Framework Convention on Tobacco Control 2030-A Program to Accelerate the Implementation of World Health Organization Framework Convention for Tobacco Control in Low- and Middle-Income Countries: A Mixed-Methods Evaluation.

BACKGROUND: Framework Convention on Tobacco Control (FCTC) 2030 Program (2017-2021) was launched to accelerate World Health Organization (WHO) FCTC implementation in 15 low- and middle-income countries (LMICs). We evaluated the Program in six domains: Governance; Smoke-Free Policies; Taxation; Packaging and Health Warnings; Tobacco Advertising, Promotion, and Sponsorship (TAPS) bans; and International and Regional Cooperation. AIMS AND METHODS: Following a mixed-methods design, we surveyed (June-September 2020) FCTC focal persons in 14 of the 15 countries, to understand the Program's financial and technical inputs and progress made in each of the six domains. The data were coded in terms of inputs (financial = 1, technical = 1, or both = 2) and progress (none = 1, some = 2, partial = 3, or strong = 4) and a correlation was computed between the inputs and progress scores for each domain. We conducted semi-structured interviews with key stakeholders in five countries. We triangulated between the survey and interview findings. RESULTS: FCTC 2030 offered substantial financial and technical inputs, responsive to country needs, across all six domains. There was a high positive correlation between technical inputs and progress in five of the six domains, ranging from r = 0.61 for taxation (p < .05) to r = 0.91 and for smoke-free policies (p < .001). The interviews indicated that the Program provided timely and relevant evidence and created opportunities for influencing tobacco control debates. CONCLUSIONS: The FCTC 2030 Program might have led to variable, but significant progress in advancing FCTC implementation in the 15 countries. As expected, much of the progress was in augmenting existing structures and resources for FCTC implementation. The resulting advances are likely to lead to further progress in FCTC policy implementation. IMPLICATIONS: What this study adds: In many LMICs, WHO FCTC policies are not in place; and even when enshrined in law, they are poorly enforced. It is not clear how financial and technical assistance to high tobacco-burden LMICs can most effectively accelerate the implementation of WHO FCTC policies and offer value for money. Bespoke and responsive assistance, both financial and technical, to LMICs aimed at accelerating the implementation of WHO FCTC policies are likely to lead to progress in tobacco control.

Consumo de cigarrillos electrónicos en Argentina Resultados de dos encuestas nacionales / Electronic cigarette use in Argentina: Results from two national surveys

INTRODUCCIÓN: Los cigarrillos electrónicos (CE) aparecieron en 2004 y actualmente se consumen en la mayoría de los países. En Argentina, la Administración Nacional de Medicamentos, Alimentos y Tecnología Médica (ANMAT) prohibió su venta en 2011. El objetivo principal de este reporte fue informar las prevalencias de consumo actual de cigarrillos tradicionales y de CE en adultos y adolescentes de Argentina. MÉTODOS: Los datos sobre adultos se obtuvieron de la Encuesta Nacional de Factores de Riesgo de 2018 con representatividad nacional. Los datos de jóvenes provinieron de la Encuesta Mundial de Tabaco en Jóvenes de 2018, que incluyó a 1845 alumnos de escuelas públicas y privadas a nivel nacional. RESULTADOS: En adultos, la prevalencia de consumo actual de cigarrillos tradicionales fue del 22,2% y la de CE fue del 1,1%. Entre los jóvenes de 13 a 15 años, el 18,0% refirió haber consumido cigarrillos tradicionales y el 7,1%, CE en los 30 días previos a la encuesta. El 14,4% había consumido CE alguna vez en su vida. El 75% conocía los CE, y el 42% creía que eran menos dañinos que los cigarrillos tradicionales. El uso de CE se evidenció también en jóvenes que nunca habían probado un cigarrillo común. DISCUSIÓN: Dos encuestas nacionales en adultos y en jóvenes escolarizados muestran que el consumo de cigarrillos tradicionales es elevado y que, a pesar de la prohibición, el CE es consumido por jóvenes y adultos. Es necesario reforzar la fiscalización de la ley vigente y la prohibición completa de todo tipo de publicidad, promoción, patrocinio y exhibición de productos de tabaco, incluidos los CE

Factores predictores del consumo de sustancias en adolescentes argentinos: Estudio longitudinal / Predictive Factors of Substance Use among Adolescents in Argentina: A Longitudinal Study

