Citation

Mutti, S., Hammond, D., Reid, J., Thrasher, J.F. (2013). The efficacy of cigarette warning labels on health beliefs in the United States and Mexico. Journal of Health Communication, 18(10), 1180-1192.

Abstract

Concern over health risks is the most common motivation for quitting smoking. Health warnings on tobacco packages are among the most prominent interventions to convey the health risks of smoking. Face-to-face surveys were conducted in Mexico (n = 1,072), and a web-based survey was conducted in the US (n = 1,449) to examine the efficacy of health warning labels on health beliefs. Respondents were randomly assigned to view two sets of health warnings (each with one text-only warning and 5–6 pictorial warnings) for two different health effects. Respondents were asked whether they believed smoking caused 12 different health effects. Overall, the findings indicate high levels of health knowledge in both countries for some health effects, although significant knowledge gaps remained; for example, less than half of respondents agreed that smoking causes impotence and less than one third agreed that smoking causes gangrene. Mexican respondents endorsed a greater number of correct beliefs about the health effects of smoking than did the U.S. sample. In both countries, viewing related health warning labels increased beliefs about the health risks of smoking, particularly for less well-known health effects such as gangrene, impotence, and stroke.

Citation

Siahpush, M., Thrasher, J.F., Yong, H.H., Cummings, K.M., Fong, G.T., Saenz-de-Miera Juarez, B., Borland, R. (2013). Cigarette prices, cigarette expenditure and smoking-induced deprivation: Findings from the International Tobacco Control Mexico Survey. Tobacco Control, 22(4), 223-226.

Abstract

Aim: Mexico implemented annual tax increases between 2009 and 2011. We examined among current smokers the association of price paid per cigarette and daily cigarette expenditure with smoking-induced deprivation (SID) and whether the association of price or expenditure with SID varies by income.

Methods: We used data (n=2410) from three waves of the International Tobacco Control Mexico survey (ie, 2008, 2010, 2011) and employed logistic regression to estimate the association of price paid per cigarette and daily cigarette expenditure with the probability of SID ('In the last 6 months, have you spent money on cigarettes that you knew would be better spent on household essentials like food?').

Results: Price paid per cigarette increased from Mex$1.24 in 2008, to Mex$1.36 in 2010, to Mex$1.64 in 2011. Daily cigarette expenditure increased from Mex$6.9, to Mex$7.6 and to Mex$8.4 in the 3 years. There was no evidence of an association between price and SID. However, higher expenditure was associated with a higher probability of SID. There was no evidence that the association of price or expenditure with SID varied by income.

Conclusion: Tax increases in Mexico have resulted in smokers paying more and spending more for their cigarettes. Those with higher cigarette expenditure experience more SID, with no evidence that poorer smokers are more affected.

Citation

Thrasher, J.F., Perez-Hernandez, R., Arillo-Santillán, E., Barrientos-Gutierrez, I. (2012). Hacia el consumo informado de tabaco en México: Efecto de las advertencias en población fumadora [Towards informed tobacco consumption in Mexico: Effects of pictorial warning labels among smokers]. Salud Publica de Mexico, 54(3), 242-253.

Abstract

Objective: Evaluate the effect of the first pictorial warning labels on cigarette packs in Mexican smokers.

Materials and Methods: A population-based representative cohort of smokers from seven Mexican cities was surveyed before (2010) and after (2011) the implementation of pictorial warning labels. To determine the change variables representing the cognitive and behavioral impact of pictorial warnings, bivariate and adjusted generalized estimating equations were estimated. Data from the second survey (2011) were analyzed to determine the factors associated with aided recall of specific pictorial warnings, as well as the factors associated with self-report of the impact that these warnings had.

Results: From 2010 to 2011, significant increases were found in smoker's knowledge about smoking risks, the toxic components of tobacco, and the quitline number for receiving cessation assistance. Recall and impact of specific pictorial warnings was generally broad and equally distributed across the smoker population. In comparison with recent ex-smokers interviewed in 2010, more recent ex-smokers in 2011 reported that pack warnings had influenced their decision to quit (RM=2.44, 95% IC 1.27-4.72).

Conclusion: The first pictorial warning labels on cigarette packages in Mexico have had a significant impact on knowledge and behavior.

