Smoking Dependence, Time-Discounting, and Sustained Cessation Behavior: A Longitudinal Study of Predominantly Light Smokers.

INTRODUCTION: This study aimed to assess whether two established psychosocial predictors of smoking abstinence, nicotine dependence and time-discounting, also apply to a population of predominantly cigarette light smokers, which is the dominant pattern of smoking in countries like Mexico. Relatively infrequent smoking is increasingly prevalent, yet still harmful, making it important to understand the predictors of cessation in this population. AIMS AND METHODS: Mexican adult smokers recruited from an online consumer panel were surveyed every 4 months between November 2018 and July 2020. We considered respondents who reported a quit attempt in between surveys (n = 1288). Dependence was measured with a 10-item version of the Wisconsin Inventory of Smoking Dependence Motives (WISDM). Time-discounting was assessed with five branching questions about hypothetical reward scenarios. Logistic models regressed sustained quit attempts (≥30 days of abstinence) at time t + 1 on study variables at time t. RESULTS: We found strong interitem reliability (α = 0.92) and intraindividual consistency of our brief WISDM (ρ = 0.68), but moderate intraindividual consistency of the time-discounting measure (ρ = 0.48). Forty-eight percent of the sample reported sustained quit attempts, and 79% were non-daily or light daily smokers (≤5 cigarettes per day). Smokers with higher WISDM-10 had lower odds of sustained quitting and this result remained when controlling for smoking frequency and the Heaviness of Smoking Index (adjusted odds ratio [AOR] = 0.768). Time-discounting was unassociated with sustained quitting. CONCLUSIONS: Our findings suggest that a brief, 10-item multidimensional measure of dependence is useful for predicting sustained quitting in a context of relatively light smoking; time-discounting appears less relevant, although our results are not conclusive because of the low test-retest reliability of our measure. IMPLICATIONS: Given the increase in non-daily and light daily cigarette smoking in many countries, including in Mexico, and the health risks this still poses, it is important to understand the predictors of cessation among relatively light smokers. The WISDM-10 multidimensional measure seems to be a good instrument to assess dependence and predict successful quitting in this population, and possibly more appropriate than physical dependence measures. As such, it could help design and target more suitable cessation treatments for non-daily and daily light cigarette smokers. While this study did not find time-discounting to be a relevant predictor of smoking abstinence, future studies should explore other measures.

Trends of Antihypertensive, Antidiabetic, and Nonsteroidal Anti-Inflammatory Drugs Use among the Health Workers Cohort Study, Mexico 2004 to 2018.

Background: Hypertension and type 2 diabetes (T2D) are the most prevalent noncommunicable diseases in Mexico and worldwide. According to international practice management guidelines, the principal chronic management therapy is daily oral medication. Aim: We aim to describe the trends of antihypertensive, antidiabetic, and nonsteroidal anti-inflammatory (NSAID) drugs use among the Mexican adult population from 2004-2018. Methods: We analyzed data from the Health Workers Cohort Study (HWCS) for males and females aged >18 years. We calculated the prevalence of chronic diseases and utilization for every kind of antihypertensive, antidiabetic, and NSAIDs (measured by self-reported utilization) at baseline and two follow-ups (2004, 2010, and 2017). Trends were analyzed using Fisher's exact test. Results: Hypertension prevalence increased from 19.8 to 30.3%, higher than T2D prevalence from 7.0 to 12.8% through fourteen years of follow-up. Like the self-reported dual therapy, the proportion of patients using beta-blockers and angiotensin II receptor blockers increased. Regarding T2D, the prevalence of metformin utilization increased to 83.9%. The utilization of common NSAIDs, mainly for muscular pain, remained around 13 to 16%. Conclusions: Our findings showed a changing prevalence of drug utilization for hypertension and T2D between 2004 and 2018 and consistent use of NSAIDs in the adult Mexican population.

Decídetexto México: Recruitment and baseline characteristics of Mexican individuals who smoke in a cessation study.

The objective of this study was to evaluate the effectiveness of digital and traditional methods and strategies in the recruitment of Mexican individuals who smoke into a cessation study. Recruitment method refers in general to either digital or traditional recruitment. Recruitment strategies refer to the particular recruitment type utilized within each recruitment method. Traditional recruitment strategies included radio interviews, word of mouth, newspaper advertisement, posters/banners placed in primary healthcare clinics, and medical referrals. Digital recruitment strategies involved emails and study advertisements through social media (i.e., Facebook, Instagram and Twitter) and website. In a 4-month period, 100 Mexican individuals who smoke were successfully enrolled into a smoking cessation study. The majority of participants were enrolled via traditional recruitment strategies (86%) compared to the digital recruitment strategies (14%). Individuals screened in the digital method were more likely to be eligible to participate in the study, compared to the traditional method. Similarly, in comparison to the traditional method, individuals in the digital method were more likely to enroll in the study. However, these differences were not statistically significant. Both traditional and digital strategies made important contributions to the overall recruitment effort.

Aceptabilidad de propuestas de regulación de los Sistemas Electrónicos de Administración de Nicotina entre consumidores en México.

OBJETIVO: Explorar la aceptabilidad de la actual prohibición de Sistemas Electrónicos de Administración de Nicotina (SEAN) y cuatro propuestas regulatorias (prohibición de saborizantes, espacios libres de emisiones, edad mínima para compra y prohibición de promociones) entre usuarios de nicotina. Material y métodos. Estudio transversal de panel realizado en fumadores y vapeadores mexicanos (no-viembre 2018-marzo 2020). Mediante análisis de regresión logística se estimaron razones de momios ajustadas (RMa) para evaluar la asociación entre las variables independientes y el apoyo a la prohibición y cuatro propuestas regulatorias. RESULTADOS: El apoyo de la prohibición fue de 20%. El nivel de aceptación de las propuestas fue de 21% prohibición de sabores, 23.2% prohibición de promociones, 40.5% espacios libres de emisiones, y 47.9% edad mínima para compra. Con-clusiones. En México existe un rechazo generalizado de los usuarios de nicotina a la prohibición de los SEAN, y mayor aceptación sobre regulación de espacios libres de emisiones y edad mínima de compra.

