Aims
To measure the effects of changing attributes of pictorial health warning labels (HWLs) on cigarette packs in a country that has already implemented pictorial HWLs.
Measures
For each choice set, ...participants were presented with two cigarette packs and asked the following three questions: (1) ‘If only these two cigarette packs were available, which would you buy?’; (2) ‘Each of these two packs has warnings on the front and back about the health effects of smoking. Which of these warnings best informs you about the dangers from smoking?’; and (3) ‘Which warning most makes you think about quitting smoking?’. As recommended for best practices in discrete choice experiments, each of these questions was followed by an ‘opt‐out’ question for participants to indicate whether they really believed there was a difference between the options presented (i.e. ‘Would you really choose one of them?’; ‘Do you really think that either of these warnings informs you about dangers from smoking?’; or ‘Do you really think that either of these warnings would make you think about quitting smoking?’, respectively). Each choice set could be viewed for as long as the participant wished. For each choice question (i.e. willingness to buy, informative, motivating to quit), the pack chosen was coded as 1 and the other pack as 0, with both packs being given a value of 0 if the participant ‘opted out’.
Design
A within‐subject discrete choice experiment that involved systematic manipulation of pictorial HWL size 75 versus 30% (current policy); inclusion of imagery on the back of the pack versus none (current policy); and color formatting black on yellow versus yellow on black (current policy).
Setting
Mexico, on‐line panel.
Participants
Adult smokers (n = 705).
Measurements
For each choice set, participants selected one pack as having the most informative HWL about smoking harms, the one that makes them think the most about quitting and the one they were most willing to buy. We assessed the independent and interactive effects of HWL attributes on choices.
Findings
Larger HWL size on the pack front (75 versus 30%) and inclusion of a pictorial image on the pack back were both independently associated with lower willingness to buy a pack b = −0.228, standard error (SE) = 0.023 and −0.089, SE = 0.016, respectively and greater perception of an HWL as informative (b = 0.214, SE = 0.022, and 0.191, SE = 0.017, respectively) and motivating to quit (b = 0.251, SE = 0.023 and 0.194, SE = 0.017, respectively). HWL with black text and yellow background were perceived as less informative (b = −0.037, SE = 0.016) and less motivating to quit (b = −0.032, SE = 0.015) compared with yellow text on a black background.
Conclusions
Among adult Mexican smokers, pictorial health warning labels on cigarette packages that are larger or cover both sides of the pack appear more effective at lowering purchase intentions and increasing risk perceptions and motivation to quit than smaller health warning labels or health warning labels with imagery only on the pack front.
Abstract Purpose Assess the prevalence and correlates of e-cigarette perceptions and trial among adolescents in Mexico, where e-cigarettes are banned. Methods Cross-sectional data were collected in ...2015 from a representative sample of middle-school students (n = 10,146). Prevalence of e-cigarette awareness, relative harm, and trial were estimated, adjusting for sampling weights and school-level clustering. Multilevel logistic regression models adjusted for school-level clustering to assess correlates of e-cigarette awareness and trial. Finally, students who had tried only e-cigarettes were compared with students who had tried: (1) conventional cigarettes only; (2) both e-cigarettes and conventional cigarettes (dual triers); and (3) neither cigarette type (never triers). Results Fifty-one percent of students had heard about e-cigarettes, 19% believed e-cigarettes were less harmful than conventional cigarettes, and 10% had tried them. Independent correlates of e-cigarette awareness and trial included established risk factors for smoking, as well as technophilia (i.e., use of more media technologies) and greater Internet tobacco advertising exposure. Exclusive e-cigarette triers (4%) had significantly higher technophilia, bedroom Internet access, and Internet tobacco advertising exposure compared to conventional cigarette triers (19%) and never triers (71%) but not compared to dual triers (6%), although dual triers had significantly stronger conventional cigarette risk factors. Conclusions This study suggests that adolescent e-cigarette awareness and use is high in Mexico, in spite of its e-cigarette ban. A significant number of medium-risk youth have tried e-cigarettes only, suggesting that e-cigarettes could lead to more intensive substance use. Strategies to reduce e-cigarette use should consider reducing exposures to Internet marketing.
Health warning labels (HWLs) on cigarette packs that use strong fear appeals may evoke defensive responses including acts of disparaging the warnings. Whether warning disparagement undermines HWL ...effectiveness remains unclear. We assessed correlates of one type of HWL disparagement and its association with subsequent cessation attempts. Longitudinal data (2012–14) on adult smokers from Australia, Canada, Mexico and the United States (US) were analyzed. HWL disparagement was assessed as the frequency of making fun of HWLs in the past month. Using Generalized Estimating Equation models we estimated correlates of HWL disparagement and whether HWL disparagement predicted subsequent cessation attempts. In each country, across all waves, 24–31% of smokers reported making fun of the warnings at least once in the past month. More frequent disparagement was found among males, younger participants, those with higher education and greater addiction, and those who recently attempted to quit. Attention to, avoidance of and talking to others about HWLs were all positively associated with HWL disparagement. In all countries, except the US, this type of HWL disparagement was an independent predictor of subsequent cessation attempts. HWL disparagement among smokers may indicate greater warning relevance and processing and does not result in counterproductive effects on cessation efforts.