El consumo de tabaco, alcohol y otras drogas comienza generalmente en la adolescencia. En Argentina, sucede a edades cada vez más tempranas. El objetivo de este estudio fue explorar factores sociales y personales predictores del inicio del consumo en adolescentes del país. MÉTODOS: En 2014 se realizó una encuesta anónima autoadministrada en estudiantes de primer año del secundario en 33 escuelas públicas y privadas de Buenos Aires, Córdoba y Tucumán, que se repitió en los mismos alumnos en 2015. Incluyó aspectos sociodemográficos, personales, consumo de tabaco en familiares y amigos, y consumo personal de tabaco, alcohol, marihuana y paco o cocaína. Mediante regresión logística multinivel con intercepto aleatorio según escuela, se determinó la asociación entre las variables independientes y el inicio del consumo de cada sustancia durante el seguimiento. RESULTADOS: En 2014 respondieron 3172 alumnos, de los cuales 2018 (64%) completaron la segunda encuesta. En 2015 hubo 16,4% de incidencia de consumo de tabaco, 49,8% de consumo de alcohol y 10,8% de drogas ilícitas. Ser mujer y tener un índice de búsqueda de sensaciones alto fueron predictores del consumo de tabaco y alcohol, y haber fumado, bebido, tener amigos que consumen y mayor edad fueron predictores del consumo de drogas ilícitas. CONCLUSIONES: Es importante identificar a los alumnos con un índice de búsqueda de sensaciones alto, que es el factor de riesgo común al inicio del consumo de todas las sustancias

Exposure to Alcohol Use in Movies and Problematic Use of Alcohol: A Longitudinal Study Among Latin American Adolescents.

OBJECTIVE: This study assesses the association between exposure to alcohol in movies and alcohol use transitions among Latin American adolescents. METHOD: A school-based longitudinal study involving 33 secondary schools in Argentina and 57 in Mexico was performed. The baseline sample included 1,504 never drinker adolescents in Argentina and 5,264 in Mexico (mean age = 12.5 years), of whom 1,055 and 3,540, respectively, completed a follow-up survey a year and a half later. Exposure to the 500 popular contemporary films was assessed by querying adolescents on 50 randomly selected titles. Films were content-coded for alcohol and exposure estimated from films seen. Logistic regression models estimated adjusted relative risk (aRR) for the following outcomes, net covariates, at follow-up: use of alcohol (having ever drank), current drinking (drinking in the past 30 days), ever binge drinking (≥ 4 drinks [females] or 5 for males). RESULTS: At follow-up, respective adolescent drinking rates for Mexico and Argentina were 31% and 36% for use of alcohol, 18% and 27% for current drinking, and 8% and 19% for ever binge drinking. Greater exposure to alcohol in movies was independently associated with trying alcohol (aRR = 1.30, 95% CI [1.17, 1.43]), current drinking (aRR = 1.22, 95% CI [1.03, 1.44]), and binge drinking (aRR = 1.71, 95% CI [1.30, 2.25]) in Mexican adolescents, whereas in Argentina, movie alcohol exposure was associated only with trying alcohol (aRR = 1.25, 95% CI [1.02, 1.53]). CONCLUSIONS: Exposure to alcohol in movies predicted underage drinking transitions in these Latin American adolescents, replicating prior results for U.S. and European cohorts.

"Technophilia": A new risk factor for electronic cigarette use among early adolescents?

PURPOSE: Develop and validate a scale that measures Technophilia (positive orientation toward new technology) and use it to address orientation toward new technologies to explain e-cigarette trial and adoption, especially in relatively low risk adolescents. METHODS: Survey data were obtained from students of the three largest cities in Mexico (n = 8123). We developed eight questions involving access, use and pleasure from different electronic media to measure technophilia. Exploratory factor analysis (EFA) was conducted. Linear GEE models were used when regressing technophilia on covariates. When regressing e-cigarette and conventional cigarette trial and use, logistic GEE models were used. Finally, we used multinomial logistic regression to evaluate the associations between technophilia and e-cigarettes as the first tobacco product. RESULTS: Technophilia were correlated with theoretically-related variables. Unadjusted and adjusted models regressing e-cigarette trial and use indicated that students in the highest quartile for technophilia were more likely to have tried e-cigarettes compared with the lowest quartile (AORQ4 vs Q1 = 1.36, 95% CI 1.14-1.62). Technophilia was not independently associated with current e-cigarette use in adjusted models. Students with higher technophilia were more likely to have first tried e-cigarettes in both crude and adjusted models (AORQ4vQ1 = 1.66, 95% CI 1.20-2.31; AORQ3vQ1 = 1.43, 95% CI 1.02-2.01). Technophilia did not have a statistically significant, independent association with first use of other tobacco products. CONCLUSION: This study suggests that technophilia is associated with trial of e-cigarettes among youth. The measure we developed appears useful for understanding why some youth are open to trying novel, technologically oriented ways to consume nicotine.

Movies promote tobacco use amongst adolescents: The need for policies to prevent this phenomenon.