Cost-effectiveness analysis of interventions to increase physical activity in hypertensive patients / Análisis de costo-efectividad de intervenciones para incrementar la actividad física en hipertensos

Abstract Objective: To perform a cost-effectiveness analysis (CEA) of two programs designed to increase the physical activity (PA) of hypertensive patients at the primary-care level: the first based on the Reference Scheme (RS) and the second on the Brief Counseling (BC) approach, both within the context of a Mexican social security institution: The Mexican Social Security Institute (IMSS). Material and Methods: A CEA was undertaken from the perspective of service providers, with a time horizon of 24 weeks. Effectiveness was estimated in two ways: an increase in the minutes of moderate-vigorous PA (MVPA) and the percentage of patients engaging in ≥150 weekly minutes of MVPA at the end of each program. Results: RS patients performed 8.1 additional minutes of PA (week 24 = 169.29 minutes; week zero = 161.23). RS program proved approximately 1% more expensive and more effective and had an incremental cost-effectiveness ratio of 299 US$ per increased percentage point of patients engaging in ≥150 weekly minutes of MVPA at the end of each program. The sensitivity analysis yielded an up to 56% probability that the RS program would be cost- effective in increasing the percentage of patients performing the targeted MVPA per week. Conclusions: Our results indicate that in the context of a social security institution such as the IMSS, it is not cost-effective to implement an RS-based program to increase physical activity levels in hypertensive patients. Further evidence is required on the cost-effectiveness of both programs regarding other effectiveness measures such as biochemical and physical condition parameters, as well as to other types of population, given that this was the first CEA of PA programs in Mexico.

Resumen Objetivo: Realizar un análisis de costo-efectividad (ACE) de dos programas diseñados para incrementar la actividad física (AF) de pacientes hipertensos: el primero basado en el Esquema de Referencia (ER) y el segundo con un enfoque de Asesoramiento o Consejería Breve (CB), ambos en el contexto de primer nivel de atención en una institución de seguridad social de México: El Instituto Mexicano del Seguro Social (IMSS). Material y métodos: Se realizó un ACE desde la perspectiva de los proveedores de servicios, con un horizonte temporal de 24 semanas. La efectividad se midió con dos indicadores: aumento en los minutos de AF moderada-vigorosa (AFMV) y en el porcentaje de pacientes que participaron en ≥150 minutos de AFMV semanales al final de cada programa. Resultados: Los pacientes con ER realizaron 8.1 minutos adicionales de AF (semana 24 = 169.29 minutos; semana cero = 161.23). El programa ER demostró ser aproximadamente 1% más costoso y efectivo, y tuvo una relación costo-efectividad incremental de 299 dólares por cada punto porcentual de incremento de pacientes que cumplían con ≥150 minutos de MVPA semanales al final de cada programa. El análisis de sensibilidad arrojó una probabilidad de hasta 56% de que el programa ER fuera costo-efectivo para aumentar el porcentaje de pacientes que cumplen con las recomendaciones de AF semanales. Conclusiones: Nuestros resultados indican que en el contexto de una institución de seguridad social como el IMSS, no es costo-efectivo implementar un programa basado en ER para aumentar los niveles de actividad física en pacientes hipertensos.Se requiere mayor evidencia sobre la relación costo-efectividad de ambos programas con respecto a otras medidas de efectividad como parámetros bioquímicos y de condición física, así como a otro tipo de población, dado que este fue el primer ACE de programas de AF en México.

Exposure to e-cigarette advertising and provaping websites, and the social acceptability of their use among nicotine users.

Objectives: To evaluate the prevalence of exposure to Internet communications on and advertising of electronic cigarettes (e-cigarettes) and their association with perceptions of the social acceptability of e-cigarettes in Mexico. Methods: Data were analyzed from eight surveys (2018-2021) of an online sample of Mexican adult (> 18 years) smokers and dual users (of combustible and electronic cigarettes). Self-reported exposure to e-cigarette advertising across various marketing channels was assessed, as well as visits to e-cigarette websites. Logistic regression analysis was used to evaluate the association between perceptions of the social acceptability of e-cigarette use and level of advertising exposure and visits to e-cigarette websites. Results: The Internet and outside e-cigarette stores were where exposure to advertising most occurred, as reported by 47.4% and 46.8% of respondents, respectively. Respondents who noticed e-cigarette advertisements on the Internet (adjusted odds ratio (OR) 1.43, 95% confidence intervals (CI) 1.25, 1.63), outside e-cigarette stores (adjusted OR 1.31, 95% CI 1.14, 1.50), and in temporary outlets (adjusted OR 1.16, 95% CI 1.01, 1.34), and those who visited e-cigarette websites (adjusted OR 1.48, 95% CI 1.25, 1.76) were more likely to perceive e-cigarettes as socially acceptable. Noticing advertisements across more channels was also associated with higher perceived social acceptability of e-cigarette use. Conclusions: Being exposed to e-cigarette marketing, either online or through traditional marketing channels, is associated with perceived social acceptability of e-cigarette use, as is contact with provaping sites. Regulatory options to avoid the proliferation of promotional websites disguised as opinion or user sites need to be considered.

