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BACKGROUND: Light and intermittent smoking has become increasingly prevalent as smokers shift to lower consumption in response to tobacco control policies. We examined changes in cigarette consumption patterns over a four-year period and determined which factors were associated with smoking transitions. METHODS: We used data from a cohort of smokers from the 2008-2012 ITC Mexico Survey administrations to investigate transitions from non-daily (ND; nâ¯=â¯669), daily light (DL; ≤5 cigarettes per day (cpd); nâ¯=â¯643), and daily heavy (DH; >5â¯cpd; nâ¯=â¯761) smoking patterns. To identify which factors (i.e., sociodemographic measures, perceived addiction, quit behavior, social norms) were associated with smoking transitions, we stratified on smoking status at time t (ND, DL, DH) and used multinomial (ND, DL) and binomial (DH) logistic regression to examine transitions (quitting/reducing or increasing versus same level for ND and DL, quitting/reducing versus same level for DH). RESULTS: ND smokers were more likely to quit at follow-up than DL or DH smokers. DH smokers who reduced their consumption to ND were more likely to quit eventually compared to those who continued as DH. Smokers who perceived themselves as addicted had lower odds of quitting/reducing smoking consumption at follow-up compared to smokers who did not, regardless of smoking status at the prior survey. Quit attempts and quit intentions were also associated with quitting/reducing consumption. CONCLUSIONS: Reducing consumption may eventually lead to cessation, even for heavier smokers. The findings that perceived addiction and quit behavior were important predictors of changing consumption for all groups may offer insights into potential interventions.
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OBJECTIVE: This study examined smokers' responses to pictorial health warnings (PHWs) with different types of imagery under natural exposure conditions. METHODS: Adult smokers from online panels in Canada (n=2357), Australia (n=1671) and Mexico (n=2537) were surveyed every 4 months from 2012 to 2013. Participants were shown PHWs on packs in their respective countries and asked about: (1) noticing PHWs; (2) negative affects towards PHWs; (3) believability of PHWs; (4) PHW-stimulated discussions; and (5) quit motivation due to PHWs. Country-specific generalised estimating equation models regressed these outcomes on time (ie, survey wave), PHW imagery type (ie, symbolic representations of risk, suffering from smoking and graphic depictions of bodily harm) and interactions between them. RESULTS: In all countries, PHW responses did not significantly change over time, except for increased noticing PHWs in Canada and Mexico, increased negative affect in Australia and decreased negative affect in Mexico. For all outcomes, symbolic PHWs were rated lower than suffering and graphic PHWs in Canada (the only country with symbolic PHWs). Graphic PHWs were rated higher than suffering PHWs for negative affect (all countries), discussions (Canada) and quit motivation (Australia). Suffering PHWs were rated higher than graphic PHWs for noticing PHWs (Canada), believability (all countries), discussions (AustraliaandMexico) and quit motivation (Mexico). Changes in noticing, believability and discussions varied somewhat by imagery type across countries. CONCLUSIONS: The different PHW imagery appears to have different pathways of influence on adult smokers. Reactions to specific PHWs are similar over 1-2 years, suggesting that wear-out of PHW effects is due to decreased attention rather than the diminishing effectiveness of content.
