Papers by L. Reynales-Shigematsu
Value in Health, 2012
To estimate the maximum willingness to pay (WTP) for an effective smoking cessation treatment amo... more To estimate the maximum willingness to pay (WTP) for an effective smoking cessation treatment among smokers in Mexico and to identify the environmental, demographic, and socioeconomic factors associated with the WTP. Methods: A cross-sectional study was conducted. The sample contained 777 smokers (willingness to quit using a WTP of Ͼ0) who had responded to the 2009 Global Adult Tobacco Survey conducted in Mexico. Statistical associations and descriptive analyses were conducted to describe smokers and their WTP by using tobacco-related environmental, socioeconomic, and demographic variables. Results: Overall, 74.4% of the smokers were men and 51.4% were daily smokers. On average, the smokers had been consuming tobacco for more than 15 years, 58.6% had made cessation attempts in the past, and around 10.0% knew about the existence of centers to aid in smoking cessation. The average WTP for an effective cessation method was US $191. Among men, the WTP was US $152 lower than among women. In all the estimated models, the higher an individual's education and socioeconomic level, the higher his or her WTP. Conclusions: This study suggests that Mexican smokers interested in quitting smoking attribute a high monetary value to an effective cessation method. Male smokers demonstrated less altruistic behavior than did female smokers. Mexico requires the implementation of more policies designed to support smoking cessation and to limit tobacco addiction. Expanding the availability of cessation programs and access to pharmacological treatments may contribute to reaching universal coverage by integrating new pharmacological alternatives into the health sector's medicine formulary.
Journal of epidemiology and community health, Jan 4, 2015
Recent increases in violent crime may impact a variety of health outcomes in Mexico. We examined ... more Recent increases in violent crime may impact a variety of health outcomes in Mexico. We examined relationships between neighbourhood-level violence and smoking behaviours in a cohort of Mexican smokers from 2011 to 2012, and whether neighbourhood-level social cohesion modified these relationships. Data were analysed from adult smokers and recent ex-smokers who participated in waves 5 and 6 of the International Tobacco Control Mexico survey. Self-reported neighbourhood violence and social cohesion were asked of wave 6 survey participants (n=2129 current and former smokers, n=150 neighbourhoods). Neighbourhood-level averages for violence and social cohesion (ranges 4-14 and 10-25, respectively) were assigned to individuals. We used generalised estimating equations to determine associations between neighbourhood indicators and individual-level smoking intensity, quit behaviours and relapse. Higher neighbourhood violence was associated with higher smoking intensity (risk ratio (RR)=1.17...
Tobacco control, Jan 27, 2015
To describe trends, correlates of use and consumer perceptions related to the product design inno... more To describe trends, correlates of use and consumer perceptions related to the product design innovation of flavour capsules in cigarette filters. Quarterly surveys from 2012 to 2014 were analysed from an online consumer panel of adult smokers aged 18-64, living in the USA (n=6865 observations; 4154 individuals); Mexico (n=5723 observations; 3366 individuals); and Australia (n=5864 observations; 2710 individuals). Preferred brand varieties were classified by price (ie, premium; discount) and flavour (ie, regular; flavoured without capsule; flavoured with capsule). Participants reported their preferred brand variety's appeal (ie, satisfaction; stylishness), taste (ie, smoothness, intensity), and harm relative to other brands and varieties. GEE models were used to determine time trends and correlates of flavour capsule use, as well as associations between preferred brand characteristics (ie, price stratum, flavour) and perceptions of relative appeal, taste and harm. Preference for ...