Citation

Borland, R., Li, L., Driezen, P., Wilson, N., Hammond, D., Thompson, M.E., Fong, G.T., Mons, U., Willemsen, M.C., McNeill, A., Thrasher, J.F., Cummings, K.M. (2012). Cessation assistance reported by smokers in 15 countries participating in the International Tobacco Control (ITC) Policy Evaluation Survey. Addiction, 107(1), 197-205.

Abstract

Aims: To describe some of the variability across the world in levels of quit smoking attempts and use of various forms of cessation support.

Design: Use of the International Tobacco Control Policy Evaluation Project surveys of smokers, using the 2007 survey wave (or later, where necessary).

Settings: Australia, Canada, China, France, Germany, Ireland, Malaysia, Mexico, the Netherlands, New Zealand, South Korea, Thailand, United Kingdom, Uruguay and United States.

Participants: Samples of smokers from 15 countries.

Measurements: Self-report on use of cessation aids and on visits to health professionals and provision of cessation advice during the visits.

Findings: Prevalence of quit attempts in the last year varied from less than 20% to more than 50% across countries. Similarly, smokers varied greatly in reporting visiting health professionals in the last year (<20% to over 70%), and among those who did, provision of advice to quit also varied greatly. There was also marked variability in the levels and types of help reported. Use of medication was generally more common than use of behavioural support, except where medications are not readily available.

Conclusions: There is wide variation across countries in rates of attempts to stop smoking and use of assistance with higher overall use of medication than behavioural support. There is also wide variation in the provision of brief advice to stop by health professionals.

Citation

Hammond, D., Thrasher, J.F., Reid, J., Driezen, P., Boudreau, C., Arillo-Santillán, E. (2012). Perceived effectiveness of pictorial health warnings among Mexican youth and adults: A population-level intervention with potential to reduce tobacco-related inequities. Cancer Causes Control, 23(Suppl 1), 57-67.

Abstract

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 sociodemographic 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.

Citation

Perez-Hernandez, R., Thrasher, J.F., Rodriquez-Bolanos, R., Barrientos-Gutierrez, I., Ibanez-Hernandez, N.A. (2012). Autorreporte de exposición a publicidad y promoción de tabaco en una cohorte de fumadores mexicanos [Self-reported exposure to tobacco advertising and promotion in a cohort of Mexican smokers]. Salud Publica de Mexico, 54(3), 204-212.

Abstract

Objective: To determine in a population-based sample of smokers the level exposure to tobacco industry marketing through different channels before and after their restriction through the General Tobacco Control Law of 2008.

Materials and Methods: Data were analyzed from a cohort of adult smokers from four Mexican cities who were surveyed in 2007 and 2008. GEE models were estimated for each indicator of advertising and promotion exposure.

Results: Increases were found in report of receiving free samples of tobacco (3.7-8.1%), branded clothing (3.6- 6.4%), noticing tobacco industry sponsored events (1.9-4.7%) and noticing ads in bars (21.4-28%). Noticing outdoor advertising decreased over this time (54.7 a 47.2%).

Conclusions: Our findings confirm tobacco industry shifting of marketing efforts when advertising and promotion bans are not comprehensive. There is a need to monitor compliance with marketing bans while working to make them comprehensive.

Citation

Thrasher, J.F., Arillo-Santillán, E., Villalobos, V., Perez-Hernandez, R., Hammond, D., Carter, J., Sebrie, E.M., Sansores, R., Regalado-Pineda, J. (2012). Can pictorial warning labels on cigarette packages address smoking-related health disparities? Field experiments in Mexico to assess pictorial warning label content. Cancer Causes Control, 23(Suppl 1), 69-80.

Abstract

Objective: The objective of this study was to determine the most effective content of pictorial health warning labels (HWLs) and whether educational attainment moderates these effects.

Methods: Field experiments were conducted with 529 adult smokers and 530 young adults (258 nonsmokers; 271 smokers). Participants reported responses to different pictorial HWLs printed on cigarette packages. One experiment involved manipulating textual form (testimonial narrative vs. didactic) and the other involved manipulating image type (diseased organs vs. human suffering).

