWLs were implemented; an increase (30%-58%) in Australia corresponded with implementation of new HWLs, after which talking stabilized; and the frequency of HWL talk in Mexico was stable over time, where new HWLs are implemented every six months. Talk about HWLs was an independent predictor of subsequent quit attempts in Canada (AOR = 1.50; 95% CI = 1.11-2.02), Australia (AOR = 1.41; 95% CI = 1.05-1.89), and Mexico (AOR = 1.53; 95% CI = 1.11-2.10), as was cognitive responses to HWLs (Australia AOR = 1.66; 95% CI = 1.22-2.24; Canada AOR = 1.56; 95% CI = 1.15-2.11; Mexico AOR = 1.30; 95% CI = 0.91-1.85). No interaction between talk and cognitive reactions to HWLs were found. These results suggest that interpersonal communication about HWLs influences smoking cessation attempts independent of other established predictors of smoking cessation, including cessation-related HWL responses. Future research should determine ways to catalyze interpersonal communication about HWLs and thereby potentiate HWL effects.

Cigarette brands with flavour capsules in the filter: trends in use and brand perceptions among smokers in the USA, Mexico and Australia, 2012-2014.

OBJECTIVE: To describe trends, correlates of use and consumer perceptions related to the product design innovation of flavour capsules in cigarette filters. METHODS: Quarterly surveys from 2012 to 2014 were analysed from an online consumer panel of adult smokers aged 18-64, living in the USA (n=6865 observations; 4154 individuals); Mexico (n=5723 observations; 3366 individuals); and Australia (n=5864 observations; 2710 individuals). Preferred brand varieties were classified by price (ie, premium; discount) and flavour (ie, regular; flavoured without capsule; flavoured with capsule). Participants reported their preferred brand variety's appeal (ie, satisfaction; stylishness), taste (ie, smoothness, intensity), and harm relative to other brands and varieties. GEE models were used to determine time trends and correlates of flavour capsule use, as well as associations between preferred brand characteristics (ie, price stratum, flavour) and perceptions of relative appeal, taste and harm. RESULTS: Preference for flavour capsules increased significantly in Mexico (6% to 14%) and Australia (1% to 3%), but not in the USA (4% to 5%). 18-24 year olds were most likely to prefer capsules in the USA (10%) and Australia (4%), but not Mexico. When compared to smokers who preferred regular brands, smokers who preferred brands with capsules viewed their variety of cigarettes as having more positive appeal (all countries), better taste (all countries), and lesser risk (Mexico, USA) than other brand varieties. CONCLUSIONS: Results indicate that use of cigarettes with flavour capsules is growing, is associated with misperceptions of relative harm, and differentiates brands in ways that justify regulatory action.

The Use of Cigarette Package Inserts to Supplement Pictorial Health Warnings: An Evaluation of the Canadian Policy.

BACKGROUND: Canada is the first country in the world to require cigarette manufacturers to enclose package inserts to supplement the exterior pictorial health warning label (HWL). In June 2012, Canada implemented new HWL package inserts that include cessation tips accompanied by a pictorial image. This study aims to assess the extent to which adult smokers report reading the newly mandated HWL inserts and to see whether reading them is associated with making a quit attempt. METHODS: Data were analyzed from an online consumer panel of Canadian adult smokers, aged 18-64 years. Five waves of data were collected between September 2012 and January 2014, separated by 4-months intervals (n = 1,000 at each wave). Logistic generalized estimating equation (GEE) models were estimated to assess correlates of reading inserts and whether doing so is associated with making a quit attempt by the subsequent wave. RESULTS: At each wave, between 26% and 31% of the sample reported having read HWL package inserts at least once in the prior month. Smokers who read them were more likely to be younger, female, have higher income, intend to quit, have recently tried to quit, and thought more frequently about health risks because of warning labels. In models that adjusted for these and other potential confounders, smokers who read the inserts a few times or more in the past month were more likely to make a quit attempt at the subsequent wave compared to smokers who did not read the inserts. CONCLUSIONS: HWL package inserts with cessation-related tips and messages appear to increase quit attempts made by smokers.

Adult smokers' responses to "corrective statements" regarding tobacco industry deception.

BACKGROUND: To inform consumers, U.S. Federal Courts have ordered the tobacco industry to disseminate "corrective statements" (CSs) about their deception regarding five topics: smoker health effects, nonsmoker health effects, cigarette addictiveness, design of cigarettes to increase addiction, and relative safety of light cigarettes. PURPOSE: To determine how smokers from diverse backgrounds respond to the final, court-mandated wording of these CSs. METHODS: Data were analyzed from an online consumer panel of 1,404 adult smokers who evaluated one of five CS topics (n=280-281) by reporting novelty, relevance, anger at the industry, and motivation to quit because of the CS. Logistic and linear regression models assessed main and interactive effects of race/ethnicity, gender, education, and CS topic on these responses. Data were collected in January 2013 and analyzed in March 2013. RESULTS: Thirty percent to 54% of participants reported that each CS provided novel information, and novelty was associated with greater relevance, anger at the industry, and motivation to quit because of the message. African Americans and Latinos were more likely than non-Hispanic whites to report that CSs were novel, and they had stronger responses to CSs across all indicators. Compared to men, women reported that CSs were more relevant and motivated them to quit. CONCLUSIONS: This study suggests that smokers would value and respond to CSs, particularly smokers from groups that suffer from tobacco-related health disparities.