Tobacco Control, 2014
In high-income countries (HICs), higher neighbourhood socioeconomic deprivation is associated wit... more In high-income countries (HICs), higher neighbourhood socioeconomic deprivation is associated with higher levels of smoking. Few studies in low-income and middle-income countries (LMICs) have investigated the role of the neighbourhood environment on smoking behaviour. To determine whether neighbourhood socioeconomic deprivation is related to smoking intensity, quit attempts, quit success and smoking relapse among a cohort of smokers in Mexico from 2010 to 2012. Data were analysed from adult smokers and recent ex-smokers who participated in waves 4-6 of the International Tobacco Control (ITC) Mexico Survey. Data were linked to the Mexican government's composite index of neighbourhood socioeconomic deprivation, which is based on 2010 Mexican Census data. We used generalised estimating equations to determine associations between neighbourhood deprivation and individual smoking behaviours. Contrary to past findings in HICs, higher neighbourhood socioeconomic deprivation was associated with lower smoking intensity. Quit attempts showed a U-shaped pattern whereby smokers living in high/very high deprivation neighbourhoods and smokers living in very low deprivation neighbourhoods were more likely to make a quit attempt than smokers living in other neighbourhoods. We did not find significant differences in neighbourhood deprivation on relapse or successful quitting, with the possible exception of people living in medium-deprivation neighbourhoods having a higher likelihood of successful quitting than people living in very low deprivation neighbourhoods (p=0.06). Neighbourhood socioeconomic environments in Mexico appear to operate in an opposing manner to those in HICs. Further research should investigate whether rapid implementation of strong tobacco control policies in LMICs, as occurred in Mexico during the follow-up period, avoids the concentration of tobacco-related disparities among socioeconomically disadvantaged groups.
Annals of Global Health, 2015
Tobacco Control, 2014
Determine (1) trends in single cigarette availability and purchasing in Mexico and (2) the associ... more Determine (1) trends in single cigarette availability and purchasing in Mexico and (2) the association between neighbourhood access to singles and cessation behaviour among adult Mexican smokers. We analysed data from Wave 4 (2010), Wave 5 (2011) and Wave 6 (2012) of the Mexican International Tobacco Control Policy Evaluation Survey. We used data from all three waves to examine time trends in singles availability and purchasing. To explore the association between neighbourhood access to singles and cessation behaviour, we used data from participants who were smokers at Wave 5 and followed up at Wave 6 (n=1272). The percentage of participants who saw singles sold daily (45.2% in 2010; 51.4% in 2011; 64.9% in 2012), who bought singles at least once a week (22.3% in 2010; 29.1% in 2011; 29.1% in 2012) and whose last cigarette purchase was a single (16.6% in 2010; 20.7% in 2011; 25.8% in 2012) increased significantly from 2010 to 2012 (all p<0.001). The average percentage of residents who reported seeing singles sold daily in their neighbourhood in 2012 was 60% (SD=25%). In adjusted analyses, smokers living in neighbourhoods with higher access to singles were less likely to make a quit attempt (risk ratio (RR)=0.72; 95% CI 0.46 to 1.12), and more likely to relapse (RR=1.30; CI 0.94 to 1.82), but these results were not statistically significant. Single cigarettes appear widely accessible in Mexico and growing in availability. Future research should explore potential explanations, consequences and effective methods for reducing the availability of single cigarettes.
Value in Health, 2011
lower turnover, and lower absenteeism associated with adalimumab use. Employer savings from adali... more lower turnover, and lower absenteeism associated with adalimumab use. Employer savings from adalimumab use varies across industries in Brazil. High-wage sectors, such as the petroleum industry, have both larger absolute costs associated with RA and larger absolute savings from adalimumab use than do low-wage sectors, such as waste treatment.