Results: Tests of mean ratings and rankings indicated that pictorial HWLs with didactic textual forms had equivalent or significantly higher credibility, relevance, and impact than pictorial HWLs with testimonial forms. Results from mixed-effects models confirmed these results. However, responses differed by participant educational attainment: didactic forms were consistently rated higher than testimonials among participants with higher education, whereas the difference between didactic and testimonial narrative forms was weaker or not statistically significant among participants with lower education. In the second experiment, with textual content held constant, greater credibility, relevance, and impact was found for graphic imagery of diseased organs than imagery of human suffering.

Conclusions: Pictorial HWLs with didactic textual forms seem to work better than those with testimonial narratives. Future research should determine which pictorial HWL content has the greatest real-world impact among consumers from disadvantaged groups, including assessment of how HWL content should change to maintain its impact as tobacco control environments strengthen and consumer awareness of smoking-related risks increases.

Citation

Thrasher, J.F., Villalobos, V., Barnova, J., Sansores, R., O’Connor, R.J. (2011). Consumption of single cigarettes and quitting behavior: A longitudinal analysis of Mexican smokers. BioMed Central Public Health, 11(1), 134.

Abstract

Background: Previous cross-sectional research has suggested single cigarettes could either promote or inhibit consumption. The present study aimed to assess the effects of single cigarette availability and consumption on downstream quit behavior.

Methods: We analyzed population-based, longitudinal data from adult smokers who participated in the 2008 and 2010 administrations of the International Tobacco Control Policy Evaluation Survey in Mexico.

Results: At baseline, 30% of smokers saw single cigarettes for sale on a daily basis, 17% bought singles at their last purchase, and 7% bought singles daily. Smokers who most frequently purchased singles, both in general and specifically to control their consumption, were no more likely to attempt to quit over the 14 month follow-up period than those who did not purchase singles. Frequency of buying singles to reduce consumption had a non-monotonic association with being quit at followup. The odds of being quit was only statistically significant when comparing those who had not bought singles to reduce consumption with those who had done so on a more irregular basis (AOR = 2.30; 95% CI 1.19, 4.45), whereas those who did so more regularly were no more likely to be quit at followup. Frequency of self-reported urges to smoke upon seeing singles for sale was unassociated with either quit attempts or being quit at followup.

Conclusions: These results suggest that the relationship between singles consumption and quit behavior is complex, with no clear evidence that singles either promote or inhibit downstream quit behavior.

Citation

Thrasher, J.F., Quah, A.C.K., Dominick, G., Borland, R., Driezen, P., Awang, R., Omar, M., Hosking, W., Sirirassamee, B., Boado Martinez, M. (2011). Using cognitive interviewing and behavioral coding to determine measurement equivalence across linguistic and cultural groups: An example from the International Tobacco Control Policy Evaluation Project. Field Methods, 23(4), 439-460.

Abstract

This study examined and compared results from two questionnaire pretesting methods (i.e., behavioral coding and cognitive interviewing [CI]) to assess systematic measurement bias in survey questions for adult smokers across six countries (United States, Australia, Uruguay, Mexico, Malaysia, and Thailand). Protocol development and translation involved multiple bilingual partners in each linguistic/cultural group. The study was conducted with convenience samples of 20 adult smokers in each country. Behavioral coding and CI methods produced similar conclusions regarding measurement bias for some questions; however, CI was more likely to identify potential response errors than behavioral coding. Coordinated qualitative pretesting of survey questions (or postsurvey evaluation) is feasible across cultural groups and can provide important information on comprehension and comparability. The CI appears to be a more robust technique than behavioral coding, although combinations of the two might be even better.

Citation

Seidenberg, A.B., Rees, V.W., Alpert, H.R., O’Connor, R.J., Connolly, G.N. (2011). Ignition strength of 25 international cigarette brands. Tobacco Control, 20(1), 77-80.

Abstract

Background: Cigarette-ignited fires are a leading cause of fire death and injury throughout the world and remain a global public health and safety problem. To reduce this harm, a small number of countries now require cigarettes to have reduced ignition propensity (RIP). It is not known if cigarette manufacturers are voluntarily introducing RIP cigarettes in other countries to help save lives.

Methods: Using the ASTM E2187-04 test method, per cent full length burn (%FLB) was measured for three popular brands from each of seven countries that did not have RIP legislation at the time of purchase. Results were compared with %FLB measurements from four popular US brands purchased in a jurisdiction (Vermont) with an RIP law. SRM 1082 reference cigarette was also tested to assure laboratory quality control.

