Lorena Peña

Parental Restriction of Mature-rated Media and Its Association With Substance Use Among Argentinean Adolescents.

OBJECTIVE To assess the independent relation between parental restrictions on mature-rated media (M-RM) and substance use among South American adolescents. METHODS Cross-sectional school-based youth survey of 3,172 students (mean age, 12.8 years; 57.6% boys) in 3 large Argentinean cities. The anonymous survey queried tobacco, alcohol, and drug use using items adapted from global youth surveys. Adolescents reported M-RM restriction for internet and video game use, television programming, and movies rated for adults. Multivariate logistic regression models were used to assess the association between parental M-RM restriction and substance use after adjustment for hourly media use, measures of authoritative parenting style, sociodemographic characteristics, and sensation-seeking. RESULTS Substance use rates were 10% for current smoking, 32% for current drinking alcohol, 17% for past 30-day binge drinking, and 8% for illicit drug use (marijuana or cocaine). Half of the respondents reported parental M-RM restriction (internet 52%, TV 43%, adult movies 34%, video game 25%). Parental M-RM restriction was only modestly correlated with authoritative parenting measures. In multivariate analyses M-RM restriction on all 4 venues was strongly protective for all substance use outcomes. Compared with no restriction, odds ratios for substance use for full restrictions were 0.32 (0.18-0.59), 0.53 (0.38-0.07), 0.36 (0.22-0.59), and 0.49 (0.26-0.92) for current smoking, drinking, binge drinking, and illicit drug use, respectively. The most important single M-RM venue was movies. CONCLUSIONS Results of this study confirmed the protective association between parental M-RM restriction during adolescence and multiple substance use outcomes, including illicit drugs. M-RM restriction is independent of traditional parenting measures. The preponderance of the evidence supports intervention development.

Parental Style and Its Association With Substance Use in Argentinean Youth

ABSTRACT 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 = 3172) 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 (adjusted odds ratio [AOR] = 0.77; 95% confidence interval (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.

Smoking in Movies and Adolescent Smoking Initiation: A Longitudinal Study among Argentinian Adolescents

Objective To assess whether exposure to movie smoking is associated with cigarette smoking among Argentinian adolescents. Study design A school‐based longitudinal study involving 33 secondary schools in Argentina was performed. The sample included 2502 never smokers (average age at entry = 12.5 years), 1700 (67.9%) of whom completed follow‐up surveys 17 months later. Exposure to the top 100 highest‐grossing films for each year between 2009 and 2013 was assessed by content‐coding films for tobacco and then by 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 aOR for the following transitions: nonsusceptible 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 nonsusceptible never smokers became susceptible, 24.1% reported having tried smoking, and 9.4% 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). Greater exposure to smoking in movies was significantly associated with increased odds of becoming susceptible (aORfirst vs third tertile 1.77, 95% CI 1.30‐2.41), of trying smoking (aORfirst vs third tertile 1.54, 1.14‐2.08), and marginally associated with current smoking (AORfirst vs third 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.

Time trends for tobacco and alcohol use in youth-rated films popular in Mexico and Argentina, from 2004-2012

Objective: To examine and compare overall prevalence and time trends in tobacco and alcohol portrayals and brand appearances in youth-rated US and nationally-produced films that were the most successful in Argentina and Mexico from 2004-2012. Materials and methods: Top-grossing nationally produced films from Argentina (n=73), Mexico (n=85) and the US (n=643) were content analyzed. Logistic regression was used to determine differences between Mexican, Argentine and US produced films. Linear regression models assessed significant cross-country differences in the mean number of tobacco and alcohol seconds. Results: Films from Mexico and Argentina were more likely than US films to contain tobacco, (OR=4.2; p<0.001) and (OR=7.2; p<0.001). Alcohol was present in 93% of Argentine, 83% in Mexican and 83% US films. Conclusions: Smoking and alcohol were highly prevalent in nationally produced films. They may have a significant impact and should be targeted by policies to reduce youth exposure to portrayals of risk behaviors.

Effectiveness of an Intervention to Teach Physicians How to Assist Patients to Quit Smoking in Argentina

INTRODUCTION We evaluated an intervention to teach physicians how to help their smoking patients quit compared to usual care in Argentina. METHODS Physicians were recruited from six clinical systems and randomized to intervention (didactic curriculum in two 3-hour sessions) or usual care. Smoking patients who saw participating physicians within 30 days of the intervention (index clinical visit) were randomly sampled and interviewed by telephone with follow-up surveys at months 6 and 12 after the index clinical visit. Outcomes were tobacco abstinence (main), quit attempt in the past month, use of medications to quit smoking, and cigarettes per day. Repeated measures on the same participants were accommodated via generalized linear mixed models. RESULTS Two hundred fifty-four physicians were randomized; average age 44.5 years, 53% women and 12% smoked. Of 1378 smoking patients surveyed, 81% were women and 45% had more than 12 years of education. At 1 month, most patients (77%) reported daily smoking, 20% smoked some days and 3% had quit. Mean cigarettes smoked per day was 12.9 (SD = 8.8) and 49% were ready to quit within the year. Intention-to-treat analyses did not show significant group differences in quit rates at 12 months when assuming outcome response was missing at random (23% vs. 24.1%, P = .435). Using missing=smoking imputation rule, quit rates were not different at 12 months (15.6% vs. 16.4% P = .729). Motivated smokers were more likely to quit at 6 months (17.7% vs. 9.6%, P = .03). CONCLUSIONS Training in tobacco cessation for physicians did not improve abstinence among their unselected smoking patients.

Exposure to tobacco in video games and smoking among gamers in Argentina

Background Our objective was to assess whether exposure to tobacco in video games is associated with smoking among adolescent gamers from Argentina. Methods Cross-sectional data were analysed from students in public and private middle schools in Argentina. Tobacco content in video games was estimated using previously validated methods and adolescents’ tobacco exposure was assessed by multiplying tobacco content in the top three video games they play by the hours played per day. The primary outcome was current smoking. Multilevel logistic regression models adjusted for clustering within schools, regressing current smoking on tobacco exposure in video games (ie, none, low, high) after controlling for age, sex, parental education, parenting style, parental rules about the use of video games, rebelliousness, sensation seeking and ‘technophilia’. Results Of the 3114 students who participated, 92% of boys (1685/1802) and 56% of girls (737/1312) played video games and were included in the analytical sample. The prevalence of smoking was 13.8% among boys and 22.0% among girls; 74.5% of boys played video games more than 1 hour per day compared with 47.7% of girls. High exposure to tobacco content in video games compared with no exposure was independently associated with current smoking among girls (OR 1.78; 95% CI 1.02 to 3.09) but not among boys (OR 0.98; 95% CI 0.64 to 1.51). Conclusions Greater exposure to tobacco content in video games was associated with higher likelihood of smoking among Argentine girls who play video games, suggesting the need for policies that limit these exposures.