Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Of the 14.3 million Mexicans who smoke, only a minority take advantage of evidence-based approaches to smoking cessation. Mobile health interventions have the potential to increase the reach of effective cessation interventions in Mexico and other Low- and Middle-Income Countries (LMICs). Objective: To assess an innovative, personalized, and interactive mobile intervention developed for Mexican smokers. Methods: We recruited 40 Mexican smokers to participate in Vive sin Tabaco… ¡Decídete!, a smoking cessation program that uses a tablet-based decision-support software to drive a 12-week text messaging smoking cessation program and pharmacotherapy support. Outcome measures included participant text messaging interactivity with the program, participant satisfaction, and 12-week end-of-treatment abstinence. Results: Average age of participants was 36 years old, primarily male (65%), with at least an undergraduate degree (62.5%). Most participants (95%) smoked daily and were interested in quitting in the next 7 days. As an indicator of participant interactivity, participants sent an average of 21 text messages during the 12-week intervention (SD=17.62). Of the 843 messages that participants sent to the program, only 96 messages (11.3%) used keywords. At 12 weeks, 16 (40%) participants were biochemically verified abstinent using intent-to-treat analysis (87.5% follow-up rate). The majority of participants (84.4%) reported being very satisfied or extremely satisfied with the program. Conclusions: The Vive sin Tabaco… ¡Decídete! smoking cessation mobile intervention was accepted by participants, generated high satisfaction and high text messaging interactivity, and resulted in noteworthy cessation rates at end-of-treatment. This intervention is a promising strategy for smoking cessation in LMICs. Additional testing as a formal randomized clinical trial appears warranted.

Introduction: While smoking remains one of the leading causes of death in Mexico, uptake of evidence-based cessation therapy remains low. Widespread use of mobile devices and internet in Mexico has created new avenues for providing access to cessation treatment. Methods: We assessed the feasibility and acceptability of “Vive Sin Tabaco… ¡Decídete!” (English: Live without Tobacco…. Decide!), a web-based, informed decision-making tool designed to help Mexican smokers develop a quit plan and take advantage of cessation resources. We invited 164 smokers in two primary care clinics. Measures included physical, situational, and psychological nicotine dependence, interest in using pharmacotherapy and counseling, smoking status at 3 months, and satisfaction with the program. Results: Most participants were light smokers and reported low-to-moderate nicotine dependence. Immediately after using ¡Vive Sin Tabaco… ¡Decídete! , the majority were interested in quitting, set a quit date, and reported interest in using pharmacotherapy and cessation counseling. Follow-up rate at 3 months was 81.5%; seven-day point prevalence abstinence was 19.1% using intention-to-treat analysis. Conclusion: Integration of e-Health tools in primary healthcare settings has the potential to improve knowledge about cessation treatments among smokers and integrate smoking cessation into routine of care.

Background. While overall trends in tobacco use among men are declining, tobacco use continues to rise significantly among women in developing countries. This study aimed to explore the gender-related beliefs and attitudes about tobacco use and smoking cessation in Mexico, one of the top five Latin America countries with the highest prevalence of tobacco consumption. Materials and Methods. This study was conducted using an explanatory qualitative methods design. Semi-structured interviews were conducted with 14 adults smokers (8 women & 6 men) who visited primary healthcare clinics in Mexico City. Two researchers independently coded the interviews and applied the final codes upon consensus. Inter-rater reliability was assessed for four groups of codewords (92% agreement), based on an ecological model on socio-cultural factors. Findings. Initiation to smoking in women begins out of curiosity, and in men by imitation. Also, women start using tobacco at an older age compared to men. During maintenance of smoking, women report experiencing loneliness and anxiety about multiple responsibilities, e.g. women reveal that they feel guilty when they smoke due to their maternal role as caregivers. Additionally, some women report that smoking is a symbol of freedom, recalling the media messages associated with promoting tobacco products. Among men, the results show that they smoke for pleasure and to socialize, and consider that women smoke to imitate men and feel powerful. Regarding cessation, women are ambivalent about quitting smoking or not, and men mention not needing professional support. For organizational barriers, women mention the cost of treatment and men, the distance to clinics. Conclusion. Smoking cessation interventions should be proposed from an approach that involves changes in social norms, seeking a more equitable relationship between men and women. Therefore, there must be broad engagement from different sectors and not just at the health sector level.

This study aimed to assess sex differences in predictors for becoming a current exclusive electronic cigarette (e-cigarette) user, current exclusive smoker, or current dual user (concurrent smoking and e-cigarette use). This longitudinal study included 2399 females and 2177 males who had tried neither cigarettes nor e-cigarettes at baseline and attended 57 middle schools in the three largest cities in Mexico. We estimated multinomial logistic models stratified by sex. At follow-up, the prevalence of current exclusive e-cigarette use was 6.4% for males and 5.5% for females; current exclusive smoking was similar among males (3.6%) and females (3.5%); dual use was 2.4% females and 1.8% males. In the adjusted model, current e-cigarette use among females was associated with baseline current drinking (ARR = 1.85; p < 0.05), having a job (ARR = 1.99; p < 0.05), higher technophilia (ARR = 1.27; p < 0.05), and higher positive smoking expectancies (ARR = 1.39; p < 0.05). Among males, only having friends who smoke cigarettes at baseline was a significant predictor of current exclusive e-cigarette use at follow-up (ARR = 1.44; p < 0.05). For both sexes, current exclusive smoking at follow-up was associated with baseline current drinking (male ARR = 2.56; p < 0.05; female ARR = 2.31; p < 0.05) and, among males, only with having a parent who smoked (ARR = 1.64; p < 0.05). For both sexes, dual use at follow-up was associated with baseline current drinking (male ARR = 3.52; p < 0.005; female ARR = 2.77; p < 0.05); among females, with having paid work (ARR = 2.50; p < 0.001); and among males, with parental smoking (ARR = 3.20; p < 0.05). Results suggested both common and different risk factors by sex, suggesting that interventions may need to consider targeting sex differences.

Objetivo. Analizar factores psicosociales asociados con la decisión de fumar en estudiantes de entre 13 y 15 años de edad en la Ciudad de México. Material y métodos. Se utilizaron modelos de regresión logística de la Encuesta de Tabaquismo en Jóvenes (n=945) y cuatro grupos focales (GF) en dos escuelas secundarias, realizada en 2011 y 2012. Resultados. Factores asociados a fumar: a) creer que es seguro (RM=2.4, IC95% 1.28-4.7), GF: capacidad de control sobre consumo y daños a largo plazo; b) tener al menos un padre fumador (RM=1.6, IC95% 1.1-2.3), GF: influyen para iniciar/mantener consumo; c) tener amigos fumadores (RM=5.0, IC95% 1.9-13.6), GF: influyen para experimentación/ repetición, escuelas sin normas sobre prohibición y tener acceso a cigarros (RM=2.1, IC95% 0.9-4.1). Factores pro­tectores: a) creer que es dañino (RM=0.3, IC95% 0.14-0.65), GF: rechazo a convivencia con fumadores; b) comunicación con familia (RM=0.5, IC95% 0.36-0.91), GF: apelar al auto-cuidado; c) Considerarse joven para fumar (RM=0.2, IC95% 0.12-0.43), GF: conocimientos sobre daños y percepción de riesgo. Conclusión. Se deben fortalecer destrezas psicosociales positivas y el cumplimiento de legislación de protección a jóvenes.