Exposure to e-cigarette advertising and provaping websites, and the social acceptability of their use among nicotine users

[ABSTRACT]. Objectives. To evaluate the prevalence of exposure to Internet communications on and advertising of elec- tronic cigarettes (e-cigarettes) and their association with perceptions of the social acceptability of e-cigarettes in Mexico. Methods. Data were analyzed from eight surveys (2018–2021) of an online sample of Mexican adult (> 18 years) smokers and dual users (of combustible and electronic cigarettes). Self-reported exposure to e-cigarette advertising across various marketing channels was assessed, as well as visits to e-cigarette websites. Logistic regression analysis was used to evaluate the association between perceptions of the social acceptability of e-cigarette use and level of advertising exposure and visits to e-cigarette websites. Results. The Internet and outside e-cigarette stores were where exposure to advertising most occurred, as reported by 47.4% and 46.8% of respondents, respectively. Respondents who noticed e-cigarette adver- tisements on the Internet (adjusted odds ratio (OR) 1.43, 95% confidence intervals (CI) 1.25, 1.63), outside e-cigarette stores (adjusted OR 1.31, 95% CI 1.14, 1.50), and in temporary outlets (adjusted OR 1.16, 95% CI 1.01, 1.34), and those who visited e-cigarette websites (adjusted OR 1.48, 95% CI 1.25, 1.76) were more likely to perceive e-cigarettes as socially acceptable. Noticing advertisements across more channels was also associated with higher perceived social acceptability of e-cigarette use. Conclusions. Being exposed to e-cigarette marketing, either online or through traditional marketing channels, is associated with perceived social acceptability of e-cigarette use, as is contact with provaping sites. Regu- latory options to avoid the proliferation of promotional websites disguised as opinion or user sites need to be considered.

[RESUMEN]. Objetivos. Evaluar la prevalencia de la exposición a las comunicaciones por Internet y la publicidad de los cigarros electrónicos (e-cigarettes), así como su asociación con las percepciones sobre la aceptabilidad social de los cigarrillos electrónicos en México. Métodos. Se analizaron los datos de ocho encuestas (2018-2021) de una muestra en línea de adultos mexicanos (mayores de 18 años) fumadores y consumidores dobles (cigarrillos combustibles y cigarrillos electrónicos). Se evaluaron la exposición —referida por los propios encuestados— a la publicidad de cigarri- llos electrónicos en varios canales de comercialización y las visitas a sitios web de cigarrillos electrónicos. Se realizó un análisis de regresión logística para evaluar la relación entre la percepción de aceptabilidad social del consumo de cigarrillos electrónicos, por una parte, y el nivel de exposición publicitaria y las visitas a sitios web de cigarrillos electrónicos, por la otra. Resultados. La mayor exposición a la publicidad se dio en las tiendas virtuales y físicas donde se ven- den cigarrillos electrónicos, según lo notificado por 47,4% y 46,8% de los encuestados, respectivamente. Los encuestados que observaron anuncios de cigarrillos electrónicos en Internet (razón de probabilidades ajustada [OR ajustada] 1,43; intervalos de confianza [IC] del 95 %: 1,25; 1,63), en tiendas físicas de cigarrillos electrónicos (OR ajustada 1,31; IC del 95 %: 1,14; 1,50) y en puntos de venta temporales (OR ajustada 1,16; IC del 95 %: 1,01; 1,34), y los que visitaron sitios web de cigarrillos electrónicos (OR ajustada 1,48; IC del 95 %: 1,25; 1,76) fueron más propensos a percibir los cigarrillos electrónicos como socialmente aceptables. Asimismo, se asoció el hecho de observar anuncios en más canales con la percepción de una mayor acept- abilidad social del consumo de cigarrillos electrónicos. Conclusiones. La exposición a la publicidad de los cigarrillos electrónicos, ya sea en línea o por los canales tradicionales, así como el contacto con sitios web que promueven el vapeo, se relaciona con la percepción acerca de la aceptabilidad social del consumo de cigarrillos electrónicos. Deberían considerarse alternativas regulatorias para evitar la proliferación de sitios web promocionales disfrazados de sitios de opinión o de usuarios.

[RESUMO]. Objetivos. Avaliar a prevalência da exposição a comunicações e propagandas sobre cigarros eletrônicos na internet e sua associação com percepções de aceitação social dos cigarros eletrônicos no México. Métodos. Foram analisados dados de oito pesquisas (2018 a 2021) de uma amostra on-line de adultos me- xicanos (maiores de 18 anos) fumantes e usuários duais (de cigarros combustíveis e eletrônicos). Avaliou-se a exposição autorrelatada à propaganda de cigarros eletrônicos em diversos canais de marketing, além de vis- itas a sites de cigarros eletrônicos. Foi utilizada uma análise de regressão logística para avaliar a associação entre percepções de aceitação social do uso de cigarros eletrônicos e o nível de exposição a propagandas e visitas a sites de cigarros eletrônicos. Resultados. A maior exposição a propaganda ocorreu na internet e no exterior de tabacarias que vendem cigarros eletrônicos, conforme relatado por 47,4% e 46,8% dos respondentes, respectivamente. Os respon- dentes que haviam notado propagandas de cigarros eletrônicos na internet (razão de chances [RC] ajustada: 1,43; intervalo de confiança [IC] de 95%: 1,25-1,63), no exterior de tabacarias que vendem cigarros eletrôni- cos (RC ajustada: 1,31; IC de 95%: 1,14-1,50) e em pontos temporários de venda (RC ajustada: 1,16; IC de 95%: 1,01-1,34), e os respondentes que visitavam sites de cigarros eletrônicos (RC ajustada: 1,48; IC de 95%: 1,25-1,76) eram mais propensos a achar que os cigarros eletrônicos eram socialmente aceitáveis. A observação de propaganda em um maior número de canais também estava associada à percepção de maior aceitação social do uso de cigarros eletrônicos. Conclusões. A exposição ao marketing de cigarros eletrônicos, seja on-line ou por meio de canais tradicio- nais de marketing, está associada à percepção de aceitação social do uso de cigarros eletrônicos, assim como o contato com sites pró-vaping. Devem-se cogitar opções regulatórias para evitar a proliferação de sites promocionais disfarçados de sites de opinião ou de usuários.

