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Nanda Naik B, Rao UR R, Verma M, Kumar Nirala S, Pandey S, M Singh C. Awareness and Attitude Towards Tobacco Products and Tobacco Industry and Perception about Government's Role in Tobacco Control among the Adult Rural Population: A Cross-sectional Study in the Indian State of Bihar. ADDICTION & HEALTH 2024; 16:83-92. [PMID: 39051034 PMCID: PMC11264484 DOI: 10.34172/ahj.2024.1438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/15/2024] [Indexed: 07/27/2024]
Abstract
Background Attitudes and impressions toward the tobacco industry and tobacco products among the general public are important determinants for curbing the menace of the tobacco epidemic. Accordingly, this study aimed to assess the knowledge and perceptions about the tobacco industry and tobacco products and analyze attitudes towards social denormalization (SD) of tobacco use and tobacco industry denormalization (TID) among the rural population of Bihar, India. Methods This community-based cross-sectional survey was conducted on 421 adults aged 18 to 65 years who were selected using multistage systematic random sampling in a rural area of Bihar State in India from January to March 2022. Results were presented as proportions and the factors associated with support for TID and SD were identified using the chi-square test and binary logistic regression. Findings Out of 421 participants, 342 (81.2%) did not consider smokeless tobacco to be very dangerous. Nearly half (192, 45.6%) of the individuals believed that tobacco companies never tell the truth about the ill effects of tobacco use on health. Maximum, 345 (89.5%) also believed that the tobacco industry is responsible for adverse health effects of tobacco use and that the government should sue them. The prevalence of favorable attitudes toward TID and SD was found to be 55.1% [95% CI: 50.3% - 59.8%] and 38.2% [95% CI: 33.7% - 42.9%], respectively. Conclusion One out of every two and one out of every three individuals showed favorable attitudes toward TID and SD, respectively. There is a need to inform and educate the public on the ill effects of tobacco and the deceptive strategies used by the tobacco industry to help them choose health over tobacco.
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Affiliation(s)
- Bijaya Nanda Naik
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, India
| | - Rajath Rao UR
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Manisha Verma
- Department of Community Medicine, NAMO Medical Education and Research Institute, Silvassa, India
| | - Santosh Kumar Nirala
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, India
| | - Sanjay Pandey
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, India
| | - C M Singh
- Dr. RML Institute of Medical Sciences, Lucknow, India
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Yao Y, Cheung YTD, Wu YS, Guo Z, Chan SK, Zhao SZ, Tong HSC, Lai VWY, Lam TH, Ho SY, Wang MP. Association between tobacco industry denormalisation beliefs and support for tobacco endgame policies: a population-based study in Hong Kong. Tob Control 2024:tc-2023-058393. [PMID: 38458757 DOI: 10.1136/tc-2023-058393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
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.
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Affiliation(s)
- Ying Yao
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Yee Tak Derek Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Yongda Socrates Wu
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Ziqiu Guo
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Sik Kwan Chan
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Sheng Zhi Zhao
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | | | | | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Man Ping Wang
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
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van der Eijk Y, Tan GPP. Tobacco industry targeting of health-conscious youth with 'lighter' cigarettes: the case of Singapore. Tob Control 2020; 30:e20-e26. [PMID: 33067408 DOI: 10.1136/tobaccocontrol-2020-055923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Despite Singapore's strict tobacco control policies, smoking rates have not decreased since 2004. We examined the primary targets, motivations and strategies behind targeted marketing activities in Singapore from the tobacco industry's perspective to understand how tobacco companies continue to target people in their marketing. METHODS Snowball search in the Truth Tobacco Industry Documents Library for documents covering the industry's targeted marketing activities in Singapore. Information from the documents was subsequently triangulated with market data obtained from the Euromonitor Passport database, analysed for trends by tar segment and data from cigarette packs purchased from Singapore retailers, analysed in terms of product positioning. RESULTS In the 1970s and 1980s, as young people in Singapore became more health-conscious, tobacco companies positioned 'light' cigarettes for growth in the 1990s. Many of these 'lights' contained similar tar and nicotine levels as regular brands; they were only light in their branding. In the 1990's, 'lights' became more popular in Singapore and this demand was largely youth driven. Into the 2010s, while the low tar (<6 mg) segment comprised only a small portion of Singapore's cigarette market, most cigarette variants were marketed as 'lighter' or as having harm reductive benefits to appeal to more health-conscious people. CONCLUSIONS The differentiation of 'lighter' cigarettes remains an important marketing tool for tobacco companies amidst Singapore's strict regulations. Legislation to remove all remaining avenues for tobacco companies to make harm reduction claims on their products, explicit or implicit, coupled with improving health literacy and exposing industry deception, could help to further bring down smoking prevalence in Singapore.
