Background Use of flavour capsule varieties (FCVs) of cigarettes has rapidly increased in many countries. Adolescents are attracted to flavours; yet, surprisingly, no quantitative study has explored adolescents’ perceptions of these products. Objective To characterise the appeal of FCVs for young adolescents in Mexico. Methods In 2015, surveys were conducted with a representative sample of Mexican middle school students (n=10 124; ages 11–16 years; mean 12.4 years). Students viewed and rated packs for FCVs and non-FCVs from major brands (Marlboro, Camel, Pall Mall), with brand names removed. For each pack, students were asked to write the brand name (ie, brand recall), to evaluate pack attractiveness, and to indicate the pack they were most interested in trying (including a ‘none’ option). Logistic generalised estimating equation (GEE) models regressed brand recall, pack attractiveness and interest in trying on brand and FCV (yes vs no), controlling for sociodemographics and smoking risk factors. Results Marlboro regular, Camel regular, Camel light and Pall Mall FCVs were most often recalled (25%, 17%, 9%, 8%). Packs for Pall Mall FCVs and Camel FCVs were most often rated as very attractive (13%, 9%, respectively) and of interest for trial (22%, 13%) along with Marlboro regular (14%). In GEE models, FCVs were independently associated with greater attractiveness (adjusted OR (AOR)=1.83, 95% CI 1.72 to 1.94) and interest in trying (AOR=1.74, 95% CI 1.54 to 1.96). Perceived pack attractiveness was also independently associated with greater interest in trying (AOR=5.63, 95% CI 4.74 to 6.68). Conclusions FCVs appear to be generating even greater appeal among young adolescents than established non-FCVs in dominant brand families.

Purpose: The purpose of this study was to determine characteristics of smokers discussing e-cigarette use with their physician and receiving physician recommendations to use e-cigarettes for smoking cessation. Methods: Data were collected from surveys of an online consumer panel of US adult smokers who had visited a physician in the previous 12 months (n=2,671). Logistic generalized estimating equation (GEE) models were used to assess the characteristics of smokers who: 1) talked to a physician about e-cigarettes, and 2) received physician advice to use e-cigarettes for smoking cessation. Results: Of all smokers in the panel, 15% (n=406) talked with their physician about e-cigarettes. Among those (n=257) asked whether their physician recommend e-cigarettes for smoking cessation, 61% responded that they had received this recommendation. Compared to smokers who never used e-cigarettes, current e-cigarette users were more likely to talk to their physicians about e-cigarettes and receive recommendations to use e-cigarettes for smoking cessation. Conclusions: The majority of smokers who talk to their physician about e-cigarettes report that they received advice to use e-cigarettes to quit smoking, despite limited evidence for their efficacy. More studies are needed to better understand e-cigarette recommendations in clinical settings.

Objectives To assess whether exposure to alcohol use in films (AUF) is associated with alcohol use susceptibility, current alcohol use, and binge drinking in adolescents from two Latin American countries. Methods Cross-sectional study with 13,295 middle school students from public and private schools in Mexico and Argentina. Exposure to alcohol use in over 400 contemporary top box office films in each country was estimated using previously validated methods. Outcome measures included current drinking (i.e., any drink in the last 30 days), ever binge-drinking (i.e., more than 4 or 5 drinks in a row for females and males, respectively) and, among never drinkers, alcohol susceptibility (i.e., might drink in the next year or accept a drink from a friend). Multivariate models were adjusted for age, sex, parental education, peer drinking, sensation seeking, parenting style and media access. Results Mean age was 12.5 years (SD = 0.7) and the prevalence of alcohol consumption and binge drinking was 19.8% and 10.9% respectively. Mean exposure to alcohol from the film sample was about 7 hours in both countries. Adjusted models indicated independent dose-response associations between higher levels of exposure to AUF and all outcomes; the adjusted odds ratios (OR) comparing quartiles 4 and 1 1.99 (95% CI 1.73 - 2.30) for current drinking, 1.68 (1.39 - 2.02) for binge drinking, and 1.80 (1.52 - 2.12) for alcohol susceptibility. Compared to Mexican adolescents, Argentine adolescents were significantly more likely to have engaged in binge drinking (OR 1.40, 95% CI 1.12 - 1.76.) and, among never drinkers, were more susceptible to trying drinking (OR 1.40, 95% CI 1.20 - 1.64). Conclusions Higher levels of exposure to alcohol use in films was associated with higher likelihood of alcohol use, binge drinking, and alcohol susceptibility in Latin American adolescents.

Objective To assess whether exposure to movie smoking is associated with cigarette smoking among Argentinian adolescents. Study design School-based longitudinal study involving 33 secondary schools in Argentina. The sample included 2502 never smokers (average age at entry =12.5y), 1,700 (67.9%) of whom completed follow-up surveys 17 months later. Exposure to the top 100 grossing films for each year between 2009 and 2013 was assessed by content-coding films for tobacco, and then asking adolescents whether they had seen each of 50 titles, randomly selected from the larger pool, then parsing exposure into tertiles. Logistic regression models estimated adjusted odds ratio (AOR) for the following transitions: non-susceptible to susceptible never smoker, never smoker to ever smoker, and never smoker to current smoking (last 30 days). Results At follow-up, 34.4% of non-susceptible never smokers became susceptible, 24.1% reported having tried smoking, and 9.6% were current smokers. Most exposure to movie smoking was from US-produced films (average 60.3 minutes compared with only 3.4 minutes from Argentine films). Higher exposure to smoking in movies was significantly associated with increased odds of becoming susceptible (AOR1st vs 3rd tertile = 1.77, 95% confidence interval 1.30–2.41), of trying smoking (AOR1st vs 3rd tertile = 1.54, 1.14–2.08), and marginally associated with current smoking (AOR1st vs 3rd tertile = 1.54, 0.99–2.40). Exposure to smoking in US- or Argentine-produced films had similar associations. Conclusion In Argentina, exposure to smoking in the movies predicted future smoking transitions among early adolescents, with most exposure coming from viewing US movies.

Rationale, aims, and objectives: There is limited research on how health care providers approach the topic of e-cigarettes in clinical encounters, especially in conjunction with other best-practice recommendations for smoking cessation. This qualitative study explored physician perceptions and recommendations involving e-cigarettes in the context of smoking cessation counselling, including their opinions about the implementation and content of patient educational materials that focus on e-cigarettes.Methods: Semistructured interviews were conducted with 15 physicians from family medicine, internal medicine, and obstetrics/gynaecology (OB/GYN).Results: Physicians did not routinely assess e-cigarette use among patients and reported that discussions were often initiated by patients. Only a minority of participants discussed e-cigarettes in conjunction with other best-practice recommendations for smoking cessation. Most others were more ambivalent about e-cigarette safety and effectiveness for cessation and did not address the topic, unless patients were already using e-cigarettes. Almost all, however, agreed that more research on e-cigarettes was needed. Physicians expressed an interest in having enhanced discussions about e-cigarettes with their patients and in using patient educational materials to accomplish this. Physicians recommended that these materials not actively promote e-cigarettes and be tailored to patients based on their demographics and motivation to quit. Conclusions:Physicians were open to improving their smoking cessation counselling and to integrating new patient educational materials that addressed e-cigarettes.Patient educational materials that provide tailored information about e-cigarettes could potentially be used initiate e-cigarette discussions and inform smokers about what is known vs unknown about e-cigarettes.