Transitions between tobacco products: Correlates of changes in cigarette smoking and e-cigarette use among exclusive adult smokers and dual users in Mexico.

This study examined transitions in tobacco products use among Mexican smokers and dual users. Data were analyzed from exclusive smokers (n = 2,946) and dual users (n = 1,643) recruited from an online consumer research panel and surveyed every-four months from November 2018 to April 2021. For exclusive smokers, estimated transitions were (time "t + 1" four months after prior survey): a) remain as exclusive smokers; b) dual use; c) exclusive e-cigarette use or quit both products. Among dual users, transitions analyzed were: a) remain as dual user; b) exclusive smoker; c) exclusive e-cigarette user or quit both products. Multinomial models regressed transitions at "t + 1" on time "t" for control variables. Most exclusive smokers (81%) remained as such, 12.6% transitioned to dual use, 2.3% to exclusive e-cigarette use, and 4% quitted both products. Exclusive smokers were more likely to transition to dual use if they recently attempted to quit (AOR = 1.45) or had partners/family or friends who used e-cigarettes (AOR = 2.47 & 2.56 respectively). Most dual users (74.8%) remained as dual users, 20.4% transitioned to exclusive smoking, 1.6% transitioned to exclusive e-cigarette use, and 3.2% quitted both products. Dual users were more likely to transition to exclusive smoking if they had lower educational attainment, recently attempted to quit e-cigarettes (AOR = 1.70). Having friends who use e-cigarettes (AOR = 0.29) and higher smoking dependence (AOR = 0.55) were associated with a lower likelihood of quitting. Recent quit attempts and e-cigarette use among close social network members may explain the short-term transitions, though longer follow-up is needed to assess sustained smoking cessation.

Soft drink and non-caloric soft drink intake and their association with blood pressure: the Health Workers Cohort Study.

BACKGROUND: A few prospective studies have investigated the potential association of soft drink and non-caloric soft drink intake with high blood pressure using methods that adequately consider changes in intake over time and hypertensive status at baseline. OBJECTIVE: To prospectively examine the association of soft drink and non-caloric soft drink intake with systolic and diastolic blood pressure in a sample of Mexican adults, overall and by hypertension status. METHODS: We used data from the Health Workers Cohort Study spanning from 2004 to 2018 (n = 1,324 adults). Soft drink and non-caloric soft drink intake were assessed with a semiquantitative food frequency questionnaire. We fit multivariable-adjusted fixed-effects models to test the association of soft drink and non-caloric soft drink intake with systolic and diastolic blood pressure. The models were adjusted for potential confounders and considering the potential modifying effect of hypertension status at baseline. RESULTS: A one-serving increase in soft drink intake was associated with a 2.08 mm Hg (95% CI: 0.21, 3.94) increase in systolic blood pressure and 2.09 mm Hg (95% CI: 0.81, 3.36) increase in diastolic blood pressure over ten years. A stronger association between soft drink intake and diastolic pressure was observed among participants with versus without hypertension at baseline. We found no association between non-caloric soft drink intake and blood pressure. CONCLUSIONS: Our findings support the hypothesis that soft drink intake increases blood pressure. While further studies should be conducted to confirm our findings, food policies and recommendations to limit soft drink intake are likely to help reduce blood pressure at the population level. We probably did not find an association between non-caloric soft drink intake and blood pressure because of the low consumption of this type of beverage in the cohort. More studies will be needed to understand the potential effect of non-caloric beverages on blood pressure.

Why Smoke Flavor Capsule Cigarettes? Preferences and Perceptions Among Adult Smokers in Mexico.

INTRODUCTION: Flavor capsule cigarettes are rapidly gaining global market share, particularly in Latin America; however, little is known about consumer profiles and perceptions since the diffusion of this product innovation has become more widespread. AIMS AND METHODS: This paper compares profiles and perceptions of smokers who prefer flavor capsule cigarettes and those who do not in Mexico. We analyzed data from six online surveys of adult Mexican smokers (n = 4488) from 2018-2020. Participants identified their preferred brand variety characteristics (no capsule; one capsule; two capsules), and reported perceptions of their brand varieties' flavor, smoothness, harmfulness, and whether they smoke to control their appetite. Separate multinomial logistic models regressed preferred cigarette type on sociodemographic and smoking-related variables, as well as perceived benefits on preferred cigarette type, adjusting for covariates. RESULTS: Most participants preferred capsule cigarettes (single capsule = 47.5%; double capsule = 12.9%). Flavor capsule users reported that their preferred varieties mostly tasted like menthol/mint (59% of single capsule users and 23% of double capsule users), cucumber (12% and 27%, respectively) or berries (10% and 22%, respectively). Females were more likely than males to prefer either single or double capsule cigarettes (AOR = 2.26 and 2.01, respectively). Preference for flavor capsules was also higher among younger smokers, e-cigarette users, those who smoke less frequently, and those who recently tried or plan to quit. Smokers who preferred capsules were more likely than non-capsule smokers to perceive their cigarettes as smoother, less harmful, and to smoke to control their appetite. CONCLUSIONS: The high prevalence of capsule use and widespread perceptions of the benefits of capsules over traditional cigarettes may help explain why tobacco control policies have not reduced smoking prevalence in Mexico. IMPLICATIONS: Flavor capsules are rapidly growing in popularity in many countries around the world, including Mexico. This study found that more Mexican adult smokers prefer brand varieties with capsules (60%) than without capsules (40%), that flavor capsule use strongly correlates with menthol cigarette use, and that perceived flavors of capsules range widely. Flavor capsule smokers have more positive smoking expectancies (eg, lower risk perceptions, dietary control) than noncapsule smokers. Capsules appeal particularly to women, young adults, less frequent smokers, and those who recently tried to quit. Policies should consider banning flavors in cigarettes, including capsules and other filter innovations.