Results: All cigarette brands purchased in countries not requiring fire safety standards for cigarettes exceeded 75% FLB. In contrast, none of the cigarette brands from the USA exceeded 10% FLB. The SRM 1082 reference cigarette demonstrated 5% FLB.

Conclusion: Cigarette ignition propensity can be greatly reduced through legislation that requires cigarette fire safety standards. RIP cigarettes have the potential to significantly decrease the number of fire deaths, injuries and destruction of property caused by cigarette-ignited fires. Appropriate standards should be applied in cigarette markets globally.

Citation

Saenz-de-Miera Juarez, B., Thrasher, J.F., Chaloupka, F., Waters, H.R., Hernández-Ávila, M., Fong, G.T. (2010). Self-reported price of cigarettes, consumption and compensatory behaviours in a cohort of Mexican smokers before and after a cigarette tax increase. Tobacco Control, 19(6), 481-487.

Abstract

Objective: To assess the impact of a 2007 cigarette tax increase from 110% to 140% of the price to the retailer on cigarette price and consumption among Mexican smokers, including efforts to offset price increases.

Methods: Data were analysed from the 2006 and 2007 administrations of the International Tobacco Control (ITC) Policy Evaluation Survey in Mexico, which is a population-based cohort of adult smokers. Self-reported price of last cigarette purchase, place of last purchase, preferred brand, daily consumption and quit behaviour were assessed at baseline and follow-up.

Results: Self-reported cigarette prices increased by 12.7% after the tax increase, with prices for international brands increasing more than for national brands (13.5% vs 8.7%, respectively). Although the tax increases were not fully passed onto consumers particularly on national brands, no evidence was found for smokers changing behaviour to offset price increases. Consistent declines in consumption across groups defined by sociodemographic and smoking-related psychosocial variables suggest a relatively uniform impact of the tax increase across subpopulations. However, decreased consumption appeared limited to people who smoked relatively more cigarettes a day (>5 cigarettes/day). Average daily consumption among lighter smokers did not significantly decline. A total of 13% (n=98) of the sample reported being quit for a month or more at follow-up. In multivariate models, lighter smokers were more likely than heavier smokers to be quit.

Conclusions: Results suggest that the 2007 tax increase was passed on to consumers, whose consumption generally declined. Since no other tobacco control policies or programmes were implemented during the period analysed, the tax increase appears likely to have decreased consumption.

Citation

Thrasher, J.F., Swayampakala, K., Arillo-Santillán, E., Sebrie, E.M., Walsemann, K.M., Bottai, M. (2010). Differential impact of local and federal smoke-free legislation in Mexico: A longitudinal study among adult smokers. Salud Publica de Mexico, 52(Suppl 2), S244-253.

Abstract

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.

Citation

Thrasher, J.F., Villalobos, V., Szklo, A.S., Fong, G.T., Perez, C., Sebrie, E.M., Sansone, N., Figueiredo, V., Boado Martinez, M., Arillo-Santillán, E., Bianco, E. (2010). Assessing the impact of cigarette package health warning labels: A cross-country comparison in Brazil, Uruguay and Mexico. Salud Publica de Mexico, 52(Suppl 2), S206-215.

Abstract

Objective: To assess the impact of different health warning labels (HWL).

Material and Methods: Data from the International Tobacco Control Survey (ITC Survey) were analyzed from adult smokers in Brazil, Uruguay and Mexico, each of which used a different HWL strategy (pictures of human suffering and diseased organs; abstract pictorial representations of risk; and text-only messages, respectively). Main outcomes were HWL salience and cognitive impact.

Results: HWLs in Uruguay (which was the only country with a HWL on the front of the package) had higher salience than either Brazilian or Mexican packs. People at higher levels of educational attainment in Mexico were more likely to read the text-only HWLs whereas education was unassociated with salience in Brazil or Uruguay. Brazilian HWLs had greater cognitive impacts than HWLs in either Uruguay or Mexico. HWLs in Uruguay generated lower cognitive impacts than the text-only HWLs in Mexico. In Brazil, cognitive impacts were strongest among smokers with low educational attainment.

Conclusions: This study suggests that HWLs have the most impact when they are prominent (i.e., front and back of the package) and include emotionally engaging imagery that illustrates negative bodily impacts or human suffering due to smoking.