Assuntos
Qualidade de Produtos para o Consumidor/legislação & jurisprudência , Imagens, Psicoterapia , Rotulagem de Produtos/estatística & dados numéricos , Fumantes/psicologia , Abandono do Hábito de Fumar/métodos , Fumar/epidemiologia , Fumar/psicologia , Adulto , Austrália/epidemiologia , Canadá/epidemiologia , Emoções , Feminino , Promoção da Saúde , Humanos , Imagens, Psicoterapia/estatística & dados numéricos , Estudos Longitudinais , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Motivação , Rotulagem de Produtos/legislação & jurisprudência , Abandono do Hábito de Fumar/psicologia , Adulto JovemRESUMO
BACKGROUND: Health warning labels (HWLs) on cigarette packs in Australia, Canada, Mexico, and the United States include varying information about toxic cigarette smoke constituents and smoking-related health risks. HWL information changed more recently in Australia, Canada, and Mexico than in the United States. AIMS: To investigate whether smokers' knowledge of toxic constituents and perceived smoking-related risks increased after adding this information to HWLs and how knowledge of toxic constituents is associated with perceptions of smoking-related risks. METHODS: Data come from a longitudinal, online cohort of 4,621 adult smokers surveyed every 4 months from September 2012 (Wave 1) to January 2014 (Wave 5) in Australia, Canada, and Mexico, with the United States being surveyed from Waves 2 to 5. Generalized estimating equation models estimated the association between perceived smoking-related risk at follow-up and prior wave knowledge of toxic constituents, adjusting for attention to HWLs, sociodemographics, and smoking-related characteristics. RESULTS: Between 2012 and 2014, knowledge of toxic constituents increased in Australia, Canada, and Mexico ( p < .001), but not in the United States. Higher levels of both attention to HWLs and knowledge of toxic constituents were associated with a higher perceived risk of smoking-related conditions at follow-up across all countries except for the United States. CONCLUSIONS: Our results suggest that information about toxic constituents on prominent HWLs not only increases smoker's knowledge of toxic constituents, but that it may also reinforce the effects of HWL messages about specific, smoking-related health outcomes.
Assuntos
Percepção , Rotulagem de Produtos/tendências , Fumar/efeitos adversos , Produtos do Tabaco/toxicidade , Austrália/epidemiologia , Canadá/epidemiologia , Feminino , Promoção da Saúde/métodos , Humanos , Estudos Longitudinais , Masculino , Fatores de Risco , Fumar/epidemiologia , Inquéritos e Questionários , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: Some researchers have raised concerns that pictorial health warning labels (HWLs) on cigarette packages may lead to message rejection and reduced effectiveness of HWL messages. This study aimed to determine how state reactance (i.e., negative affect due to perceived manipulation) in response to both pictorial and text-only HWLs is associated with other types of HWL responses and with subsequent cessation attempts. METHODS: Survey data were collected every 4 months between September 2013 and 2014 from online panels of adult smokers in Australia, Canada, Mexico, and the US were analyzed. Participants with at least one wave of follow-up were included in the analysis (n = 4,072 smokers; 7,459 observations). Surveys assessed psychological and behavioral responses to HWLs (i.e., attention to HWLs, cognitive elaboration of risks due to HWLs, avoiding HWLs, and forgoing cigarettes because of HWLs) and cessation attempts. Participants then viewed specific HWLs from their countries and were queried about affective state reactance. Logistic and linear Generalized Estimating Equation (GEE) models regressed each of the psychological and behavioral HWL responses on reactance, while controlling for socio-demographic and smoking-related variables. Logistic GEE models also regressed having attempted to quit by the subsequent survey on reactance, each of the psychological and behavioral HWL responses (analyzed separately), adjustment variables. Data from all countries were initially pooled, with interactions between country and reactance assessed; when interactions were statistically significant, country-stratified models were estimated. RESULTS: Interactions between country and reactance were found in all models that regressed psychological and behavioral HWL responses on study variables. In the US, stronger reactance was associated with more frequent reading of HWLs and thinking about health risks. Smokers from all four countries with stronger reactance reported greater likelihood of avoiding warnings and forgoing cigarettes due to warnings, although the association appeared stronger in the US. Both stronger HWLs responses and reactance were positively associated with subsequent cessation attempts, with no significant interaction between country and reactance. CONCLUSIONS: Reactance towards HWLs does not appear to interfere with quitting, which is consistent with its being an indicator of concern, not a systematic effort to avoid HWL message engagement.
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Promoção da Saúde/métodos , Rotulagem de Produtos/métodos , Abandono do Hábito de Fumar/psicologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/psicologia , Adolescente , Adulto , Austrália , Canadá , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos , Adulto JovemRESUMO
The aim of the present study was to assess smokers' level of agreement with smoking-related risks and toxic tobacco constituents relative to inclusion of these topics on health warning labels (HWLs). 1000 adult smokers were interviewed between 2012 and 2013 from online consumer panels of adult smokers from each of the three countries: Australia (AU), Canada (CA) and Mexico (MX). Generalized estimating equation models were estimated to compare agreement with smoking-related risks and toxic tobacco constituents. For disease outcomes described on HWLs across all three countries, there were few statistical differences in agreement with health outcomes (e.g. emphysema and heart attack). By contrast, increases in agreement where the HWLs were revised or introduced on HWLs for the first time (e.g. blindness in AU and CA, bladder cancer in CA). Similarly, samples from countries that have specific health content or toxic constituents on HWLs showed higher agreement for that particular disease or toxin than countries without (e.g. higher agreement for gangrene and blindness in AU, higher agreement for bladder cancer and all toxic constituents except nitrosamines and radioactive polonium in CA). Pictorial HWL content is associated with greater awareness of smoking-related risks and toxic tobacco constituents.