Heated tobacco product use, its correlates, and reasons for use among Mexican smokers.

BACKGROUND: Little is known about the use of novel heated tobacco products (HTPs) in low- and middle-income countries. We examined among smokers in Mexico the prevalence and correlates of HTP use, as well as reasons for using HTPs. METHODS: We analyzed data from five surveys (November 2019-March 2021) of an open cohort of adult smokers (n = 6500), including an oversample of those who also use e-cigarettes. Mixed-effects multinomial logistic models were used to estimate associations between study variables and current HTP use or prior HTP trial relative to never trying HTPs. RESULTS: The weighted prevalence of current HTP use was 1.1%. Independent correlates of current HTP use included smoking frequency, intention to quit, e-cigarette use, having partners/family-members who use e-cigarettes, friends who use HTPs, and exposure to HTP information inside/outside tobacco shops. Having partners/family members who smoke and not knowing about the harm of HTPs relative to cigarettes were associated with lower likelihood of current HTP use. Having tried HTPs was more likely among light daily smokers, those with family who use HTPs and exposure to HTP information outside shops and on newspapers/magazines. Among current users, the top reasons for using HTPs were greater social acceptability (50.6%) and lower perceived harm (34.9%) relative to cigarettes. CONCLUSIONS: Uptake of HTPs appears relatively low among Mexican smokers, and correlates of use are similar to those for e-cigarette use. Further research is needed to determine if HTPs use promotes or impedes smoking cessation, given current HTP users are also likely to use various nicotine products.

[PREVENIMSS: a brief overview of its 20 years, challenges and opportunities]. / PREVENIMSS: un breve recorrido de sus 20 años, retos y oportunidades.

Twenty years after its launch, the most ambitious preventive program implemented at the institutional level in Mexico called PREVENIMSS focuses on new challenges and moves towards relaunching. This paper reviews the foundations and design of PREVENIMSS and its evolution throughout these two decades. The PREVENIMS coverage assessment through national surveys set a relevant precedent in evaluating programs at the Mexican Institute of Social Security. PREVENIMSS has shown progress in preventing vaccine-preventable diseases. However, given the current epidemiological profile, there is still a need to provide more effective primary and secondary prevention of chronic noncommunicable diseases. New digital resources and orientation of PREVENIMSS towards a more comprehensive approach that contemplates secondary prevention and rehabilitation can help to face the growing challenges that the program still faces.

A 20 años de su lanzamiento, el programa preventivo más ambicioso implementado a nivel institucional en México llamado PREVENIMSS se enfoca en nuevos desafíos y avanza hacia el relanzamiento. Este artículo hace un breve recorrido de sus fundamentos, diseño y evolución a lo largo de estas dos décadas. La estimación de las coberturas de PREVENIMSS a través de encuestas nacionales también marcó un precedente en la evaluación de programas en el Instituto Mexicano del Seguro Social. PREVENIMSS ha mostrado avances en prevención de enfermedades prevenibles por vacunación, pero aún existe la necesidad de brindar prevención primaria y secundaria más efectivos de las enfermedades crónicas no transmisibles ante el perfil epidemiológico actual. Nuevos recursos digitales y la orientación hacia un enfoque más integral que contemple la prevención secundaria y la rehabilitación pueden ayudar a enfrentar los crecientes desafíos que aún enfrenta el programa.

Smoking Cessation Mobile Interventions in Latin America: A Systematic Review.

OBJECTIVE: To systematically review published articles reporting the use of smoking cessation mobile health (mHealth) interventions in Latin America. METHODS: Five different databases were searched from database inception to 2020. Criteria: (1) the research was a smoking cessation randomized controlled trial (RCT), quasi-experimental research, or single-arm study; (2) the intervention used at least one type of mHealth intervention; (3) the research was conducted in Latin American; and (4) the research reported the cessation rate. RESULTS: Of the seven selected studies, four were conducted in Brazil, two in Mexico, and one in Peru. Only one study was an adequately powered RCT. Interventions relied on text messages (n = 3), web-based tools (n = 2), and telephone calls (n = 3). Some studies (n = 4) provided pharmacotherapy support. Smoking cessation outcomes included self-reported (n = 5) and biochemically verified (n = 2) abstinence. Follow-ups were conducted at Month 6 (n = 2), Week 12 (n = 4), and Day 30 (n = 1). Cessation rates varied from 9.4% at Week 12 to 55.5% at Day 30. CONCLUSION: Despite the promising cessation rates of mHealth interventions in Brazil, Mexico, and Peru, there is a need to rigorously evaluate these interventions in different Latin American countries with RCTs that are long-term, adequately powered, and use biochemical verification of cessation.