Value in Health, 2011
A descriptive analysis was performed for all databases. Central tendency and dispersion measures ... more A descriptive analysis was performed for all databases. Central tendency and dispersion measures were calculated for the continuous variable (mean, median, standard deviation, maximum and minimum value) as well as frequencies and percentages for the categorical variables. Costing was done in 2007 Belize Dollars after adjusting by inflation using the Belize National Consumer Price Index. Costs were also discounted at an annual rate of 3% and 5%. Multi-way sensitivity analysis was carried out in order to incorporate uncertainty in the estimations. RESULTS: A total of 63 (or 61 if adjusted) people died as a consequence of RTI during 2007 (a mortality rate of 20.72 deaths per 100,000 inhabitants), 338 were hospitalized and a total of 565 slightly injured was estimated. A total of 2,501 Years of Potential Life were Lost in Belize due to premature death. All this translated in a total economic cost of BZ$31,966,045 due to RTI during 2007. This figure represents 1.26% of Belizean GDP during 2007. The great majority of the cost is for fatal injuries, specifically on indirect cost attributed to premature death. Direct cost was estimated at BZ$491,549, of which 2.09% was spent on fatalities, 61.61% on severely injured and 36.30% on slightly injured. CONCLUSIONS: The economic cost estimations make clear the need to prevent RTI utilizing a strategic and multisectoral approach that focuses on addressing the main problems identified. HS4 IMPACTO ECONOMICO EN LA ATENCION MEDICA DE ENFERMEDADES ASOCIADAS AL TABAQUISMO EN UNA POBLACION MEXICANA OBJECTIVOS: Estimar la carga económica que representan las enfermedades vinculadas al consumo de tabaco en el Hospital Central Militar (HCM), a través del costo directo de atención médica (CDAM). METODOLOGÍAS: La estimación del CDAM atribuible al consumo de tabaco fue realizada en pacientes con diagnóstico de primera vez de las enfermedades: CP (20), IAM (123), EPOC (160) y EVC , en 2009. El análisis de costos fue realizado desde la perspectiva del proveedor de servicios, aplicando la metodología Cost of Illness (COI), basada en la prevalencia así como la creación de un panel de expertos multidisciplinario, que clasificó la atención médica: Ambulatoria, Urgencias, Hospitalización, Quirófano, Unidad de Cuidados Intensivos, Quimioterapia y Radioterapia. Finalmente utilizamos la fracción atribuible por tabaco para estimar los costos. Los costos fueron reportados en pesos mexicanos ($) y en dólares (USD) del 2009. RESULTADOS: Durante el 2009, el costo promedio anual por paciente sin importar la gravedad de la enfermedad fue de $213,723.6 (16,357.4 USD) para el IAM, $130,901.8 (10,018.6 USD) para el ECV, $85,272.6 (6,526.3 USD) para el EPOC y $767,709.5 (58,756.7 USD) para el CP; respectivamente. Para el mismo año, el costo total anual asociado al tabaquismo fue de $21,159,968.2 (1,619,480.3 USD) para el IAM, $20,000,245.3 (1,530,720.8 USD) para el ECV, $15,652,522.9 (1,197,967.4 USD) para el EPOC y $35,203,438.6 (2,694,298.2 USD) para el CP; respectivamente. El CP resultó más costoso para el HCM. CONCLUSIONES: Los resultados obtenidos dimensionan el enorme costo económico del problema de la atención de las enfermedades asociadas al tabaquismo en el HCM y proveen información sólida para apoyar las políticas de salud para el control del tabaco. Ya que las enfermedades asociadas al tabaquismo son prevenibles, los recursos económicos destinados al tratamiento de dichas enfermedades podrían dirigirse a otros programas prioritarios del HCM.