Citation

Thrasher, J.F., Villalobos, V., Dorantes-Alonso, A., Arillo-Santillán, E., Cummings, K.M., O’Connor, R.J., Fong, G.T. (2009). Does the availability of single cigarettes promote or inhibit cigarette consumption? Perceptions, prevalence and correlates of single cigarette use among adult Mexican smokers. Tobacco Control, 18(6), 431-437.

Abstract

Background: Single cigarette use and its implications have rarely been studied among adults.

Objective: To assess perceptions, prevalence and correlates of single cigarette purchase behaviour and its relation to harm reduction.

Design: Focus group transcripts and cross-sectional data were analysed.

Setting and participants: Focus groups among convenience samples of adult smokers in two Mexican cities and a population-based sample of 1079 adult smokers from the International Tobacco Control Policy Evaluation Project in four Mexican cities.

Main outcome measures: Purchase of single cigarettes last time cigarettes were bought, frequency of purchasing single cigarettes in the previous month and intention to quit in the next 6 months.

Results: Focus group data indicated that smokers bought single cigarettes as a harm reduction strategy. Survey data indicated that 38% of participants purchased single cigarettes in the last month and 10% purchased them the last time they bought cigarettes, with more frequent consumption among young adults and those with lower income. Purchasing single cigarettes was independently associated with the frequency of using single cigarettes to reduce consumption and, less consistently, with the frequency of being cued to smoke after seeing single cigarettes for sale. Using single cigarettes to reduce consumption was positively associated with quit intention, whereas being cued to smoke by single cigarettes was negatively associated with quit intention.

Conclusions: Study results suggest that some adult Mexican smokers purchase single cigarettes as a method to limit, cut down on and even quit smoking. Nevertheless, promotion of the availability of single cigarettes as a harm reduction strategy could provide additional smoking cues that undermine quit attempts and promote youth smoking.

Citation

Thrasher, J.F., Boado Martinez, M., Sebrie, E.M., Bianco, E. (2009). Smoke-free policies and the social acceptability of smoking in Uruguay and Mexico: Findings from the International Tobacco Control Policy Evaluation Project. Nicotine & Tobacco Research, 11(6), 591-599.

Abstract

Introduction: Little research has been conducted to determine the psychosocial and behavioral impacts of smoke-free policies in middle-income countries.

Methods: Cross-sectional data were analyzed from the 2006 waves of the International Tobacco Control Policy Evaluation. Survey comparing adult smokers in Mexico (n = 1,080), where smoke-free legislation at that time was weak, and Uruguay (n = 1,002), where comprehensive smoke-free legislation was implemented. Analyses aimed to determine whether exposure to smoke-free policies and perceived antismoking social norms were associated with smokers' receiving cues about the bothersome nature of secondhand smoke (SHS), with smokers' reactance against such cues, and with smokers' level of support for smoke-free policies in different venues.

Results: In bivariate analyses, Uruguayan smokers were more likely than Mexican smokers to experience verbal anti-SHS cues, lower reactance against anti-SHS cues, stronger antismoking societal norms, and stronger support for 100% smoke-free policies in enclosed workplaces, restaurants, and bars. In multivariate models for both countries, the strength of voluntary smoke-free policies at home was independently associated with support for smoke-free policies across all venues queried, except for in bars among Uruguayans. Perceived strength of familial antismoking norms was consistently associated with all indicators of the social acceptability of smoking in Uruguay but only with the frequency of receiving anti-SHS verbal cues in Mexico.

Discussion: These results are generally consistent with previous research indicating that comprehensive smoke-free policies are likely to increase the social unacceptability of smoking and that resistance against such policies is likely to diminish once such policies are in place.

Citation

Fong, G.T., Hammond, D., Hitchman, S.C. (2009). The impact of pictures on the effectiveness of tobacco warnings. Bulletin of the World Health Organization, 87(8), 640-643.

