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. 2016 May;35(5):442-53.
doi: 10.1037/hea0000298. Epub 2016 Feb 11.

Depressive symptoms and responses to cigarette pack warning labels among Mexican smokers

Amira Osman  1 , James F Thrasher  1 , Ebru Cayir  1 , James W Hardin  2 , Rosaura Perez-Hernandez  3 , Brett Froeliger  4
Affiliations

Depressive symptoms and responses to cigarette pack warning labels among Mexican smokers

Amira Osman et al. Health Psychol. 2016 May.

Abstract

Objective: We examine whether having depressive symptoms (DS) is associated with different responses to cigarette package health warning labels (HWLs) before and after the implementation of pictorial HWLs in Mexico.

Method: We analyze data from adult smokers from Wave 4 and Wave 5 (n = 1,340) of the International Tobacco Control Policy Evaluation Project in Mexico. Seven Center for Epidemiological Studies Depression Scale (CES-D) items assessed DS, with scores ≥7 indicating elevated DS. Outcomes included: attention to HWLs, cognitive responses to HWLs, tobacco constituents awareness, putting off smoking due to HWLs, avoidance of HWLs, and awareness of telephone support for cessation (i.e., quitlines). Mixed effects models were used to assess main and interactive effects of DS and time (i.e., survey wave) on each outcome.

Results: All HWL responses increased over time, except putting off smoking. Statistically significant interactions were found between DS and time for models of tobacco constituents awareness (b = -0.36, SE = 0.15, p = .022), putting off smoking (OR = 0.41, 95% CI [0.25, 0.66]), avoidance of HWLs (OR = 1.84, 95% CI [1.03, 3.29]), and quitline awareness (OR = 0.35, 95% CI [0.21, 0.56]). Compared to smokers with low DS, smokers with elevated DS reported stronger HWL responses at baseline; however, HWL responses increased over time among smokers with low DS, whereas HWL responses showed little or no change among smokers with elevated DS.

Discussion: Population-level increases in HWL responses after pictorial HWLs were introduced in Mexico appeared mostly limited to smokers with low DS. In general, however, smokers with elevated DS reported equivalent or stronger HWL responses than smokers with low DS.

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Figures

Figure 1
Figure 1
Predicted means, by survey wave and depressive symptoms for: (a) Knowledge of toxic tobacco constituents included on HWLs (Table 4, Model 3). Predicted probabilities, by survey wave and depressive symptoms (Table 5, Model 3) for (b) Putting off smoking because of HWLs; (c) Avoidance of HWLs (d) Awareness of quit line number included on HWLs: Wave 4 (2010) and Wave 5 (2011), International Tobacco Control Policy Evaluation Survey in Mexico (ITC Mexico).
See this image and copyright information in PMC

References

    1. Andrade L, Caraveo-anduaga JJ, Berglund P, Bijl RV, Graaf RD, Vollebergh W, Dragomirecka E, Kohn R, Keller M, Kessler R, Kawakami N, Kilic C, Offord D, Ustun TB, Wittchen HU. The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. International Journal of Methods in Psychiatric Research. 2003;12(1):3–21. - PMC - PubMed
    1. Benjet C, Wagner F, Borges G, Medina-Mora M. The relationship of tobacco smoking with depressive symptomatology in the Third Mexican National Addictions Survey. Psychological Medicine. 2004;34:881–888. - PubMed
    1. Borland R, Yong HH, Wilson N, Fong GT, Hammond D, Cummings KM, Warwick Hosking W, McNeill A. How reactions to cigarette packet health warnings influence quitting: findings from the ITC Four-Country survey. Addiction. 2009 doi: 10.1111/j.1360-0443.2009.02508.x. - DOI - PMC - PubMed
    1. Breslau N, Kilbey MM, Andreski P. Nicotine dependence, major depression, and anxiety in young adults. Archives of General Psychiatry. 1991;48:1069–1074. - PubMed
    1. Burke HM, Fernald LC, Gertler PJ, Adler NE. Depressive symptoms are associated with blunted cortisol stress responses in very low-income women. Psychosomatic Medicine. 2005;67(2):211–216. - PubMed

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