Exposure to e-cigarette advertising and provaping websites, and the social acceptability of their use among nicotine users / Exposición a la publicidad de cigarrillos electrónicos y sitios web que promueven el vapeo y la aceptabilidad social de su uso entre los consumidores de nicotina / Exposição a propaganda de cigarros eletrônicos e sites pró-vaping e aceitação social de seu uso entre usuários de nicotina

ABSTRACT Objectives. To evaluate the prevalence of exposure to Internet communications on and advertising of electronic cigarettes (e-cigarettes) and their association with perceptions of the social acceptability of e-cigarettes in Mexico. Methods. Data were analyzed from eight surveys (2018-2021) of an online sample of Mexican adult (> 18 years) smokers and dual users (of combustible and electronic cigarettes). Self-reported exposure to e-cigarette advertising across various marketing channels was assessed, as well as visits to e-cigarette websites. Logistic regression analysis was used to evaluate the association between perceptions of the social acceptability of e-cigarette use and level of advertising exposure and visits to e-cigarette websites. Results. The Internet and outside e-cigarette stores were where exposure to advertising most occurred, as reported by 47.4% and 46.8% of respondents, respectively. Respondents who noticed e-cigarette advertisements on the Internet (adjusted odds ratio (OR) 1.43, 95% confidence intervals (CI) 1.25, 1.63), outside e-cigarette stores (adjusted OR 1.31, 95% CI 1.14, 1.50), and in temporary outlets (adjusted OR 1.16, 95% CI 1.01, 1.34), and those who visited e-cigarette websites (adjusted OR 1.48, 95% CI 1.25, 1.76) were more likely to perceive e-cigarettes as socially acceptable. Noticing advertisements across more channels was also associated with higher perceived social acceptability of e-cigarette use. Conclusions. Being exposed to e-cigarette marketing, either online or through traditional marketing channels, is associated with perceived social acceptability of e-cigarette use, as is contact with provaping sites. Regulatory options to avoid the proliferation of promotional websites disguised as opinion or user sites need to be considered.

RESUMEN Objetivos. Evaluar la prevalencia de la exposición a las comunicaciones por Internet y la publicidad de los cigarros electrónicos (e-cigarettes), así como su asociación con las percepciones sobre la aceptabilidad social de los cigarrillos electrónicos en México. Métodos. Se analizaron los datos de ocho encuestas (2018-2021) de una muestra en línea de adultos mexicanos (mayores de 18 años) fumadores y consumidores dobles (cigarrillos combustibles y cigarrillos electrónicos). Se evaluaron la exposición —referida por los propios encuestados— a la publicidad de cigarrillos electrónicos en varios canales de comercialización y las visitas a sitios web de cigarrillos electrónicos. Se realizó un análisis de regresión logística para evaluar la relación entre la percepción de aceptabilidad social del consumo de cigarrillos electrónicos, por una parte, y el nivel de exposición publicitaria y las visitas a sitios web de cigarrillos electrónicos, por la otra. Resultados. La mayor exposición a la publicidad se dio en las tiendas virtuales y físicas donde se venden cigarrillos electrónicos, según lo notificado por 47,4% y 46,8% de los encuestados, respectivamente. Los encuestados que observaron anuncios de cigarrillos electrónicos en Internet (razón de probabilidades ajustada [OR ajustada] 1,43; intervalos de confianza [IC] del 95 %: 1,25; 1,63), en tiendas físicas de cigarrillos electrónicos (OR ajustada 1,31; IC del 95 %: 1,14; 1,50) y en puntos de venta temporales (OR ajustada 1,16; IC del 95 %: 1,01; 1,34), y los que visitaron sitios web de cigarrillos electrónicos (OR ajustada 1,48; IC del 95 %: 1,25; 1,76) fueron más propensos a percibir los cigarrillos electrónicos como socialmente aceptables. Asimismo, se asoció el hecho de observar anuncios en más canales con la percepción de una mayor aceptabilidad social del consumo de cigarrillos electrónicos. Conclusiones. La exposición a la publicidad de los cigarrillos electrónicos, ya sea en línea o por los canales tradicionales, así como el contacto con sitios web que promueven el vapeo, se relaciona con la percepción acerca de la aceptabilidad social del consumo de cigarrillos electrónicos. Deberían considerarse alternativas regulatorias para evitar la proliferación de sitios web promocionales disfrazados de sitios de opinión o de usuarios.

RESUMO Objetivos. Avaliar a prevalência da exposição a comunicações e propagandas sobre cigarros eletrônicos na internet e sua associação com percepções de aceitação social dos cigarros eletrônicos no México. Métodos. Foram analisados dados de oito pesquisas (2018 a 2021) de uma amostra on-line de adultos mexicanos (maiores de 18 anos) fumantes e usuários duais (de cigarros combustíveis e eletrônicos). Avaliou-se a exposição autorrelatada à propaganda de cigarros eletrônicos em diversos canais de marketing, além de visitas a sites de cigarros eletrônicos. Foi utilizada uma análise de regressão logística para avaliar a associação entre percepções de aceitação social do uso de cigarros eletrônicos e o nível de exposição a propagandas e visitas a sites de cigarros eletrônicos. Resultados. A maior exposição a propaganda ocorreu na internet e no exterior de tabacarias que vendem cigarros eletrônicos, conforme relatado por 47,4% e 46,8% dos respondentes, respectivamente. Os respondentes que haviam notado propagandas de cigarros eletrônicos na internet (razão de chances [RC] ajustada: 1,43; intervalo de confiança [IC] de 95%: 1,25-1,63), no exterior de tabacarias que vendem cigarros eletrônicos (RC ajustada: 1,31; IC de 95%: 1,14-1,50) e em pontos temporários de venda (RC ajustada: 1,16; IC de 95%: 1,01-1,34), e os respondentes que visitavam sites de cigarros eletrônicos (RC ajustada: 1,48; IC de 95%: 1,25-1,76) eram mais propensos a achar que os cigarros eletrônicos eram socialmente aceitáveis. A observação de propaganda em um maior número de canais também estava associada à percepção de maior aceitação social do uso de cigarros eletrônicos. Conclusões. A exposição ao marketing de cigarros eletrônicos, seja on-line ou por meio de canais tradicionais de marketing, está associada à percepção de aceitação social do uso de cigarros eletrônicos, assim como o contato com sites pró-vaping. Devem-se cogitar opções regulatórias para evitar a proliferação de sites promocionais disfarçados de sites de opinião ou de usuários.