Value in Health, 2011
OBJECTIVOS: El presente estudio evaluó las coberturas de vacunación antirotavírica en la cohorte ... more OBJECTIVOS: El presente estudio evaluó las coberturas de vacunación antirotavírica en la cohorte de población colombiana menor de 2 años de edad que ha sido vacunada desde el año 2008 y además, estimó la incidencia acumulada de hospitalización por diarrea y la efectividad de la vacuna contra la enfermedad diarreica severa. METODOLOGÍAS: Se realizó una encuesta poblacional en hogares con niños mayores de dos meses y menores de 24 meses en 5 ciudades de Colombia (Cali, Bogotá, Barranquilla, Cartagena y Riohacha). Los 3500 niños se seleccionaron aleatoriamente, usando un muestreo por conglomerados bietápico, de las zonas más vulnerables de las ciudades seleccionadas. RESULTADOS: Se encontró una cobertura de vacunación del 87.3% contra rotavirus. El 43,2% (1453) con un (IC95%: 36,8 -66,7) niños menores de 24 meses reportaron haber tenido al menos 1 episodio de EDA desde el nacimiento. Se encontró una incidencia acumulada de hospitalización de 4,5% en los niños con dos dosis de vacuna a diferencia de los niños sin vacuna que tuvieron 11,3% (OR 0,37; IC 95% 0,24-0,57). Se encontró que una o dos dosis de vacuna contra rotavirus son protectoras para hospitalización y esta diferencia es estadísticamente significativa (OR: 0,31 IC95%: 0,16 -0,57). CONCLUSIONES: La efectividad de la vacuna (con el esquema completo) para enfermedad severa (hospitalización) se mantiene en niveles muy similares a los obtenidos en los estudios clínicos experimentales. Esto confirma la validez de los estudios pre introducción que pese a la limitación de la información epidemiológica que usaron, aparentemente mostraban la carga de enfermedad real. Una o dos dosis de vacuna contra rotavirus protegen contra hospitalización por EDA. Dado que este estudio se realizó en poblaciones de alta morbilidad y mortalidad por diarrea y se encontró una protección adecuada de la vacuna podríamos inferir que otras poblaciones de menor riesgo también se están viendo beneficiadas.
Tobacco Control, 2011
Objective To evaluate the economic impact of Mexico City's 2008 smoke-free lawdThe Non-Smokers' H... more Objective To evaluate the economic impact of Mexico City's 2008 smoke-free lawdThe Non-Smokers' Health Protection Law on restaurants, bars and nightclubs. Material and methods We used the Monthly Services Survey of businesses from January 2005 to April 2009dwith revenues, employment and payments to employees as the principal outcomes. The results are estimated using a differences-in-differences regression model with fixed effects. The states of Jalisco, Nuevo León and México, where the law was not in effect, serve as a counterfactual comparison group. Results In restaurants, after accounting for observable factors and the fixed effects, there was a 24.8% increase in restaurants' revenue associated with the smoke-free law. This difference is not statistically significant but shows that, on average, restaurants did not suffer economically as a result of the law. Total wages increased by 28.2% and employment increased by 16.2%. In nightclubs, bars and taverns there was a decrease of 1.5% in revenues and an increase of 0.1% and 3.0%, respectively, in wages and employment. None of these effects are statistically significant in multivariate analysis. Conclusions There is no statistically significant evidence that the Mexico City smoke-free law had a negative impact on restaurants' income, employees' wages and levels of employment. On the contrary, the results show a positive, though statistically non-significant, impact of the law on most of these outcomes. Mexico City's experience suggests that smoke-free laws in Mexico and elsewhere will not hurt economic productivity in the restaurant and bar industries.
Tobacco Control, 2008
Background: The price of cigarettes to consumers in Mexico, and Latin America in general, remains... more Background: The price of cigarettes to consumers in Mexico, and Latin America in general, remains low in comparison with other regions of the world. In Mexico, taxes represented 59% of the total price of cigarettes in 2006, compared to 75% or more in many high-income countries. The feasibility of raising taxes on cigarettes in Mexico-to both discourage consumption and increase revenues-is an important policy question. Methods: Using household survey data, we undertake a pooled cross-sectional analysis of the demand for cigarettes in Mexico. We use a two-part model to estimate the price elasticity of cigarettes. This model controls for the selection effect that arises from the fact that the impact of price on the decision to smoke or not is estimated using all households in the dataset.
Nicotine & Tobacco Research, 2012
Evaluation & the Health Professions, 2008
The World Health Organization Framework Convention on Tobacco Control (WHO-FCTC) promotes the imp... more 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
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Papers by L. Reynales-Shigematsu