Tobacco use is the primary preventable cause of death and disability in the world. To combat the tobacco epidemic, most countries have signed and ratified the World Health Organzation's Framework Convention on Tobacco Control (WHO FCTC). Article 13 of this treaty requires implementation of a comprehensive ban on tobacco advertising, promotion and sponsorship. Implementation guidelines for Article 13 recognize that the depiction of tobacco use in commercially-produced films promotes tobacco use amongst young people. In this article we review the relationship between the tobacco industry and the movie industry over the past 100 years; the cross sectional and longitudinal studies that demonstrate a causal relationship between exposure to movie smoking depictions and youth smoking initiation; and the policy interventions recommended by the WHO to limit youth exposure to tobacco in movies.

El consumo de Tabaco es la primera causa de mortalidad prevenible en el mundo. Para combatir esta epidemia, los países miembros de la Organización Mundial de la Salud han firmado, y la mayoría de ellos ratificado, el Convenio Marco para el Control del Tabaco. El articulo 13 de este tratado toda forma de publicidad, promoción y patrocinio del tabaco. Las guías para la implementación de este artículo reconocen que la presencia de tabaco en el cine es una forma de promoción de los productos del tabaco dirigida principalmente a los jóvenes.En esta revisión describimos la relación entre la industria del cine y la del tabaco en los últimos 100 año, los estudios de corte transveral y longitudinales que demiuestran como la exposición a tabaco en el cine induce a los jóvenes a iniciarse en el tabaquismo, y las políticas públicas recomendadas para evitar la presencia de tabaco en el cine, al menos en las películas para niños y adolescentes.

Smoking susceptibility as a predictive measure of cigarette and e-cigarette use among early adolescents.

OBJECTIVE: To assess the validity of a standard measure of smoking susceptibility for predicting cigarette and e-cigarette use in a sample of early adolescents in Argentina and Mexico. MATERIALS AND METHODS: A school-based longitudinal survey was conducted in 2014-16 among secondary students. We analyzed students who were never smokers of regular cigarettes or e-cigarettes at baseline and who completed both surveys. The main independent variable was smoking susceptibility. Multilevel logistic regression models were used, adjusting for sociodemographic and personal variables, social network use of cigarettes and exposure to advertising. RESULTS: In the adjusted analysis, smoking susceptibility independently predicted cigarette initiation (Argentina: AOR 2.28; 95%CI 1.66-3.14; Mexico: AOR 2.07; 95%CI 1.74-2.45) and current smoking (Argentina: AOR 3.61; 95%CI 2.48-5.24; Mexico: AOR 1.69; 95%CI 1.29-2.22); however, it only predicted e-cigarette initiation in Mexico (Mexico: AOR 1.29; 95%CI 1.02-1.63). CONCLUSIONS: Smoking susceptibility was a valid measure to predict future cigarette smoking in this sample.

Smoking susceptibility as a predictive measure of cigarette and e-cigarette use among early adolescents / Susceptibilidad a fumar como medida predictiva del consumo de cigarros y cigarros electrónicos en adolescentes

Abstract Objective To assess the validity of a standard measure of smoking susceptibility for predicting cigarette and e-cigarette use in a sample of early adolescents in Argentina and Mexico. Materials and methods A school-based longitudinal survey was conducted in 2014-16 among secondary students. We analyzed students who were never smokers of regular cigarettes or e-cigarettes at baseline and who completed both surveys. The main independent variable was smoking susceptibility. Multilevel logistic regression models were used, adjusting for sociodemographic and personal variables, social network use of cigarettes and exposure to advertising. Results In the adjusted analysis, smoking susceptibility independently predicted cigarette initiation (Argentina: AOR 2.28; 95%CI 1.66-3.14; Mexico: AOR 2.07; 95%CI 1.74-2.45) and current smoking (Argentina: AOR 3.61; 95%CI 2.48-5.24; Mexico: AOR 1.69; 95%CI 1.29-2.22); however, it only predicted e-cigarette initiation in Mexico (Mexico: AOR 1.29; 95%CI 1.02-1.63). Conclusion Smoking susceptibility was a valid measure to predict future cigarette smoking in this sample.