Screen-Based Sedentary Behaviors and Their Association With Metabolic Syndrome Components Among Adults in Mexico.

INTRODUCTION: Approximately 25% of the adult population worldwide and 49.8% of Mexican adults have metabolic syndrome. Metabolic syndrome is the result of unhealthy dietary and sleeping patterns, sedentary behaviors, and physical inactivity. The objective of our study was to evaluate the association between sedentary behaviors as screen-based sedentary time (SBST) and each component of metabolic syndrome among adults who participated in the Mexico National Survey of Health and Nutrition Mid-way 2016. METHODS: We analyzed sociodemographic, clinical, and physical activity data from 3,166 adults aged 20 years or older. The International Physical Activity Questionnaire was used to evaluate sedentary behavior. SBST was obtained by counting minutes per week spent watching television, playing video games, and interacting with computers and smartphones. We used Poisson regression to estimate the prevalence ratio of time in front of screens as a continuous variable and its association with metabolic syndrome. RESULTS: The mean (SD) hours per day of SBST in men was 3.6 (0.4) and in women was 2.8 (0.2). The prevalence of metabolic syndrome was 59.6%. In men, the risk for metabolic syndrome increased 4% (P < .05) for each hour of SBST. Similarly, for each hour of SBST, the risk of abdominal obesity increased by 4% (P < .01). In women, we observed that the risk of hypertension or high-density lipoprotein cholesterol deficiency increased for each hour of SBST, and the risk of abdominal obesity increased for each hour of SBST in those who were inactive. CONCLUSION: Sedentary behavior based on screen time is associated with metabolic syndrome and its components among Mexicans, depending on hours of sleep. Current public health policies should consider strategies for reducing SBST.

Similarities and Differences in Substance Use Patterns Among Lesbian, Gay, Bisexual, and Heterosexual Mexican Adult Smokers.

Purpose: This study aimed to characterize the patterns of smoking, e-cigarette use, other substance use (alcohol and marijuana), and depression by sexual orientation in a sample of Mexican adult smokers. Methods: Data came from a 2018-2020 (six waves) online survey of adult smokers, recruited from a commercial research panel (92.5% heterosexual, n = 4786; 3.1% lesbian/gay, n = 160; and 4.4% bisexual, n = 229). After stratifying the data by sex, logistic, multinomial, and linear logistic regression models were estimated (depending on the outcome), including as independent variables sexual orientation (i.e., gay/lesbian, bisexual, heterosexual = Reference), age, education, household income, and wave. Results: Being a gay male was independently associated with greater smoking dependence (ß = 0.20; 95% confidence interval [CI]: 0.02 to 0.39), greater likelihood of preference for flavored capsule cigarettes (adjusted odds ratio [AOR] = 2.10, 95% CI: 1.33 to 3.28), and depression diagnosis (AOR = 2.85, 95% CI: 1.64 to 4.95). Bisexual males had higher e-cigarette dependence (ß = 0.37; 95% CI: 0.05 to 0.68, among dual users only) and were more likely to have been diagnosed with depression (AOR = 2.34, 95% CI: 1.30 to 4.18). Lesbian females were more likely to prefer menthol cigarettes (AOR = 3.32, 95% CI: 1.60 to 6.86), to have used marijuana more than once (AOR = 3.23, 95% CI: 1.83 to 5.72), and to have depressive symptoms (AOR = 1.85, 95% CI: 1.04 to 3.29). Bisexual females had a greater likelihood of depressive symptoms (AOR = 1.71, 95% CI: 1.14 to 2.56) and depression diagnosis (AOR = 2.22, 95% CI: 1.43 to 3.42). Conclusion: Lesbian, gay, and bisexual adult smokers in Mexico appear more likely than heterosexual adult smokers to report having depression. Substance use and depression among sexual minority populations need to be addressed further.

Smoking Behaviors, Mental Health, and Risk Perceptions during the Beginning of the COVID-19 Pandemic among Mexican Adult Smokers.

Mexico is one of the countries most affected by COVID-19. Studies have found that smoking behaviors have been impacted by the pandemic as well; however, results have varied across studies, and it remains unclear what is causing the changes. This study of an open cohort of smokers recruited from a consumer panel (n = 2753) examined changes in cigarettes per day (CPD), daily vs. non-daily smoking, recent quit attempts, perceived stress, depression, and perceived severity of COVID-19 at two points during the pandemic: March and July 2020. Differences in CPD between waves were estimated with Poisson regression using generalized estimating equations (GEE). Differences in perceived stress were estimated with linear regression using GEE, and differences in recent quit attempts, depression, and perceived severity of COVID-19 were estimated using separate logistic regression GEE models. Rates of depression were higher in July compared to March (AOR = 1.55, 95% C.I. 1.31-1.85), and the likelihood of recent quit attempt was lower in July compared to March (AOR = 0.85, 95% C.I. 0.75-0.98). There was no statistically significant change in CPD, daily smoking, or perceived stress. Perceived COVID-19 severity for oneself increased significantly (AOR: 1.24, 95% C.I. 1.02-1.52); however, the perceived COVID-19 severity for smokers remained constant. Our study suggests that as the COVID-19 pandemic expanded in Mexico, smoking frequency remained stable, and quit attempts decreased, even as adult smokers increasingly perceived infection with COVID-19 for themselves as severe. These results can aid in the development of health communication strategies to educate smokers about their risk for COVID-19, potentially capitalizing on concerns that stem from this syndemic of communicable and smoking-related non-communicable disease.

