title: Depressive symptoms and responses to cigarette pack warning labels among Mexican smokers.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina.
authors: Amira
authors: A
authors: Osman
authors: Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina.
authors: James F
authors: JF
authors: Thrasher
authors: Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina.
authors: Ebru
authors: E
authors: Cayir
authors: Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina.
authors: James W
authors: JW
authors: Hardin
authors: National Institute of Public Health, Department of Tobacco Research, Population Health Research Center.
authors: Rosaura
authors: R
authors: Perez-Hernandez
authors: Department of Neuroscience, Hollings Cancer Center, Medical University of South Carolina.
authors: Brett
authors: B
authors: Froeliger
mesh_terms: D000293:Adolescent; D000328:Adult; D001364:Awareness; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008800:Mexico / Q000453:epidemiology; D016017:Odds Ratio; D011356:Product Labeling / Q000592:standards / Q000639:trends; D015397:Program Evaluation; D012907:Smoking; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology; D062789:Tobacco Products