Resumen Objetivo Evaluar la validez de una medida estándar de susceptibilidad para predecir el consumo de cigarros convencionales y electrónicos en una muestra de adolescentes de Argentina y México. Material y métodos Entre 2014 y 2016 se realizó una encuesta longitudinal en alumnos de secundarias. Se analizaron los alumnos no fumadores y que no habían probado cigarrillos electrónicos en la encuesta basal y que completaron ambas encuestas. La variable independiente principal era la susceptibilidad al consumo de cigarros. Se efectuó una regresión logística multinivel, ajustando por variables sociodemográficas y personales, consumo en el círculo social íntimo y exposición a la publicidad. Resultados En el análisis ajustado, la susceptibilidad al consumo predijo de manera independiente el inicio del consumo de cigarros convencionales (Argentina: RMA2.28; IC95%1.66-3.14; México: RMA2.07; IC95%1.74-2.45) y su consumo actual (Argentina: RMA3.61; IC95%2.48-5.24; México: RMA1.69; IC95%1.29-2.22). Sin embargo, sólo predijo el inicio del consumo de cigarros electrónicos en México (México: ORA 1.29; IC95%1.02-1.63). Conclusión Esta medida es válida para predecir el futuro consumo de cigarros en esta muestra.

El cine induce a los adolescentes a consumir tabaco. es necesario implementar políticas públicas para contrarrestar este fenómeno / Cinema induces adolescents to consume tobacco. it is necessary to implement public policies to counteract this phenomenon

El consumo de tabaco es la primera causa de mortalidad prevenible en el mundo. Para combatir esta epidemia, los países miembros de la Organización Mundial de la Salud han firmado, y la mayoría de ellos ratificado, el Convenio Marco para el Control del Tabaco. El artículo 13 de este tratado regula toda forma de publicidad, promoción y patrocinio del tabaco. Las guías para la implementación de este artículo reconocen que la presencia de tabaco en el cine es una forma de promoción de los productos del tabaco dirigida principalmente a los jóvenes. En esta revisión describimos la relación entre la industria del cine y la del tabaco en los últimos 100 años, los estudios de corte transversal y longitudinales que demuestran cómo la exposición a tabaco en el cine induce a los jóvenes a iniciarse en el tabaquismo, y las políticas públicas recomendadas para evitar la presencia de tabaco en el cine, al menos en las películas para niños y adolescentes.

Tobacco use is the primary preventable cause of death and disability in the world. To combat the tobacco epidemic, most countries have signed and ratified the World Health Organzation’s Framework Convention on Tobacco Control (WHO FCTC). Article 13 of this treaty requires implementation of a comprehensive ban on tobacco advertising, promotion and sponsorship. Implementation guidelines for Article 13 recognize that the depiction of tobacco use in commercially-produced films promotes tobacco use amongst young people. In this article we review the relationship between the tobacco industry and the movie industry over the past 100 years; the cross sectional and longitudinal studies that demonstrate a causal relationship between exposure to movie smoking depictions and youth smoking initiation; and the policy interventions recommended by the WHO to limit youth exposure to tobacco in movies.

A longitudinal study of electronic cigarette use and onset of conventional cigarette smoking and marijuana use among Mexican adolescents.

PURPOSE: This study evaluated whether e-cigarette trial among Mexican adolescents increased the likelihood of trial and use of conventional cigarettes or marijuana use at follow-up. METHOD: A school-based longitudinal survey was conducted in 60 public middle schools from the three largest cities in Mexico. Students (12-13years old) were surveyed in 2015 and followed up 20 months later (n=6574). Generalized estimating equations models were used to evaluate the association between e-cigarette trial at baseline and conventional cigarettes smoking and marijuana use at follow-up. RESULT: Adolescents who had tried e-cigarettes (but not cigarettes) at baseline were more likely to have tried conventional cigarettes at followup compared to adolescents who had tried neither e-cigarettes nor cigarettes (43% vs. 24%, respectively; RR 1.41, 95% CI 1.18-1.70). We also found that adolescents who had tried both conventional cigarettes and e-cigarettes at baseline were more likely to have tried marijuana at follow-up compared to adolescents who had tried neither tobacco product (20% vs. 4%, respectively; RR 2.67, 95% CI 1.78-4.02). Trial of only e-cigarettes was not independently associated with marijuana use at followup. CONCLUSIONS: Adolescents who had tried e-cigarettes were more likely to have tried conventional cigarettes and marijuana 20 months later. Although e-cigarettes have been banned in Mexico, it is likely that additional policies and public health campaigns are needed to reduce adolescent use of e-cigarettes and its consequences.

[Exposure to point-of-sale tobacco displays in Argentina: evidence from the 2013 National Risk Factor Survey]. / Exposición a la publicidad del tabaco en los puntos de venta en Argentina. Evidencias de la Encuesta Nacional de Factores de Riesgo 2013.