Many adolescents in majority world countries emulate U.S. American culture, which can influence their development. Globalization allows adolescents from majority world countries to learn about U.S. ...American culture through mass media and the exchange of information via the Internet and other forms of communication. As such, youth in Mexico may experience remote acculturation, which can influence their smoking behaviors. We developed and tested a measure of remote acculturation (i.e., orientation to U.S. American and Mexican culture) among adolescents in Mexico and examined the association of remote acculturation with adolescents’ smoking-related cognitions. Data came from a school-based survey of 5,492 never-smoker, urban adolescents (51% female, M age = 14.07 years). Confirmatory factor analyses supported two latent factors—one for U.S. American and another for Mexican cultural orientation. Structural equation models revealed that stronger Mexican cultural orientation was associated with lower positive smoking-related attitudes, which were related with lower smoking susceptibility. Consistent with research on acculturation among U.S. Hispanic youth, findings indicate that stronger orientation toward U.S. culture may put adolescents in Mexico at risk of cigarette smoking, whereas greater orientation toward Mexican culture may prevent youth smoking in Mexico. We discuss directions for future research and policy-making strategies to prevent youth smoking in Mexico.
Background. This study examined how risk perceptions and social norms around e-cigarettes are associated with susceptibility (i.e., openness to using the product in the next 12 months) of ...e-cigarettes and smoking among adolescents. Methods. We analyzed data from a 2016 representative survey of 8,718 middle school students in Mexico. The study sample was restricted to students who had tried neither e-cigarettes nor cigarettes, (N = 4471). Students reported on the risks of e-cigarettes compared with those of cigarettes, and product-specific norms were measured by assessing current use by family members, at least one close friend, and, for e-cigarettes, by perceived societal acceptability of use (i.e., acceptability among people in general). Adjusted prevalence ratios (APR) were estimated using generalized estimating equation models that regressed e-cigarette societal acceptability on study variables. Adjusted generalized estimating equation models also regressed susceptibility for each product on study variables. Results. Susceptibility to both e-cigarettes and smoking was higher among students who reported that their family and friends used only cigarettes or both products when compared with students whose family and friends did not use either of these products. Friend use of e-cigarettes was associated with e-cigarette susceptibility (APR = 1.33) but not smoking susceptibility. Students who perceived that e-cigarettes were less risky than smoking were more susceptible to e-cigarette use (APR = 1.45). The association between e-cigarette susceptibility and friend or family use was not mediated by societal acceptability. Conclusions. E-cigarette use among family and peers appears associated with susceptibility to use e-cigarettes in a way that is similar to the patterns found for cigarettes. However, the influences appear somewhat specific to the type of product that network members use.
Purpose Pictorial health warnings on cigarette packages are a prominent and effective means of communicating the risks of smoking; however, there is little research on effective types of message ...content and socio-demographic effects. This study tested message themes and content of pictorial warnings in Mexico. Methods Face-to-face surveys were conducted with 544 adult smokers and 528 youth in Mexico City. Participants were randomized to view 5-7 warnings for two of 15 different health effects. Warnings for each health effect included a text-only warning and pictorial warnings with various themes: "graphic" health effects, "lived experience", symbolic images, and testimonials. Results Pictorial health warnings were rated as more effective than text-only warnings. Pictorial warnings featuring "graphic" depictions of disease were significantly more effective than symbolic images or experiences of human suffering. Adding testimonial information to warnings increased perceived effectiveness. Adults who were female, older, had lower education, and intended to quit smoking rated warnings as more effective, although the magnitude of these differences was modest. Few interactions were observed between socio-demographics and message theme. Conclusions Graphic depictions of disease were perceived by youth and adults as the most effective warning theme. Perceptions of warnings were generally similar across socio-demographic groups.
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.
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.
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.
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.
We assessed attitudes and beliefs about smoke-free laws, compliance, and secondhand smoke exposure before and after implementation of a comprehensive smoke-free law in Mexico City.
Trends and odds of ...change in attitudes and beliefs were analyzed across 3 representative surveys of Mexico City inhabitants: before implementation of the policy (n=800), 4 months after implementation (n=961), and 8 months after implementation (n=761).
Results indicated high and increasing support for 100% smoke-free policies, although support did not increase for smoke-free bars. Agreement that such policies improved health and reinforced rights was high before policy implementation and increased thereafter. Social unacceptability of smoking increased substantially, although 25% of nonsmokers and 50% of smokers agreed with smokers' rights to smoke in public places at the final survey wave. Secondhand smoke exposure declined generally as well as in venues covered by the law, although compliance was incomplete, especially in bars.
Comprehensive smoke-free legislation in Mexico City has been relatively successful, with changes in perceptions and behavior consistent with those revealed by studies conducted in high-income countries. Normative changes may prime populations for additional tobacco control interventions.
We aimed to assess the level of awareness and impact of a social marketing campaign to promote Mexico City's 2008 comprehensive smoke-free law.
Four months after the smoke-free law was implemented ...but before the campaign launch, we collected data from a population-based, random sample of 961 inhabitants of Mexico City. We analyzed data from 786 respondents who completed follow-up at the end of the campaign to determine campaign exposure and the association between campaign exposure and changes in campaign-targeted knowledge and attitudes.
Recall of any of the 5 campaign materials was 69%, with a uniform distribution of exposure to 1, 2, and 3 or more campaign materials (25%, 25%, and 19%, respectively). Exposure to a greater number of campaign materials was associated in a monotonic relation with campaign-targeted knowledge of ammonia and arsenic in cigarette smoke. In models assessing support for, perceived benefits of, and perceived right to smoke-free places, campaign exposure accounted for a positive change in half of the indicators within each of these domains.
Social marketing campaigns can reinforce knowledge and attitudes that favor smoke-free laws, thereby helping to establish smoke-free norms.
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.
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.
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.
Dual users had a higher risk profile than exclusive smokers, which was even more prominent in dual-users who used e-cigarettes frequently.
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