Abstract
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.
Introduction The effectiveness of clinical–community linkages for promotion of physical activity (PA) has not been explored in low- and middle-income countries. This study assessed the effectiveness ...of a primary care–based, 16-week intervention rooted in behavioral theory approaches to increase compliance with aerobic PA recommendations. Study design Pragmatic cluster randomized trial. Setting/participants Patients had diagnosed (<5 years) hypertension, were aged 35–70 years, self-reported as physically inactive, had a stated intention to engage in PA, and attended Primary Healthcare Centers in the Social Security health system in Cuernavaca, Mexico. Of 23 Primary Healthcare Centers, four were selected based on proximity (5 km radius) to a center. Intervention Each center was randomized to a brief PA counseling (BC, n =2) or an exercise referral (ER, n =2) intervention. The study was conducted between 2011 and 2012. Main outcome measures Change in objectively measured PA levels (ActiGraph GT3X accelerometers) at baseline, 16, and 24 weeks. Intention-to-treat analyses were used to assess the effectiveness of the intervention overall and according to ER intervention attendance. Longitudinal multilevel mixed-effects analyses considering the interaction (time by intervention) were conducted. Each model was also adjusted by baseline value of the outcome measure, demographic and health variables, social support, PA self-efficacy, and barriers. Results Minutes/week of objectively measured moderate to vigorous PA increased by 40 and 53 minutes in the ER and BC groups, respectively ( p =0.59). Participants attending >50% of ER program sessions increased their moderate to vigorous PA by 104 minutes/week and compliance with aerobic PA recommendations by 23.8%, versus the BC group (both p <0.05). Conclusions Both BC and ER led to modest improvements in PA levels, with no significant differences between groups. Adequate adherence with the ER program sessions led to significant improvements in compliance with aerobic PA recommendations versus BC. These results can help guide development and implementation of programs integrating standardized PA assessment, counseling, and referrals via clinical–community linkages in Mexico and other low- and middle-income countries in the region.
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 (noviembre 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. Conclusiones. 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.
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,
= 2) or an exercise referral (ER,
= 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.
We still lack information about how changes in modifiable health risk behaviors influence the utilization of healthcare services. This study assesses the relationships between prospective patterns of ...modifiable health risk behaviors and the utilization of healthcare services.
This was a prospective study among men and women participants in the Health Workers Cohort Study, aged 18 years and older. The following data about modifiable health risk behaviors was collected in two waves of the study (2004-2006 and 2010-2012): 1) physical activity, b) consumption of fruit and vegetables, 3) alcohol, and 4) tobacco consumption, to determine the association between the utilization of healthcare services after 6 years of follow-up (period 2010-2012). Information was collected through self-administered questionnaires; clinical and anthropometric variables were measured following standard procedures. Analyses were conducted using zero-inflated negative binomial regression models.
Participants with a pattern of consumption of < 3 portions of fruits and vegetables per day (p = 0.035) and did not meet recommended levels of PA (p = 0.013) during the two waves of the study had fewer preventative consultations; those who quit smoking reported a higher frequency of preventative consultations (p = 0.021) and more visits with a medical specialist (p = 0.048). Participants who reduced alcohol consumption to low or completely stopped its consumption reported fewer visits to the general physician (p = 0.031), p < 0.05.
Changes in prospective patterns of modifiable health risk behaviors influenced the use of healthcare services after 6 years of follow-up. Findings in this study could be useful to determine possible demands of healthcare services among populations with specific modifiable health risk behaviors.
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.
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.
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.
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.
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.
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.
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.
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.
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.
With increased globalization, Latin America is experiencing transitions from traditional lifestyle and dietary practices to those found in higher income countries. Healthy diets, physical activity ...and optimal body fat can prevent approximately 15% of cancers in low-income and 20% in high-income countries. We discuss links between diet, obesity, physical activity and cancer, emphasizing strategies targeting children to decrease risk of obesity, control obesity-related risk factors, and reduce sedentary lifestyles, as this will have high impact on adult cancer risk. We focus on individual behaviors, economic, cultural and societal changes that may guide future interventions in the Americas.
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.
To examine different health outcomes that are associated with specific lifestyle and genetic factors.
From March 2004 to April 2006, a sample of employees from three different health and academic ...institutions, as well as their family members, were enrolled in the study after providing informed consent. At baseline and follow-up (2010-2013), participants completed a self-administered questionnaire, a physical examination, and provided blood samples.
A total of 10 729 participants aged 6 to 94 years were recruited at baseline. Of these, 70% were females, and 50% were from the Mexican Social Security Institute. Nearly 42% of the adults in the sample were overweight, while 20% were obese.
Our study can offer new insights into disease mechanisms and prevention through the analysis of risk factor information in a large sample of Mexicans.
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