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Affiliation(s)
- Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Grace Ping Ping Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Wang L, Chen J, Ho SY, Leung LT, Wang MP, Lam TH. Exposure to e-cigarette advertising, attitudes, and use susceptibility in adolescents who had never used e-cigarettes or cigarettes. BMC Public Health 2020; 20:1349. [PMID: 32887586 PMCID: PMC7650221 DOI: 10.1186/s12889-020-09422-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/23/2020] [Indexed: 12/02/2022] Open
Abstract
Background Tobacco advertisements have been banned in Hong Kong, but low intensity e-cigarette (EC) advertising can still be found in various media outlets. We investigated the associations between exposure to EC advertising and susceptibility to EC use in adolescents who had never used cigarettes or ECs, with potential mediation by attitudes towards ECs and the tobacco industry. Methods The School-based Smoking Survey 2016/17 assessed exposure to EC advertising in the past 30 days, attitudes towards ECs and the tobacco industry, susceptibility to EC use, and other covariates. Generalised linear mixed models and multiple mediation analysis methods were used in data analyses. Results Among 7082 students (mean age 14.9 years), 28.8% reported exposure to EC advertising. Exposure was associated with being uncertain about the harm of EC use, being tolerant towards ECs, believing the tobacco industry is respectable, and being susceptible to EC use; the magnitudes of these associations increased with the number of types of advertising exposed (0, 1, and ≥ 2) (all p-values < 0.01). These attitudinal factors were in turn associated with EC use susceptibility (all p-values < 0.001). The perception that tobacco companies make youth smoke was not associated with the advertising exposure or EC use susceptibility. Of the total effects of EC advertising on use susceptibility, only 16.6% were mediated by attitudinal factors: perceived harm (3.1%), attitudes towards ECs (8.2%), and attitudes towards the tobacco industry (4.9%). Conclusions Even exposure to low intensity EC advertising was associated with susceptibility to EC use in adolescents who had never used cigarettes or ECs. The association was weakly mediated by tolerant attitudes towards ECs and the tobacco industry. The government should reinforce the regulations on EC advertising to protect adolescent health.
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Affiliation(s)
- Lijun Wang
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China
| | - Jianjiu Chen
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China
| | - Sai Yin Ho
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China.
| | - Lok Tung Leung
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China
| | - Man Ping Wang
- School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, P. R. China
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China
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Adolescent Smoking in Hong Kong: Prevalence, Psychosocial Correlates, and Prevention. J Adolesc Health 2019; 64:S19-S27. [PMID: 31122545 DOI: 10.1016/j.jadohealth.2019.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 01/04/2019] [Accepted: 01/04/2019] [Indexed: 11/24/2022]
Abstract
Preventing adolescent smoking is important as smoking is typically initiated by young people. This article reviews the prevalence, psychosocial correlates, and prevention of smoking in Hong Kong adolescents. The past 30-day smoking prevalence in adolescents decreased from 9.6% in 2003 to 2.5% in 2017. Tobacco advertisements, parental and best friends smoking, nonintact families, poor family relationships, lower socioeconomic status, being a new immigrant, poor knowledge of smoking-related harm, positive attitudes toward smoking, overestimation of peer smoking, and depressive symptoms were positively associated with smoking outcomes, whereas positive youth development, authoritative mother and permissive father, family functioning, school competence, and stronger tobacco industry denormalization beliefs were protective against smoking. Along with tobacco tax increase, ban on tobacco advertisements, smoke-free law and pictorial warnings, educational efforts through theater performances, social norms campaigns, and positive adolescent training programs have been conducted to prevent adolescent smoking. To achieve the ultimate goal of tobacco endgame, further tax increase, plain packaging, banning point-of-sale display of tobacco products, smoke-free area extension, and raising minimum age of purchase should be implemented. The government proposed law to ban e-cigarettes, and heated tobacco products should be passed soon to protect children and adolescents from using these products.
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Chen J, Ho SY, Leung LT, Wang MP, Lam TH. School-level electronic cigarette use prevalence and student-level tobacco use intention and behaviours. Sci Rep 2019; 9:1690. [PMID: 30737443 PMCID: PMC6368577 DOI: 10.1038/s41598-018-38266-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/20/2018] [Indexed: 11/10/2022] Open
Abstract
Prevalent electronic cigarette (e-cigarette) use in schools may undermine tobacco denormalisation, and thus increase tobacco use in students. We investigated the associations of school-level e-cigarette use prevalence with student-level intention and behaviours related to e-cigarettes, cigarettes, and other tobacco products. In a 2014-15 school-based cross-sectional survey of 41035 secondary school students (grade 7–12; age 11–18 years) in Hong Kong, information was collected on the use of e-cigarettes, cigarettes, and non-cigarette tobacco products (NCTPs), susceptibility to e-cigarette and cigarette use, intention to quit cigarette smoking, and sociodemographic characteristics. The adjusted odds ratio (AOR) of e-cigarette use susceptibility in relation to high (vs low) school-level e-cigarette use prevalence was 1.40 (95% CI 1.05–1.87) in never e-cigarette users. The AORs of cigarette smoking susceptibility in relation to medium and high (vs low) school-level e-cigarette use prevalence were 1.24 (1.01–1.52) and 1.34 (1.02–1.75), respectively, in never cigarette smokers. School-level e-cigarette use prevalence was associated with ever and past 30-day cigarette smoking, but not with intention to quit (in past 30-day cigarette smokers) or past 30-day NCTP use. The findings highlight the importance of strictly banning e-cigarettes in schools, and add to the evidence that prevalent e-cigarette use in adolescents may increase cigarette smoking prevalence.
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Affiliation(s)
- Jianjiu Chen
- School of Public Health, University of Hong Kong, Hong Kong, People's Republic of China
| | - Sai Yin Ho
- School of Public Health, University of Hong Kong, Hong Kong, People's Republic of China.
| | - Lok Tung Leung
- School of Public Health, University of Hong Kong, Hong Kong, People's Republic of China
| | - Man Ping Wang
- School of Nursing, University of Hong Kong, Hong Kong, People's Republic of China
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, People's Republic of China
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