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Neighbourhood deprivation and smoking and quit behaviour among smokers in Mexico: findings from the ITC Mexico Survey
  1. Nancy L Fleischer1,
  2. James F Thrasher2,3,
  3. Belén Sáenz de Miera Juárez3,
  4. Luz Myriam Reynales-Shigematsu3,
  5. Edna Arillo-Santillán3,
  6. Amira Osman2,
  7. Mohammad Siahpush4,
  8. Geoffrey T Fong5,6,7
  1. 1Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
  2. 2Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
  3. 3Departamento de Investigación sobre Tabaco, Instituto Nacional de Salud Pública, Cuernavaca, México
  4. 4Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
  5. 5Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
  6. 6School of Public health and Health Systems, University of Waterloo, Ontario, Canada
  7. 7Ontario Institute for Cancer Research, Toronto, Ontario, Canada
  1. Correspondence to
    Dr Nancy L Fleischer, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; nfleischer{at}


Background 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.

Objective 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.

Methods 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.

Findings 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).

Conclusions 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.

  • Low/Middle income country
  • Socioeconomic status
  • Cessation
  • Global health

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