Vulnerable populations and tobacco control in Latin America

Tobacco is responsible for over 7 million deaths every year. Various policies through the WHO Framework Convention on Tobacco Control contributed to reduce the burden of tobacco consumption with important heterogeneity across regions and population subgroups. Latin America is the most unequal region in the world, where health, social, and economic disparities likely result in a differential impact of tobacco control policies between and within countries. This dissertation explores the trends in tobacco smoking in Latin America from a multi-country perspective as well as through country specific analyses. Specifically, we analyzed trends in income inequalities regarding smoking in Mexico and evaluated the effectiveness of a comprehensive tobacco control policy implemented in Uruguay targeting adolescents and young adults. Furthermore, this dissertation is characterized by a focus on disparities in relation to gender, age, and income. Nationally representative surveys were the main sources of data, and the methods employed quasi-experimental designs, decomposition analyses, and estimation of income inequalities, among others. Results showed important heterogeneities in this region regarding inequalities in cigarette consumption by gender, age and income. Findings from eleven Latin American countries showed that over the past 20 years, teenagers did not follow the smoking trends observed among adults, with marked differences across gender groups. We also found that adult women in the lowest income categories in Mexico showed higher reductions in tobacco smoking during a period of sharp increase in cigarette prices, as compared to men, and to women in higher income categories. Finally, a comprehensive tobacco control policy was shown to be highly effective in reducing smoking prevalence among the youth in Uruguay. The characteristics of the region and the findings of the study support the need to continue expanding tobacco control policies and research in Latin America with a focus on aligning policies to regional, gender and income differences to achieve maximal public health impact