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Promoção da Saúde/métodos , Rotulagem de Produtos/métodos , Fumar/efeitos adversos , Fumar/etnologia , Produtos do Tabaco/efeitos adversos , Adolescente , Adulto , Austrália/epidemiologia , Conscientização , Canadá/epidemiologia , Doenças Cardiovasculares/induzido quimicamente , Comparação Transcultural , Feminino , Humanos , Intenção , Entrevistas como Assunto , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Rotulagem de Produtos/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/induzido quimicamente , Medição de Risco , Fatores de Risco , Fumar/psicologia , Abandono do Hábito de Fumar/etnologia , Abandono do Hábito de Fumar/psicologia , Fatores Socioeconômicos , Adulto JovemRESUMO
BACKGROUND: Mexican smokers are more likely to be non-daily smokers and to consume fewer cigarettes per day than smokers in other countries. Little is known about their quit behaviors. AIM: The aim of this study is to determine factors associated with having made a quit attempt and being successfully quit at 14-month follow-up in a population-based cohort of adult Mexicans who smoke at different levels of intensity. DESIGN: A longitudinal analysis of wave-III and wave-IV (2010) Mexican administration of International Tobacco Control Policy Evaluation Project was conducted. SETTING: This study was conducted in six large urban centers in Mexico PARTICIPANTS: The participants of this study comprised 1206 adults who were current smokers at wave-III and who were followed to wave-IV. MEASUREMENTS: We compared three groups of smokers: non-daily smokers-who did not smoke every day in the past 30 days (n=398), daily light smokers who smoked every day at a rate of ≤5 cigarettes per day (n=368) and daily heavy smokers who smoked every day at a rate of >5 cigarettes per day (n=434). Data on smoking behavior, psychosocial characteristics and socio-demographics were collected at baseline and after 14 months. FINDINGS: In multivariate logistic regression predicting having made a quit attempt at follow-up, significant factors included being a non-daily smoker versus a heavy daily smoker (ORadj=1.83, 95% CI: 1.19-2.83), less perceived addiction (ORadj=1.86, 95% CI: 1.20-2.87), greater worry that cigarettes will damage health (ORadj=2.04, 95% CI: 1.16-3.61) and having made a quit attempt in the past year at baseline (ORadj=1.70, 95% CI: 1.23-2.36). In multivariate logistic regression predicting being successfully quit at one-year follow-up, significant factors included being a non-daily smoker versus a heavy daily smoker (ORadj=2.54, 95% CI: 1.37-4.70) and less perceived addiction (not addicted: ORadj=3.26, 95% CI: 1.73-6.14; not much: ORadj=1.95, 95% CI: 1.05-3.62 versus very much). CONCLUSIONS: Mexican adult smokers who are non-daily smokers were more likely than daily heavy smokers to have attempted to quit during follow-up and to succeed in their quit attempt. Future research should determine whether tobacco control policies and programs potentiate this tendency and which interventions are needed to help heavier smokers to quit.
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Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/epidemiologia , Adolescente , Adulto , Fatores Etários , Atitude Frente a Saúde , Estudos de Coortes , Feminino , Humanos , Renda/estatística & dados numéricos , Intenção , Modelos Logísticos , Estudos Longitudinais , Masculino , Estado Civil/estatística & dados numéricos , México/epidemiologia , Pessoa de Meia-Idade , Razão de Chances , Comportamento de Redução do Risco , Tabagismo/epidemiologia , Adulto JovemRESUMO
OBJECTIVES: 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. METHODS: 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: 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. CONCLUSIONS: 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.