OBJECTIVE:: To describe the population that reports to have visited tobacco points of sale (POS) in Argentina and their perception of tobacco advertising. MATERIALS AND METHODS:: We used data from the 2013 National Risk Factor Survey. RESULTS:: We included 31 167 respondents (96% of the total) who attended a store that sells cigarettes in the previous 30 days. Overall, 54.1% (67.3% of current smokers, 55.1% of former smokers and 49% of non smokers) referred having seen tobacco advertising at the POS. Males (OR=1.2) and current smokers (OR=1.9 vs. non smokers) were more likely to report having seen tobacco advertising at the POS. Those who were exposed to second hand smoke in bars and restaurants (OR=1.2) were also more likely to have seen advertising. We found that younger people (age 18 - 24) were more likely to be exposed (OR=2.8 vs older than 65). Among smokers, those who referred to have seen the advertising were more likely to have tried to quit smoking during the previous year. CONCLUSIONS:: It is important to regulate advertising at the POS to limit exposure, particularly among young people.

Time trends for tobacco and alcohol use in youth-rated films popular in Mexico and Argentina, from 2004-2012.

OBJECTIVE:: To examine and compare overall prevalence and time trends in tobacco and alcohol portrayals and brand appearances in youth-rated US and nationally-produced films that were the most successful in Argentina and Mexico from 2004-2012. MATERIALS AND METHODS:: Top-grossing nationally produced films from Argentina (n=73), Mexico (n=85) and the US (n=643) were content analyzed. Logistic regression was used to determine differences between Mexican, Argentine and US produced films. Linear regression models assessed significant cross-country differences in the mean number of tobacco and alcohol seconds. RESULTS:: Films from Mexico and Argentina were more likely than US films to contain tobacco, (OR=4.2; p<0.001) and (OR=7.2; p<0.001). Alcohol was present in 93% of Argentine, 83% in Mexican and 83% US films. CONCLUSIONS:: Smoking and alcohol were highly prevalent in nationally produced films. They may have a significant impact and should be targeted by policies to reduce youth exposure to portrayals of risk behaviors.

Factores de riesgo asociados al consumo de tabaco, alcohol y otras drogas en adolescentes escolarizados de tres ciudades de Argentina / Risk factors associated with tobacco, alcohol and drug use among adolescents attending secondary school in three cities from Argentina

El consumo de tabaco, alcohol y otras drogas comienza a temprana edad. Es importante identificar los factores de riesgo asociados al inicio. En 2014, se encuestaron estudiantes de primer año del secundario en Buenos Aires, Córdoba y Tucumán. Respondieron 3172 alumnos (42% de mujeres); edad media de 12,8 años. El 10% había fumado; el 32% había consumido alcohol; el 17% había tenido consumo excesivo durante el último mes, y 8% había consumido, al menos, una droga ilícita en su vida. El índice de búsqueda de emociones alto se asoció al consumo de tabaco (OR 4,25; IC 95%: 2,2-8,1), alcohol (OR 5,56; IC 95%: 3,73-8,31) y marihuana / paco / cocaína (OR 11,73; IC 95%: 5,81-23,69). Tener amigos que consumían tabaco / alcohol se asoció al consumo de tabaco (OR 12,6; IC 95%: 7,8-20,5) y alcohol (OR 5,17; IC 95%: 4,15-6,40). Tener padres que imponían pocas restricciones en el uso de medios se asoció al consumo de tabaco (OR 3,7; IC 95%: 2,1-6,5) y percibir un bajo control y soporte parental (OR 3,02; IC 95%: 1,40-6,52) se asoció al consumo de marihuana/paco/cocaína.

Tobacco, alcohol and drug use starts at an early age. It is important to identify risk factors associated with initiation. In 2014, a survey was conducted among students attending first year of secondary schools in Buenos Aires, Córdoba, and Tucumán. A total of 3172 students completed the survey (42% were girls); their mean age was 12.8 years old. Findings showed that 10% had smoked; 32% had consumed alcohol; 17% had a heavy drinking episode in the past month; and 8% had used at least one illegal drug once in their lifetime. A high sensation seeking index was associated with the use of tobacco (odds ratio [OR]: 4.25, 95% confidence interval [CI]: 2.2-8.1), alcohol (OR: 5.56, 95% CI: 3.73-8.31), and marijuana, coca paste or cocaine, (OR: 11.73, 95% CI: 5.81-23.69). Having friends who smoke or drink was associated with tobacco (OR: 12.6, 95% CI: 7.8-20.5) and alcohol use (OR: 5.17, 95% CI: 4.15-6.40). Having permissive parents in terms of media use was associated with tobacco use (OR: 3.7, 95% CI: 2.1-6.5), and perceiving a low parental support and control (OR: 3.02, 95% CI: 1.40-6.52) was associated with marijuana, coca paste and cocaine use

Risk factors associated with tobacco, alcohol and drug use among adolescents attending secondary school in three cities from Argentina. / Factores de riesgo asociados al consumo de tabaco, alcohol y otras drogas en adolescentes escolarizados de tres ciudades de Argentina.