Abstract

Cigarette packages in most countries carry a health warning; however, the position, size and general strength of these warnings vary considerably across jurisdictions.1 Article 11 of the WHO Framework Convention on Tobacco Control (FCTC) and the Article 11 Guidelines adopted at the Third Conference of the Parties in November 2008 have put the spotlight on the inclusion of pictures on tobacco package health warnings. Beginning with Canada in 2001, 28 countries have introduced pictorial warnings and many other countries are in the process of drafting regulations for pictorial warnings (Box 1 and Box 2). This paper presents a brief review of the research studies that support pictorial warnings, reviewed in greater depth by Hammond and by the International Tobacco Control (ITC) Policy Evaluation Project.

Citation

Thrasher, J.F., Reynales-Shigematsu, L.M., Baezconde-Garbanati, L., Villalobos, V., Tellez-Giron, P., Arillo-Santillán, E., Dorantes-Alonso, A., Valdes-Salgado, R., Lazcano-Ponce, E. (2008). Promoting the effective translation of the framework convention on tobacco control: A case study of challenges and opportunities for strategic communications in Mexico. Evaluation & the Health Professions, 31(2), 145-166.

Abstract

The World Health Organization Framework Convention on Tobacco Control (WHO-FCTC) promotes the implementation of best-practices tobacco control policies at a global scale. This article describes features of the sociocultural and political-economic context of Mexico that pose challenges and opportunities to the effective translation of WHO-FCTC policies there. It also considers how strategic communication efforts may advance these policies by framing their arguments in ways that resonate with prevalent values, understandings, and concerns. A focus on a smoke-free policy illustrates barriers to policy compliance, including how similar issues have been overcome among Latino populations in California. Overall, this article aims to lay the foundation for comparative research from policy uptake to impact so that the scientific evidence base on tobacco control policies includes examination of how context moderates this process.

Citation

Thrasher, J.F., Hammond, D., Fong, G.T., Arillo-Santillán, E. (2007). Smokers' reactions to cigarette package warnings with graphic imagery and with only text: A comparison between Mexico and Canada. Salud Publica de Mexico, 49(Suppl 2), S233-240.

Abstract

Objective: This comparison of population-based representative samples of adult smokers in Canada (n=1 751) and Mexico (n=1 081) aimed to determine whether cigarette packages with graphic warning labels in Canada had a stronger impact than the text-only warning labels in Mexico.

Materials and methods: Bivariate and multivariate adjusted models were used in this study. Results. Canadian smokers reported higher warning label salience (i.e., noticing labels & processing label messages) than Mexican smokers, and warning label salience independently predicted intention to quit. Moreover, Canadians had higher levels of knowledge about smoking-related health outcomes that were included as content on Canadian, but not Mexican, warning labels. Finally, a majority of Mexican smokers want their cigarette packs to contain more information than they currently contain.

Discussion: These results are consistent with other studies that indicate that cigarette packages whose warning labels contain prominent graphic imagery are more likely than text-only warning labels to promote smoking-related knowledge and smoking cessation.

Citation

Thrasher, J.F., Chaloupka, F., Hammond, D., Fong, G.T., Borland, R., Hastings, G., Cummings, K.M. (2006). Evaluación de las políticas contra el tabaquismo en paises Latino Americanos en la era del Convenio Marco para el Control del Tabaco [Evaluating tobacco control policy in Latin American countries during the era of the Framework Convention on Tobacco Control]. Salud Publica de Mexico, 48(Suppl 1), S155-S166.

Abstract

Objective: The Framework Convention on Tobacco Control (FCTC) aims to coordinate tobacco control policies around the world that reduce tobacco consumption. The FCTC's recommended policies are likely to be effective in low- and middle-income countries. Nevertheless, policy evaluation studies are needed to determine policy impact and potential synergies across policies.

Materials and methods: The International Tobacco Control Policy Evaluation Project (ITC) is an international collaboration to assess the psychosocial and behavioral impact of the FCTC's policies among adult smokers in nine countries. The ITC evaluation framework utilizes multiple country controls, a longitudinal design, and a theory-driven conceptual model to test hypotheses about the anticipated effects of given policies.

Results: ITC Project results generally confirm previous studies that form the evidence base for FCTC policy recommendations, in particular: the use of graphic warning labels; banning of "light" and "mild" descriptors; smoking bans; increasing tax and price; banning advertising; and using new cigarette product testing methods.

Conclusions: Initial findings from the ITC Project suggest that Latin American countries could use similar methods to monitor and evaluate their own tobacco control policies while contributing to the evidence base for policy interventions in other countries.