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Air pollution as a catalyst for supporting tobacco control policies? Evidence from a nationwide study on Chinese medical students
  1. Xiaozhao Yousef Yang1,
  2. Tingzhong Yang2,
  3. Fanhao Nie3
  1. 1 Department of Political Science and Sociology, Murray State University, Murray, Kentucky, USA
  2. 2 Center for Tobacco Control Research, Zhejiang University, Hangzhou, China
  3. 3 Department of Social and Behavioral Sciences, Dixie State University, St. George, Utah, USA
  1. Correspondence to Dr Tingzhong Yang, Center for tobacco control research, Zhejiang University, Hangzhou 310058, China; Tingzhongyang{at}


Purpose Few studies have discussed how the increasing ambient air pollution may affect policy-related attitudes. Medical professionals constitute an important interest group who analyse and solve public issues within a medicalised framework. The current study investigates whether ambient air pollution is associated with a greater likelihood of supporting tobacco control measures among medical students.

Methods We conducted multistage sampling among the medical students from 42 cities in China. We employed propensity-score matching to eliminate the selection bias and used multilevel logistic regressions for the main analysis (n1=9458, n2=42).

Results we found that city-level air particulate matter is consistently associated with the support for tobacco control among medical students, net of other individual-level and city-level covariates. For one standard increase in air particulate matter, people are 1.21 times more likely to fully support tobacco control measures (p<0.05). This association is significantly stronger among medical students who are financially worse-off and are ethnic majority.

Conclusions Environmental pollution has a significant correlation with people’s attitudes towards health policies, even when such policies are not directly concerned with the natural environment. Policy makers may use this opportunity to implement tobacco control measures against the backdrop of China’s pollution crisis.

  • ambient air pollution
  • tobacco control
  • multilevel modeling
  • policy support
  • medical professionals

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  • Contributors XYY designed the study and analysed the data provided by TY. FN revised the manuscript.

  • Funding This study is supported by the National Natural Science Foundation of China, Grant Number: 71473221.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.