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Original research
Association between tobacco industry denormalisation beliefs and support for tobacco endgame policies: a population-based study in Hong Kong
  1. Ying Yao1,
  2. Yee Tak Derek Cheung1,
  3. Yongda Socrates Wu2,
  4. Ziqiu Guo1,
  5. Sik Kwan Chan1,
  6. Sheng Zhi Zhao1,
  7. Henry Sau Chai Tong3,
  8. Vienna Wai Yin Lai3,
  9. Tai Hing Lam4,
  10. Sai Yin Ho4,
  11. Man Ping Wang1
  1. 1School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
  2. 2Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
  3. 3Hong Kong Council on Smoking and Health, Hong Kong, Hong Kong
  4. 4School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
  1. Correspondence to Prof Man Ping Wang, School of Nursing, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong; mpwang{at}hku.hk

Abstract

Objectives To examine the associations between tobacco industry denormalisation (TID) beliefs and support for tobacco endgame policies.

Methods A total of 2810 randomly selected adult respondents of population-based tobacco policy-related surveys (2018–2019) were included. TID beliefs (agree vs disagree/unsure) were measured by seven items: tobacco manufacturers ignore health, induce addiction, hide harm, spread false information, lure smoking, interfere with tobacco control policies and should be responsible for health problems. Score of each item was summed up and dichotomised (median=5, >5 strong beliefs; ≤5 weak beliefs). Support for tobacco endgame policies on total bans of tobacco sales (yes/no) and use (yes/no) was reported. Associations between TID beliefs and tobacco endgame policies support across various smoking status were analysed, adjusting for sociodemographics.

Results Fewer smokers (23.3%) had strong beliefs of TID than ex-smokers (48.4%) and never smokers (48.5%) (p<0.001). Support for total bans on tobacco sales (74.6%) and use (76.9%) was lower in smokers (33.3% and 35.3%) than ex-smokers (74.3% and 77.9%) and never smokers (76.0% and 78.3%) (all p values<0.001). An increase in the number of TID beliefs supported was positively associated with support for a total ban on sales (adjusted risk ratio 1.06, 95% CI 1.05 to 1.08, p<0.001) and use (1.06, 95% CI 1.05 to 1.07, p<0.001). The corresponding associations were stronger in smokers than non-smokers (sales: 1.87 vs 1.25, p value for interaction=0.03; use: 1.78 vs 1.21, p value for interaction=0.03).

Conclusion Stronger TID belief was associated with greater support for total bans on tobacco sales and use. TID intervention may increase support for tobacco endgame, especially in current smokers.

  • End game
  • Public policy
  • Public opinion
  • Tobacco industry
  • Denormalization

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/tc-2023-058393

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors MPW, THL, YTDC and SYH conceptualised the survey and obtained the funding. YSW and YY conceptualised the study. YY conducted statistical analyses and drafted the first version of the manuscript. All authors reviewed the manuscript, interpreted the data, critically revised the manuscript and approved the final version of the manuscript. YY is responsible for the overall content as guarantor.

    • Funding The surveys were supported by the Hong Kong Council on Smoking and Health.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.