Tobacco, alcohol and drug use starts at an early age. It is important to identify risk factors associated with initiation. In 2014, a survey was conducted among students attending first year of secondary schools in Buenos Aires, Córdoba, and Tucumán. A total of 3172 students completed the survey (42% were girls); their mean age was 12.8 years old. Findings showed that 10% had smoked; 32% had consumed alcohol; 17% had a heavy drinking episode in the past month; and 8% had used at least one illegal drug once in their lifetime. A high sensation seeking index was associated with the use of tobacco (odds ratio [OR]: 4.25, 95% confidence interval [CI]: 2.2-8.1), alcohol (OR: 5.56, 95% CI: 3.73-8.31), and marijuana, coca paste or cocaine, (OR: 11.73, 95% CI: 5.81-23.69). Having friends who smoke or drink was associated with tobacco (OR: 12.6, 95% CI: 7.8-20.5) and alcohol use (OR: 5.17, 95% CI: 4.15-6.40). Having permissive parents in terms of media use was associated with tobacco use (OR: 3.7, 95% CI: 2.1-6.5), and perceiving a low parental support and control (OR: 3.02, 95% CI: 1.40-6.52) was associated with marijuana, coca paste and cocaine use.

El consumo de tabaco, alcohol y otras drogas comienza a temprana edad. Es importante identificar los factores de riesgo asociados al inicio. En 2014, se encuestaron estudiantes de primer año del secundario en Buenos Aires, Córdoba y Tucumán. Respondieron 3172 alumnos (42% de mujeres); edad media de 12,8 años. El 10% había fumado; el 32% había consumido alcohol; el 17% había tenido consumo excesivo durante el último mes, y 8% había consumido, al menos, una droga ilícita en su vida. El índice de búsqueda de emociones alto se asoció al consumo de tabaco (OR 4,25; IC 95%: 2,2-8,1), alcohol (OR 5,56; IC 95%: 3,73-8,31) y marihuana/paco/cocaína (OR 11,73; IC 95%: 5,81-23,69). Tener amigos que consumían tabaco/alcohol se asoció al consumo de tabaco (OR 12,6; IC 95%: 7,8-20,5) y alcohol (OR 5,17; IC 95%: 4,15-6,40). Tener padres que imponían pocas restricciones en el uso de medios se asoció al consumo de tabaco (OR 3,7; IC 95%: 2,1-6,5) y percibir un bajo control y soporte parental (OR 3,02; IC 95%: 1,40-6,52) se asoció al consumo de marihuana/paco/cocaína.

Time trends for tobacco and alcohol use in youth-rated films popular in Mexico and Argentina, from 2004-2012 / Tendencias en el tiempo del uso de tabaco y alcohol en las películas para adolescentes más populares en México y Argentina: 2004 a 2012

Abstract: Objective: To examine and compare overall prevalence and time trends in tobacco and alcohol portrayals and brand appearances in youth-rated US and nationally-produced films that were the most successful in Argentina and Mexico from 2004-2012. Materials and methods: Top-grossing nationally produced films from Argentina (n=73), Mexico (n=85) and the US (n=643) were content analyzed. Logistic regression was used to determine differences between Mexican, Argentine and US produced films. Linear regression models assessed significant cross-country differences in the mean number of tobacco and alcohol seconds. Results: Films from Mexico and Argentina were more likely than US films to contain tobacco, (OR=4.2; p<0.001) and (OR=7.2; p<0.001). Alcohol was present in 93% of Argentine, 83% in Mexican and 83% US films. Conclusions: Smoking and alcohol were highly prevalent in nationally produced films. They may have a significant impact and should be targeted by policies to reduce youth exposure to portrayals of risk behaviors.

Resumen: Objetivo: Este estudio evalúa la representación en el tiempo de contenidos de tabaco y alcohol en las películas para adolescentes más populares en Argentina y México de 2004 a 2012. Material y métodos: Se analizaron las películas localmente más taquilleras producidas en Argentina (n=73), México (n=85) y EE.UU. (n=643). Se realizaron modelos de regresión logística para determinar diferencias entre películas mexicanas, argentinas y norteamericanas en variables dicotómicas, y de regresión lineal para evaluar las diferencias significativas entre países para variables continuas. Resultados: Las películas mexicanas y argentinas muestran mayor contenido de tabaco en comparación con las norteamericanas (OR=4.2; p<0.000) y (OR=7.2; p<0.000, respectivamente). El alcohol estuvo presente en 93% de películas argentinas, y en 83% tanto de las mexicanas como de las norteamericanas. Conclusión: Los resultados observados muestran tendencias que pueden tener un impacto significativo en la exposición de conductas de riesgo en jóvenes, y por ello son relevantes en la política pública.