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Política Pública/legislação & jurisprudência , Abandono do Hábito de Fumar/legislação & jurisprudência , Fumar/legislação & jurisprudência , Poluição por Fumaça de Tabaco/legislação & jurisprudência , Humanos , Modelos Logísticos , México/epidemiologia , Fumar/epidemiologia , Prevenção do Hábito de Fumar , Comportamento Social , Meio Social , Poluição por Fumaça de Tabaco/prevenção & controle , População UrbanaRESUMO
OBJECTIVE: To assess the impact of Mexico City and federal smoke-free legislation on secondhand tobacco smoke (SHS) exposure and support for smoke-free laws. MATERIAL AND METHODS: Pre- and post-law data were analyzed from a cohort of adult smokers who participated in the International Tobacco Control (ITC) Policy Evaluation Suvey in four Mexican cities. For each indicator, we estimated prevalence, changes in prevalence, and between-city differences in rates of change. RESULTS: Self-reported exposure to smoke-free media campaigns generally increased more dramatically in Mexico City. Support for prohibiting smoking in regulated venues increased overall, but at a greater rate in Mexico City than in other cities. In bars and restaurants/cafés, self-reported SHS exposure had significantly greater decreases in Mexico City than in other cities; however, workplace exposure decreased in Tijuana and Guadalajara, but not in Mexico City or Ciudad Juárez. CONCLUSIONS: Although federal smoke-free legislation was associated with important changes smoke-free policy impact, the comprehensive smoke-free law in Mexico City was generally accompanied by a greater rate of change.
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Prevenção do Hábito de Fumar , Fumar/legislação & jurisprudência , Poluição por Fumaça de Tabaco/legislação & jurisprudência , Poluição por Fumaça de Tabaco/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estudos Longitudinais , Masculino , México , Pessoa de Meia-Idade , Saúde da População Urbana , Adulto JovemRESUMO
Objective. To assess the impact of Mexico City and federal smoke-free legislation on secondhand tobacco smoke (SHS) exposure and support for smoke-free laws. Material and Methods. Pre- and post-law data were analyzed from a cohort of adult smokers who participated in the International Tobacco Control (ITC) Policy Evaluation Suvey in four Mexican cities. For each indicator, we estimated prevalence, changes in prevalence, and between-city differences in rates of change. Results. Self-reported exposure to smoke-free media campaigns generally increased more dramatically in Mexico City. Support for prohibiting smoking in regulated venues increased overall, but at a greater rate in Mexico City than in other cities. In bars and restaurants/cafés, self-reported SHS exposure had significantly greater decreases in Mexico City than in other cities; however, workplace exposure decreased in Tijuana and Guadalajara, but not in Mexico City or Ciudad Juárez. Conclusions. Although federal smoke-free legislation was associated with important changes smoke-free policy impact, the comprehensive smoke-free law in Mexico City was generally accompanied by a greater rate of change.
Objetivo. Evaluar el impacto de la legislación federal y del Distrito Federal (DF) de espacios libres de humo de tabaco (ELHT) sobre la exposición al humo de tabaco y el apoyo a las leyes. Material y métodos. Se analizaron datos antes y después de la ley en una cohorte de fumadores adultos de cuatro ciudades mexicanas donde se aplicó la Encuesta Internacional para Evaluar las Políticas Públicas para el Control del Tabaco (Encuesta ITC). Para cada indicador, se estimó la prevalencia, cambios en la prevalencia y diferencias entre ciudades en las tasas de cambio. Resultados. La exposición autorreportada a las campañas sobre los ELHT incrementaron dramáticamente en el DF. El apoyo para prohibir fumar en lugares regulados aumentó en general, pero aumentó más en el DF. La exposición autorreportada al humo de tabaco en bares y restaurantes, en el DF disminuyó significativamente más que en las otras ciudades; sin embargo, la exposición en lugares de trabajo disminuyó en Tijuana y Guadalajara, pero no en el DF o Ciudad Juárez. Conclusiones. La ley federal que promovió ELHT tuvo impactos importantes; sin embargo, la ley del DF, que es más integral, fue acompañada por unas mayores tasas de cambio.