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.

Background Recent increases in violent crime may impact a variety of health outcomes in Mexico. We examined relationships between neighborhood-level violence and smoking behaviors in a cohort of Mexican smokers from 2011–2012, and whether neighborhood-level social cohesion modified these relationships. Methods Data were analyzed from adult smokers and recent ex-smokers who participated in Waves 5–6 of the International Tobacco Control Mexico Survey. Self-reported neighborhood violence and social cohesion were asked of Wave 6 survey participants (n=2129 current and former smokers, n=150 neighborhoods). Neighborhood-level averages for violence and social cohesion (range 4–14 and 10–25, respectively) were assigned to individuals. We used generalized estimating equations to determine associations between neighborhood indicators and individual-level smoking intensity, quit behaviors, and relapse. Results Higher neighborhood violence was associated with higher smoking intensity (Risk Ratio (RR)=1.17, 95% Confidence Interval (CI) 1.02–1.33), and fewer quit attempts (RR=0.72, 95% CI 0.61–0.85). Neighborhood violence was not associated with successful quitting or relapse. Higher neighborhood social cohesion was associated with more quit attempts and more successful quitting. Neighborhood social cohesion modified the association between neighborhood violence and smoking intensity: in neighborhoods with higher social cohesion, as violence increased, smoking intensity decreased and in neighborhoods with lower social cohesion, as violence increased, so did smoking intensity. Conclusion In the context of recent increased violence in Mexico, smokers living in neighborhoods with more violence may smoke more cigarettes per day and make fewer quit attempts than their counterparts in less violent neighborhoods. Neighborhood social cohesion may buffer the impact of violence on smoking intensity.

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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=3,172) 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 (AOR=0.77; 95% 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.

Purpose Flavor capsule cigarettes are rapidly gaining global market share, particularly in Latin America. This paper compares profiles and perceptions of smokers who prefer flavor capsule cigarettes and those who do not in Mexico. Methods 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.