Smoking in Movies and Adolescent Smoking Initiation: A Longitudinal Study among Argentinian Adolescents.

OBJECTIVE: To assess whether exposure to movie smoking is associated with cigarette smoking among Argentinian adolescents. STUDY DESIGN: A school-based longitudinal study involving 33 secondary schools in Argentina was performed. The sample included 2502 never smokers (average age at entry = 12.5 years), 1700 (67.9%) of whom completed follow-up surveys 17 months later. Exposure to the top 100 highest-grossing films for each year between 2009 and 2013 was assessed by content-coding films for tobacco and then by asking adolescents whether they had seen each of 50 titles, randomly selected from the larger pool, then parsing exposure into tertiles. Logistic regression models estimated aOR for the following transitions: nonsusceptible to susceptible never smoker, never smoker to ever smoker, and never smoker to current smoking (last 30 days). RESULTS: At follow-up, 34.4% of nonsusceptible never smokers became susceptible, 24.1% reported having tried smoking, and 9.4% were current smokers. Most exposure to movie smoking was from US-produced films (average 60.3 minutes compared with only 3.4 minutes from Argentine films). Greater exposure to smoking in movies was significantly associated with increased odds of becoming susceptible (aORfirst vs third tertile 1.77, 95% CI 1.30-2.41), of trying smoking (aORfirst vs third tertile 1.54, 1.14-2.08), and marginally associated with current smoking (AORfirst vs third tertile 1.54, 0.99-2.40). Exposure to smoking in US- or Argentine-produced films had similar associations. CONCLUSION: In Argentina, exposure to smoking in the movies predicted future smoking transitions among early adolescents, with most exposure coming from viewing US movies.

Parental Style and Its Association With Substance Use in Argentinean Youth.

BACKGROUND: In Europe and the United States, family relationships and parenting behavior can influence youth substance use, but less is known about their influence in Latin American countries. OBJECTIVE: To explore whether parenting behavior is associated with substance use among Latin American youth. METHODS: A cross-sectional, school-based survey of middle-school youth (n = 3172) in three Argentinian cities queried tobacco, alcohol, and drug use using items adapted from global youth surveys. Parenting behavior was assessed with previously validated items that tapped into demandingness and responsiveness, separately for mothers and fathers. Multilevel logistic regression models assessed associations between parenting behavior and substance use after adjusting for student characteristics, socioeconomic indicators, sensation seeking, and smoking amongst peers and family members. RESULTS: Substance use prevalence was 10% for current smoking, 32% for current drinking alcohol, 17% for past 30-day binge drinking (≥5 drinks), and 8% for previous year illicit drug use (marijuana or cocaine). Greater maternal demandingness was independently associated with lower likelihood of current smoking (adjusted odds ratio [AOR] = 0.77; 95% confidence interval (CI): 0.64-0.92), current drinking (AOR = 0.81; 95% CI: 0.71-0.92), binge drinking (AOR = 0.77; 95% CI: 0.66-0.99, and drug use (AOR = 0.71; 95% CI: 0.61-0.83). No other parenting behavior were independently associated with substance use, except for paternal demandingness and binge drinking (AOR = 0.84; 95% CI: 0.74-0.97). For all outcomes, no interactions were found between parenting behavior and student gender. CONCLUSIONS: Among Argentine adolescents, maternal demandingness was the strongest and most consistent correlate of substance use, regardless of adolescent substance use behavior or gender.

Association Between Cigarette Smoking Prevalence and Income Level: A Systematic Review and Meta-Analysis.