Profile and patterns of dual use of e-cigarettes and combustible cigarettes among Mexican adults / Perfil y patrones de uso dual de cigarrillos electrónicos y cigarrillos combustibles en adultos mexicanos

Abstract: Objective: To describe the profile and patterns of dual uses (n=954) and exclusive cigarette users (n=2 070) and determine the correlates of more frequent e-cigarette use among dual users and their reasons for e-cigarette use. Materials and methods: An online survey of Mexican adult smokers. Logistic models regressed dual-use (exclusive smoking vs. dual user) on sociodemographic, smoking variables and substance use behaviors. We conducted censorial binomial models to estimate the correlates of frequency of e-cigarette use among dual users. Results: Dual users were younger had higher education (AOR=2.22) and higher levels of smoking dependence (AOR=1.31), preferred cigarettes with flavor capsules (AOR=1.58) and had recently attempted to quit smoking (AOR=1.38). Marijuana use and being daily smokers were correlates of higher frequency of use among dual users. Conclusion: Dual users had a higher risk profile than exclusive smokers, which was even more prominent in dual-users who used e-cigarettes frequently.

Resumen: Objetivo: Describir el perfil de los usuarios duales y fumadores exclusivos, así como los factores asociados con la frecuencia de uso de cigarro electrónico. Material y métodos: Se realizaron modelos logísticos de una encuesta en línea de fumadores adultos para estimar asociaciones de usuarios duales (fumador exclusivo vs. usuario dual) sobre variables sociodemográficas, tabaquismo y otras sustancias. Adicionalmente, mediante modelos binomiales censurados se evaluaron los factores asociados con la frecuencia de consumo de cigarro electrónico. Resultados: Los usuarios duales fueron más jóvenes, con mayor educación (AOR=2.22), tenían mayores niveles de dependencia de tabaquismo (AOR=1.31), preferirían usar cigarros con cápsulas de sabor (AOR=1.58) y tuvieron una mayor proporción de intentos de dejar de fumar (AOR=1.38). El consumo de marihuana y fumar diario se asoció con una mayor frecuencia de consumo de cigarro electrónico. Conclusión: El uso dual se asoció con un perfil de riesgo más alto; este perfil es más prominente en usuarios duales que usan cigarros electrónicos con mayor frecuencia.

Profile and patterns of dual use of e-cigarettes and combustible cigarettes among Mexican adults.

OBJECTIVE: To describe the profile and patterns of dual uses (n=954) and exclusive cigarette users (n=2 070) and determine the correlates of more frequent e-cigarette use among dual users and their reasons for e-cigarette use. MATERIALS AND METHODS: An online survey of Mexican adult smokers. Logistic models regressed dual-use (exclusive smoking vs. dual user) on sociodemographic, smoking varia-bles and substance use behaviors. We conducted censorial binomial models to estimate the correlates of frequency of e-cigarette use among dual users. RESULTS: Dual users were younger had higher education (AOR=2.22) and higher levels of smoking dependence (AOR=1.31), preferred cigarettes with flavor capsules (AOR=1.58) and had recently attempted to quit smoking (AOR=1.38). Marijuana use and being daily smokers were correlates of higher frequency of use among dual users. CONCLUSION: Dual users had a higher risk profile than exclusive smokers, which was even more prominent in dual-users who used e-cigarettes frequently.

Levels of Adherence of an Exercise Referral Scheme in Primary Health Care: Effects on Clinical and Anthropometric Variables and Depressive Symptoms of Hypertensive Patients.

Among the modifiable health behaviors, physical activity (PA) promotion has been one of the challenges in primary care, particularly how to translate the results of proven interventions and implement them in the real world. This study was aimed to compare whether two programs designed for hypertensive patients achieve changes in clinical and anthropometric variables, quality of life, and depressive symptoms; and if higher levels of adherence to one of the interventions using an exercise referral (ER) approach achieved better health outcomes. Pragmatic cluster randomized trials were carried out in four Primary Health Care Units (PHCUs). Physicians in the PHCUs identified hypertensive patients and assessed whether they were eligible to be part of this trial. Each center was randomized to a brief PA counseling (BC, n = 2) or an exercise referral (ER, n = 2) intervention to conducted PA programs among hypertensive patients aged 35-70 years, self-reported as physically inactive. Outcome variables included changes in blood pressure levels, triglycerides, HDL cholesterol, fasting glucose, body mass index, waist/hip ratio, abdominal obesity, and metabolic syndrome risk score, health-related quality of life, and depressive symptoms. Longitudinal multilevel analyses assessed the effects of the BC and ER programs and the level of adherence of the ER on clinical, anthropometric, and mental health variables, models were linear for continuous variables, and logistic for dichotomous variables. Differences were observed in triglycerides, BMI, metabolic risk scores variables, and depressive symptoms among ER and BC programs. In addition, differences in the ER group were observed according to the level of adherence in blood pressure levels, waist circumference and waist/hip ratio, depressive symptoms, and the mental health component of health-related quality of life. An ER program in comparison to a BC intervention is promoting changes in some specific health indicators of hypertensive patients, showing the usefulness of these PA programs in primary health care facilities.