INTRODUCTION: Previous evidence linked low socioeconomic status with higher smoking prevalence. Our objective was to assess the strength of this association in the world population, updating a previous work. METHODS: Systematic review and meta-analysis of observational studies. Subgroup analyses included continents, WHO regions, country mortality levels, gender, age, risk of bias, and study publication date. Independent reviewers selected studies, assessed potential bias and extracted data. We searched MEDLINE, EMBASE, CENTRAL, SOCINDEX, AFRICAN INDEX MEDICUS, and LILACS, and other sources from 1989 to 2013 reporting direct measurements of income and current cigarette smoking. RESULTS: We retrieved 13,583 articles and included 93 for meta-analysis. Median smoking prevalence was 17.8% (range 3-70%). Lower income was consistently associated with higher smoking prevalence (odds ratio [OR]: 1.45; 95% confidence interval [CI]: 1.35-1.56). This association was statistically significant in the subgroup analysis by WHO regions for the Americas (OR: 1.54; 95% CI: 1.42-1.68), South East Asia (OR: 1.53; 95% CI: 1.10-2.00), Europe (OR: 1.45; 95% CI: 1.29-1.63), and Western Pacific (OR: 1.32; 95% CI: 1.02-1.72), and in studies conducted during 1990s (OR: 1.42; 95% CI: 1.24-1.62) and 2000s (OR: 1.48; 95%CI: 1.30-1.64). Likewise, it was noted in low-mortality countries (OR: 1.48; 95% CI: 1.37-1.60) and for both genders. Prevalence was highest in the lowest income levels compared to the middle (OR: 1.69; 95% CI: 1.49-1.92), followed by the middle level compared to the highest (OR: 1.31; 95% CI: 1.20-1.43). CONCLUSIONS: Our results show that current cigarette smoking was significantly associated with lower income worldwide and across subgroups, suggesting a dose-response relationship. IMPLICATIONS: This unique updated systematic review shows a consistent inverse dose-response relationship between cigarette smoking and income level, present among most geographical areas and country characteristics. Public health measures should take into account this potential inequity and consider special efforts directed to disadvantaged populations.

Exposición a la publicidad del tabaco en los puntos de venta en Argentina. Evidencias de la Encuesta Nacional de Factores de Riesgo 2013 / Exposure to point-of-sale tobacco displays in Argentina: evidence from the 2013 National Risk Factor Survey

Resumen: Objetivo: Describir las características de la población que refiere haber acudido a los puntos de venta (PV) de tabaco en relación con la percepción de la publicidad en Argentina. Material y métodos: Se analizaron datos de la Encuesta Nacional de Factores de Riesgo de 2013. Resultados: Se incluyeron 31 167 encuestados que acudieron a comercios donde venden cigarrillos en los últimos 30 días. De éstos, 54.1% dijo haber visto publicidad de cigarrillos. Los varones (RM=1.2) y los fumadores actuales (RM=1.9 vs. no fumador) tuvieron más posibilidad de percibirla. Aquéllos que refirieron estar expuestos al humo de tabaco en bares y restaurantes (RM= 1.2) tuvieron más posibilidad de ver publicidad de tabaco en los puntos de venta. Hubo un gradiente en relación con la edad: los jóvenes de 18 a 24 fueron más susceptibles a referir exposición (RM=2.8 vs >65 años). Entre los fumadores, aquéllos que percibieron publicidad refirieron con mayor frecuencia haber intentado dejar de fumar en el último año. Conclusiones: Es importante que la regulación de la publicidad en los PV sea más estricta para limitar la exposición a la publicidad, particularmente en los jóvenes.

Abstract: Objective: To describe the population that reports to have visited tobacco points of sale (POS) in Argentina and their perception of tobacco advertising. Materials and methods: We used data from the 2013 National Risk Factor Survey. Results: We included 31 167 respondents (96% of the total) who attended a store that sells cigarettes in the previous 30 days. Overall, 54.1% (67.3% of current smokers, 55.1% of former smokers and 49% of non smokers) referred having seen tobacco advertising at the POS. Males (OR=1.2) and current smokers (OR=1.9 vs. non smokers) were more likely to report having seen tobacco advertising at the POS. Those who were exposed to second hand smoke in bars and restaurants (OR=1.2) were also more likely to have seen advertising. We found that younger people (age 18 - 24) were more likely to be exposed (OR=2.8 vs older than 65). Among smokers, those who referred to have seen the advertising were more likely to have tried to quit smoking during the previous year. Conclusions: It is important to regulate advertising at the POS to limit exposure, particularly among young people.

Brief Counseling on Secondhand Smoke Exposure in Pregnant Women in Argentina and Uruguay.

Argentina and Uruguay have a high prevalence of smoking during pregnancy, as well as of secondhand smoke (SHS) exposure. In this secondary analysis of a trial to implement brief smoking cessation counseling during antenatal care in Argentina and Uruguay, we aim to evaluate the effects of the intervention on the rates of self-reported SHS exposure at home and at work, and on attitudes recalled by non-smoker women enrolled in the intervention group compared with the control group. We randomly assigned (1:1) 20 antenatal care clusters in Argentina and Uruguay to receive a multifaceted intervention to implement brief smoking cessation counseling, which also included questions and counseling regarding SHS exposure, or to receive the standard of care. There was not a statistically significant difference between groups of the intervention's effect (reduction of exposure to SHS) on any of the three exposure outcome measures (exposure at home, work or other indoor areas) or on the attitudes of women regarding exposure (avoiding breathing SHS and having rooms where smoking is forbidden). This analysis shows that we should not expect reductions in SHS exposure with this modest intervention alone. To achieve such reductions, strategies engaging partners and other household members may be more effective.